无精子症患者外周血和睾丸组织睾酮、雄激素受体、热休克蛋白90水平的变化

目的 探讨无精子症患者外周血和睾丸组织睾酮(T)、雄激素受体(AR)、热休克蛋白90(HSP90)相互之间的关联性。方法 选择45例无精子症患者,测量其静脉血FSH、LH、T、AR、HSP90;给予行睾丸穿刺,取得的生精小管在显微镜下观察有无精子,之后用滤纸吸去培养液、电子天平秤重、投入液氮,次晨取出磨碎,加入1000倍量PBS,混匀,200g离心,测量上清液T、AR、HSP90的含量。按睾丸穿刺结果和FSH值分为A(睾丸穿刺有精子,FSH<8IU/L)、B(睾丸穿刺无精子,FSH<8IU/L)、C(睾丸穿刺无精子,FSH>8IU/L)三组,比较三组间外周血和睾丸组织T、AR、HSP90的差异性,分析FSH、LH、T、AR、HSP90之间的直线相关关系。结果 三组间比较,外周血AR(F=5.478,p=0.026)和HSP90(F=5.972,p=0.019)、睾丸组织T(F=6.757,p=0.006)和AR(F=4.988,p=0.047)差异有统计学意义,而外周血T和睾丸组织HSP90差异无统计学意义。直线相关性分析,FSH与外周血HSP90(r=0.729,p=0.001)、睾丸组织T(r=0.722,p=0.002)呈正相关关系,有统计学意义; LH与外周血(r=0.629,p=0.012)和睾丸组织(r=0.610,p=0.016)T均呈正相关关系,有统计学意义;外周血T与外周血AR(r=-0.665,p=0.005)呈负相关关系,而睾丸组织T与睾丸组织AR(r=0.544,p=0.029)呈正相关关系,有统计学意义;外周血(r=0.559,p=0.042)和睾丸组织(r=0.803,p=0.000)AR与其相应的HSP90呈正相关关系,有统计学意义。结论 睾丸体积正常的无精子症患者,外周血T浓度波动,HSP90和AR浓度显著升高,反馈作用于FSH和LH,睾丸内T和AR逐渐升高,HSP90变化不明显。     

Lung involvement in primary Sjögren's syndrome: Correlation between high-resolution computed tomography score and mortality

BackgroundLung involvement is one of the major systemic manifestations of primary Sjögren's syndrome (pSS). This study aims to demonstrate the correlation between high-resolution computed tomography (HRCT), pulmonary function test (PFT) results, and outcome in these patients.MethodsForty-four pSS patients were enrolled and their PFT results and HRCT findings/scores were retrospectively investigated.ResultsAll patients had reduced carbon monoxide-diffusing capacity (DL_CO; <75% of the predicted value); <60% of the predicted value of peak expiratory flow (PEF), of forced vital capacity (FVC), and of forced expiratory volume in the 1st second (FEV₁) were noted in 15 (34.1%) patients, 13 (29.5%) patients, and 12 (27.3%) patients, respectively. HRCT scores had a negative correlation with DL_CO (r = −0.376, p = 0.012), but not with other PFT results. Twelve patients (27.3%) expired during a mean follow-up of 3.7 years; 11 (91.7%) patients died of respiratory failure in the lung-involved patients, of which three were present with pneumonia. The expired patients had lower predicted values of FEV₁ (63.1 ± 19.4% vs. 79.0 ± 22.7%, p = 0.017), FVC (58.7 ± 20.4% vs. 77.1 ± 17.5%, p = 0.005), and PEF (54.3 ± 20.5% vs. 72.0 ± 24.8%, p = 0.035), and higher HRCT scores (9.2 ± 5.7 vs. 5.2 ± 3.5, p = 0.033) than those patients who survived. Patients with FEV₁, FVC, PEF < 60% of the predicted value, or high HRCT score (13–18) presented shorter median overall survival (p = 0.005, p < 0.001, p = 0.021, p < 0.001, respectively). Multivariate analysis adjusted for PFT results showed that HRCT ≥13 was an independent risk factor for mortality (p = 0.007).ConclusionThe clinical outcome of pSS patients with lung involvement in Taiwan is not very favorable. Although HRCT score was poorly correlated with PFT, high HRCT score was significantly associated with higher mortality.     

