The prognostic impact of left axis deviation (LAD) on clinical outcomes in acute heart failure syndrome (AHFS) with left bundle branch block (LBBB) is unknown. The aim of this study was to determine ...the prognostic significance of axis deviation in acute heart failure patients with LBBB.
Between March 2011 and February 2014, 292 consecutive AHFS patients with LBBB were recruited from 10 tertiary university hospitals. They were divided into groups with no LAD (n=189) or with LAD (n=103) groups according to QRS axis <-30 degree. The primary outcome was all-cause mortality.
The median follow-up duration was 24 months. On multivariate analysis, the rate of all-cause death did not significantly differ between the normal axis and LAD groups (39.7% vs. 46.6%, adjusted hazard ratio, 1.01; 95% confidence interval, 0.66, 1.53; p=0.97). However, on the multiple linear regression analysis to evaluate the predictors of the left ventricular ejection fraction (LVEF), presence of LAD significantly predicted a worse LVEF (adjusted beta, -3.25; 95% confidence interval, -5.82, -0.67; p=0.01). Right ventricle (RV) dilatation was defined as at least 2 of 3 electrocardiographic criteria (late R in lead aVR, low voltages in limb leads, and R/S ratio <1 in lead V₅) and was more frequent in the LAD group than in the normal axis group (p<0.001).
Among the AHFS with LBBB patients, LAD did not predict mortality, but it could be used as a significant predictor of worse LVEF and RV dilatation (Trial registry at KorAHF registry, ClinicalTrial.gov, NCT01389843).
Minimally invasive robot-assisted laparoscopic radical prostatectomy (RALP) has replaced open prostatectomy. However, RALP does not reduce postoperative pain compared to the open approach. We ...explored whether bundled intraoperative intravenous infusion of dexmedetomidine and ketorolac reduced opioid requirements during the 24 h after RALP.
Eighty patients (two parallel groups) were enrolled in this prospective non-randomized study from September 2020 to November 2020. All received preoperative rectus sheath blocks for analgesia after RALP. A multimodal analgesic bundle (dexmedetomidine and ketorolac) was administered intraoperatively in the study group (n = 39) but not in the control group (n = 40). The total postoperative opioid requirements (expressed in milligrams of intravenous morphine) and pain scores (derived using a visual analog scale) were compared between the two groups up to 24 h after surgery.
The two groups were demographically similar. During surgery, patients in the study group received less remifentanil and more ephedrine than controls. The study group required significantly less opioids during the 24 h after surgery (28.3 vs. 40.0 mg, p = 0.006). The between-group pain scores differed significantly at 1 and 6 h after surgery. All other postoperative characteristics were comparable between the two groups.
The intraoperative multimodal analgesic bundle (intravenous dexmedetomidine and ketorolac) improved postoperative analgesia after RALP in patients with rectus sheath blocks, as evidenced by the opioid-sparing effect after surgery.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Acetabular dysplasia is one of the most common sources of hip arthritis. With the recent innovation in hip arthroscopy, the question has been raised whether arthroscopy can be used to treat ...dysplastic hip conditions. The purposes of this systematic review are (i) describe the prevalence of intra-articular pathologies and (ii) report the outcomes of dysplastic hip treatment with hip arthroscopy as a sole treatment. Medical databases were searched for articles including arthroscopic findings and treatment of dysplastic hip with predetermined criteria. PubMed, Ovid database and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched up until 7 January 2015. Two reviewers independently assess the eligibility of retrieved studies using titles, abstracts and full-text articles. Thirteen studies were eligible to be included for the systematic review. Overall, labral tear was the most common pathology with a prevalence rate of 77.3%. All of the four studies describing arthroscopic treatment for only borderline dysplasia reported favorable outcome. With regard to more severely dysplastic hips, two out of three studies reported acceptable outcomes while one study reported negative results. This review indicates that intra-articular pathology is commonly observed in symptomatic dysplastic hips with a labral tear being the most common pathology. Arthroscopic treatment of borderline dysplasia could provide benefits whereas treatment of more dysplastic hips is controversial. Nevertheless, there is a lack of evidence for using arthroscopy alone in hips with a center edge angle <20°. Level IV, systematic review of Level IV studies.
