Comparative Analysis of Carotid Artery Stenting and Carotid Endarterectomy in Clinical Practice

The objective of the study was to describe immediate and long-term results of carotid endarterectomy (CEA) versus carotid stenting (CAS) with embolic protection in patients with severe carotid artery stenosis in clinical practice. Materials and Methods: This is a retrospective cohort study, conducted between 2009 and 2017.During the analyzed period, 2132 operations (2006 patients) were performed: 1215 (57%) CEA and 917 (43%) CAS. 278 patients (13.8% of 2006) were not contactable during the follow-up period (>30 days) leaving 1791 cases (1728 patients) for inclusion in the analysis. Propensity score matching was used to compare the treatment results of groups (561 cases were matched out of 1791). The results of 615 CEA (316 eversion, 299 “classic” with patch) and 615 CAS (using a variety of carotid stents) were compared. Results: In the asymptomatic subgroup (n = 455), the 30-day rate of stroke was not significantly different between the CEA group and the CAS group (1.5% versus 2.4%, P = .48). The 5-year rate of stroke was not significantly higher for CAS than for CEA (4.6% versus 3.3%, P = .3). In the symptomatic subgroup (n = 160), the 30-day rate of stroke was significantly higher in the CAS group than in the CEA group (7.5% versus 2.5%, P = .04). The 5-year rate of stroke was 13% for CAS and 8.7% for CEA (P = .2). Conclusions: In the symptomatic subgroup, the 30-day rate of stroke was significantly higher in the CAS group than in the CEA group, therefore the use of CAS for symptomatic patients in routine practice should be limited. Our study demonstrates that the rates of stroke and survival after CEA and CAS in patients aged 80 years or younger with asymptomatic or symptomatic severe carotid stenosis did not differ significantly over a period of 5 years.     

Alcohol-induced changes in urinary aminolevulinic acid and porphyrins: Unrelated to liver disease

Urinary porphyrins and their metabolites aminolevulinic acid (ALA) and porphobilinogen (PBG) were determined in 15 normal volunteers and in 45 alcoholics, subdivided into three groups according to their liver function tests and histology: alcoholics exhibiting no evidence of hepatocellular damage; alcoholics with fatty liver and impaired function of liver enzymes; and alcoholics with proven liver cirrhosis. The dominant trend observed in those alcoholics devoid of any evidence of liver disease was increased ALA, PBG, and uroporphyrin. Coproporphyrinuria was shared by the patients exhibiting liver damage. The data shown enabled us to differentiate between the direct, primary effect of alcohol on the heme biosynthetic pathway and the secondary indirect effect, which is probably related to liver damage that follows alcohol consumption. Evaluation of the results led to the suggestion that urinary ALA could possibly serve as a marker of alcoholism. The specificity and sensitivity of the test were found to be 87A and 80%, respectively.     

腹膜后局限型Castleman病的CT表现(附2例报道)

目的探讨腹膜后局限型Castleman病的CT表现,进一步提高临床及影像对该病的认识。方法分析该院收治的2例腹膜后局限型Castleman病的CT特点,并结合有关文献进行分析。结果 2例腹膜后局限型Castleman病均为透明血管型,CT平扫与肌肉相比呈等密度;动态增强CT扫描,多数肿块动脉期明显强化,在延迟期均表现为持续强化,强化程度邻近动脉相仿。结论腹膜后Castleman病较为少见,但CT表现具有一定特征性,应提高对该病的认识,避免误诊。     

Human Leucocyte Antigen–Matching Can Improve Long Term Outcome of Renal Allografts from Donors Older Than 75 Years

BackgroundRenal transplantation is the therapy of choice for kidney failure. The Eurotransplant Senior Program (ESP) has been established to allocate kidneys ≥65 years to recipients of the same age group considered a regional allocation with short cold ischemia (CIT) but not human-leukocyte-antigen (HLA)-matching. The acceptance of organs aged ≥75 years is also still controversial within the ESP.MethodsIn a multicenter approach, 179 kidney grafts ≥75 years (mean donor age 78 years) that were transplanted in 174 patients in 5 German transplant centers were analyzed. The primary focus of the analysis was long-term outcome of the grafts and the impact of CIT, HLA matching, and recipient related risk factors.ResultsThe mean graft survival was 59 months (median 67 months) with a mean donor age of 78.3 ± 2.9 years. Grafts with 0 to 3 HLA-mismatches had a significantly better overall graft survival compared to grafts with ≥4 mismatches (69 months vs 54 months; P = .008). The mean CIT was short (11.9 ± 5.3 hours) and had no impact on graft survival.ConclusionRecipients receiving a kidney graft from donors aged ≥75 years can benefit from nearly 5 years of survival with a functioning graft. Even minimal HLA matching may improve long term allograft survival.     

Prospectively Collected Cardiovascular Biomarkers and White Matter Hyperintensity Volume in Ischemic Stroke Patients

Background: Few prospective cohort studies collect detailed information on stroke characteristics among individuals who experience ischemic stroke, including white matter hyperintensity volume, and thus cannot explore how prospectively collected biomarkers prior to the stroke influence white matter hyperintensity volume. We explored the association between a large panel of prospectively collected lipid and inflammatory biomarkers and white matter hyperintensity volume among participants in the Women's Health Study with incident ischemic stroke. Methods: Among Women's Health Study participants with first ischemic stroke who had baseline serum biomarkers and available magnetic resonance imaging, we measured white matter hyperintensity volume using a validated semi-automated method. Linear regression was used to explore the associations between biomarkers and log-transformed white matter hyperintensity volume. Results: After multivariate adjustment, a 1% increment in HbA1c% was associated with an increase in white matter hyperintensity volume (P value = .05). Evidence of a nonlinear association between high density lipoprotein cholesterol levels and ApoA1 levels with white matter hyperintensity volume was noted (P values for nonlinearity = .01 and .001, respectively). No other biomarkers were significantly associated with white matter hyperintensity volume. Conclusions: Chronic hyperglycemia as evidenced by HbA1c levels measured years prior to stroke is associated with white matter hyperintensity volume at the time of stroke. Additional research is needed to explain why low levels of high density lipoprotein cholesterol levels and ApoA1 may be associated with similar white matter hyperintensity volume as high levels.     

