To study the efficacy of inside-out technique in completely eradicating the cholesteatoma from middle ear and mastoid, preservation of hearing & and quality of life post mastoidectomy with regards to ...recurrent discharge, wax, granulations.
Non-randomized, prospective, observational study performed at the Department of ENT in our hospital. In the study we included 100 patients presenting with chronic suppurative otitis media with cholesteatoma, they underwent inside out mastoidectomy and were followed up till the end of the study to evaluate the efficacy of inside out mastoidectomy in eradicating the disease from the middle ear cleft. To assess preservation of hearing and to assess cavity problems.
Of the 100 patients, 98 patients had a total clearance of disease by the inside out approach, and 2 patients, had doubtful clearance. All patients came for regular follow up and none of them had residual disease at the end of the study period. Thus, the overall success rate was 100% in our study. A significant improvement in the mean air conduction (p < 0.01) and the mean air bone gap (p < 0.01) was seen in all postoperatively at 3rd month PTA. Only one patient had conductive hearing loss one and a half years postoperatively after initial improvement. A dry self-cleansing cavity was achieved in 95% of the patients and only 5% required regular cleaning of wax the cavities.
Inside out mastoidectomy is a better alternative in canal wall down procedures as it not only clears the disease from the middle ear cleft, but also leaves behind a small postoperative cavity, which will preserve the hearing, decrease the cavity problems and increase the quality of life of such patients.
Diagnosis of pulmonary aspergillosis (PA), a fungal disease caused by
is challenging since symptoms are unspecific. The galactomannan (antigen secreted by
) test in bronchoalveolar lavage (BAL) fluid ...is a valuable diagnostic adjunct test in the diagnosis of PA. However, BAL collection is invasive and may not be suitable to severely ill patients. Sputum is non-invasive, easily collected, and lung specific and may be an alternative to BAL. The aim of this research was to retrospectively evaluate the utility of sputum galactomannan in the diagnosis of pulmonary aspergillosis in patients with chronic respiratory diseases and to estimate the sputum galactomannan cut-off value. We collected data from patients with clinical suspicion of pulmonary aspergillosis who had sputum galactomannan, culture, and
IgG tests performed within four weeks. Sputum galactomannan was validated against the clinical diagnosis of aspergillosis,
culture, and
IgG tests. In total, 218 patients met inclusion criteria. Overall, sputum GM showed satisfactory agreement with clinical diagnosis of aspergillosis,
culture, and
IgG. When a receiver operating characteristic curve was constructed using
culture/IgG and clinical diagnosis, the same cut-off (CO) of 0.71 (AUC: 0.83; CI: 0.69-0.86,
< 0.001) was determined. Against clinical diagnosis, sputum GM gave sensitivity and specificity of 70% and 71%, respectively. Sensitivity of 77% and specificity of 78% were found when sputum GM was evaluated against
culture/IgG. In conclusion, this study showed that sputum galactomannan antigen testing has utility in the diagnosis of chronic forms of pulmonary aspergillosis and further prospective validation is indicated.
The purpose of this study was to evaluate the safety and diagnostic utility of 1.5-T MRI examinations of individuals with conventional and MRI-conditional cardiac implantable electronic devices ...(CIEDs).
Patients with a CIED who were referred for MRI were evaluated by radiologists and cardiac electrophysiologists for study participation. CIED interrogation was performed immediately before and after MRI, and cardiac telemetry monitoring was performed during MRI. CIED programming changes, malfunctions, and intraprocedural events were documented. Whether diagnostic questions were answered and whether artifacts related to the CIED were present and negatively affected image interpretation were recorded.
One hundred thirteen MRI examinations were performed for 104 patients with CIEDs (74 pacemakers 60 conventional, 14 MRI conditional; 39 implantable cardiac defibrillators). Device reprogramming was required before MRI for 62.8% of studies (71/113). No significant changes in lead parameters were noted during or after MRI. Electromagnetic noise was detected on at least one lead in 7.1% of studies. Three patients reported transient symptoms (one case each of heating at the pocket site, tingling at the pocket site, and palpitations). All images were considered diagnostic for the original clinical query. Artifacts related to CIEDs were described in 3.5% of MRI reports (4/113) and were present only when the pulse generator was included in the FOV. CIED-related artifacts limited evaluation of tissues immediately adjacent to the pulse generator.