早期与延迟他汀治疗对急性缺血性卒中患者血清超敏C-反应蛋白及预后的影响

目的 探讨早期与延迟他汀治疗对急性缺血性卒中（AIS）患者血清超敏C-反应蛋白（hs-CRP）和预后的影响。方法 选择2016年10月至2018年1月安徽省立医院神经内科住院的AIS患者267例,采用随机数字表法分为早期他汀治疗组（n=134）与延迟他汀治疗组（n=133）。两组患者分别于发病24 h内和第7天开始接受他汀治疗。采用美国国立卫生研究院卒中量表评价入院时和发病第7天患者神经功能缺损情况;使用改良Rankin量表（mRS）评定第90天临床预后;通过胶乳增强免疫比浊法测定患者发病24 h内、第7天、第90天的hs-CRP水平。比较两组患者血清hs-CRP的变化、急性期神经功能的改善及90天预后良好比例,并分析延迟他汀治疗与预后不良的相关性。结果 早期他汀治疗组患者第7天hs-CRP水平较发病24 h内下降[（5.02±0.65）mg/L vs（6.45±0.59）mg/L],差异有统计学意义（P<0.05）。早期他汀治疗组患者90天mRS评分预后良好的比例高于延迟他汀治疗组[48.51%vs 36.09%],差异有统计学意义（P<0.05）。logstics回归分析显示,第7天hs-CRP水平、延迟治疗是预后不良的影响因素（P<0.05）。结论 早期他汀治疗可降低AIS患者急性期血清hs-CRP浓度,并可改善预后。     

Changes in maternal serum insulin-like growth factor-I during pregnancy and its relationship to maternal anthropometry

BackgroundInsulin-like growth factor (IGF)-I is primarily produced by the liver under the stimulation of growth hormone, and has systemic growth effects. Placental growth hormone in maternal circulation increases from early pregnancy and is responsible for the increment in maternal serum IGF-I. The purpose of this study was to evaluate the changes in maternal serum IGF-I during pregnancy and their relationship to maternal anthropometry, including body weight (BW) and body mass index (BMI).MethodsWe obtained 332 blood samples from 114 expectant mothers at different gestational ages (Gas) without adverse medical history. Serum IGF-I levels were measured by immunoradiometric assay. Linear regression analysis for continuous variables and t test for comparisons of categorical variables were used to test for significance.ResultsMaternal serum IGF-I during pregnancy was significantly correlated not only to GA (p < 0.001, r = 0.358), but also to maternal BW (p = 0.001, r = 0.202), and maternal BMI (p < 0.001, r = 0.263). The mean maternal IGF-I was highest in the third trimester [1st vs. 2nd, p < 0.001, 95% confidence interval (CI) = ?70.17 to ?28.22; 1st vs. 3rd, p < 0.001, 95% CI = ?138.02 to ?76.94; 1st vs. 3rd, p < 0.001, 95% CI = ?88.86 to ?27.71].ConclusionMaternal serum IGF-I is significantly related to GA, maternal BW, and BMI during pregnancy.     

Treatment selection for tonsillar squamous cell carcinoma

BackgroundThe optimal treatment for tonsillar squamous cell carcinoma (SCC) remains controversial. The purpose of this study was to evaluate long-term treatment outcomes of patients with tonsillar SCC, in order to aid in appropriate treatment selection.MethodsWe conducted a retrospective chart review of 105 patients with curatively treated tonsillar SCC between January 1996 and December 2005. Forty-three patients (41.0%) underwent primary surgery with or without adjuvant therapy (primary surgery group), and 62 patients (59.0%) were treated with radiotherapy/chemoradiotherapy (RT/CRT, organ preservation group). Twenty patients (19%) received tumor tonsillectomy before definitive RT/CRT and were grouped into the organ preservation group.ResultsNo significant differences were observed between the primary surgery and organ preservation groups in terms of local control (p = 0.212), regional control (p = 0.684), distant metastasis (p = 0.627), 5-year disease-specific survival (DSS, p = 0.774), and overall survival rates (OS, p = 0.667). The rates of major complication (p = 0.216), long-term dependency on feeding tubes (p = 0.876), and tracheostomy (p = 0.401) were also similar. Advanced T classification (T3–4) was the only factor associated with significantly worse DSS (p = 0.007) and OS (p = 0.012). However, there was also no difference in final treatment outcomes in T3–4 patients regardless of whether they were treated with primary surgery or RT/CRT. In the organ preservation group, tumor tonsillectomy before RT/CRT did not improve local control (p = 0.520) or other treatment outcomes, including 5-year DSS (p = 0.707) and OS (p = 0.745).ConclusionBoth primary surgery and RT/CRT organ preservation are effective treatments for tonsillar SCC. Single modality treatment, either surgery or RT/CRT, can typically be provided for stage I–II diseases. Although RT/CRT organ preservation is used more frequently for stage III–IV tonsillar SCC in recent years, primary surgery combined with adjuvant therapy still achieves equivalent outcomes. Multidisciplinary pretreatment counseling and the facilities and personnel available are therefore important for decision-making. In addition, if RT/CRT organ preservation is selected as the primary treatment, tumor tonsillectomy is not indicated.     

