AbstractObjectiveCarotid artery stenting (CAS) was introduced as an alternative carotid revascularization procedure in patients deemed to be at high risk for carotid endarterectomy. Although ...techniques and selection criteria for patients have dramatically improved, CAS continues to have higher risk of stroke and death in comparison to carotid endarterectomy. Several risk factors are known to be associated with worse outcomes. Whereas knowledge of these independent factors is helpful, clinical decision-making is further refined when these are considered in aggregate. This study aimed to develop a score to predict the risk of stroke/death after transfemoral CAS (TFCAS). MethodsWe analyzed the Vascular Quality Initiative CAS data set from 2010 to 2018. Lesions due to trauma, dissection, or transcarotid artery stenting and cases performed without an embolic protection device were excluded. Univariable and multivariable logistic regression methods with bootstrapping (1000 repetitions) were used to identify predictors associated with 30-day stroke/death. Stepwise backward selection for variables was used to achieve model parsimony. A risk score was made by converting regression coefficients for each predictor to integers from which probability was calculated. Scores were grouped into simplified categories. ResultsWe identified 10,753 patients undergoing TFCAS during the study period with a combined 30-day stroke/death rate of 4.1%. On multivariable adjustment, independent predictors of 30-day stroke/death included age (odds ratio OR, 1.05; 95% confidence interval CI, 1.03-1.06; P < .001), nonwhite race (OR, 1.42; 95% CI, 1.16-1.74; P = .001), diabetes (OR,1.34; 95% CI, 1.08-1.67; P = .01), coronary artery disease (OR, 1.40; 95% CI, 1.13-1.73; P = .001), congestive heart failure (OR, 1.41; 95% CI, 1.07-1.85; P = .02), symptomatic status (OR, 2.11; 95% CI, 1.64-2.72; P < .001), and contralateral occlusion (OR, 1.64; 95% CI, 1.22-2.19; P = .001). On the other hand, preoperative use of statins (OR, 0.074; 95% CI, 0.59-0.93; P = .02) and dual antiplatelet therapy (P2Y 12 inhibitors and aspirin; OR, 0.46; 95% CI, 0.32-0.66; P < .001) were associated with a significant reduction in stroke/death after TFCAS. The model had a C statistic of 69.0%. The coefficients of these predictors were used to develop a risk score calculator that estimates the probability of 30-day stroke/death after TFCAS. ConclusionsIn an analysis of 10,753 patients undergoing TFCAS between 2010 and 2018, significant predictors of perioperative stroke or death included old age, nonwhite race, symptomatic status, diabetes, coronary artery disease, congestive heart failure, and contralateral occlusion in addition to perioperative dual antiplatelet therapy and statin use. These variables were used to develop a risk score calculator that estimates the probability of 30-day stroke/death after TFCAS. External validation of this tool in different populations of patients and data sets is warranted to evaluate its predictive performance.
Few reports in the literature describe the treatment experience of benign lesions of the femoral head and neck. Between July 2005 and August 2009, twenty-four patients with bone tumor of the femoral ...neck and head were treated at the authors' institution. Fourteen patients had pathological fractures of the femoral neck; in the other 10 patients, the bone cortex was involved. Average tumor size was 78 cc (range, 45-130 cc). The patients were treated by curettage plus bone grafting via an anterior approach (Smith-Petersen incision) and internal fixation via a lateral approach (Hardinge approach). Average follow-up was 34 months (range, 10-68 months).Average blood loss and operative time were 450 mL and 87 minutes, respectively. Six patients experienced complications: 2 superficial wound infections, 2 immunological rejections, and 2 hollow screw loosenings and slight limps at 12 and 16 months postoperatively, respectively. No recurrence or other serious complications, such as pathological fracture, ischemic necrosis of the femoral head, or joint degeneration, occurred. Average Musculoskeletal Tumor Society score for lower extremity function was 29.2 (range, 27-30) at final follow-up, and all patients resumed their normal preoperative work and were pain free postoperatively, although 1 patient had a slight limp at final follow-up.A combination of anterior and lateral approaches may produce good clinical and functional results with minimal complications in bone tumors of the femoral neck.
