Evaluation of the effect of carrot seed (Daucus Carota) in women of fertile age with hypoactive sexual desire disorder: A randomized double-blind clinical trial

BackgroundHypoactive Sexual Desire Disorder (HSDD) is a common sexual problem of women which has negative impacts on their health and quality of life. Given the side effects of pharmacologic interventions, it would be beneficial to patients trying to find new options based on herbal medicine.ObjectivesTo evaluate efficacy of carrot seed on sexual dysfunction of women with HSDD compared with placebo.MethodsIn this randomized double-blind clinical trial, 68 participants randomly assigned to the intervention group which took 500 mg carrot seed three times a day for 12 weeks versus placebo. Participants in two groups filled Female Sexual Function Index (FSFI) questionnaire at baseline, week six and 12. Repeated measure analysis of variance (ANOVA) test was used for statistical analysis.ResultsThirty women in carrot seed group and thirty women in placebo group completed 12 weeks of the study. In general, carrot seed compared to placebo improved the total score of FSFI 7.329 ± 0.830 (p < 0.001), desire 4.1±0.7 (p < 0.001), lubrication 4.7±0.4 (p = 0.019), arousal 4.1±0.08 (p < 0.001), satisfaction 4.8±1.1 (p < 0.001), orgasm 3.9±0.9 (p < 0.001) and pain 5.4±1(p < 0.001). No adverse event was reported in this study.ConclusionsWomen with HSDD may benefit from six weeks' treatment with carrot seed for improvement of sexual dysfunction. Further large clinical studies are warranted to confirm efficacy of this herbal drug.     

Point-of-care ultrasound diagnosis of small bowel-small bowel vs ileocolic intussusception

BackgroundIdentification of intussusception is feasible with emergency department (ED) point-of-care ultrasound (PoCUS) due to its ease-of-use and high accuracy. Little is known about the clinical characteristics and outcomes of small bowel-small bowel intussusception (SB-SBI) relative to ileocolic intussusception (ICI) identified by PoCUS.MethodsWe conducted a retrospective cohort study at a single, tertiary care, urban pediatric ED of intussusception identified by PoCUS. Demographic information, clinical data, and outcomes, including clinical course, intussusception characteristics, recurrence rates, and interobserver agreement (Cohen's kappa), were evaluated.ResultsED PoCUS identified thirty-seven patients with intussusception over a 4-year period. Twenty-one patients (57%) identified were SB-SBI. The median age was 54 months (IQR 35–76 months) for SB-SBI and 8 months (IQR 5.8–13.5 months) for ICI. The mean diameter was 1.68 cm (SD 0.52 cm) for SB-SBI and 2.74 cm (SD 0.43 cm) for ICI (p < 0.05). Two of 21 (9.5%) SB-SBI subjects required surgical intervention, while the rest spontaneously reduced. Fourteen of 16 (88%) ICI subjects required intervention. There were two (9.5%) recurrences of SB-SBI and 1 (6.3%) recurrence of ICI confirmed on PoCUS. Cohen's kappa was 0.85 (95% CI 0.68–1.0).ConclusionsSB-SBI may be identified more frequently than previously thought when screened with ED PoCUS. Older children with SB-SBI may have underlying lead-points and may require surgical intervention. PoCUS can help differentiate between variants of intussusception that range from a surgical emergency to a transient source of abdominal pain that may be recurrent and otherwise unexplained, allowing clinicians to better manage these patients accordingly.     

Assessment of Tumor Response in Mice with Ovarian Peritoneal Carcinomatosis using Doppler Ultrasound of the Superior Mesenteric Artery and Celiac Trunk

The goal of the work described here was to assess the performance of Doppler ultrasound (US) of the superior mesenteric artery (SMA) and celiac trunk (CT) in the evaluation of tumor response in female mice with ovarian peritoneal carcinomatosis treated either with bevacizumab or with carboplatin. Compared with untreated mice, carboplatin-treated mice had a lower weight (23.3 ± 2.0 vs. 27.9 ± 2.9 g, p < 0.001), peritoneal carcinomatosis index (PCI, 11 ± 3 vs. 28 ± 6, p < 0.001), Ki67-positive staining surfaces (p < 0.001), vascular density (p < 0.001), mean blood flow velocity (mBFVel) in the SMA (7.0 ± 1.4 vs. 10.9 ± 1.8 cm/s, p < 0.001) and CT (8.0 ± 1.8 vs. 14.3 ± 4.6 cm/s, p < 0.001) and no ascites. Weight and mBFVel were similar in bevacizumab-treated and untreated mice. The mBFVels in the SMA and CT correlated with the PCI used as an estimation of the tumor burden, R = 0.70 (p < 0.0001) and R = 0.65 (p < 0.0001), respectively. Doppler US allows non-invasive assessment of the effects of anticancer therapy in ovarian peritoneal carcinomatosis-induced mice.     

