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57). Degree of LA enlargement differed in 8194 patients (29%); 96% of the disagreement was related to underestimation of the degree of LA enlargement using LA
. Agreement for the degree of LA enlargement was poor in obese and good in non-obese patients (kappa=0.28 and 0.71, respectively). As illustrative clinical implications, diastolic function grade was modified in 8.3% of patients with preserved ejection fraction and 10.8% of patients with reduced left ventricular ejection fraction/myocardial disease, and timing for intervention was potentially different in 12.9% of patients with primary mitral regurgitation.
Indexing LA volume to measured BSA versus ideal BSA markedly underestimates the presence and severity of LA enlargement, especially in obese patients, with potential important clinical implications.
Indexing LA volume to measured BSA versus ideal BSA markedly underestimates the presence and severity of LA enlargement, especially in obese patients, with potential important clinical implications.
Acute severe ulcerative colitis (ASUC) is a life-threatening condition that requires timely referral for therapy. Sarcopenia has been associated with clinical outcomes of inflammatory bowel disease (IBD). This study investigated the role of sarcopenia in predicting the clinical course of ASUC.
This retrospective cohort study included ASUC patients with abdominal CT scans. Univariate and multivariable regression analyses were performed to identify a practical predictive index for the clinical course of ASUC.
Of 233 included patients, 151 had intravenous corticosteroid (IVS) failure, among whom 32 received surgery without medical rescue therapy. Fifty patients underwent colectomy after medical rescue therapy failure. Of these 82 surgical patients, 42 suffered postoperative complications. Multivariable regression analysis showed that sarcopenia remained an independent risk factor for IVS failure (OR=2.969; 95% CI, 1.547-5.701; p = 0.001), colectomy after medical rescue therapy failure (OR=3.411; 95% CI, 1.147-10.141; p = 0.027), and postoperative complications after colectomy (OR=4.157; 95% CI, 1.364-12.667; p = 0.012). During follow-up, patients with colectomy after first-line treatment had a lower comprehensive complication index and better health-related quality of life.
Sarcopenia is useful in predicting the clinical course and postoperative outcomes of ASUC.
Sarcopenia is useful in predicting the clinical course and postoperative outcomes of ASUC.
We have previously reported on neurogenic bladder dysfunction among Congenital Zika Vírus Syndrome (CZS) patients, but it is unknown how they will respond to treatment.
To assess whether children with neurological lower urinary tract dysfunction and CZS will respond to Standard therapies.
A prospective observational cohort study of children with CZS referred for urological assessment between 2016 and 2020 to our quaternary center in Brazil. Urological protocol included clinical history, urinalysis and culture, renal and bladder ultrasonography and urodynamic study. Patients were treated based on findings from the first evaluation, with oxybutynin chloride for overactive bladder and low bladder compliance, clean intermittent catheterization for ineffective bladder emptying, or dual therapy when both were observed. Urological outcomes were evaluated between the first and second visits considering patient's adherence. Outcomes measured included clinical, imaging, and urodynamic variables. Data was analyzedhough not statically significant. Adherence to treatment, specifically to CIC, remains a challenge.We report a case of a 36 year old gentleman presenting with polyneuropathy and Korsakkoff Syndrome complicating Sleeve Gastrectomy.
The response rate for osimertinib is high among patients with untreated epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC). However, there exist no biomarkers to predict the efficacy of the same. This study investigated whether BIM-γ mRNA expression in circulating tumor cells (CTCs) predicts poor outcomes for osimertinib treatment in patients with EGFR mutation-positive NSCLC.
Patients with advanced EGFR-tyrosine kinase inhibitor-untreated NSCLC or post-operative recurrence with EGFR-sensitive mutations (exon 19 deletion or L858R mutation) were included. Informed consent was obtained from all participants. The candidate biomarker BIM-γ was measured in CTCs after blood collection (10mL of whole blood) at baseline. CTCs were collected with the ClearCell FX system, and quantitative real-time PCR was performed. Relative expression of BIM-γ mRNA from CTCs, as normalized to the reference gene (GAPDH mRNA), was calculated using the KCL22cell line for calibration.
We enrolled 30 EGFR mutation-positive NSCLC patients treated with osimertinib during the period from April 2018 through December 2019. All the patients had an EGFR mutation at the primary site exon 19 deletion in 15 cases and L858R in 15 cases. Median CTC count at baseline was 12 (range 3-127)/7.5mL, and median BIM-γ mRNA expression was 0.073 (range 0-1.37). Furthermore, the response rate to osimertinib was worse in patients with high than in those with low BIM-γ mRNA expression (n=15 each) (26.6% vs. 73.3%, respectively; p=0.011). Progression-free survival did not significantly differ between groups (p=0.13).
BIM-γ mRNA overexpression in CTCs from EGFR mutation-positive NSCLC patients is a potential a biomarker for poor response to osimertinib.
UMIN00032055.
UMIN00032055.
