Abstract Background Acute coronary involvement (ACI) due to acute aortic dissection (AAD) type A is potentially fatal. We examined selected patients with AAD type A, which had evolved over 14 years, ...and acute coronary involvement. The purpose of this study was to determine the characteristics of patients with ACI due to AAD type A. Methods Between 1997 and 2011, we recruited 20 patients (14.1%) with ACI (14 men, 6 women; mean age: 51.8 ± 11.8 years; age range: 35–79 years) from 142 patients who had undergone surgical repair of AAD type A. Results We propose a novel 4-category classification scheme based on the surgical pathological findings. The right coronary artery was involved in 15 patients, and the left was involved in 5 patients. Fourteen patients had preoperative myocardial ischemia. In the other 6 patients, acute coronary involvement was found intraoperatively. Patients with ACI were significantly younger than those without ACI (51.8 ± 11.8 vs. 61.0 ± 11.8; p = 0.001), a lower prevalence of intramural hematoma (5.0% vs. 32.8%; p = 0.011), a higher aortic regurgitation rate (95.0% vs. 53.5%; p = 0.001). Patients presenting with ACI had an in-hospital mortality rate of 20.0% (4/20), while those without ACI had an in-hospital mortality rate of 19.7% (24/122). Conclusions Acute coronary involvement due to AAD type A is not always associated with coronary malperfusion. Patients with ACI were much younger, had a higher aortic regurgitation rate, and, less commonly, had intramural hematoma. This new classification scheme would make it more convenient for surgeons to decide on treatment options for this special cohort.
Background/purpose Diffuse panbronchiolitis (DPB) is a rare clinicopathological entity. To date, no cohort study of DPB has been conducted in Taiwan. Erythromycin treatment improves the clinical ...outcome of DPB; however, whether relapse will occur or not is unclear. Herein, we report the first retrospective cohort of DPB patients in one medical center in Taiwan, including their clinical presentation and outcomes of erythromycin treatment. Methods The study comprised a retrospective cohort analysis of 27 patients with a confirmed diagnosis of DPB. Clinical, radiological, and laboratory parameters were analyzed, and the course and outcome of erythromycin treatment were examined. Results The mean age at symptom onset was 56.6 ± 18.5 years, and the time between symptom onset and a correct diagnosis was 4.3 ± 4.2 years. The percentages of patients with centrilobular micronodules on chest computed tomography, obstructive ventilator impairment with hypoxemia, and an elevated cold agglutinin titer were 72%, 37%, and 78%, respectively. After erythromycin treatment, 22 of the 27 (81.5%) patients showed clinical improvement, of whom six suffered a relapse. Four of these six patients clinically improved after a second course of erythromycin treatment. Conclusion Erythromycin therapy was suitable for DPB in our experience. In this study cohort, 27% experienced a relapse, of which two-thirds of the patients improved after a second course of erythromycin treatment.
•CT-DBS increases in the functional connectivity of the corticostriatal, corticolimbic, and thalamocortical networks.•CT-DBS enhances the cognitive function of learning and memory.•Changes in the ...dopamine receptors after CT-DBS suggest that CT-DBS alters the synapse plasticity.
Deep brain stimulation (DBS) is a promising treatment for neurological and psychiatric disorders. It acts by altering brain networks and facilitating synaptic plasticity. For enhancing cognitive functions, the central thalamus (CT) has been shown to be a potential DBS target. The network-level mechanisms contributing to the effect exerted by DBS on the CT (CT-DBS) remain unknown. Combining CT-DBS with functional magnetic resonance imaging (fMRI), this study explored brain areas activated while applying CT-DBS in rats, using a newly developed neural probe that was compatible with MRI and could minimize the image distortion and resolve safety issues. Results showed activation of the anterior cingulate cortex, motor cortex, primary and secondary somatosensory cortices, caudate putamen, hypothalamus, thalamus, and hippocampus, suggesting that the corticostriatal, corticolimbic, and thalamocortical brain networks were affected. Behaviorally, the CT-DBS group required a shorter time than sham controls to learn a water-reward lever-pressing task and made more correct choices in a T-maze task. Concurrent with enhanced learning performance, bilateral CT-DBS resulted in alteration in the functional connectivity of brain networks determined by resting-state fMRI. Western blot analyses showed that the protein level of both dopamine D1 and α4-nicotinic acetylcholine receptors was increased, and dopamine D2 receptor was decreased. These data suggest that CT-DBS can enhance cognitive performance as well as brain connectivity through the modulation of synaptic plasticity, such that CT is a target providing high potential for the remediation of acquired cognitive learning and memory disabilities.
To determine if the 3-level scales yield data as reliable and valid as data obtained for the original scales, 2 simplified 3-level measures of balance--a modified Berg Balance Scale (BBS-3P) and a ...modified Postural Assessment Scale for Stroke Patients (PASS-3P)--were proposed by the researchers, and psychometric properties of each were compared with those of the original measures (the Berg Balance Scale BBS and the Postural Assessment Scale for Stroke Patients PASS, respectively) in patients with stroke.