Establishment of a multidisciplinary work flow allows individuals with conventional and MRI-conditional CIEDs to safely undergo 1.5-T MRI with diagnostic questions consistently answered.
In an era when education is supposed to be a means for good jobs and linked to extrinsic values such as fame and money, students are losing interest in school education. The goal of this research is ...to see if there is any correlation between the students' views of school worthiness and schoolwork, and demographic variables. Our hypothesis is that several key demographics involving diversity, income, and education will affect how students view school and its importance. Results show that there is no correlation between the demographic variables we analyzed and the student perception of school worthiness.
Embedded Electrode Ablation
Introduction
Intracardiac electrogram voltage remains an important metric for radiofrequency lesion application. Embedded micro‐electrodes within ablation catheters are ...now approved for use in humans.
Objective
This study examined electrogram characteristics of miniaturized electrode bipoles (iEGMmini) compared to distal ablation tip bipoles (iEGMstandard) in the setting of typical atrial flutter in humans.
Methods
This was a single‐center prospective trial involving 21 patients. A total of 54 non‐ablated and 56 ablated sites were analyzed offline by separate blinded observers for iEGM voltage after a clinically successful radiofrequency (RF) ablation for typical atrial flutter. Ablation sites were defined as sites that were localized anatomically within the RF lesion set and did not have atrial capture at 10 mA and 2 milliseconds. Non‐ablated sites were defined as sites adjacent to or remote from the ablation lesion set with capture at 10 mA and 2 milliseconds.
Results
iEGMmini had greater voltages at non‐ablated sites and lower voltages at ablated sites than iEGMstandard (non‐ablated sites iEGMstandard 0.64 mV vs. iEGMmini 1.0 mV; ablated sites iEGMstandard 0.15 mV, iEGMmini 0.08 mV, P < 0.001). The difference for each patient between ablated and non‐ablated sites was greater for iEGMmini compared to iEGMstandard (0.94 mV ± 0.57 iEGMmini vs. 0.52 mV ± 0.35 iEGMstandard, P < 0.001). Inter‐observer agreement was good among all non‐ablated sites and iEGMmini ablated sites, but was less robust for ablated sites using iEGMstandard.
Conclusions
Imbedded mini‐electrode iEGM bipoles had higher voltages in non‐ablated tissue, lower voltages in ablated tissue, and significantly greater intra‐patient differences between ablated and non‐ablated sites. These data suggest a potential role for miniaturized electrode bipole use in RF lesion monitoring.
Program in Neuroscience and Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
Submitted 23 May 2008;
accepted in final form 25 July 2008
Huntington's disease ...(HD) is an autosomal dominant condition that compromises behavioral output. Dysfunction of medium spiny neurons (MSNs), which are the sole output system of the striatum, is thought to underlie HD pathophysiology. What is not known is how HD alters MSN information processing during behavior, which likely drives the HD behavioral phenotype. We recorded from populations of MSNs in two freely behaving and symptomatic HD mouse models: R6/2 transgenics are based on a C57BL/6J*CBA/J background and show robust behavioral symptoms, whereas knock-in (KI) mice have a 129sv background and express relatively mild behavioral signs. At the single-unit level, we found that the MSN firing rate was elevated in R6/2 but not in KI mice compared with their respective wild-type (WT) controls. In contrast, burst activity, which corresponds to periods of high-frequency firing, was altered in both HD models compared with WT. At the population level, we found that correlated firing between pairs of MSNs was a prominent feature in WT that was reduced in both HD models. Similarly, coincident bursts, which are bursts between pairs of neurons that overlap in time and occur more often in pairs of MSNs that exhibit correlated firing, were decreased in HD mice. Our results indicate an important role in both bursting and correlated burst firing for information processing in MSNs. Dysregulation of this processing scheme, moreover, is a key component of HD pathophysiology regardless of the severity of HD symptoms, genetic construct, and background strain of the mouse models.
