Recurrent cardiac intimal sarcoma misdiagnosed as a myxoma or malignant transformation of a cardiac myxoma?

Cardiac intimal sarcoma is extremely rare and aggressive primary malignant cardiac tumors. Here, we reported the case of a young man initially operated for a tumor of the left atrium, causing a dynamic obstruction of the mitral valve and (mis‐)diagnosed as a myxoma at the histopathological analysis. Patient presented a local recurrence at 3 months and was reoperated. Pathology revealed this time the presence of an intimal sarcoma. Patient received adjuvant chemotherapy. Despite a good local control, the 1‐year follow‐up positron emission tomography scan revealed the presence of a metastasis in the left adrenal gland that was surgically resected. This article aims to highlight the risk of misdiagnosis in case of cardiac tumors, the hypothetical concept of malignant transformation of a cardiac myxoma, the aggressive course of the extremely rare cardiac intimal sarcoma, and the therapeutic modalities available to treat this pathology.     

Association between atherosclerotic cardiovascular diseases risk and renal outcome in patients with type 2 diabetes mellitus

AimsChronic kidney disease (CKD) and diabetes mellitus increase atherosclerotic cardiovascular diseases (ASCVD) risk. However, the association between renal outcome of diabetic kidney disease (DKD) and ASCVD risk is unclear.MethodsThis retrospective study enrolled 218 type 2 diabetic patients with biopsy-proven DKD, and without known cardiovascular diseases. Baseline characteristics were obtained and the 10-year ASCVD risk score was calculated using the Pooled Cohort Equation (PCE). Renal outcome was defined as progression to end-stage renal disease (ESRD). The association between ASCVD risk and renal function and outcome was analyzed with logistic regression and Cox analysis.ResultsAmong all patients, the median 10-year ASCVD risk score was 14.1%. The median of ASCVD risk score in CKD stage 1, 2, 3, and 4 was 10.9%, 12.3%, 16.5%, and 14.8%, respectively (p = 0.268). Compared with patients with lower ASCVD risk (＜14.1%), those with higher ASCVD risk had lower eGFR, higher systolic blood pressure, and more severe renal interstitial inflammation. High ASCVD risk (>14.1%) was an independent indicator of renal dysfunction in multivariable-adjusted logistic analysis (OR, 3.997; 95%CI, 1.385–11.530; p = 0.010), though failed to be an independent risk factor for ESRD in patients with DKD in univariate and multivariate Cox analysis.ConclusionsDKD patients even in CKD stage 1 had comparable ASCVD risk score to patients in CKD stage 2, 3, and 4. Higher ASCVD risk indicated severe renal insufficiency, while no prognostic value of ASVCD risk for renal outcome was observed, which implied macroangiopathy and microangiopathy in patients with DKD were related, but relatively independent.     

To screen or not to screen? The development of a prediction model for aorto-iliac stenosis in kidney transplant candidates

Screening for aorto-iliac stenosis is important in kidney transplant candidates as its presence affects pre-transplantation decisions regarding side of implantation and the need for an additional vascular procedure. Reliable imaging techniques to identify this condition require contrast fluid, which can be harmful in these patients. To guide patient selection for these imaging techniques, we aimed to develop a prediction model for the presence of aorto-iliac stenosis. Patients with contrast-enhanced imaging available in the pre-transplant screening between January 1st, 2000 and December 31st, 2018 were included. A prediction model was developed using multivariable logistic regression analysis and internally validated using bootstrap resampling. Model performance was assessed with the concordance index and calibration slope. Three hundred and seventy-three patients were included, 90 patients (24.1%) had imaging-proven aorto-iliac stenosis. Our final model included age, smoking, peripheral arterial disease, coronary artery disease, a previous transplant, intermittent claudication and the presence of a femoral artery murmur. The model yielded excellent discrimination (optimism-corrected concordance index: 0.83) and calibration (optimism-corrected calibration slope: 0.91). In conclusion, this prediction model can guide the development of standardized protocols to decide which patients should receive vascular screening to identify aorto-iliac stenosis. External validation is needed before this model can be implemented in patient care.     