Open,multi-center,phase IV study to assess the efficacy and tolerability of triptorelin in Taiwanese patients with advanced prostate cancer

BackgroundTo evaluate the efficacy and safety of administering a 3-month formulation of triptorelin as part of disease management of Taiwanese men with advanced adenocarcinoma of the prostate.MethodsPatients with newly diagnosed, locally advanced, or metastatic adenocarcinoma of the prostate were enrolled in our study, after informed consent was obtained. All patients received bicalutamide 50 mg daily for 28 days, starting 7 days before the first injection of triptorelin. A dosage of 11.25 mg triptorelin was injected on Day 0 (baseline) and repeated on Day 90. Prostate-specific antigen (PSA) and testosterone concentrations were measured on Days 90 and 180.ResultsA total of 41 patients were enrolled, with a median age of 78 (57–92) years, and a baseline median PSA of 122.69 ng/mL. One patient dropped out of the study, one was excluded in the fourth month due to a protocol violation, and one died 4 months after initiation of treatment as a result of disease progression. In total, 40 men were eligible for Day 90 and 38 men for Day 180 analysis. On Day 90, 97.5% of men had reached castration testosterone concentration ≤0.5 ng/mL, and all men had reached this concentration on Day 180. Serum PSA concentration declined to 10.40 ± 23.42 ng/mL on Day 90 (p = 0.0126) and 11.61 ± 23.93 ng/mL on Day 180 (p = 0.0172). The most frequently seen adverse event was gastrointestinal disturbance, including abdominal pain, diarrhea and constipation. Generally, adverse events were mild and patient manageable.ConclusionTriptorelin 11.25 mg is effective in achieving medical castration and lowering PSA concentrations and can maintain its medicinal effect for at least 90 days in Taiwanese men with advanced prostate cancer. This suggests that it can be an effective treatment for advanced prostatic cancer.     

Bacterial pneumonia following acute ischemic stroke

BackgroundThe most common serious complication following acute ischemic stroke is pneumonia, which may increase mortality and worsen clinical outcomes. The purpose of this study was to investigate the predictors of 30-day mortality in patients with pneumonia following acute ischemic stroke.MethodsFrom June 2006 to May 2011, we retrospectively included 51 patients with pneumonia following acute ischemic stroke. We analyzed the clinical features, microbiologic data, and outcomes. Predictors of 30-day mortality were investigated by univariate and multivariate analysis.ResultsThe acute ischemic strokes were caused by large-artery atherosclerosis in 37 (72.5%) of the 51 patients. We found that the most common pathogen responsible for poststroke pneumonia was Klebsiella pneumoniae, followed by Pseudomonas aeruginosa and Escherichia coli. Ultimately, 12 patients died of progressive sepsis due to pneumonia after the acute ischemic stroke. The 30-day mortality rate was 23.5%. In the univariate analysis, patients who died within 30 days had higher National Institutes of Health Stroke Scale scores, higher CURB-65 scores, elevated instability of hemodynamic status, and lower Glasgow Coma Scale (GCS) scores. In Cox regression analysis, a GCS score of <9 on the day of pneumonia onset was only significant indicator for 30-day mortality (hazard ratio, 6.72; 95% confidence interval, 2.12–21.30, p = 0.001).ConclusionPneumonia after acute ischemic stroke is a severe complication. Once stroke-related pneumonia develops, neurologic assessment, CURB-65 score, and shock can be used to predict the ultimate prognosis.     