Transient small bowel intussusceptions: ultrasound findings and clinical significance

Purpose To study the ultrasound (US) findings and clinical significance of transient small bowel intussusceptions (TSBI) in adults and children. Methods Clinical records and US findings of 108 consecutive patients of intestinal intussusception diagnosed on US between August 1995 and August 2004 were reviewed. In all cases, the length, diameter, wall thickness and color Doppler study of the bowel segment involved in intussusception were evaluated. Subsequent follow-up scans were performed at 30 min, 3 days and 2 weeks. Patients were clinically followed up for 6 months. Results Forty-one patients were diagnosed as TSBI. Thirty-six intussusceptions were incidentally detected during US performed for some unrelated disease or vague abdominal symptom. Five patients presented with signs of obstruction at the time of the initial US diagnosis; however, the intussusceptions resolved without any treatment and were not detected on follow-up scans. Sixty-seven symptomatic patients required surgical intervention. Conclusion Incidentally detected, small bowel intussusceptions without an identifiable pathological lead point, with a normal wall thickness, a length of less than 3.5 cm, normal nondilated proximal bowel and normal vascularity on color Doppler reduce spontaneously and are of no clinical significance.     

Sonographic Features of Small-bowel Intussusception in Pediatric Patients

OBJECTIVE: Small-bowel intussusception (SBI) for pediatric patients is unusual and difficult to diagnose preoperatively. This study sought to determine the sonographic findings of pediatric SBI. METHODS: The sonographic features and surgical findings of 13 pediatric patients (7 boys, 6 girls; age range 4 months-15 years; average age 4 years and 2 months) with SBI encountered in the authors' hospital over a 12-year period were retrospectively reviewed. RESULTS: Most of the patients presented with nonspecific symptoms, including vomiting, abdominal pain, and/or irritable crying. Sonographic screening in the emergency department revealed a doughnut or crescent-in-doughnut sign, or a multiple-concentric-rings sign for 11 of the 13 patients, and the lesions appeared short. Eight lesions were found in the paraumbilical or left abdominal regions. Sonographic measurement of the size of the lesions from these 11 patients ranged from 2 cm to 3.7 cm (average 2.77 cm). Subsequent barium enemas were performed for these 11 patients, none of which revealed colon lesions. Surgery revealed ileoileal intussusceptions for eight cases, jejunoileal for three, and jejunojejunal for the remaining two. Bowel ischemia or necrosis and pathologic lead points were demonstrated for seven and six patients, respectively, although none were recognized preoperatively. CONCLUSIONS: Small-bowel intussusception is often over-looked due to nonspecific clinical presentations. Sonographic demonstration of a 2-3-cm sized, short, doughnut-like lesion, especially in the left abdomen or paraumbilical regions, should lead to strong suspicion of SBI.     

Proximal small bowel intussusceptions in adults: CT appearance and clinical significance

Background: According to the clinical literature, intestinal intussusception in adults is rare, is associated with a pathologic lead point, and is usually treated surgically. Nonobstructing small bowel intussusception has been reported as a transient finding on computed tomographic (CT) studies.Methods: We evaluated the radiographic and clinical findings in 24 patients who were found to have 26 proximal small bowel intussusceptions on abdominal CT scans performed for a variety of indications.Results: Twenty patients with intussusceptions had no evidence of small bowel obstruction. The transient and clinically insignificant nature of 22 intussusceptions in these 20 patients was proven radiologically (n = 14), surgically (n = 1), or by clinical follow-up (n = 7). These patients demonstrated a bowel-within-bowel pattern on multiple contiguous images and absence of strangulation or intestinal dilatation. No lead points were demonstrated in these patients. Three other patients had symptoms of low-grade small bowel obstruction and were treated conservatively. Extensive follow-up investigations showed no recurrence of intussusception or a lead point. One patient had high-grade obstructive intussusception with intestinal ischemia and required surgical resection of necrotic bowel.Conclusions: Proximal small bowel intussusceptions are likely to be transient and nonobstructive and unlikely to have a significant lead point.     