Abstract True aneurysmal vein graft dilation is rare, and its etiology remains speculative. However, systemic dilation diathesis is regarded as a risk factor. We herein report a case of a rapidly ...expanding aneurysm in a great saphenous vein graft, resulting in distal malperfusion in a patient who had previously undergone open repair of multiple popliteal artery aneurysms. After an unsuccessful endovascular intervention, the dilated section was eventually replaced by a reversed segment of the contralateral great saphenous vein. Subsequent whole-exome sequencing identified no relevant mutations. This case provides further evidence that aneurysmal disease may be associated with systemic dilation diathesis.
Abstract Purpose The current study aims to analyze multiple variables and to determine the factors influencing postoperative complications in reconstructive microsurgeries for head and neck cancer. ...Patients and Methods We retrospectively reviewed the medical records of head and neck cancer patients who underwent free flap reconstruction after ablation surgery at Cathay General Hospital from January 2010 to December 2014. Clinical and surgical procedure-related factors were retrieved from a database and analyzed. Major complications included flap failure and life-threatening events. Minor complications were defined as problems that only needed routine wound care or conservative treatments. To evaluate the group differences, the chi-square test was applied for categorical variables and the Mann–Whitney U-test was used for continuous variables. Results A total of 158 patients was included in the study. The mean age of our study population was 52.4 years (range 34–84 years). Of the 158 study patients, 145 (91.8%) were men and 13 (8.2%) were women. The mean body mass index (BMI) was 23.71 kg/m2 . Most of the patients (93.7%) had a history of cigarette smoking. Some patients had diabetes (20.3%) and hypertension (31.6%). The percentage of patients who underwent radiotherapy before surgery was 19.6%. The percentage for whom the flap needed a further salvage operation was 8.9%. The success rate of our microvascular surgeries was 95.6%. The major complication rate was 6.3% and the minor complication rate was 27.8%. No surgical mortality was noted. Conclusion In our groups, poor nutrition status such as low BMI and low albumin data were associated with a higher tendency for patients to experience postoperative complications. Patients who had diabetes or who had received radiotherapy before surgery had a high risk for major complications. Large skin paddle size seemed to be an influencing factor for minor complications such as wound dehiscence and superficial loss of flaps.
Evidence supports a possible link between eosinophilic esophagitis (EoE) and environmental aeroallergens, which can manifest as seasonal exacerbation of esophageal eosinophilia. Few studies have ...examined this link in pediatric patients with EoE.
To identify the proportion of patients with seasonal induced esophageal eosinophilia.
A retrospective chart review was conducted of all patients diagnosed with EoE at the authors' institution. Demographic data were collected by chart review. Seasonal variation or flare was defined as a change from fewer than to at least 15 eosinophils per high-power field and a minimum of a 2-fold increase in eosinophil count between 2 consecutive biopsy specimens in different seasons without dietary or medication modifications.
Of the 1,180 patients with EoE, 160 (14%) were suspected of having aeroallergen-associated triggers by history. Of these 160 patients, 32 (20%) had biopsy examination-confirmed variation of EoE triggered by aeroallergens. Most of these patients were boys (84%), all had a history or examination consistent with allergic rhinitis, and most had a history of asthma (75%). Thirty-two subjects had obvious seasonal variation, 22 of whom also had known food-induced symptoms.
Children with EoE and allergic rhinitis might have exacerbations in their esophageal eosinophilia during certain seasons depending on the specific aeroallergens to which they are sensitized. Identification of environmental allergens to sensitized patients is important and can guide therapy.
Avian influenza A H6N1 virus is one of the most common viruses isolated from wild and domestic avian species, but human infection with this virus has not been previously reported. We report the ...clinical presentation, contact, and environmental investigations of a patient infected with this virus, and assess the origin and genetic characteristics of the isolated virus.