Changes in left atrial functional indexes in ischemic stroke patients

BackgroundIncreased left atrial (LA) size has been proposed as a predictor of multiple adverse cardiovascular events including stroke. LA dysfunction can occur in the absence of increased LA size. However, the relationship between stroke and changes in LA function is not well known.MethodsPatients with acute ischemic stroke and healthy controls were enrolled prospectively. Stroke patients received standard work-ups to determine the etiology of their strokes. Those patients with significant cardiac arrhythmia and heart failure were excluded. All participants received echocardiography examination. Conventional echocardiographic parameters were calculated and cardiac contractile characteristics of the left atrium and left ventricle were analyzed using vector velocity imaging (VVI) technique.ResultsIn total, 87 patients with acute ischemic stroke and 20 controls were recruited. The mitral inflow E-wave velocities were lower and A-wave velocities were higher in stroke patients (0.76 ± 0.19 vs. 0.84 ± 0.16, p = 0.048; and 0.97 ± 0.20 vs. 0.76 ± 0.11, p < 0.001 respectively). Stroke patients had a higher active emptying percent of total LA emptying (60.5 ± 19.0%) compared with that in controls (33.5 ± 11.7%, p < 0.001). The minimal LA volume was larger in stroke patients (15.0 ± 10.5 mL) than that in controls (9.9 ± 4.2 mL, p = 0.021), whereas there was no difference in maximal LA volume between stroke patients (37.3 ± 16.5 mL) and controls (33.3 ± 9.9 ml, p = 0.366). The diastolic emptying index of the LA was significantly lower in stroke patients compared with that in controls (61.4 ± 14.6% vs. 70.2 ± 11.0%, p = 0.016). The mitral A-wave velocity and active emptying percent of total LA emptying were significantly higher in all stroke subtypes than those in controls.ConclusionAcute ischemic stroke patients had altered mitral inflow velocities and emptying function of the left atrium. VVI is convenient for quantitative assessment of left atrial volumes and contractile characteristics. Functional changes of LA may occur without significant structural changes. Therefore, the clinical implications of LA functional indexes require further study.     

Correlation between thrombophilia and recurrent pregnancy loss in patients with polycystic ovary syndrome: A comparative study

BackgroundPatients with polycystic ovary syndrome (PCOS) have an increased prevalence of thrombophilia, leading to higher rates of pregnancy loss. The aim of this study was to determine the association between thrombophilia and recurrent pregnancy loss (RPL) in patients with and without PCOS.MethodsIn this comparative case–control study, we included 60 patients with RPL (≥3 consecutive pregnancy losses at <20 weeks of gestation) and PCOS (Group 1), 60 patients with PCOS and without RPL (Group 2), 60 patients with RPL and without PCOS (Group 3), and 60 healthy individuals (Group 4). These four study groups were compared regarding serum levels of testosterone, fasting insulin, homocysteine (Hcy), plasminogen activator inhibitor activity (PAI-Fx), protein C, protein S, antithrombin III, activated protein C ratio (APCR), factor V Leiden, prothrombin G20210A, and methylene tetrahydrofolate reductase gene mutations.ResultsPatients in Group 1 had significantly higher levels of testosterone (p = 0.026), dehydroepiandrosterone sulfate (p = 0.035), fasting insulin (p = 0.015), Hcy (p = 0.036), and PAI-Fx (p = 0.008) compared to Group 3. They also had higher proportions of APCR (p = 0.009) and a higher prevalence of factor V Leiden mutations compared to Group 3 (p = 0.001). However, there was no significant difference in protein C (p = 0.088), protein S (p = 0.514), or antithrombin III (p = 0.627) between the four study groups.ConclusionHyperinsulinemia, hyperandrogenemia, hypofibrinolysis, and hyperhomocysteinemia as well as APCR and factor V Leiden mutations are associated with RPL in patients with PCOS.     