New inflammatory predictors for non-valvular atrial fibrillation: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio

The objective of this study was to investigate the relationship of echocardiographic epicardial fat thickness (EFT) and neutrophil to lymphocyte ratio (NLR) with different types of non-valvular atrial fibrillation (AF) in a clinical setting. A total of 197 consecutive patients were enrolled in the study. Seventy-one patients had paroxysmal non-valvular AF, 63 patients had persistent/permanent non-valvular AF, and 63 patients had sinus rhythm (control group). EFT was measured with echocardiography, while NLR was measured by dividing neutrophil count by lymphocyte count. EFT was significantly higher in patients with paroxysmal non-valvular AF compared with those in the sinus rhythm group (6.6 ± 0.7 vs. 5.0 ± 0.9 mm, p < 0.001). Persistent/permanent non-valvular AF patients had a significantly larger EFT compared with those with paroxysmal AF (8.3 ± 1.1 vs. 6.6 ± 0.7 mm, p < 0.001). EFT had a significant relationship with paroxysmal non-valvular AF (odds ratio 4.672, 95 % CI 2.329–9.371, p < 0.001) and persistent/permanent non-valvular AF (OR 24.276, 95 % CI 9.285–63.474, p < 0.001). NLR was significantly higher in those with paroxysmal non-valvular AF compared with those in the sinus rhythm group (2.5 ± 0.6 vs. 1.8 ± 0.4, p < 0.001). Persistent/permanent non-valvular AF patients had a significantly larger NLR when compared with paroxysmal non-valvular AF patients (3.4 ± 0.6, vs. 2.5 ± 0.6, p < 0.001). NLR (>2.1) had a significant relationship with non-valvular AF (OR 11.313, 95 % CI 3.025–42.306, b 2.426, p < 0.001). EFT and NLR are highly associated with types of non-valvular AF independent of traditional risk factors. EFT measured by echocardiography and NLR appears to be related to the duration and severity of AF.     

2-D Shear Wave Elastography for Focal Lesions in Liver Phantoms: Effects of Background Stiffness,Depth and Size of Focal Lesions on Stiffness Measurement

The aim of this study was to determine the factors influencing stiffness and conspicuity of focal lesions in deep organs by focusing on target properties using 2-D shear wave elastography (SWE). Two normal (4 ± 1 kPa) and cirrhotic (16 ± 2 kPa) liver-mimicking phantoms with spherical inclusions (23 ± 3 kPa) were used. Inclusions of three sizes (20, 15 and 10 mm in diameter) were arranged in a row at depths of 3, 5 and 7 cm. Two observers acquired quantitative stiffness values and a qualitative five-grade morphologic score at each inclusion using SWE. The coefficients of variation (CVs) of stiffness were calculated to assess measurement reliability. The generalized estimating equation was used to identify whether stiffness, CV and morphologic score were independent of background stiffness, depth and size of inclusions and observer. In the quantitative assessment, stiffness of the inclusion and CV were dependent on the type of phantom and depth of inclusion (p < 0.001). There were no significant differences in stiffness and CV according to the observer. Morphologic score differed significantly only in the size of the inclusion (p < 0.001). When the depth of the inclusion was 7 cm, the stiffness was the highest, and the 10 mm-sized inclusions had lower morphologic scores than the other inclusions (all p values < 0.001). In conclusion, 2-D SWE assessment of focal lesions could be affected by background stiffness and depth of focal lesions, and may be limited in evaluating focal hepatic lesions.     