The Association Between Erectile Dysfunction and Sleep Parameters: Data from a Prospective,Controlled Cohort

BackgroundMany studies have reported a possible strong relationship between poor sleep quality, sleep disruption, sleep disorders, and erectile dysfunction (ED).AimThis study aimed to investigate the relationship between sleep quality and ED.MethodsPatients diagnosed with ED by the International Index of Erectile Function-5 (IIEF-5) questionnaire and 72 healthy adult men were included. Participants completed the questionnaire, underwent a detailed physical examination, and provided blood samples. All enrolled subjects then wore the Fitbit Charge 2 that monitored sleep throughout the night.OutcomesPrimary outcome measures included scores on the IIEF-5, General Anxiety Disorder-7 (GAD-7) scale, Patient Health Questionnaire-9 (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), and sleep monitoring parameters obtained from Fitbit Charge 2.ResultsFinally, a total of 107 ED patients and 72 healthy adult men were enrolled in this study. Univariate analysis indicated that the GAD-7 (P < .001), PHQ-9 (P < .001), and PSQI scores (P < .001) significantly differed according to the presence/absence of ED. Further multiple logistic regression analysis showed that the PHQ-9 (odds ratio [OR]: 1.227, 95% confidence interval [CI]: 1.070-1.407; P = .003) and PSQI scores (OR: 1.220, 95%CI: 1.116-1.334; P < .001) were independent risk factors for ED. Analysis of objective sleep monitoring parameters showed that total sleep time (TST) (P = .001), sleep onset latency (SOL) (P = .026), deep sleep (N3) duration (P = .011) and rapid eye movement (REM) sleep duration (P < .001) were significantly differed between the 2 groups, with durations in the ED group significantly lower than those in the non-ED group. In addition, receiver operating characteristic (ROC) curve analysis indicated that the REM sleep duration had the highest area under the curve (AUC: 0.728) of all sleep parameters, with a P value < .001, a sensitivity of 72.2% and a specificity of 73.8%.Clinical ImplicationsUrologists and andrologists should be aware of impacted sleep quality and depression in ED patients.Strengths & LimitationsThe strength of this study is that the relationship between sleep quality and ED was assessed with both a subjective scale and an objective sleep monitoring tool. However, our study only described an association between sleep quality and ED and did not establish a causal relationship.ConclusionSleep parameters are strongly associated with ED, indicating that poor sleep quality may increase the likelihood of ED.Wu X, Zhang Y, Zhang W, et al. The Association Between Erectile Dysfunction and Sleep Parameters: Data from a Prospective, Controlled Cohort. J Sex Med 2022;19:1387–1396.     

青少年精神分裂症患者生活事件及应对方式与家庭功能的相关性研究

目的 探讨青少年精神分裂症患者生活事件、应对方式与家庭功能的关系.方法 采用青少年生活事件量表(ASLEC)、特质应对方式问卷(TCSQ)、家庭关怀度指数量表(APGAR),对53例青少年精神分裂症患者进行调查分析.结果 36例(67.92%)青少年精神分裂症患者有家庭功能障碍.不同家庭功能患者ASLEC总分及受惩罚因子评分比较,差异有统计学意义(均P＜0.05).消极应对与家庭功能中的合作度、亲密度呈显著负相关(均P＜0.05);家庭关怀度指数总分与ASLEC总分存在显著负相关(P＜0.01).结论 青少年精神分裂症患者生活事件、应对方式与家庭功能有关.在对患者心理治疗和护理干预的同时,应对家庭成员进行相关干预,以提升家庭功能.     

新冠肺炎疫情下儿童青少年焦虑症状检出率及影响因素

目的探讨新冠肺炎(COVID-19)疫情期间居家儿童青少年焦虑症状检出率及危险因素,为给予其心理支持提供参考。方法 2020年2月13日-14日,采用电子问卷调查方式,由安徽省7～16岁的中小学生在线填写一般资料和儿童焦虑性情绪障碍筛查表(SCARED)。SCARED评分≥23分为焦虑组,SCARED评分23分为非焦虑组。采用单因素分析、二元Logistic回归分析儿童青少年焦虑症状的危险因素。结果共回收有效问卷5 392份,其中焦虑组1 045人(19. 4%),非焦虑组4 347人(80. 6%);单因素分析显示,焦虑检出率在性别、年龄、所在年级、身体健康状况、第一次了解此次疫情的途径、负面信息占比、不实信息占比上差异均有统计学意义(P均0. 05);二元Logistic回归分析显示,女生(OR=1. 423,P0. 01)、大龄儿童(OR=1. 411,P0. 01)、目前的身体状况不佳(OR=1. 620,P0. 01)、高负面信息占比(OR=1. 240,P0. 01)、高不实信息占比(OR=1. 265,P 0. 01)是儿童青少年存在焦虑症状的独立危险因素。结论新冠肺炎疫情期间居家隔离儿童青少年焦虑检出率未见明显增高,其中女性、大龄儿童、目前身体状况不佳、不良疫情信息是焦虑症状的危险因素。