Efficacy of spinal magnetic stimulation in elderly persons with chronic constipation

BackgroundThe development of primary constipation in elderly adults usually has a multifactorial etiology. Slow transit constipation and pelvic floor dysfunction (PFD) are the two most commonly seen constipation subtypes in the elderly. PFD is usually a persistent condition that remains unresponsive to treatment in spite of various therapies currently available to relieve constipation. The aim of this study was to assess the usefulness of spinal magnetic stimulation (SMS) in controlling intractable constipation in elderly patients.MethodsNineteen patients over the age of 65 with intractable constipation were enrolled in this study, and participated in a 12-session magnetic conditioning protocol consisting of a 20-minute stimulation session once daily. Colonic transit time (CTT) and the dynamics of evaluation as revealed in defecography were measured, and the Knowles–Eccersley–Scott Symptom (KESS) Questionnaire was administered before the intervention, and after finishing the protocol.ResultsThere was a statistically significant improvement in CTT and defecography following the intervention. The difference in the anorectal angles between resting and evacuation (p = 0.001) and the changes in pelvic floor descent (p = 0.011) both reached significance after the intervention. The mean CTT (p = 0.001), Knowles–Eccersley–Scott Symptom score (p = 0.001), frequency of bowel movement (p = 0.005), unsuccessful evacuation (p = 0.018), and time needed for bowel hygiene (p = 0.032) all showed marked improvement after SMS conditioning.ConclusionOur findings reveal that SMS intervention may benefit elderly patients with severe constipation. The amelioration of geriatric bowel dysfunction across the subtypes of slow transit constipation and PFD indicated that SMS, featuring broad-spectrum applications, can be an effective form of adjuvant treatment in the care of elderly adults.     

No adverse impact of depressive symptoms on the effectiveness of postacute care service: A multicenter male-predominant prospective cohort study

BackgroundAlthough the clinical effectiveness of community hospital-based postacute care (PAC) services has been shown, little was known regarding the impact of depression on the clinical outcomes of older patients receiving PAC services in Taiwan.MethodsFrom January 2009 to August 2010, patients aged 65 years and older referred from tertiary medical centers or acute wards of community hospitals to PAC units were invited for study. All patients received the 4-week Comprehensive Geriatric Assessment-based intervention program in the PAC units. The functional assessment was composed of Geriatric Depression Scale–Short Form (GDS), Mini-Mental Status Examination, Barthel Index, Instrumental Activities of Daily Living, and Braden Score.ResultsAmong the 401 participants (mean age, 82.0 years; 95.5% males), 66 (16.5%) patients were depressed at PAC unit admission. Depressed patients had significantly lower Barthel Index (38.1 ± 2.4 vs. 47.6 ± 1.2, p = 0.002) and Braden Score (17.7 ± 0.3 vs. 18.8 ± 0.2, p = 0.004) than nondepressed patients. Improvement was noted on all measures of functional outcome among patients receiving PAC services. Furthermore, GDS was significantly improved in depressed patients (from 6.4 ± 0.2 to 2.8 ± 0.2 in depressed patients vs. from 1.6 ± 0.1 to 0.9 ± 0.1 in nondepressed patients, p < 0.001).ConclusionDepression was common when patients were newly admitted to PAC services, which was highly associated with poorer physical function. Improvement in physical function and depressive symptoms among all patients after PAC service was found, and the presence of depressive symptoms at PAC admission did not predict any adverse outcome of PAC services.     

Abnormal thyroid function predicts mortality in patients receiving long-term peritoneal dialysis: A case-controlled longitudinal study

BackgroundThe population of uremia patients receiving long-term peritoneal dialysis (PD) is growing, and abnormal thyroid function occurs increasingly in patients with chronic kidney disease in comparison with the normal population. We aimed to elucidate the clinical impact of abnormal thyroid function in long-term PD patients.MethodsThis was a retrospective, case-controlled, longitudinal study. We collected the characteristics, laboratory data, dialysis parameters, and thyroid and heart function of patients who underwent long-term PD for >8 years during the past 25 years in Taipei Veterans General Hospital, Taiwan. Patients with hyperthyroidism were excluded. None of these subjects presented a recent history of infection or inflammatory disease or took any drugs known to influence thyroid function. Abnormal thyroid function was defined as the presence of primary hypothyroidism and sick euthyroid syndrome.ResultsA total of 46 patients were enrolled. The mean duration of PD therapy was 147.8 (48.3) months. Nineteen of 46 (41.3%) patients had abnormal thyroid function tests. Patients with abnormal thyroid function had a worse prognosis in cumulative patient survival analysis by Kaplan–Meier method (p = 0.02). After adjusting for diabetes mellitus, cardiothoracic ratio, C-reactive protein (CRP), and cardiovascular diseases, abnormal thyroid function remained as an independent predictor of patient survival (hazard ratio = 7.633, 95% confidence interval 1.3–43.9, p = 0.02). The CRP levels were significantly inversely correlated with free thyroxine levels (r = –0.547; p = 0.01). The most common cause of death among the patients was sepsis (67.7%) rather than cardiovascular disease (20.0%).ConclusionPD patients with abnormal thyroid function had poor cumulative survival. Lower thyroid hormone level in PD patients was associated with high CRP levels. Physicians should be alert for the presence of abnormal thyroid function and proinflammatory status in long-term PD patients.     