Role of Lung Ultrasound in Adjusting Ultrafiltration Volume in Hemodialysis Patients

Chronic fluid over-hydration is common in dialysis patients. It is associated with mortality and cardiovascular events. Optimal methods for adjusting fluid volume status and ideal dry weight remain uncertain. The purpose of this study was to evaluate the usefulness of ultrasound in quantifying body water. In 35 hemodialysis patients, we performed ultrasound of the chest, pre-tibial skin tissue thickness (TT), heart and inferior vena cava (IVC) before and after dialysis. We compared B-line scores of lungs, IVC diameters and cardiac functions in pre-dialysis and post-dialysis groups. We then estimated the correlations between ultrasound parameters and ultrafiltration volumes. Ultrafiltration parameters were adjusted prospectively for subsequent dialysis. As a result, both extravascular and intravascular water decreased during ultrafiltration. The median numbers of B-line scores (10 [0–42] vs. 4 [0–30]; p < 0.001); mitral valve blood flow velocities E (0.83 ± 0.23 m/s vs. 0.70 ± 0.20 m/s; p < 0.001), A (0.93 ± 0.28 vs. 0.89 ± 0.23 m/s; p < 0.001) and E/e' (12.47 ± 4.92 vs. 10.37 ± 4.0; p < 0.001); IVC diameters at end-expiration (17.51 ± 3.33 mm vs. 14.26 ± 3.45 mm; p < 0.001); and right pre-tibial TT (2.86 ± 1.36 mm vs. 2.43 ± 1.24 mm; p < 0.001) decreased during dialysis. Ultrafiltration volume was most associated with B-line score (adjusting for age and sex) (β?=?–3.340; p?=?0.003). In addition, the B-line score after dialysis was significantly associated with left ventricular ejection fraction (r?=?–0.393; p?=?0.019) and TT (r?=?–0.447; p?=?0.007). Ultrafiltration volume was prospectively increased then if the B-line score was >6 in the previous dialysis. All patients tolerated the protocol well without any symptoms. Ultrafiltration volume was most associated with lung water, reflected by variation in B-line score. It was not associated with cardiac function, IVC diameter, IVC collapse rate or TT. Lung ultrasound is a useful imaging tool for dialysis patients.     

Hyponatremia and hyperkalemia in relation to hyperglycemia in insulin-treated diabetic out-patients

Interrelations between glucose and electrolyte homeostasis were evaluated in 193 insulin-treated diabetic out-patiens. All had normal serum creatinine and were studied during their everyday metabolic control. Although the patients were selected to be without proteinuria and ketonuria, they exhibited wide ranges of blood glucose values (2.5–29.5 mmol/1) and urine glucose excretions (0–301 mmol/mmol creatinine). Patients with blood glucose values within 2.5–10 mmol/1 (n = 80) had entirely normal levels of serum sodium (140.6 ± 2.7 (SD) versus 141.0 ± 2.6 mmol/1) and potassium (4.35 ± 0.38 versus 4.40 ± 0.38 mmol/1) as compared with normals (n = 371). In contrast, diabetics with higher blood glucose concentrations (n = 113) showed hyponatremia (137.7 ± 2.6 mmol/1, p < 0.001) and a moderate increase of serum potassium (4.60 ± 0.39 mmol/1, p < 0.001). On stratification into classes of blood glucose, serum sodium declined from 142 to 135 mmol/1 (r = ?0.61, p < 0.001), whereas serum potassium rose from 4.33 to 4.87 mmol/1 (r = 0.37, p < 0.001). Despite these reciprocal changes the urinary excretion rates relative to creatinine of sodium, potassium and water rose with rising degrees of glycosuria (r = 0.24, p < 0.001; r = 0.28, p < 0.001; and r = 0.63,p < 0.001, respectively).The decline in serum sodium represents a well-known osmoregulatory response to hyperglycemia. However, the rising level of serum potassium in virtual absence of renal failure and ketonuria suggests an abnormality in potassium homeostasis. Diabetic dysregulation, or rather relative insulin deficiency may be its cause.     