Address for reprint requests and other correspondence: G. V. Rebec, Program in Neuroscience, 1101 East 10th St., Bloomington, IN 47405 (E-mail: rebec{at}indiana.edu )
Subjects of Chinese heritage have been found to participate in clinical research at lower rates than other groups despite growing in numbers as a population. While much research has examined research ...participants' motivation, there has not been a comprehensive synthesis of this information with respect to participants of Chinese descent. We sought to identify the factors that promote and hinder participation in clinical research among participants of Chinese heritage.
We conducted a systematic review of the literature in Pubmed, OpenJGATE, SCIRUS, and COCHRANE databases and performed a meta-synthesis of retrieved articles. We extracted qualitative data, such as quotes to identify emerging themes. We identified five studies that met our selection criteria. Of them, only one (1/5) was conducted in China while other studies involved Chinese emigrants in USA (3/5) and Singapore (1/5). Participants from China were similar to emigrants with regard to factors that either promoted or decreased research participation. Four studies reported data exclusively on Chinese subjects. Three of the five studies involved qualitative interviews while the others were conducted using a survey design. Six themes favoring research participation were identified: Personal Benefit to Participants, Financial Incentives, Participant Sense of Altruism, Family or Physician Recommendations, Advertisements, and Convenience to the Participant. Five factors were seen as a barrier to participation in clinical trials: Mistrust of Researchers, Language Barrier, Lack of Financial and Other Support, Cultural and Social Barriers, Lack of Knowledge about Clinical Trials.
Chinese heritage clinical research participants value personal benefit, financial incentives, the ability to help others, recommendations of others, advertisements, and convenience when considering clinical research participation. In addition, the establishment of trust and addressing knowledge deficits are important factors to them. Investigators seeking to optimize enrolment in these populations should incorporate these findings into their study design and subject handouts.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Contrary to most examples of disparities in health outcomes, black patients have improved survival compared with white patients after initiating hemodialysis. Understanding potential explanations for ...this observation may have important clinical implications for minorities in general. This study tested the hypothesis that greater use of activated vitamin D therapy accounts for the survival advantage observed in black and Hispanic patients on hemodialysis. In a prospective cohort of non-Hispanic white (n = 5110), Hispanic white (n = 979), and black (n = 3214) incident hemodialysis patients, higher parathyroid hormone levels at baseline were the primary determinant of prescribing activated vitamin D therapy. Median parathyroid hormone was highest among black patients, who were most likely to receive activated vitamin D and at the highest dosage. One-year mortality was lower in black and Hispanic patients compared with white patients (16 and 16 versus 23%; P < 0.01), but there was significant interaction between race and ethnicity, activated vitamin D therapy, and survival. In multivariable analyses of patients treated with activated vitamin D, black patients had 16% lower mortality compared with white patients, but the difference was lost when adjusted for vitamin D dosage. In contrast, untreated black patients had 35% higher mortality compared with untreated white patients, an association that persisted in several sensitivity analyses. In conclusion, therapy with activated vitamin D may be one potential explanation for the racial differences in survival among hemodialysis patients. Further studies should determine whether treatment differences based on biologic differences contribute to disparities in other conditions.
Introduction: Breast cancer is second most common cancer all over the world. Majority of breast cancer cases are registered to hospital at a later stage of cancer presentation. Objective: To study ...socio-demographic, clinical presentation and outcome of Breast cancer patients attending tertiary care centre of Gujarat state. Method: This was a retrospective study made up of 5774 patients registered in tertiary care centre of Gujarat state. Data including patient’s socio-demographic information like age, marital status, education level and clinical diagnosis including clinical presentation at time of registration, treatment history etc was collected. The data was analysed using MS office 2010 and Epi Info software version 7.0. Result: The age ranged between 17-99 years, with a median of 50 years and interquartile range of 42-58 years. There were 62.07% patients presented with locally advanced breast cancer, while 17.57% patients had distant metastasis at diagnosis. Significant association (p<0.05) was found between presentation of disease and literacy status. The overall Kaplan-Meier survival rate at 5 years was 35.8% + 5.0%. Survival rate was consistently declining with increase in clinical extension of disease. Conclusion: Majority of patients were in early advanced stage during their first hospital visit which was associated with poor survival. This information may help authorities to focus on early diagnosis of breast cancer.
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