Quantitative measures of functional outcomes and quality of life in patients with C5 palsy

BackgroundIt is generally understood that postoperative C5 palsy can occur with anterior or posterior decompression surgery, but functional measures of the palsy have not been well documented. This study aimed to investigate the incidence of C5 palsy in different surgical procedures, examine the correlations between muscle strength, upper extremity functional measures, and health-related quality of life, and to observe potential risk factors contributing to C5 palsy.MethodsOur investigation involved a retrospective study design. A total of 364 patients who underwent decompression surgery were indicated within the selected exclusion criteria. Additionally, 12 C5 palsy patients were recruited. The relationships between the manual muscle test (MMT), the action research arm test (ARAT), the Jebsen test of hand function (JTHF), and the European quality of life-5 dimensions (EQ-5D) were studied, and univariate analyses were performed to search possible risk factors and recovery investigation.ResultsThe data analyzed in the 12 cases and C5 palsy incidences (3.3%) were: 0.7% in anterior procedures (n = 2), 8.8% in posterior procedures (n = 6), and 36.4% in combined procedures (n = 4). Moderate-to-high correlations were observed between the ARAT, JTHF, EQ-5D visual analog scale scores, and MMT (r = 0.636–0.899). There were significant differences in patient age, etiology of cervical lesion, variable decompression procedures, and the number of decompression levels between the C5 palsy and non-C5 palsy groups. For female patients (p = 0.018) and number of decompression levels (p = 0.028), there were significant differences between the complete recovery and the incomplete recovery groups.ConclusionPatients undergoing combined anterior–posterior decompression surgery had the highest incidence of C5 palsy, and correlations between the ARAT, JTHF, EQ-5D visual analog scale clinical tools, and MMT scores supported these findings. Female status and lower decompression levels could also be predictive factors for complete recovery, although additional research is needed to substantiate these findings.     

Risk factors of suicidal ideation and attempt in women with drug user spouses

BackgroundDespite ample evidence of the presence of mental and psychological disorders observed in the family members of drug users, few studies have attempted to focus on suicidal behavior in women whose spouses are drug users.MethodsThis cross-sectional study focused on 131 women who had a drug user spouse. They had all been married for >2 years, with no mental or psychological disorders and no history of drug use prior to marriage. Drug use history after marriage, the extent and nature of physical and non-physical wife abuse, and any history of suicidal ideation and attempt in the past year were collected, in addition to data about anxiety and depression.ResultsOur study showed that women who identified with a history of suicidal ideation and attempt were younger, had a shorter marital duration, had a more extensive history of drug use, were more likely to be abused by their spouse, and had higher anxiety and depression scores than their counterparts. Suicidal ideation predictors included a personal history of drug use [odds ratio (OR) = 9.217, 95% confidence interval (CI) = 1.727–49.180, p = 0.009] and anxiety and depression (OR = 1.080, 95% CI = 1.022–1.141, p = 0.004), whereas suicidal attempt predictors included a personal history of drug use (OR = 7.236, 95% CI = 1.671–31.326, p = 0.010), exposure to physical abuse by spouse (OR = 4.005, 95% CI = 1.393–11.523, p = 0.008), and anxiety and depression (OR = 1.092, 95% CI = 1.015–1.175, p = 0.018).ConclusionThe findings of this study showed that a personal history of drug use, an elevated anxiety score, and depression and exposure to physical abuse by their spouse may act as predictors of suicidal ideation or attempt in women with a drug user spouse. These findings may serve to benefit and support healthcare systems, associated with ongoing efforts to develop preventive programs for suicidal behavior in this population.     

