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1.
Pedro Pileggi Vinha Alan Luiz Eckeli Ana Célia Faria Samuel Porfirio Xavier Francisco Veríssimo de Mello-Filho 《Sleep & breathing》2016,20(2):501-508
Purpose
The aim of the study was to evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on obstructive sleep events and daytime sleepiness in adults with obstructive sleep apnea syndrome (OSAS).Methods
Sixteen individuals (7 women/9 men) aged 40.2?±?10.2 (range, 24.4 to 62.2 years) with maxillary transverse deficiency and OSAS (respiratory disturbance index [RDI] greater than 5) confirmed with full-night polysomnography (PSG) underwent SARME to evaluate its efficiency for OSAS treatment.Results
Several PSG parameters and the Epworth Sleepiness Scale (ESS) results were compared in selected individuals before and after they underwent SARME. An RDI reduction from 35.4?±?38.5 to 16.0?±?19.7 was found, corresponding to a mean decrease of 54.6 % (p?=?0.0013). A 56.2 % (33.23?±?39.5 to 14.5?±?19.4, p?=?0.001) decrease was found in the apnea-hypopnea index (AHI), in addition to decreases in the desaturation and microarousal rates, among other parameters. The ESS scores improved from 12.5?±?5.3 to 7.2?±?3.5 (p?<?0.001).Conclusions
SARME promotes an improvement in OSAS symptoms; decreases the rates of respiratory disturbances; microarousal, and desaturation; and reduces daytime sleepiness.2.
Katalin Fekete Afroditi K. Boutou Georgia Pitsiou Nikolaos Chavouzis Athanasia Pataka Ioanna Athanasiou Georgios Ilonidis Theodoros Kontakiotis Paraskevi Argyropoulou Ioannis Kioumis 《Sleep & breathing》2016,20(1):121-128
Purpose
Data on the impact of obstructive sleep apnea syndrome (OSAS) and its treatment on resting energy expenditure (REE) are currently few and conflicting. The purpose of the present study was to investigate the impact of OSAS on REE, as measured before and after sleep, and the changes in REE after a single continuous positive airway pressure (CPAP) application, for the first time in literature.Methods
This is a nested case-control study. From the initial study population, two groups were formed, based on the results of nocturnal polysomnography: a group of male OSAS patients and a group of male, age-matched non-OSAS controls. REE was measured in both groups before and after sleep by indirect calorimetry, while patients repeated REE measurements before and after a single nasal CPAP application.Results
Ninety-two male OSAS patients (45.3?±?12.8 years old) and 19 male non-OSAS controls (50.8?±?11.7 years old) were studied. REE/lean body mass (LBM) was higher among patients compared to controls both pre- (29.6?±?12 vs 22.9?±?7.9 kcal/kg; p?=?0.022, correspondingly) and post-sleep (26.4?±?9.6 vs 21.6?±?9 kcal/kg; p?=?0.047 correspondingly). REE/LBM decreased significantly after sleep in OSAS patients (p?=?0.002), but not in controls; this difference was most evident among patients with more severe disease and higher desaturation. A single nasal CPAP application diminished the pre-post REE/LBM difference (30.3?±?8.2 vs 28.3?±?10.3 kcal/kg; p?=?0.265), but only among responders.Conclusions
In OSAS patients, REE values are high and vary significantly before and after sleep. A single nasal CPAP application diminishes this difference among responders, possibly through reversal of nocturnal desaturation.3.
Jing Xu Ning Ding Xilong Zhang Nana Wang Bing Sun Rong Zhang Xiaochen Xie Zongren Wan Yanli Gu Shan Zhang Yongqing Hong Mao Huang Zili Meng 《Sleep & breathing》2018,22(4):1045-1052
Purpose
Obstructive sleep apnea syndrome (OSAS) can induce dramatic blood pressure (BP) fluctuations during sleep and it can be associated with hypertension. We investigated the properties and associated influential factors of BP fluctuation in severe OSAS with and without hypertension.Methods
Two hundred one severe OSAS subjects were divided into hypertensive and normotensive groups. BP was continuously monitored via measurement of pulse transmit time (PTT). The value of apnea-related systolic BP elevation (ΔSBP) was used to reflect the amplitude of BP fluctuation, and the SBP index (the number of ΔSBP >?10 mmHg per hour of sleep time) was used to stand for the frequency of significant BP fluctuations.Results
Compared with the normotensive group, △SBP and SBP index were higher in the hypertensive group (13.8?±?4.4 mmHg vs 10.9?±?3.1 mmHg; 44.8?±?21.3 events/h vs 26.8?±?15.8 events/h, all p?<?0.001). Multiple regression analysis showed that percentage of sleep time with oxygen saturation <?90% (TST90) and SBP index correlated more with mean level of awakeness and sleep SBP than with apnea-hypopnea index (AHI). Analysis of all apnea events demonstrated that △SBP and the frequency of BP fluctuations were more remarkable following hypoxia than following arousal; △SBP correlated more with oxygen desaturation degree (r?=?0.388, p?<?0.01) and minimal SpO2 (r?=?0.392, p?<?0.01) than with apnea length and desaturation duration.Conclusions
In severe OSAS, nocturnal and awake BP levels are associated more with the nocturnal hypoxic duration and BP fluctuation than with AHI. Nocturnal BP fluctuation can be induced by both hypoxia and arousal, and especially by hypoxia.Trial registration
NCT028764714.