Concordance and diagnostic accuracy of vasodilator stress cardiac MRI and 320-detector row coronary CTA

Vasodilator stress cardiac magnetic resonance (CMR) detects ischemia whereas coronary CT angiography (CTA) detects atherosclerosis. The purpose of this study was to determine concordance and accuracy of vasodilator stress CMR and coronary CTA in the same subjects. We studied 151 consecutive subjects referred to detect or exclude suspected obstructive coronary artery disease (CAD) in patients without known disease or recurrent stenosis or ischemia in patients with previously treated CAD. Vasodilator stress CMR was performed on a 1.5 T scanner. CTA was performed on a 320-detector row system. Subjects were followed for cardiovascular events and downstream diagnostic testing. Subjects averaged 56 ± 12 years (60 % male), and 62 % had intermediate pre-test probability for obstructive CAD. Follow-up averaged 450 ± 115 days and was 100 % complete. CMR and CTA agreed in 92 % of cases (κ 0.81, p < 0.001). The event-free survival was 97 % for non-ischemic and 39 % for ischemic CMR (p < 0.0001). The event-free survival was 99 % for non-obstructive and 36 % for obstructive CTA (p < 0.0001). Using a reference standard including quantitative invasive angiography or major cardiovascular events, CMR and CTA had respective sensitivities of 93 and 98 %; specificities of 96 and 96 %; positive predictive values of 91 and 91 %; negative predictive values of 97 and 99 %; and accuracies of 95 and 97 %. Non-ischemic vasodilator stress CMR or non-obstructive coronary CTA were highly concordant and each confer an excellent prognosis. CMR and CTA are both accurate for assessment of obstructive CAD in a predominantly intermediate risk population.     

Transient adult jejunal intussusception

Intussusception is a rare cause of abdominal pain in adults. It occurs in fewer than 1% of all cases of adult small bowel obstruction. In the adult population, most cases are the result of some type of intestinal lesion like adhesions, melanomas, lipomas or adenomatous polyps. Idiopathic intussusceptions are an extremely rare occurrence in adults, comprising only 2–23% of diagnosed intussusceptions. This report describes two cases of transient, idiopathic adult jejunal intussusception in a 19-year-old woman and a 39-year-old man, both presenting to the same hospital 1 week apart. Both patients complained of nonspecific abdominal pain and nausea and were diagnosed with intussusception by computed tomography (CT) scan. In both cases, no underlying bowel abnormality was identified and neither required a bowel resection. This report discusses the common presentation, diagnosis, and treatment of adult intussusception and questions whether patients with transient intussusceptions require exploratory laparotomy.     

Echocardiographic assessment of right ventricular functions in patients with proximal right coronary artery chronic total occlusion

To assess right ventricular functions by echocardiography in patients with proximal right coronary artery (RCA) CTO and correlating it with clinical and angiographic variables. We studied 60 consecutive patients with CTO of the proximal RCA and no other significant lesions in the left coronary system. Echocardiography was performed in order to measure left ventricular (LV) dimensions, LVEF, RV end diastolic area (RVEDA), RV end systolic area (RVESA), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), Doppler myocardial performance index (MPI), trans-tricuspid E and A waves, E/A ratio, S′, e′ and a′. Grades of coronary collaterals was assessed. Doppler MPI showed negative correlation with TAPSE (r = ?0.8997, p < 0.0001) and RVFAC (r = ?0.928, p < 0.0001). Positive correlation with trans-tricuspid E/A ratio (r = 0.893, p < 0.0001) and E/e′ ratio (r = 0.783, p < 0.0001). Patients with no evidence of MI had more well-developed (grade 3) coronary collaterals (83.8 vs. 17.4 %). Patients with evidence of MI had lower RVFAC 38.13 ± 5.39 versus 45.08 ± 4.99 % (p < 0.0001), lower TAPSE 20.17 ± 3.85 versus 25.35 ± 3.46 mm (p < 0.0001), higher MPI 0.4 ± 0.08 versus 0.31 ± 0.05 (p < 0.0001), higher trans-tricuspid E/A ratio 1.79 ± 0.38 versus 1.13 ± 0.36 (p < 0.0001) and E/e′ ratio 5.23 ± 1.02 versus 3.61 ± 0.88 (p < 0.0001). Patients with poorly developed collaterals had lower TAPSE and RVFAC and a higher MPI (p < 0.0001 for each). Patients with proximal RCA CTOs and evidence of inferior wall MI have significant impairment of RV functions in addition to poorly developed coronary collaterals. Those with proximal RCA CTOs and well-developed coronary collaterals have better RV functions.     