Factors influencing discomfort during anterior ultrasound-guided injection for hip arthrography

BackgroundAlthough ultrasound (US)-guided injection techniques for magnetic resonance arthrography of the hip have been used with increasing frequency to diagnose internal joint derangements, little is known about patient tolerance, which is relevant information for patients. The objective of this study was to evaluate prospectively the association between possible influencing factors and discomfort felt during the performance of anterior US-guided injection techniques targeting the femoral head–neck junction during hip arthrography.MethodsForty-four consecutive patients (21 women and 23 men; mean age, 41 years) undergoing magnetic resonance hip arthrography were sequentially assigned to receive injection alternating between fixed and freehand US-guided injection. Discomfort was assessed using a visual analog scale and relative ratings. Patient body mass index, extra-articular contrast leakage, the duration of the procedure, the needle advancement distance, and the fixed trajectory of the needle were assessed. Pearson’s correlation coefficients and multiple logistic regression analysis were used to determine the association.ResultsPuncture was successfully accomplished in all cases, and no relevant complications were reported. The only significant relationships were between discomfort and the time required for needle manipulation (r = 0.8) and fixed US-guided injection (r = 0.6; p < 0.001). Compared with the freehand technique, the fixed technique resulted in significantly less pain and took significantly less time to perform (p < 0.001). The procedure time during needle manipulation in the fixed US-guided injections (4.0 ± 0.9 seconds) was significantly less than that in the freehand US-guided injections (19.4 ± 17.6 seconds; p < 0.001). No significant relationships were found between discomfort and other parameters (r < 0.3, p > 0.05).ConclusionThe procedure time appears to be the most important factor influencing patient discomfort. Fixed US-guided injection is a time-saving technique that alleviates procedure-related discomfort.     

Efficacy,safety, and predictors of response to botulinum toxin type A in refractory chronic migraine: A retrospective study

BackgroundDue to its persistent and debilitating nature, refractory chronic migraine (RCM) can cause significant socioeconomic burden. This study retrospectively reviewed the efficacy and safety of botulinum toxin type A (BoNT-A) in the treatment of RCM. Predictors of treatment response were also investigated.MethodsWe enrolled 94 patients in this study after reviewing the records of those patients who received BoNT-A injections ≥75 U in our headache clinic, and who fulfilled the criteria for RCM established by Schulman et al. The outcome variables included headache frequency, migraine disability assessment score, and adverse events recorded in headache diaries. Treatment response was defined as ≥30% reduction in headache frequency from baseline at 12 weeks. Potential predictors of treatment response were evaluated, including patient demographics, headache directionality, ocular-type headache, medication overuse, BoNT-A dosage, body mass index, and Beck depression inventory score.ResultsFor the 94 patients with RCM who were enrolled, their mean baseline headache frequency was 23.9 days/28 days. At 12 weeks after BoNT-A injection, the mean reduction in headache frequency was 6.5 days/28 days (p < 0.001), and the median migraine disability assessment score decreased from 60.0 to 30.0 (p < 0.001). Thirty-seven (39.4%) patients responded to treatment, and only ocular-type headache was associated with a higher response rate (ocular vs. nonocular, 54.8% vs. 31.7%; p = 0.031). The most common adverse event was lateral eyebrow elevation (19.1%), followed by neck soreness (5.3%).ConclusionAbout 40% of patients with RCM obtained ≥30% reduction in headache frequency at 12 weeks after BoNT-A injection, and treatment-related adverse events were transient and acceptable. Ocular-type headache may predict treatment response.     

Prevalence and risk factors of erosive esophagitis in Taiwan

BackgroundErosive esophagitis is a common condition in the western population. However, the prevalence and risk factors of this disorder in Taiwan remain unclear. This study investigated the current prevalence of erosive esophagitis in Taiwan and attempted to identify the risk factors for this disease.MethodsFrom January 2008 to May 2009, 2040 consecutive subjects who underwent upper gastrointestinal endoscopy during their annual health check-up were enrolled. The severity of erosive esophagitis was evaluated according to the Los Angeles classification, and the independent risk factors of erosive esophagitis were analyzed using the logistic regression method.ResultsThe prevalence of erosive esophagitis was 17.3% (352/2040), with 71.6%, 27.8%, 0.5% and 0% cases of grades A, B, C and D, respectively, according to the Los Angeles classification. Univariate analysis revealed that male sex, smoking, alcohol consumption, betel nut chewing habit, body mass index ≥ 27 kg/m², hypertension, use of calcium channel blockers, diabetes, hyperglycemia, hypertriglyceridemia, and hiatus hernia were associated with the development of erosive esophagitis. Multivariate analysis revealed that male sex [odds ratio (OR) = 2.013, 95% confidence interval (CI) = 1.439–2.815; p < 0.001), smoking (OR = 1.301, 95% CI = 1.089–1.555; p = 0.004), body mass index > 27 (OR = 1.348, 95% CI = 1.138–1.598; p = 0.001), and hiatus hernia (OR = 4.331, 95% CI = 3.304–5.784; p < 0.001) were independent risk factors for the development of erosive esophagitis.ConclusionThe current prevalence of erosive esophagitis in Taiwan is 17.3%. Male sex, smoking, obesity, and hiatus hernia are four independent risk factors for the development of erosive esophagitis in the Taiwanese population.     

