Midterm Outcomes of the Dissected Aorta Repair Through Stent Implantation Trial

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An observational pilot study of a novel loss of resistance syringe for locating the epidural space

BackgroundThe EpiFaith® syringe is a novel loss-of-resistance syringe that utilizes a spring-loaded plunger that automatically moves forward within the syringe when there is a loss of resistance. We evaluated the syringe in a clinical setting among a cohort of pregnant women receiving neuraxial labor analgesia.MethodsIn a non-randomized observational study, four anesthesiologists used the EpiFaith® syringe 10 times each while placing epidural catheters for labor analgesia. The anesthesiologists scored each placement on an 11-point Likert scale (−5 = absolutely worse, 0 = the same, and 5 = absolutely better than using their regular loss-of-resistance syringe technique).ResultsAll 40 neuraxial placements correctly located the epidural space. Air was used in the syringe in 35 of the 40 cases. In 50%, 27.5% and 22.5% of cases the anesthesiologists reported that using the EpiFaith® syringe was better than, the same as, or worse than using their regular syringe, respectively. There were no inadvertent dural punctures.ConclusionsThis feasibility study found that three of the four anesthesiologists scored the EpiFaith® syringe as better or the same as using their regular loss-of-resistance syringe. More extensive studies are required to determine if the EpiFaith® syringe reduces adverse outcomes such as unintentional dural punctures.     

The association of sleep quality and night sleep duration with coronary heart disease in a large-scale rural population

ObjectiveThe purposes of the present study were to explore independent and interactive associations between night sleep duration, night sleep quality and coronary heart disease (CHD) based on a rural population in China.MethodsA total of 27,935 participants (11,177 men and 16,758 women) were investigated from the Henan Rural Cohort. Information about sleep was assessed by using the Pittsburgh Sleep Quality Index (PSQI). Restricted cubic splines and logistic regression were used to estimate the relationship between night sleep duration and quality with CHD.ResultAmong the 27,935 participants, 1506 participants with CHD were identified. Compared with participants with scores lower than 3, the odds ratios (ORs) and 95% confidence intervals (95% CIs) of participants with score of 3–5, 6–8, ≥9 were respectively 1.42 (1.24–1.63), 1.99 (1.70–2.33), and 2.56 (2.13–3.08) with full adjustment of covariates. Compared with night sleep duration of 7 h, men and women who slept less than 5 h were 1.55 (1.11–2.17), 1.12 (0.59–2.12) and 1.80 (1.20–2.68), after being adjusted ORs (95% CIs) of the total. Moreover, the ORs and 95% CIs of CHD increased with the shortening of sleep duration at PSQI score above the highlighted levels.ConclusionPoor sleep quality and short night sleep duration were all associated with CHD in Chinese rural areas. Moreover, the association was more obvious in women. In addition, the strongest prevalence of CHD was found in short sleepers with poor sleep quality.     

Good综合征诊治一例

Good综合征（伴胸腺瘤的免疫缺陷症）是一种成人免疫缺陷病,特点是合并胸腺瘤及低丙种球蛋白血症。该病有细胞和体液免疫双重缺陷,患者常表现为反复感染。该文报道1例62岁AB型胸腺瘤女性患者,反复细菌、真菌和病毒感染,血清Ig低下,B淋巴细胞缺如、CD4⁺ T淋巴细胞下降、CD4⁺/CD8⁺ T淋巴细胞比值下降,诊断为Good综合征。该患者同时有粒细胞缺乏、慢性病性贫血,进一步骨髓宏基因组测序发现KIT与ARID1A基因突变,予补充Ig及抗感染治疗,患者症状好转出院。随访患者仍有Ig下降,予定时复查血常规、Ig,并适时补充Ig。Good综合征相对罕见,临床表现复杂,容易延误诊断,临床医师需引起重视。     

Deep learning for intelligent diagnosis in thyroid scintigraphy

ObjectiveTo construct deep learning (DL) models to improve the accuracy and efficiency of thyroid disease diagnosis by thyroid scintigraphy.MethodsWe constructed DL models with AlexNet, VGGNet, and ResNet. The models were trained separately with transfer learning. We measured each model’s performance with six indicators: recall, precision, negative predictive value (NPV), specificity, accuracy, and F1-score. We also compared the diagnostic performances of first- and third-year nuclear medicine (NM) residents with assistance from the best-performing DL-based model. The Kappa coefficient and average classification time of each model were compared with those of two NM residents.ResultsThe recall, precision, NPV, specificity, accuracy, and F1-score of the three models ranged from 73.33% to 97.00%. The Kappa coefficient of all three models was >0.710. All models performed better than the first-year NM resident but not as well as the third-year NM resident in terms of diagnostic ability. However, the ResNet model provided “diagnostic assistance” to the NM residents. The models provided results at speeds 400 to 600 times faster than the NM residents.ConclusionDL-based models perform well in diagnostic assessment by thyroid scintigraphy. These models may serve as tools for NM residents in the diagnosis of Graves’ disease and subacute thyroiditis.     

In-Hospital Complications in Pregnant Women With Current or Historical Cancer Diagnoses

ObjectiveTo assess the temporal trends, characteristics and comorbidities, and in-hospital cardiovascular and obstetric complications and outcomes of pregnant women with current or historical cancer diagnosis at the time of admission for delivery.MethodsWe analyzed delivery hospitalizations with or without current or historical cancer between January 1, 2004, and December 31, 2014, from the US National Inpatient Sample database.ResultsWe included 43,132,097 delivery hospitalizations with no cancer, 39,118 with current cancer, and 67,336 with historical diagnosis of cancer. The 5 most common types of current cancer were hematologic, thyroid, cervical, skin, and breast cancer. Women with current and historical cancer were older (29 years and 32 years vs 27 years) and incurred higher hospital costs ($4131 and $4078 vs $3521) compared with women without cancer. Most of the cancer types were associated with preterm birth (hematologic: adjusted odds ratio [aOR], 1.48 [95% CI, 1.35 to 1.62]; cervical: aOR, 1.47 [95% CI, 1.32 to 1.63]; breast: aOR, 1.93 [95% CI, 1.72 to 2.16]). Current hematologic cancer was associated with the highest risk of peripartum cardiomyopathy (aOR, 12.19 [95% CI, 7.75 to 19.19]), all-cause mortality (aOR, 6.50 [95% CI, 2.22 to 19.07]), arrhythmia (aOR, 3.82 [95% CI, 2.04 to 7.15]), and postpartum hemorrhage (aOR, 1.31 [95% CI, 1.11 to 1.54]). Having a current or historical cancer diagnosis did not confer additional risk for stillbirth; however, metastases increased the risk of maternal mortality and preterm birth.ConclusionWomen with a current or historical diagnosis of cancer at delivery have more comorbidities compared with women without cancer. Clinicians should communicate the risks of multisystem complications to these complex patients.