Introduction
Pneumothorax often develops in pulmonary Langerhans cell histiocytosis (PLCH), but some patients take a long time to be correctly diagnosed.Objectives
This study assessed the frequency of pneumothorax in PLCH and analysed the role of chest computed tomography (CT) in the prompt diagnosis.Patients and material
Of the 90 patients with PLCH seen from 2000 to 2015, 29 (32%) had pneumothorax as the initial finding. In this group, 18 (62%) patients were diagnosed within 1 month, whereas the diagnosis was delayed for 4–120 months in 11 (38%) patients.Results
Patients who had pneumothorax as the initial sign of PLCH tended to be younger (mean age 27.7?±?7.92 vs. 39.9?±?13.21 years; P?=?0.0001), male (69% vs. 43%; P?=?0.028), smoked less (mean pack/years 8.4?±?6.85 vs. 19?±?17.16; P?=?0.003), and had a significantly lower mean FVC (77.96?±?19.62 vs. 89.47?±?21.86% pred.; P?=?0.015) and FEV1 (68.6?±?19.93 vs. 79.4?±?21.48% pred.; P?=?0.03 than patients who had no pneumothorax. Recurrent pneumothorax was diagnosed more frequently in the group with a delayed diagnosis (82% vs. 39%; P?=?0.02). CT was performed in all of the patients who were diagnosed promptly, but in none of the patients with a delayed diagnosis.Conclusions
Patients who had pneumothorax as the initial sign of PLCH were younger, more frequently men, and had greater respiratory impairment than those who had no pneumothorax. CT in patients with pneumothorax led to a correct diagnosis of this disease.5.
Lluis Asmarats Mathieu Bernier Gilles O’Hara Jean-Michel Paradis Kim O’Connor Jonathan Beaudoin Sylvie Bilodeau Rafael Cavalcanti Jean Champagne Josep Rodés-Cabau 《Journal of interventional cardiac electrophysiology》2018,53(2):151-157
Purpose
Percutaneous left atrial appendage (LAA) closure has become a valid alternative to anticoagulation therapy for the prevention of thromboembolic events in patients with atrial fibrillation (AF). However, scarce data exist on the impact of LAA closure on left atrial and ventricular function. We sought to assess the acute hemodynamic changes associated with percutaneous LAA closure in patients with paroxysmal AF.Methods
The study population consisted of 31 patients (mean age 73?±?10 years; 49% women) with paroxysmal AF who underwent successful percutaneous LAA closure. All patients were in sinus rhythm and underwent 2D transthoracic echocardiography at baseline and the day after the procedure. A subset of 14 patients underwent preprocedural cardiac computed tomography (CT) with 3D LA and LAA reconstruction.Results
Left ventricular systolic function parameters and LA volumetric indexes remained unchanged after the procedure. No significant changes in left ventricular stroke volume (72.4?±?16.0 vs. 73.3?±?15.7 mL, p?=?0.55) or LA stroke volume (total 15.6?±?4.2 vs. 14.6?±?4.2 mL, p?=?0.21; passive 9.0?±?2.8 vs. 8.3?±?2.6 mL, p?=?0.31; active 10.3?±?5.6 vs. 10.0?±?6.4 mL, p?=?0.72) occurred following LAA closure. Mean ratio of LAA to LA volume by 3D CT was 10.2?±?2.3%. No correlation was found between LAA/LA ratio and changes in LA stroke volume (r?=?0.35, p?=?0.22) or left ventricular stroke volume (r?=?0.28, p?=?0.33).Conclusions
The LAA accounts for about 10% of the total LA volume, but percutaneous LAA closure did not translate into any significant changes in LA and left ventricular function.6.