脑卒中患者口腔健康素养现状及其影响因素分析

目的 调查脑卒中患者口腔健康素养现状并分析其影响因素,为制订个体化干预方案提供参考.方法 采用人口学资料及相关影响因素调查表、脑卒中患者口腔健康素养量表、口腔生活质量影响程度量表、汉密尔顿抑郁量表对199例脑卒中患者进行调查.结果 脑卒中患者口腔健康素养总分为(82.24±5.90)分;脑卒中患者口腔健康素养与口腔生活质量影响程度及抑郁呈负相关(均P＜0.01).文化程度、居住地、领悟社会支持、营养状态、婚姻状态、医疗支付方式、经济来源、吞咽功能、患慢性病种数、自觉经济压力、神经系统功能、自我感受负担、主要陪护者是脑卒中患者口腔健康素养的影响因素(P＜0.05,P＜0.01).结论 脑卒中患者口腔健康素养有待提高,其影响因素较多.医护人员应采取针对性措施提高患者的口腔健康素养.     

心理筛查异常孕妇产后抑郁发生状况及影响因素分析

目的 调查建档产检时心理筛查异常孕妇产后抑郁症状发生情况并分析其影响因素.方法 纳入建档产检时心理筛查异常孕妇681例.根据爱丁堡产后抑郁量表筛查结果判定产妇是否存在产后抑郁症状,采用Logistic回归分析探讨产后抑郁症状的影响因素.结果 681例中出现产后抑郁症状105例(占15.4％).个人精神心理疾病史,孕晚期存在焦虑症状、抑郁症状和焦虑抑郁症状并存是发生产后抑郁症状的危险因素(P＜0.05,P＜0.01).结论 建档产检时心理筛查异常产妇产后抑郁症状发生率不高,提示可能需要重新考虑合适的孕期心理筛查时间点和量表.需重视孕晚期心理筛查异常孕妇和有精神心理疾病史孕妇的跟踪随访,同时提高从业者的心理保健能力,保障心理保健效果.     

临床营养专科护士培训实践与成效

目的 探讨临床营养专科护士培训实践方法,为国内临床营养专科护士的培养提供参考.方法 基于临床营养专科护士核心能力构建培训体系,对115名学员采用理论授课(4周)与临床实践(8周)相结合方式分阶段进行培训.结果 学员总成绩(90.69±2.28)分;学员对培训的总体满意度为98.26％.结论 临床营养专科护士培训可提高专科护士营养相关知识和技能,促进专科护士持续成长.     

早期股骨头坏死塌陷风险预测评估体系的临床研究

目的:建立早期股骨头坏死塌陷风险评估预测体系,预测评估塌陷风险。方法:结合Steinberg分期、力学承载的ABC分型和近端硬化带比例建立早期股骨头坏死塌陷风险评估体系,首先应用Steinberg分期系统分期,Ⅰ期应用ABC分型预测风险,C型无风险,B型为低风险型,A型和BC型为中风险型,A-C和AB型为高风险型。SteinbergⅡ-Ⅲ分期首先进行硬化带分型,若为2型直接预测为低风险型;若为1型,则进一步进行ABC分型的划分,预测C型为无风险,B型为低风险型,A型和BC型为中风险型,A-C和AB型为高风险型。依据此预测体系应用回顾性分析的方法,预测由中国中医科学院广安门医院骨科门诊收集的188例(301髋)股骨头病例塌陷风险。并对3名医生及1名医生前后不同时间应用该体系预测结果的一致性进行评价。结果:188例(301髋)股骨头坏死病例。其中男136例,女52例;年龄19~64(42.61±12.07)岁;单髋75例,双髋113例;病程0.33~5.00(3.62±1.93)年。301髋病例中206髋发生塌陷(塌陷率68.44%)。无风险组,1髋中0髋发生塌陷,塌陷率0%;低风险组,91髋中9髋发生塌陷,塌陷率9.89%;中风险组,19髋中12髋发生塌陷,塌陷率63.16%;高风险组,190髋中185髋发生塌陷,塌陷率97.37%,不同风险组间差异有统计学意义(P=0.00)。该体系预测价值较高(ROC曲线AUC=0.95,P=0.00)。不同医生预测结果一致性良好(IC C=0.94,P=0.00),同一医生前后两次预测结果一致性良好(Kappa系数=0.90,P=0.00)。结论:早期股骨头坏死风险评估预测体系根据不同时期影像学特点选择不同方法预测塌陷风险,结合多风险因素综合评估,适用范围广泛,操作简捷,便于临床应用。     