Myocardial Strain Imaging With Electrocardiogram-Gated and Coherent Compounding for Early Diagnosis of Coronary Artery Disease

Myocardial elastography (ME) is an ultrasound-based technique that uses radiofrequency signals for 2-D cardiac motion tracking and strain imaging at a high frame rate. Early diagnosis of coronary artery disease (CAD) is critical for timely treatment and improvement of patient outcome. The objective of this study was to assess the performance of ME radial and circumferential strains in the detection and characterization of CAD in patients. In this study, 86 patients suspected of CAD were imaged with ME prior to invasive coronary angiography (ICA). End-systolic radial and circumferential left ventricular strains were estimated in all patients in each of their perfusion territories: left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA). ME radial strains were capable of differentiating the obstructive CAD group (55.3 ± 29.8%) from the non-obstructive CAD (72.5 ± 46.8%, p < 0.05) and no CAD groups (73.4 ± 30.4%, p < 0.05) in the RCA territory. ME circumferential strains were capable of differentiating the obstructive CAD group (–3.1 ± 7.5%) from the non-obstructive CAD (–7.2 ± 6.8%, p < 0.05) and normal (–6.9 ± 8.0%, p < 0.05) groups in the LAD territory and to differentiate the normal group (–17.1 ± 8.2%) from the obstructive (–12.8 ± 7.2%, p < 0.05) and non-obstructive CAD (–13.6 ± 8.5%, p < 0.05) groups in the RCA territory. ME circumferential strain performed better than ME radial strain in differentiating normal, non-obstructive and obstructive perfusion territories. In the LCX territory, both ME radial and circumferential strains decreased when the level of stenosis was higher. However, it was not statistically significant. The findings presented herein indicate that ME radial and circumferential estimation obtained from ECG-gated and compounded acquisitions is a promising tool for early, non-invasive and radiation-free detection of CAD in patients.     

Echocardiographic features of patients with paroxysmal atrial fibrillation

Background. There are several risk factors for the initiation of paroxysmal atrial fibrillation (PAF) and the underlying mechanisms are multifactorial. Our study aims to explore the echocardiographic parameters that can identify in patients with PAF compared to normal subjects. Methods. Eighty consecutive patients who were with PAF detected by 24-h Holter monitoring (HM) were assigned in our study. The control group (n = 80) consisted individuals with no PAF on HM. Indication for HM was palpitations at rest. All patients underwent routine echocardiographic evaluation. Patients with aortic and mitral stenosis, hyperthyroidism, and hypothyroidism were excluded from the study. Comprehensive clinical data were collected. Results. Mean age of the patients with PAF was 63 ± 11 years and of those 42% were male subjects. There was no difference in the prevalence of hypertension in both groups. Mean left ventricular ejection fraction (LVEF) was 57 ± 15% in PAF group and 64 ± 2% in control subjects (p < 0.001). Mean values of left atrial (LA) diameter for PAF and control groups were 3.7 ± 0.6 cm vs. 3.1 ± 0.4 cm (p < 0.001), respectively. Patients with PAF had more severe valve insufficiency, higher values of mean pulmonary artery systolic pressures (PAP) (29 ± 10 mmHg vs. 25 ± 2 mmHg, respectively; p = 0.001) and deteriorated MV inflow velocities (E:A ratio 0.9 ± 0.4 vs. 1.1 ± 0.3, respectively; p = 0.008) when compared to control group. In multivariate logistic regression analysis, LA diameter predicted the development of PAF after adjusted for age and gender. Conclusion. Our results indicate that LA diameter predicts the development of PAF.     

Comparison of Focused Ultrasound Surgery and Hysteroscopic Resection for Treatment of Submucosal Uterine Fibroids (FIGO Type 2)

The aim of the study described here was to compare the effectiveness of focused ultrasound surgery (FUS), which uses high-intensity focused ultrasound to perform tissue ablation, with that of hysteroscopic transcervical resection of myoma (TCRM) for the treatment of type 2 submucosal fibroids. A prospective cohort study was performed in patients who underwent FUS or TCRM from January 2012 to December 2014. Uterine Fibroid Symptom (UFS) and Quality of Life (QoL) questionnaires were used to measure fibroid-related symptoms and quality of life before and at 3, 6 and 12 mo after treatment. Technical results, adverse events and post-operative recovery times of both groups were also compared. A total of 81 patients with at least one type 2 submucosal fibroid were enrolled. The mean diameter of type 2 submucosal fibroids was 3.8 ± 0.9 cm (range: 2.0–5.0 cm) for 39 patients in the FUS group and 3.5 ± 0.8 cm (range: 2.0–4.8 cm) for the 42 patients enrolled in the TCRM group. No major complication occurred in any patients for either treatment. In both groups, the UFS score decreased significantly and the QoL score increased significantly from baseline successively at 3, 6 and 12 mo post-treatment (p < 0.05). Time spent in hospital post-treatment was significantly shorter (2.56 ± 0.98 d) for the FUS group compared with the TCRM group (3.31 ± 0.60 d) (p < 0.05). Time to return to work after treatment was also significantly shorter for the FUS group (3.14 ± 0.83 d) than for the TCRM group (6.09 ± 0.9 d) (p < 0.05). FUS and TCRM are both tolerable and effective treatments with significant improvement of symptom and quality of life for patients with type 2 submucosal fibroids ≤5 cm in diameter.     