Intravenous thrombolysis for acute ischemic stroke with extended time window

Background:Intravenous thrombolysis (IVT) is an effective way for treating acute ischemic stroke (AIS). However, its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for >4.5 h.Methods:We searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT (IVT group) and placebo or usual care (control group [CG]) in AIS patients with disease onset for >4.5 h. The outcomes of interest included the favorable functional outcome (defined as modified Rankin Scale [mRS] scores 0–1) at 90 days, the functional independence (defined as mRS scores 0–2) at 90 days, proportion of patients with symptomatic intracerebral hemorrhage (sICH) and death at 90 days. We assessed the risk of bias using the Cochrane tool. Pre-specified subgroup analyses were performed by age (≤70 years or >70 years), National Institute of Health Stroke Scale (NIHSS, ≤10 or >10) and time window (4.5–9.0 h or >9.0 h).Results:Four trials involving 848 patients were eligible. The risk of bias of included trials was low. Patients in the IVT group were more likely to achieve favorable functional outcomes (45.8% vs. 36.7%; OR 1.48, 95% CI 1.12–1.96) and functional independence (63.8% vs. 55.7%; OR 1.43, 95% CI 1.08–1.90) at 90 days, but had higher risk of sICH (3.0% vs. 0.5%; OR 5.28, 95% CI 1.35–20.68) at 90 days than those in the CG. No significant difference in death at 90 days was found between the two groups (7.0% vs. 4.1%; OR 1.80; 95% CI 0.97–3.34).Conclusions:Use of IVT in patients with extended time window may improve their functional outcomes at 90 days, although IVT may induce increased risk of sICH. Care of these patients should well balance the potential benefits and harms of IVT.     

A cross-sectional study of liver function tests in HIV-infected persons in Western India

BackgroundDerangement of liver function tests (LFTs) is common in people living with human immunodeficiency virus/acquired immune deficiency syndrome (PLHA). The cause is multifactorial. Drug-induced liver injury (DILI) is the commonest cause and others being alcohol abuse and concomitant viral hepatitis. The aim of the research was to study the prevalence of LFT abnormalities in PLHA.MethodsThe study was carried out in a tertiary care hospital. Evaluation included a detailed history, thorough clinical examination and investigations including a haemogram, serum biochemistry, serology for hepatitis, and CD4 cell count.ResultsA total of 247 patients were evaluated. Of these, 212 (85.82%) were on antiretroviral therapy (ART), 111 (44.93%) were on anti-tubercular therapy (ATT), and 94 (38.05%) were on concurrent ATT–ART.Abnormal LFTs were seen in 128/247 (51.82%) PLHA. In the majority (88.28%), the LFT abnormalities were mild. LFT abnormalities were seen in 109/212 (51.4%) patients on ART, in 56/111 (50.5%) patients on ATT, 46/94 (48.93%) patients on concurrent ART–ATT. There was no difference in LFT abnormalities among the three groups nor was there any significant association with alcohol consumption. There was a statistically significant co-relation between albumin/globulin ratio and CD4 count (p = 0.0002). Counter-intuitively, LFT abnormalities were commoner in patients not receiving nevirapine (p = 0.043), but severe abnormalities (grade III/grade IV) were commoner in those receiving nevirapine (p = 0.005) and in those on concurrent ART–ATT (p = 0.008).ConclusionLFT abnormalities in PLHA are common; but usually mild. There is a strong association between severe abnormalities and nevirapine-based therapy (p = 0.02) and concurrent ATT–ART (p = 0.008).