Applying international organization for standards 9001 to create an effective surgical quality committee

BackgroundEfforts to improve surgical safety are limited by several factors and no consensus exists regarding the most effective way to improve surgical quality. The use of ISO 9001 quality standards within healthcare is recognized but has not been widely applied for improving surgical outcomes.MethodsA surgical quality committee was created using ISO 9001:2015 standards. Quality objectives were assessed to understand how any suggested changes will be impacted due to risks and opportunities inherent in the system.ResultsThe initial quality focus was on surgical site infections in 5 services. Change in surgical infection ratio from 2018 to 2019 showed significant improvement: coronary bypass 1.288 vs. 0.901; Colon 1.359 vs. 0.589; Hysterectomy 2.119 vs. 1.022; Knee 1.391 vs. 0.306; Hip 0 vs. 0.302.ConclusionsThis is one of the first studies using ISO 9001 to improve surgical quality. The results indicate both acceptance and success of applying continual improvement strategies.     

Cardiovascular events in patients undergoing hip fracture surgery treated with remote ischaemic preconditioning: 1-year follow-up of a randomised clinical trial

Remote ischaemic preconditioning reduces the risk of myocardial injury within 4 days of hip fracture surgery. We aimed to investigate the effect of remote ischaemic preconditioning on the incidence of major adverse cardiovascular events 1 year after hip fracture surgery. We performed a phase-2, multicentre, randomised, observer-blinded, clinical trial between February 2015 and September 2017. We studied patients aged ≥ 45 years with a hip fracture and a minimum of one cardiovascular risk factor. Patients were allocated randomly to remote ischaemic preconditioning applied just before surgery or no treatment (control group). Remote ischaemic preconditioning was performed on the upper arm with a tourniquet in four cycles of 5 min ischaemia and 5 min reperfusion. Primary outcome was the occurrence of major adverse cardiovascular events within 1 year of surgery. A total of 316 patients were allocated randomly to the remote ischaemic preconditioning group and 309 patients to the control group. Major adverse cardiovascular events occurred in 43 patients (13.6%) in the remote ischaemic preconditioning group compared with 51 patients (16.5%) in the control group (adjusted hazard ratio (95%CI) 0.83 (0.55–1.25); p = 0.37). Fewer patients in the remote ischaemic preconditioning group had a myocardial infarction (11 (3.5%) vs. 22 (7.1%); hazard ratio (95%CI) 0.48 (CI 0.23–1.00); p = 0.04). Remote ischaemic preconditioning did not reduce the occurrence of major adverse cardiovascular events within 1 year of hip fracture surgery. The effect of remote ischaemic preconditioning on clinical cardiovascular outcomes in non-cardiac surgery needs confirmation in appropriately powered randomised clinical trials.     

Management of knee and hip osteoarthritis: an opportunity for the Canadian chiropractic profession

Knee and hip osteoarthritis (OA) place a significant burden on the Canadian health system and are a major public health challenge. This brief commentary discusses the recently published Osteoarthritis Research Society International guideline and the American College of Rheumatology guideline for the management of OA. Special attention has been given to the role of manual therapy, exercise, and patient education for the treatment of knee and hip OA. This article also reviews the Good Life with osteoArthritis in Denmark (GLA:D^®) treatment program for knee and hip OA and the implementation of this program in Canada. Lastly, the authors discuss the opportunity for the Canadian chiropractic profession to embrace treatment programs like GLA:D^® and take an active role in the strengthening of the Canadian health system from a musculoskeletal perspective.