Kinesiologic taping reduces morbidity after oral and maxillofacial surgery: a pooled analysis

Abstract

Background: Postoperative morbidity is a major disadvantage after oral and maxillofacial (OMF) surgery, often caused by pain, trismus and swelling affecting patients’ quality of life. The goal of this study was to examine the effect of kinesiologic taping (KT) on swelling, pain, trismus and patients’ satisfaction after OMF surgery. Materials and methods: Performing a pooled analysis of 96 patients that were assigned for maxillofacial treatment (midface fractures n?=?30, mandibular fractures n?=?26, wisdom tooth removal n?=?40) divided into treatment either with or without kinesiologic tape application. Tape was applied directly after surgery and maintained for at least 5?d postoperatively. Facial swelling was quantified at six specific points in time using a five-line measurement. Pain and degree of mouth opening was measured. Patients’ objective feeling and satisfaction was queried. Results: Application of KT after OMF surgery has a significant influence on the reduction of swelling decreasing the turgidity for 60% during the first 2?d after surgery. Evaluating all patients swelling was significantly lower in the KT treatment group (T2: 63.5?cm?±?4.3; T3: 62.5?cm?±?4.2; T4: 61.6?cm?±?4.2) than in the no-KT group (T2: 67.6?cm?±?5.0; T3: 67.0?cm?±?5.0; T4: 64.8?cm?±?4.8) at T2 (p?<?0.001), T3 (p?<?0.001), and T4 (p?=?0.001). VAS Pain values were scored significantly lower for the KT group (T1: 2.5?±?2.0 (p?=?0.006); T2: 1.7?±?2.0 (p?<?0.001); T3: 1.5?±?2.3 (p?=?0.004); T4: 0.6?±?1.1 (p?=?0.001) compared to the no-KT group (T1: 3.8?±?2.5; T2: 3.5?±?2.7; T3: 2.9?±?2.2; T4: 1.6?±?1.7). A statistically significant amelioration in mean mouth opening ability was observed in the KT group (T1-BL: ?0.08?cm?±?0.49 (p?=?0.025); T2-BL: 0.07?cm?±?0.59 (p?=?0.012); T3-BL: 0.20?±?0.63 (p?=?0.013); T4-BL: 0.42?±?0.59 (p?=?0.003)) compared to the no-KT group (T1-BL: ?0.47?cm?±?0.86; T2-BL: ?0.39?cm?±?0.84; T3-BL: ?0.24?±?0.89; T4-BL: ?0.13?±?1.02). Conclusion: KT after OMF surgery is a promising, simple, less traumatic, economical approach free from systemic adverse reaction upgrading patients’ quality of life.     

Neointimal coverage and vasodilator response to titanium-nitride-oxide-coated bioactive stents and everolimus-eluting stents in patients with acute coronary syndrome: insights from the BASE-ACS trial

