In patients given a diagnosis of chronic spontaneous urticaria (CSU), there are no obvious external triggers, and the factors that initiate the clinical symptoms of wheal, flare, and itch arise from ...within the patient. Most patients with CSU have an autoimmune cause: some patients produce IgE autoantibodies against autoantigens, such as thyroperoxidase or double-stranded DNA, whereas other patients make IgG autoantibodies against FcεRI, IgE, or both, which might chronically activate mast cells and basophils. In the remainder of patients with CSU, the nature of the abnormalities has not yet been identified. Accumulating evidence has shown that IgE, by binding to FcεRI on mast cells without FcεRI cross-linking, can promote the proliferation and survival of mast cells and thus maintain and expand the pool of mast cells. IgE and FcεRI engagement can also decrease the release threshold of mast cells and increase their sensitivity to various stimuli through either FcεRI or other receptors for the degranulation process. Furthermore, IgE-FcεRI engagement potentiates the ability of mast cells to store and synthesize de novo inflammatory mediators and cytokines. Administration of omalizumab, by virtue of its ability to deplete IgE, attenuates the multiple effects of IgE to maintain and enhance mast cell activities and hence reduces the ability of mast cells to manifest inflammatory mechanisms in patients with CSU.
To evaluate outcomes and predictive factors for additional ProGlide device deployment in percutaneous endovascular aortic repair (PEVAR) with the preclose technique.
Clinical data of patients who ...underwent PEVAR with the preclose technique from February 2012 to January 2015 were retrospectively reviewed. A total of 268 patients (229 men, 39 women) who underwent PEVAR (thoracic endovascular aortic repair TEVAR, n = 113; endovascular abdominal aortic repair EVAR, n = 152; simultaneous TEVAR and EVAR, n = 3) with 418 femoral access sites were enrolled. The mean age of the patients was 69 years ± 14. Univariate and multivariate analyses were performed to identify predictive factors associated with additional ProGlide device deployment.
Primary technical success with adequate hemostasis and two ProGlide devices was 87.6%, and 48 femoral arterial access sites (11.5%) required additional ProGlide device deployment. The secondary technical success rate was 99.0%. Four femoral access sites (1.0%) needed surgical repair. Anterior wall calcification near the arteriotomy increased the risk of additional ProGlide device deployment (adjusted odds ratio, 6.19; 95% confidence interval, 2.81-13.64; P < .001), whereas larger sheath size, common femoral artery (CFA) diameter, and depth from the skin to the arteriotomy did not.
Additional ProGlide device deployment reduces the rate of surgical repair after primary hemostasis failure in PEVAR. Anterior CFA wall calcification is a significant predictor for additional ProGlide device deployment.
Objective Many genetic factors have been implicated in the development of oral squamous cell carcinoma (OSCC). Although mutations associated with OSCC have been well documented, the rate of these ...mutations is known to vary by location. The goal of this study was to determine the frequency of RAS , BRAF , PIK3CA , and TP53 mutations in OSCC within the Taiwanese population. Study Design A total of 79 OSCC tissue specimens were screened for the presence of RAS , BRAF , PIK3CA , and TP53 mutations. Results Missense mutations in HRAS were found in 10 of 79 cases (12.66%), and were significantly associated with tumor grade. PIK3CA mutations were observed in 11 of 79 cases (13.92%), including a rare mutation, Q546 P, that had not previously been reported in OSCC. TP53 mutations were observed in 26 of 79 patients (32.91%) and were significantly correlated with poor survival. Conclusions The results suggest that HRAS , PIK3CA , and TP53 may play a role in OSCC tumorigenesis.
Abstract Purpose The purpose of this study is to investigate the prognostic values of the serum levels of lipids in patients with severe community-acquired pneumonia (CAP) that required intensive ...care unit (ICU) admission. Materials and methods Patients who had severe CAP that required ICU admission were included. Serum lipid level was collected on the days 1 and 7 of ICU stay. Clinical outcome, including length of ICU stay, hospital stay, and death, were monitored prospectively. Results A total of 40 patients were enrolled in this study. Lower high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were found in nonsurvival group on ICU admission day 7 (survivors vs nonsurvivors; mean HDL, 41.8 vs 13.0 mg/dL, P = .002; LDL, 62.3 vs 30.3 mg/dL, P = 0.006, respectively). High-density lipoprotein cholesterol level of less than or equal to 17 mg/dL on day 7 (odds ratio, 1.23) and LDL cholesterol level of less than or equal to 21 mg/dL on day 7 (odds ratio, 1.10) could be a predictor of hospital mortality. The mean change in levels of HDL cholesterol in nonsurvivors decreased significantly than those in survivors from days 1 to 7 (8.5 vs − 17.4 mg/dL, P = .04) but not LDL cholesterol. Conclusions Decreased serum HDL cholesterol level from days 1 to 7 may be of prognostic value.