Firat Uygur Hakan Tanrıverdi Murat Can Fatma Erboy Bulent Altınsoy Figen Atalay Tacettin Ornek Murat Damar Furuzan Kokturk Meltem Tor 《Sleep & breathing》2016,20(3):939-945
Purpose
Inflammation and oxidative stress play important roles in the pathogenesis of obstructive sleep apnoea syndrome (OSAS). Omentin is expressed in visceral adipose tissue and is associated with the inflammatory response. The aim of this study was to assess the relationship between OSAS and omentin based on a comparison of its serum levels at baseline and after 3 months of continuous positive airway pressure (CPAP) therapy.Methods
Ninety-six newly diagnosed OSAS patients and 31 non-apnoeic controls were enrolled in this study. Blood samples were obtained in the morning after polysomnography. Within the OSAS group, 30 patients were started on CPAP therapy and then reassessed clinically, including a blood test for serum omentin and other biochemical analysis, at 3 months.Results
Serum omentin levels were significantly lower in the OSAS group than in the control group (27.7?±?7.6 and 42.5?±?5.2 ng/mL, P?<?0.001). In the subgroup analysis, omentin concentrations were significantly lower in patients with severe OSAS than in those with mild/moderate OSAS (P?<?0.001). Circulating omentin levels were significantly correlated with the apnoea–hypopnoea index (AHI), mean SaO2, oxygen desaturation index, and serum C-reactive protein levels. Treatment with CPAP resulted in a significant increase in circulating omentin levels after 3 months, from 22.7?±?1.4 to 41.2?±?3.3 ng/mL (P?<?0.001).Conclusions
OSAS is associated with low serum omentin levels, and these levels can be reversed by effective CPAP treatment.7.
Purpose
Pulmonary hypertension (PH) in the setting of parenchymal lung disease adversely affects quality of life and survival. However, PH-specific drugs may result in ventilation/perfusion imbalance and currently, there are no approved PH treatments for this patient population. In the present retrospective study, data from 22 patients with PH associated with lung disease treated with inhaled treprostinil (iTre) and followed up clinically for at least 3 months are presented.Methods
PH was defined by resting right heart catheterization as a mean pulmonary artery pressure (mPAP) ≥?35 mmHg, or mPAP?≥?25 mmHg associated with pulmonary vascular resistance ≥?4 Woods Units. Follow-up evaluation was performed at the discretion of the attending physician.Results
From baseline to follow-up, we observed significant improvement in functional class (n?=?22, functional class III-IV 82 vs. 59%, p?=?0.041) and 6-min walk distance (n?=?11, 243?±?106 vs. 308?±?109; p?=?0.022), without a deleterious effect on resting peripheral oxygen saturation (n?=?22, 92?±?6 vs. 94?±?4; p?=?0.014). Most of the patients (86%, n?=?19/22) were using long-term nasal supplemental oxygen at baseline. During follow-up, only one patient had increased supplemental oxygen requirement. The most common adverse events were cough, headache, and diarrhea. No severe adverse event was reported.Conclusions
The results suggest that iTre is safe in patients with Group 3 PH and evidence of pulmonary vascular remodeling in terms of functional class, gas exchange, and exercise capacity. Additionally, iTre was well tolerated. The potential role of PH-specific drugs in Group 3 PH should be further assessed in larger prospective studies.8.
Eberhard P. Scholz Patrick Fischer Patrick Lugenbiel Panagiotis Xynogalos Patrick A. Schweizer Daniel Scherer Dierk Thomas Hugo A. Katus Edgar Zitron 《Journal of interventional cardiac electrophysiology》2018,53(3):347-355
Purpose
Left bundle branch block (LBBB) has a predictive value for response to cardiac resynchronization therapy as reported by Zareba et al. (Circulation 123(10):1061–1072, 2011). However, based on ECG criteria, the discrimination between complete LBBB and nonspecific intraventricular conduction delay is challenging. We tested the hypothesis that discrimination can be performed using standard electrophysiological catheters and a simple stimulation protocol.Methods
Fifty-nine patients were analyzed retrospectively. Patients were divided into groups of narrow QRS (n?=?20), wide QRS of right bundle branch block (RBBB) morphology (n?=?14), and wide QRS of LBBB morphology (n?=?25). Using a diagnostic catheter placed in the coronary sinus, left ventricular activation was assessed during intrinsic conduction as well as during right ventricular (RV) stimulation.Results
In patients with narrow QRS and RBBB, the Q-LV/QRS ratio was 0.43?±?0.013 (n?=?20) and 0.41?±?0.026 (n?=?14), respectively. In patients with LBBB morphology, the Q-LV/QRS split up into a group of patients with normal (0.43?±?0.022, n?=?7) and a group with delayed left ventricular activation (0.75?±?0.016, n?=?18). By direct comparison of the Q-LV/QRS ratio during intrinsic conduction with the Q-LV/QRS ratio during RV pacing leading to a functional LBBB, a clear distinction between a group of “true LBBB” and another group of “apparent LBBB”/nonspecific intraventricular conduction delay (NICD) could be generated.Conclusions
We present a novel and practical method that might facilitate discrimination between patients with apparent LBBB and true LBBB by comparing Q-LV/QRS ratios during intrinsic activation and during RV stimulation. Although this method can already be directly applied, validation by 3D electrical mapping and prospective correlation to cardiac resynchronization therapy (CRT) response will be required for further translation into clinical practice.9.