Incomplete stent endothelialization is associated with late and very late stent thrombosis. In a post hoc analysis of the BASE-ACS trial, we sought to assess neointimal coverage and coronary flow reserve (CFR) 9 months after implantation of titanium-nitride-oxide-coated bioactive stents (BAS) versus everolimus-eluting stents (EES) in patients with acute coronary syndrome (ACS). In the BASE-ACS trial, 827 patients with ACS were randomized to receive either BAS or EES. In the current study, we examined neointimal growth and strut coverage by optical coherence tomography and CFR by trans-thoracic echocardiography in 28 consecutive non-diabetic patients with the culprit lesion in the left anterior descending coronary artery. The primary endpoints were binary stent strut coverage and CFR at 9-month follow-up. A total of 13 patients were included in the BAS group (2,033 struts); 15 in the EES group (2,898 struts). Binary stent strut coverage was higher and malapposed struts lower with BAS versus EES (99.4 vs 89.2, and 0.2 vs 4.6 %, respectively, p < 0.001 for both). Neointimal hyperplasia thickness was greater with BAS versus EES (274.2 vs 100.1 μm, respectively, p < 0.001). CFR was lower with EES versus BAS (2.2 ± 0.8 vs 3.0 ± 0.5, respectively, p = 0.001). Abnormal CFR (<2.5) were detected in 10 patients in the EES group versus one in the BAS group (p = 0.002). The current study demonstrated that in patients with ACS, BAS resulted in improved neointimal stent strut coverage and better coronary vasodilator function as compared with EES at 9-month follow-up.     

Assessment of pulmonary arterial stiffness in obstructive sleep apnea

Pulmonary hypertension (PH) is one of the major complications of obstructive sleep apnea syndrome (OSAS). Pulmonary arterial stiffness (PAS) can be used in determination of PH. The aim of the present study was to evaluate the PAS and cardiac function of patients with OSAS and analyses the relationship between OSAS severity and PAS. Sixty newly diagnosed patients with OSAS (mean age 49.6 ± 11.7 years) and 30 healthy controls (mean age 46.4 ± 14 years) were enrolled. Right ventricle (RV) and left ventricle (LV) echocardiographic parameters and PAS values of study groups were compared. There were no significant differences in terms of LV ejection fraction, LV Tei-index and tricuspid annular plane systolic excursion. PAS, mean pulmonary arterial pressure (PAP) and RV Tei-index were significantly higher but tricuspid annulus early diastolic myocardial velocity was lower in patients with OSAS than control subjects (respectively p < 0.001, p < 0.001, p = 0.001, p = 0.001). Moreover, we found a higher PAS in OSAS patients without PH compared to controls (p < 0.001). When we investigated the relationship between polysomnographic variables and echocardiographic parameters, we found positive correlations between apnea hypopnea index and total oxygen desaturation with PAS and mean PAP (r = 0.384, p < 0.001; r = 0.404, p < 0.001; r = 0.36, p < 0.001; r = 0.349, p = 0.001 respectively). PAS and mean PAP were increased in patients with OSAS. Pulmonary vascular bed may be affected due to the fluctuation of PAP during day and night time. Therefore, assessment of PAS can be more useful than PAP in OSAS patients.     

First in vivo head-to-head comparison of high-definition versus standard-definition stent imaging with 64-slice computed tomography

The aim of this study was to compare image quality characteristics from 64-slice high definition (HDCT) versus 64-slice standard definition CT (SDCT) for coronary stent imaging. In twenty-five stents of 14 patients, undergoing contrast-enhanced CCTA both on 64-slice SDCT (LightSpeedVCT, GE Healthcare) and HDCT (Discovery HD750, GE Healthcare), radiation dose, contrast, noise and stent characteristics were assessed. Two blinded observers graded stent image quality (score 1 = no, 2 = mild, 3 = moderate, and 4 = severe artefacts). All scans were reconstructed with increasing contributions of adaptive statistical iterative reconstruction (ASIR) blending (0, 20, 40, 60, 80 and 100 %). Image quality was significantly superior in HDCT versus SDCT (score 1.7 ± 0.5 vs. 2.7 ± 0.7; p < 0.05). Image noise was significantly higher in HDCT compared to SDCT irrespective of ASIR contributions (p < 0.05). Addition of 40 % ASIR or more reduced image noise significantly in both HDCT and SDCT. In HDCT in-stent luminal attenuation was significantly lower and mean measured in-stent luminal diameter was significantly larger (1.2 ± 0.4 mm vs. 0.8 ± 0.4 mm; p < 0.05) compared to SDCT. Radiation dose from HDCT was comparable to SDCT (1.8 ± 0.7 mSv vs. 1.7 ± 0.7 mSv; p = ns). Use of HDCT for coronary stent imaging reduces partial volume artefacts from stents yielding improved image quality versus SDCT at a comparable radiation dose.