Background Early detection of esophageal cancer in patients with head and neck cancers may alter treatment planning and improve survival. However, standard endoscopic screening is not feasible for ...some patients with tumor-related airway compromise or postirradiation trismus. Objective To evaluate a novel, sequential approach by integrating ultrathin endoscopy with narrow-band imaging and Lugol chromoendoscopy. Design Cross-sectional study. Setting Single center in Taiwan. Patients Forty-four consecutive patients with transoral difficulty screened for synchronous or metachronous esophageal cancer. Main Outcome Measurements Sensitivity, specificity, and accuracy in the detection of mucosal high-grade neoplasia or invasive cancer. Results Fifty-four endoscopic interpretations were obtained, and 11 mucosal high-grade neoplasia and 7 invasive cancers were confirmed by histology. The mean examination time was 19.4 minutes (range 7.9-35.2 minutes), and all patients tolerated the procedure well. Sensitivity, specificity, and accuracy (with 95% CI) were 55.6% (95% CI, 33.5%-75.6%), 97.2% (95% CI, 85.8%-99.3%), and 83.3% (95% CI, 71.2%-90.9%), respectively, for standard endoscopy; 88.9% (95% CI, 66.9%-96.6%), 97.2% (95% CI, 85.8%-99.3%), and 94.4% (95% CI, 84.9%-97.9%), respectively, with the adjunct of narrow-band imaging; and 88.9% (95% CI, 66.9%-96.6%), 72.2% (95% CI, 55.9%-84.1%), and 77.8% (95% CI, 64.9%-86.8%), respectively, with the adjunct of Lugol chromoendoscopy. When we integrated all interpretations on the basis of the sequential approach, the estimated probability of false-negative findings was 1.2% (95% CI, 0.1%-4.6%). Limitations Inherent shortcomings of ultrathin endoscopy, such as its resolution, light source, and lack of magnification. Conclusions The use of ultrathin endoscopy in a sequential approach for multimodal detection is feasible in patients with transoral difficulty and substantially increases the detection rate of synchronous or metachronous neoplasms.
Abstract Introduction The objective of this study was to investigate the antibacterial, biocompatibility, and mechanical properties of mineral trioxide aggregate (MTA) set using a calcium lactate ...gluconate (CLG) solution. Methods ProRoot white MTA (WMTA) (Dentsply Tulsa Dental, Tulsa, OK) was used as the control group; MTA-like cement was prepared by mixing Portland cement/bismuth oxide/calcium sulfate (75/20/5) as the experiment group. A solution of 23.1 wt% CLG was used as a hydration accelerant and was compared with deionized water (DDW). Changes in pH values, antibacterial properties, in vitro cell viability, and diametral tensile strength (DTS) of the hydrated cements were assessed. Results Like WMTA, pH values for the MTA-like cement set using DDW and the CLG solution showed minor but statistically significant differences ( P < .05). The antibacterial effects of hydrated specimens set by DDW and CLG against Streptococcus mutans assessed with an in vitro tube dilution test showed a significant difference in the early hydration time but no significant difference after 60 minutes ( P > .05). A mouse osteoblastic cell (MC3T3-E1)-based MTT assay revealed that WMTA set using CLG had significantly higher cell viability than that set using DDW ( P < .05). The DTS test for hydrated MTA-like cement with different liquids showed a significant difference on day 1 but no statistical difference on day 21. Conclusions The results suggest that using a CLG solution as the hydration accelerant may enhance the biocompatibility but not compromise WMTA’s antibacterial and mechanical properties.
Abstract Background Hypokalemic nonperiodic paralysis represents a group of heterogeneous disorders with a large potassium (K+ ) deficit. Rapid diagnosis of curable causes with appropriate treatment ...is challenging to avoid the sequelae of hypokalemia. We prospectively analyzed the etiologies and therapeutic characteristics of hypokalemic nonperiodic paralysis. Methods Over an 8-year period, patients with hypokalemic nonperiodic paralysis were enrolled by excluding those with hypokalemic periodic paralysis due to acute shift of K+ into cells. Blood and spot urine samples were collected for the measurements of electrolytes, pH, and biochemistries. Intravenous potassium chloride (KCl) at a rate of 10-20 mmol/h was administered until muscle strength recovered. Results We had identified 58 patients with hypokalemic nonperiodic paralysis from 208 consecutive patients with hypokalemic paralysis, and their average K+ concentration was 1.8 ± 0.2 mmol/L. Among patients with low urinary K+ excretion (n = 17), chronic alcoholism, remote diuretic use, and anorexia/bulimia nervosa were the most common causes. Among patients with high urinary K+ excretion (n = 41) and metabolic acidosis, renal tubular acidosis and chronic toluene abuse were the main causes, while primary aldosteronism, Gitelman syndrome, and diuretics were the leading diagnoses with metabolic alkalosis. The average KCl dose needed to restore muscle strength was 3.8 ± 0.8 mmol/kg. Initial lower plasma K+ , volume depletion, and high urinary K+ excretion were associated with higher recovery KCl dosage. During therapy, patients with paradoxical hypokalemia (n = 32) who required more KCl supplementation than patients without (4.1 ± 0.7 vs 3.4 ± 0.7 mmol/kg, P < 0.001) often exhibited significantly higher plasma renin activity and received a higher volume of normal saline before its appearance. Conclusions Understanding the common etiologies of hypokalemic nonperiodic paralysis may aid in early diagnosis. Patients with initial lower plasma K+ , renal K+ wasting, and hypovolemia required higher recovery K+ dosage. Paradoxical hypokalemia is prone to develop in hypovolemic patients even during K+ supplementation with volume repletion.