Sensory information is crucial when performing daily activities, and Parkinson's disease may diminish sensitivity to sensory cues. This study aimed to examine the detection threshold of passive motion of knee and ankle joints in individuals with Parkinson's disease.
Eighteen individuals in the early stages of idiopathic Parkinson's disease (age 62.7 ± 7.3 years) and 18 healthy matched controls (age 62.5 ± 7.1 years) first performed a simple reaction time test. Participants were asked to perform ten trials, during which they had to watch a square on a screen and press a button as quickly as possible when the square lit up. Thereafter, the participants were tested for their detection threshold of passive motion of their lower limb joints. Participants were seated in a specially designed chair and their knee or ankle joint was passively moved at a velocity of 0.5º/s. Participants kept their eyes closed and were instructed to press a button as quickly as possible when any joint motion was detected.
Individuals with Parkinson's disease needed more time to perform the reaction time test than did the control participants. Individuals with Parkinson's disease also needed larger angular displacement, even when reaction time was used as a covariate measure, to detect any passive motion, in both knee (0.70º ± 0.20º) and ankle (1.03º ± 0.23º) joints than did the control participants [(0.57º ± 0.20º) and (0.84º ± 0.27º), respectively].
Impaired joint proprioception can be observed in the early stages of Parkinson's disease, which may compromise the use of proprioception cues from lower limbs.
Impaired joint proprioception can be observed in the early stages of Parkinson's disease, which may compromise the use of proprioception cues from lower limbs.
To determine the pharmacokinetics and pharmacodynamics of high-concentration formulation of buprenorphine (1.8 mg mL
; Simbadol) following subcutaneous (SC) administration in horses.
Prospective, randomized, crossover trial.
A group of six healthy adult horses weighing 521-602 kg.
On three occasions, Simbadol (0.005 mg kg
; treatment S5), (0.0025 mg kg
; treatment S2.5) or saline (treatment SAL) were administered SC at least 7 days apart in random order. Electrical nociceptive threshold (ENT) measured on the neck region, physiologic variables, locomotor activity, degree of restlessness and presence of excitatory signs were measured at baseline and for up to 48 hours after injection. Blood was collected for pharmacokinetic analysis at the same time intervals and plasma buprenorphine concentration (C
) measured using liquid chromatography-tandem mass spectrometry.
Buprenorphine was quantifiable in all horses from 15 minutes after administration up to 8-12 hours. ENT was significantly increased in apidly absorbed and Cp decreased rapidly. Side effects commonly seen in horses after opioids were observed in both Simbadol treatments, but degree of opioid-induced excitement lasted significantly longer in treatment S5. Simbadol (0.0025 mg kg-1) SC has the potential to be used clinically to treat pain in horses. However, at this dose, duration of antinociceptive effects was not longer than that reported for conventional buprenorphine, and side effects, including reduction in gastrointestinal motility and increased locomotor activity, were documented.
To describe dye distribution and spinal nerve involvement after a simulated erector spinae plane (ESP) block performed on fresh equine cadavers.
Experimental cadaver study.
A group of 11 adult equine cadavers.
The spinal region surrounding the sixteenth thoracic vertebra (Th16) of one cadaver was removed and underwent magnetic resonance imaging. In 10 adult equine cadavers [body weight, 549 ± 58 kg (mean ± standard deviation)], 0.2 mL kg
of a 501 2% lidocaine/dye solution was injected bilaterally (n= 20 injections) into the fascial plane between the transverse process of Th16 and the erector spinae muscles. An in-plane ultrasound-guided technique with a convex transducer was used to guide injection. Dissection was performed immediately following injection. see more The craniocaudal and lateral extent of dye distribution was measured (cm) and the number of vertebral bodies involved were counted (n= 20). Abdominal and thoracic cavities as well as the epidural space were also examined for presence of dye (yes/ns caused by epidural contamination.Inflammation is a host defense mechanism orchestrated through imperative factors - acute inflammatory responses mediated by cellular and molecular events leading to activation of defensive immune subsets - to marginalize detrimental injury, pathogenic agents and infected cells. These potent inflammatory events, if uncontrolled, may cause tissue damage by perturbing homeostasis towards immune dysregulation. A parallel host mechanism operates to contain inflammatory pathways and facilitate tissue regeneration. Thus, resolution of inflammation is an effective moratorium on the pro-inflammatory pathway to avoid the tissue damage inside the host and leads to reestablishment of tissue homeostasis. Dysregulation of the resolution pathway can have a detrimental impact on tissue functionality and contribute to the diseased state. Multiple reports have suggested peculiar dynamics of miRNA expression during various pro- and anti-inflammatory events. The roles of miRNAs in the regulation of immune responses are well-established. However, understanding of miRNA regulation of the resolution phase of events in infection or wound healing models, which is sometimes misconstrued as anti-inflammatory signaling, remains limited. Due to the deterministic role of miRNAs in pro-inflammatory and anti-inflammatory pathways, in this review we have provided a broad perspective on the putative role of miRNAs in the resolution of inflammation and explored their imminent role in therapeutics.