The study consisted of 2 parts. The first part examined the reliability and concurrent and convergent validity of measurements obtained with these instruments. A total of 77 patients participated in this part of the study. The 3 levels in the center of the BBS were collapsed to a single level (ie, 0-2-4) to form the BBS-3P. Similarly, the 2 middle scores of the center of the PASS were averaged (ie, 0-1.5-3) to form the PASS-3P. In the second part of the study, the predictive validity and responsiveness of these measures were examined. The BBS and PASS scores of 226 patients were retrieved from the records of participants in the Quality of Life After Stroke Study, and these scores were converted into the proposed BBS-3P and PASS-3P scores.
The BBS-3P and PASS-3P showed high concurrent validity with the BBS and PASS, good predictive validity for disability, and moderate to high responsiveness. Importantly, the psychometric properties of the BBS-3P and PASS-3P were essentially identical to those of the original BBS and PASS.
The psychometric properties of both simplified 3-level balance measures were comparable to those of the full, nontruncated scales. Future study is needed to investigate how much meaningful utility can be gained from the scheme of simplification of scaling.
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Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
In this study, bamboo charcoal/stainless steel (B/S) core-sheath yarns were made of stainless steel wires and bamboo charcoal polyester textured yarn using a rotor twister machine. The speed of rotor ...twister was from 7000 to 11000 rpm and the wrapped amount varied from 2 to 7 turns/cm. The tenacity of 3.08 g/d was obtained when the speed of rotor twister was 8000 rpm and wrapped amount was 4.0 turns/cm. The tensile strain of 24.9% was yielded when the speed of the rotor twister was 7000 rpm and the wrapped amount was 5.0 turns/cm. The laminated amount of the knitted fabrics varied from 1 to 6 layers. The far infrared ray emissivity of the knitted fabrics was 0.934 when the laminated amount was 2 layers and wrapped amount was 6 turns/cm. Finally, the optimum anion density of the knitted fabrics was 610 ions/cm3.
The anticoagulation activity of warfarin in populations with CYP2C9, VKORC1, and CYP4F2 variants differs between individuals and is correlated with poor international normalized ratio (INR) control. ...Pharmacogenetics-guided warfarin dosing has been successfully developed for patients with genetic variations in recent years. However, few real-world data have been used to investigate the INR and warfarin dosage and the time to target INR. This study examined the largest collection of genetic and clinical real-world data related to warfarin to provide further evidence supporting the benefits of pharmacogenetics in clinical outcomes.
We retrieved a total of 69,610 INR-warfarin records after the index date from 2,613 patients in the China Medical University Hospital database between January 2003 and December 2019. Each INR reading was obtained from the latest laboratory data after the hospital visit date. Patients with a history of malignant neoplasms or pregnancy before the index date were excluded, as were patients without data on INR measurements after the fifth day of prescription, genetic information, or gender variables. The primary outcomes were the INR and warfarin dosage during days 7, 14, 28, 56, and 84 after prescription. The secondary outcome was the time required to reach the INR ranges of 1.5 to 3.0 and >4.0.
A total of 59,643 INR-warfarin records from 2188 patients were retrieved. The average INR was higher for homozygous carriers of the minor allele at CYP2C9 and VKORC1 during the first 7 days (1.83 1.03 CYP2C9*1 and 2.46 1.44 CYP2C9*3, P < 0.001; 1.39 0.36 rs9923231 G/G, 1.55 0.79 rs9923231 G/A, and 1.96 1.13 rs9923231 A/A, P < 0.001) than for the wild-type allele. These patients with variants required lower warfarin doses than those with the wild-type allele during the first 28 days. CYP4F2 variant patients seemed to require higher doses of warfarin than those in the wild-type group; however, no significant difference in the average INR was observed (1.95 1.14 homozygous V433 carriers, 1.78 0.98 heterozygous V433M carriers, and 1.66 0.91 homozygous M433 carriers, P = 0.016).
Our study indicates that genetic variants in the Han population may enhance warfarin responsiveness, which holds clinical relevance. An increased warfarin dosage was not linked to a shorter time to therapeutic INR between CYP4F2 variant patients and those with a wild-type allele. Assessing CYP2C9 and VKORC1 genetic polymorphisms before initiating warfarin treatment in real-world practice is essential for potentially vulnerable patients and is likely to optimize therapeutic dosing.
A positive captopril renography indicates that patient's hypertension is renin dependent, most commonly caused by renal artery stenosis. The authors reported a case of positive captopril renography; ...however, CT demonstrated that renal arteries were intact, but there was a huge chromophobe renal cell carcinoma. Renin-dependent hypertension was relieved soon after nephrectomy. It is an uncommon cause of positive captopril renography.