Abstract
A significant number of patients suffers from refractory trigeminal neuralgia (TN) after receiving microvascular decompression (MVD) or other neuro-destructive procedure such as gamma knife ...radiosurgery (GKRS). This study aims to demonstrate a remediable, reproducible approach to treating refractory pain effectively by percutaneous radiofrequency trigeminal rhizotomy (RF-TR).
A total of 392 patients with TN were treated by RF-TR during the past 10 years. Among these patients, 48 cases who had received either MVD, GKRS alone, or a combination of both were assigned to group A. Those who had not received any form of treatment (125 patients) or failed to respond medically (130 patients) were assigned as the control group (group B). All the RF-TR were performed by a single surgeon with the aid of intraoperative computed tomography (iCT)-based neuronavigation with magnetic resonance (MR) image fusion. The outcome measure was the numerical rating scale (NRS) expressed subjectively by patients. The paired Student
t
test and the analysis of covariance (ANCOVA) were used for statistical analysis.
In group A, 21 of 24 patients (88%) had significant improvement (NRS change ≥5) in facial pain after RF-TR. The average NRS score was 9.75 ± 0.53 before the procedure and 1.92 ± 3.35 post-treatment (significant NRS decrease
P
= .000). On the other hand, in group B, 226 of 255 patients (89%) also had dramatic amelioration of facial pain after RF-TR. The average NRS score was 9.46 ± 0.69 before the procedure and 1.62 ± 2.85 post-treatment (7.84 ± 2.82 in NRS decrease
P
= .008). By using a univariate ANCOVA, no statistical significance was found in NRS score improvement between the two groups.
Repeated MVD and GKRS for refractory TN may be less desirable due to a greater risk of mortality (up to 0.8%) and morbidity (4% of serious complications). Conversely, RF-TR administration with the novel navigation technique by using iCT and MR image fusion is free from any remarkable and irreversible morbidities. In this study, RF-TR not only provided an alternative and effective strategy if TN recurred but also resulted in the same NRS score improvement regardless of the status of prior treatment.
Abstract Purpose: MicroRNA-145 (miR-145) has known anti-tumor properties and has been reported to be involved in regulating corneal epithelium differentiation. The exact role of miR-145 in ocular ...tissue remains unclear. In this study, we evaluate the effect of miR-145 expression levels on pterygium properties. Setting: Ophthalmology department of a tertiary medical center. Design: Case series study. Methods: Information regarding patient age, pterygium recurrence and pterygium severity (extension E, vascularity V and thickness T) were gathered from records. Expression levels of miR-145 were obtained through examination of excised pterygium tissue. Correlations between age, pterygium classification, and miR-145 levels were evaluated. Results: This study evaluated 253 patients (mean age 54.1±10.8 years). As pterygium severity increased, miR-145 levels decreased. Negative correlations were also found between miR-145 expression levels and pterygium extension (E) and vascularity (V). Thickness (T) had a weak negative correlation. There was only a mild negative correlation between patient age and miR-145 levels, which was only seen in patients with primary pterygium (not recurrent ones). Additionally, miR-145 expression was significantly higher in primary samples than in recurrent ones. Conclusions: We demonstrated an association between miR-145 and pterygium characteristics, consistent with its known tumor suppression effect. Because the management of pterygium is often difficult, we suggest that miR-145 should be further studied as a potential treatment.
Objective: To investigate the feasibility and accuracy of artificial intelligence (AI) methods of facial deidentification in hospital-recorded epileptic seizure videos, for improved patient privacy ...protection while preserving clinically important features of seizure semiology. Patients and Methods: Videos of epileptic seizures displaying seizure-related involuntary facial changes were selected from recordings at Taipei Veterans General Hospital Epilepsy Unit (between August 1, 2020 and February 28, 2023), and a single representative video frame was prepared per seizure. We tested 3 AI transformation models: (1) morphing the original facial image with a different male face; (2) substitution with a female face; and (3) cartoonization. Facial deidentification and preservation of clinically relevant facial detail were calculated based on: (1) scoring by 5 independent expert clinicians and (2) objective computation. Results: According to the clinician scoring of 26 facial frames in 16 patients, the best compromise between deidentification and preservation of facial semiology was the cartoonization model. A male facial morphing model was superior to the cartoonization model for deidentification, but clinical detail was sacrificed. Objective similarity testing of video data reported deidentification scores in agreement with the clinicians’ scores; however, preservation of semiology gave mixed results likely due to inadequate existing comparative databases. Conclusion: Artificial intelligence-based face transformation of medical seizure videos is feasible and may be useful for patient privacy protection. In our study, the cartoonization approach provided the best compromise between deidentification and preservation of seizure semiology.
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