Polar ice sheets conserve atmospheric aerosols at the time of snowfall, which can be used to reconstruct past climate and environmental conditions. We investigated mineral dust and major ion records ...in snowpit samples obtained from the northwestern Greenland ice sheet near the North Greenland Eemian Ice Drilling (NEEM) camp in June 2009. We analyzed the samples for mineral dust concentrations as well as stable water isotopes (δ18O, δD, and deuterium excess) and major ions (Cl−, SO42-, methanesulfonic acid (MSA), Na+, and Ca2+). Seasonal δ18O and δD cycles indicate that the snowpit samples covered a six-year period from spring 2003 to early summer 2009. Concentrations of mineral dust, nss-Ca2+, and nss-SO42- showed seasonal deposition events with maxima in the winter–spring layers. On the other hand, the Cl−/Na+ ratio and the concentrations of MSA exhibited maxima in the summer layers, making them useful indicators for the summer season. Moreover, an anomalous atmospheric mineral dust event was recorded at a depth of 165–170 cm corresponding to late winter 2005 to spring 2006. A back trajectory analysis suggests that a major contributor to the Greenland aerosol was an air mass passing over the Canadian Arctic and North America. Several trajectories point to Asian regions as a dust source. The mineral dust deposited at NEEM was strongly influenced by long-range atmospheric transport and dust input from arid source areas in northern China and Mongolia.
•We provide mineral dust and major ion records in a 3.2-m snowpit from Greenland.•The snowpit covers a six-year period from spring 2003 to summer 2009.•An anomalous dust event was occurred at the winter–spring 2005/2006 period.•A back trajectory analysis suggests possible Asian dust source regions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Despite recent advances in skull base reconstructive techniques, including the multilayer technique during the last decade, complete reconstruction of grade 3 intraoperative high-flow cerebrospinal ...fluid (CSF) leak remains challenging. This study was designed to investigate the role of injectable hydroxyapatite (HXA) used in the multilayer technique on the clinical outcome of skull base reconstruction for intraoperative high-flow CSF leak.
This study enrolled 187 patients who experienced intraoperative high-flow CSF leak after endoscopic endonasal surgery for anterior skull base or suprasellar pathologies between January 2014 and July 2021. All skull base defects were reconstructed using the conventional multilayer technique including a vascularized naso-septal flap (NSF, n = 141) and the combined use of HXA with the conventional multilayer technique (HXA group, n = 46). We retrospectively evaluated the efficacy of the HXA group by 1:2 propensity score matching analysis.
Overall, 17 of 187 patients (9.1%) showed postoperative CSF leaks, resulting in second reconstruction surgery. There were no statistical differences in patient age, sex, body mass index, tumor location, tumor type, and degree of resection, except for the follow-up period between the two groups. The HXA group showed a significantly lower incidence of postoperative CSF leak than the control group (0% vs. 12.1%, p < 0.05). Postoperative lumbar drain (LD) was performed in 8.7% of the HXA group compared to 46.1% of the control group (p < 0.01). CSF leak-related infection rates showed a decreasing tendency in the HXA group compared to the control group (0 vs. 7.1%, p = 0.06). A total of 46 patients in the HXA group were well matched with the control group (92 patients) at a 1:2 ratio. In the propensity score-matched control group, there were higher rates of postoperative CSF leaks than in the HXA group.
The use of HXA combined with the conventional multilayer technique completely reduced postoperative CSF leaks in this study. This technique resulted in reduced CSF leakage, even without postoperative LD, and decreased infection rates. Further randomized comparative studies are required to confirm our findings.
► This study compared the effectiveness of DBS and levodopa in relieving resting tremors. ► This study compared the effectiveness of STN DBS and GPi DBS in relieving resting tremors. ► DBS had more ...effects on subjects with resting tremors than levodopa. ► STN DBS had more effects on subjects with resting tremors than GPi DBS.