Tissue-resident macrophages (TRMs) are heterogeneous cell populations found throughout the body. Depending on their location, they perform diverse functions maintaining tissue homeostasis and ...providing immune surveillance. To survive and function within, TRMs adapt metabolically to the distinct microenvironments. However, little is known about the metabolic signatures of TRMs. The thymus provides a nurturing milieu for developing thymocytes yet efficiently removes those that fail the selection, relying on the resident thymic macrophages (TMφs). This study harnesses multiomics analyses to characterize TMφs and unveils their metabolic features. We find that the pentose phosphate pathway (PPP) is preferentially activated in TMφs, responding to the reduction-oxidation demands associated with the efferocytosis of dying thymocytes. The blockade of PPP in Mφs leads to decreased efferocytosis, which can be rescued by reactive oxygen species (ROS) scavengers. Our study reveals the key role of the PPP in TMφs and underscores the importance of metabolic adaptation in supporting Mφ efferocytosis.
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•TMφs are a metabolically and transcriptionally distinct cell population•The pentose phosphate pathway (PPP) is preferentially activated in TMφs•PPP supports the reduction-oxidation demands associated with efferocytosis in TMφs•Disturbance in PPP affects the efferocytosis efficiency
Tsai et al. present multiomics analyses on the TMφs population and reveal that PPP is a crucial metabolic adaptation for TMφs to cope with oxidative stress and support efferocytosis. These results highlight the metabolic flexibility of TRMs and the multifaceted involvement of metabolic pathways in different biological settings.
Background/purpose Using multidomain developmental screening tools is a feasible method for pediatric health care professionals to identify children at risk of developmental problems in multiple ...domains simultaneously. The purpose of this study was to develop a Rasch-based tool for Multidimensional Screening in Child Development (MuSiC) for children aged 0–3 years. Methods The MuSic was developed by constructing items bank based on three commonly used screening tools, validating with developmental status (at risk for delay or not) on five developmental domains. Parents of a convenient sample of 632 children (aged 3–35.5 months) with and without developmental delays responded to items from the three screening tools funded by health authorities in Taiwan. Item bank was determined by item fit of Rasch analysis for each of the five developmental domains (cognitive skills, language skills, gross motor skills, fine motor skills, and socioadaptive skills). Children's performance scores in logits derived in Rasch analysis were validated with developmental status for each domain using the area under receiver operating characteristic curves. Results MuSiC, a 75-item developmental screening tool for five domains, was derived. The diagnostic validity of all five domains was acceptable for all stages of development, except for the infant stage (≤11 months and 15 days). Conclusion MuSiC can be applied simultaneously to well-child care visits as a universal screening tool for children aged 1–3 years on multiple domains. Items with sound validity for infants need to be further developed.
Background
In the treatment of oral cavity squamous cell carcinoma (OCSCC), surgical quality measures which are expected to affect outcomes, including the achievement of a clear margin, are ...surgeon-dependent but might not be invariably associated with hospital volume. Our objective was to explore surgical margin variations and survival differences of OCSCC between two highest-volume hospitals in Taiwan.
Materials and methods
A total of 2009 and 1019 patients with OCSCC who were treated at the two highest-volume Taiwanese hospitals (termed Hospital 1 and Hospital 2, respectively) were included. We examined how a pathological margin <5 mm impacted patient outcomes before and after propensity score (PS) matching.
Results
The prevalence of margins <5 mm was markedly lower in Hospital 1 than in Hospital 2 (34.5%/65.2%,
p
<0.0001). Compared with Hospital 2, tumor severity was higher in Hospital 1. On univariable analysis, being treated in Hospital 2 (versus Hospital 1; hazard ratio HR for 5-year disease-specific survival DSS = 1.34,
p
=0.0002; HR for 5-year overall survival OS = 1.17,
p
=0.0271) and margins <5 mm (versus ≥5 mm; HR for 5-year DSS = 1.63,
p
<0.0001; HR for 5-year OS = 1.48,
p
<0.0001) were identified as adverse factors. The associations of treatment in Hospital 2 and margins <5 mm with less favorable outcomes remained significant after adjustment for potential confounders in multivariable analyses, as well as in the PS-matched cohort. The 5-year survival differences between patients operated in Hospital 1 and Hospital 2 were even more pronounced in the PS-matched cohort (before PS matching: DSS, 79%/74%,
p
=0.0002; OS, 71%/68%,
p
=0.0269; after PS matching: DSS, 84%/72%,
p
<0.0001; OS, 75%/66%,
p
<0.0001). In the entire cohort, the rate of adjuvant therapy was found to be lower in patients with margins ≥5 mm than in those with margins <5 mm (42.7%
/
57.0%,
p
<0.0001).
Conclusions
Within the two highest-volume hospitals in Taiwan, patients with OCSCC with a clear margin status (≥5 mm) achieved more favorable outcomes. These results have clinical implications and show how initiatives aimed at improving the margin quality can translate in better outcomes. A clear margin status can reduce the need for adjuvant therapy, ultimately improving quality of life.
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