A 20-year-old woman with an influenza-like illness presented to a hospital with shortness of breath in May, 2013. An unsubtyped influenza A virus was isolated from her throat-swab specimen and was transferred to the Taiwan Centres for Disease Control (CDC) for identification. The medical records were reviewed to assess the clinical presentation. We did a contact and environmental investigation and collected clinical specimens from the case and symptomatic contacts to test for influenza virus. The genomic sequences of the isolated virus were determined and characterised.
The unsubtyped influenza A virus was identified as the H6N1 subtype, based on sequences of the genes encoding haemagglutinin and neuraminidase. The source of infection was not established. Sequence analyses showed that this human isolate was highly homologous to chicken H6N1 viruses in Taiwan and had been generated through interclade reassortment. Notably, the virus had a G228S substitution in the haemagglutinin protein that might increase its affinity for the human α2-6 linked sialic acid receptor.
This is the first report of human infection with a wild avian influenza A H6N1 virus. A unique clade of H6N1 viruses with a G228S substitution of haemagglutinin have circulated persistently in poultry in Taiwan. These viruses continue to evolve and accumulate changes, increasing the potential risk of human-to-human transmission. Our report highlights the continuous need for preparedness for a pandemic of unpredictable and complex avian influenza.
Taiwan Centres for Disease Control.
To observe the efficacy of the circumferential decompression with posterior transpedicular osteotomy and segmental instrumentation with interbody fusion for thoracic ossification of posterior ...Iongitudinal ligament (T-OPLL).
From May 2012 to June 2015, 16 consecutive patients underwent posterior transpedicular osteotomy and segmental instrumentation with interbody fusion.Osteotomy range was depended by length and types of OPLL.Patient's data included level, clinical presentation, blood loss, length of surgery, complications, VAS, JOA, and Frankel grading system before and after the surgery. All data were collected, retrospectively.
The follow-up period was (30±19) months (range from 12 to 50 months). The operation time was (261.6±51.3) min (range from 190 to 310 min). The blood loss was (980.3±370.5) ml (range from 600 to 2 100 ml). All patients were well treated with posterior compression and segmental instrumentation with interbody fusion.The VAS score was (4.2±0.2) in all patients at a week, improving to (2
Aberrant microRNA expression is common in colorectal cancer and DNA methylation is believed to be responsible for this alteration. In this study, we performed evaluation in vivo and in vitro to ...determine the role of miR-181b as a potential diagnostic and prognostic biomarker in colorectal cancer. Ninety-seven pairs of colorectal cancer tissues and adjacent normal tissues were collected. The expression level and methylation status of miR-181b was determined in tissue samples and multiple colorectal cancer cell lines. RASSF1A, a predicted target gene of miR-181b, was investigated in vitro. Further mechanistic explorations were conducted. It was found that miR-181b expression was frequently downregulated in cancer samples. This lower expression level resulted from higher hypermethylation in cancer tissue and was closely related to TNM stage. Following artificial synthesis of miR-181b stimulation, colorectal cancer cell proliferation was greatly inhibited in CRC cells while apoptosis percentage markedly increased. miR-181b achieved the tumor suppressive effects via direct targeting of the RASSF1A gene. This study indicated the clinical significance of miR-181b and the influence of miR-181b promoter region in epigenetic silencing of tumorigenicity in colorectal cancer, and implied the possible usage of miR-181b as a diagnostic and prognostic biomarker in colorectal cancer.
The Chunqiu and Zhanguo Periods are usually regarded as the birth of Chinese philosophy, especially with regard to practical or moral philosophy. If we think about the concept of political legitimacy ...in the Early Zhou Period, with ideas like the “Mandate of Heaven”, “respect virtue” and “protect ruled people”, then this Period is not only the origin of this in ancient China, but also of Chinese philosophy, and primarily the political philosophy of Confucianism. The paper will first explain some documents in the “inscriptions on ancient bronze objects” in order to prove that the ideas of the “Mandate of Heaven”, “respect virtue” and “protect ruled people” really originated from this time. Through analysis of several Zhou documents from the Book of the Documents the paper will then demonstrate that these ideas are the three most important innovations in the history of Chinese thinking at that time.
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