As a treatment for Parkinsonian resting tremors, deep brain stimulation (DBS) has been reported to be more effective than levodopa, and of the forms of DBS, subthalamic nucleus (STN) DBS has been reported to be more effective than internal globus pallidus (GPi) DBS. To assess the veracity of these claims, this study compared the effectiveness of DBS and levodopa and of STN DBS and GPi DBS in relieving resting tremors using a novel methodology consisting of wavelet transform (WT) technology and a neural network with weighted fuzzy membership functions (NEWFM). This simplified methodology offers the advantages of efficiency, low cost, and ease of use. The results indicate that subjects with high-amplitude resting tremors obtained almost the same relief from on-DBS and off-levodopa treatment than on-DBS and on-levodopa treatment; that subjects with low-amplitude resting tremors experienced greater relief from on-DBS and off-levodopa treatment than on-DBS and on-levodopa treatment, indicating that relief could be relieved by DBS administration alone; and that DBS had stronger effects on subjects with high-amplitude resting tremors than subjects with low-amplitude resting tremors. This study’s successful employment of WT technology and NEWFM to compare treatment effects demonstrated the utility of a simplified approach that even non-experts can utilize.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
PurposeDespite the role of carbon monoxide in ameliorating ischemia-reperfusion injury (IRI), its use in the clinical setting is restricted owing to its toxicity. Herein, we investigated the in vivo ...effects of carbon monoxide-releasing molecule-3 (CORM-3) on IRI. Materials and MethodsFifteen rats were equally and randomly divided into three groups: sham (right nephrectomy), control (right nephrectomy and left renal ischemia), and CORM-3 (right nephrectomy and CORM-3 injection before left renal ischemia). Kidney tissues and blood samples collected from sacrificed rats were evaluated to determine the renoprotective effect and mechanism of CORM-3. ResultsConcentrations of serum creatinine and kidney injury molecule-1 in the CORM-3 group were significantly lower than in the control group after 75 minutes of IRI (1.2 vs. 2.4 mg/dL, p=0.01, and 292 vs. 550 pg/mL, p<0.001, respectively). Furthermore, the CORM-3 group exhibited a higher portion of normal tubules and glomeruli. TUNEL staining revealed fewer apoptotic renal tubular cells in the CORM-3 group than in the control group. The expression of 960 genes in the CORM-3 group was also altered. Pretreatment with CORM-3 before renal IRI produced a significant renoprotective effect. Fifteen of the altered genes were found to be involved in the peroxisome proliferator-activated receptors signaling pathway, and the difference in the expression of these genes between the CORM-3 and control groups was statistically significant (p<0.001). ConclusionsCORM-3 ameliorates IRI by decreasing apoptosis and may be a novel strategy for protection against renal warm IRI.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
We investigated to determine what effects, if any, the respective water extracts of Radix scutellariae (RS), Fructus schisandrae chinensis (FSC), Huang-Lian-Jie-Du-Tang (HLJDT), and HLJDT ...supplemented with FSC, and Rhizoma Polygonati odorati (HLJDT-M) would have on glucose tolerance by modulating glucose-stimulated insulin secretion, β-cell mass, and morphometry in 90% pancreatectomized (Px) diabetic rats fed high-fat diets. Through the elevation of intracellular cAMP levels, FSC RS, HLJDT, and HLJDT-M increased insulin secretion in Min6 cells and GLP-1 secretion in NCI-H716 cells. After an 8-week period of treatment, it was found that HLJDT-M improved glucose tolerance in an oral glucose tolerance test in Px rats. HLJDT-M also potentiated first- and second-phase insulin secretion, but RS and HLJDT elevated only the second phase at hyperglycemic clamp. RS and HLJDT increased β-cell mass by hyperplasia and hypertrophy, while HLJDT-M increased it only by hyperplasia. The rise in hyperplasia was associated with elevated IRS2 and PDX-1 expression in the islets. In conclusion, HLJDT-M worked as an anti-diabetic prescription by enhancing insulinotropic actions in diabetic rats.
We evaluated the association between coding region variants of adrenergic receptor genes and therapeutic effect in patients with congestive heart failure (CHF).
One hundred patients with stable CHF ...(left ventricular ejection fraction LVEF < 45%) were enrolled. Enrolled patients started 1.25 mg bisoprolol treatment once daily, then up-titrated to the maximally tolerable dose, at which they were treated for 1 year.
Genotypic analysis was carried out, but the results were blinded to the investigators throughout the study period. At position 389 of the β-1 adrenergic receptor gene (ADRB1), the observed minor Gly allele frequency (Gly389Arg + Gly389Gly) was 0.21, and no deviation from Hardy-Weinberg equilibrium was observed in the genotypic distribution of Arg389Gly (p = 0.75). Heart rate was reduced from 80.8 ± 14.3 to 70.0 ± 15.0 beats per minute (p < 0.0001). There was no significant difference in final heart rate across genotypes. However, the Arg389Arg genotype group required significantly more bisoprolol compared to the Gly389X (Gly389Arg + Gly389Gly) group (5.26 ± 2.62 mg vs. 3.96 ± 2.05 mg, p = 0.022). There were no significant differences in LVEF changes or remodeling between two groups. Also, changes in exercise capacity and brain natriuretic peptide level were not significant. However, interestingly, there was a two-fold higher rate of readmission (21.2% vs. 10.0%, p = 0.162) and one CHF-related death in the Arg389Arg group.
The ADRB1 Gly389X genotype showed greater response to bisoprolol than the Arg389Arg genotype, suggesting the potential of individually tailoring β-blocker therapy according to genotype.
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