Sachin Nayyar Lauren Wilson Anand Ganesan Thomas Sullivan Pawel Kuklik Glenn Young Prashanthan Sanders Kurt C. Roberts-Thomson 《Journal of interventional cardiac electrophysiology》2018,51(1):13-24
Purpose
Protected channels of surviving myocytes in late postinfarction ventricular scar predispose to ventricular tachycardia (VT). However, only a few patients develop VT spontaneously. We studied differences in electric remodeling and protected channels in late postinfarction patients with and without spontaneous VT.Methods
Patients with ischemic cardiomyopathy (ICM) with recurrent sustained monomorphic VT (n?=?22) were compared with stable ICM patients without spontaneous VT (control group; n?=?5). Left ventricular mapping was performed with a 20-pole catheter. Detailed pace mapping was used to identify channels of protected conduction, and confirmed, when feasible, by entrainment. Anatomical and electrophysiological properties of VT channels and non-VT channels in VT patients and channels in controls were evaluated.Results
Seventy-three (median 3) VTs were inducible in VT patients compared to two (median 0) in controls. The VT channels in VT patients (n?=?57, 3?±?1 per patient) were lengthier (mean?±?SEM 53?±?5 vs. 33?±?4 vs. 24?±?8 mm), had longer S-QRS (73?±?4 vs. 63?±?3 vs. 44?±?8 ms), longer conduction time (103?±?13 vs. 33?±?4 vs. 24?±?8 ms), and slower conduction velocity (CV) (0.85?±?0.21 vs. 1.39?±?0.20 vs. 1.31?±?0.41 m/s) than non-VT channels in VT patients (n?=?183, 8?±?6 per patient) (p?≤?0.01) and channels in controls (n?=?46, 9?±?8 per patient) (p?≤?0.01). Additionally, non-VT channels in VT patients had longer S-QRS (p?=?0.02); however, they were similar in length, conduction time, and CV compared to channels in controls.Conclusions
Channels supporting VT are lengthier, with longer conduction times and slower CV compared to channels in patients without spontaneous VT. These observations may explain why some ICM patients have spontaneous VT and others do not.10.
11.
Shinya Yamada Fa-Po Chung Yenn-Jiang Lin Shih-Lin Chang Li-Wei Lo Yu-Feng Hu Tze-Fan Chao Jo-Nan Liao Chung-Hsing Lin Chin-Yu Lin Yao-Ting Chang Abigail Louise D. Te Ying-Chieh Liao Po-Ching Chi Shih-Ann Chen 《Journal of interventional cardiac electrophysiology》2018,53(2):175-185
Purpose
In spite of several proposed predictors for premature ventricular complex (PVC)-induced cardiomyopathy (PVC-CMP), the specific ECG features of idiopathic right ventricular outflow tract (RVOT) PVC-CMP remain unknown.Methods
A total of 130 patients (49 males, mean age 44 years) with symptomatic and drug-refractory idiopathic RVOT PVCs undergoing radiofrequency catheter ablation (RFCA) were enrolled. The patients were categorized into two groups, including those with and without RVOT PVC-CMP (left ventricular ejection fraction (LVEF) <?50%, n?=?25 and LVEF ≥?50%, n?=?105, respectively). The 12-lead PVC morphologies were assessed.Results
Patients with RVOT PVC-CMP had a lower LVEF (42?±?5% vs. 60?±?7%, P?<?0.01) and higher PVC burden (24?±?14% vs. 15?±?11%, P?=?0.02) when compared to patients without RVOT PVC-CMP. The PVC features in those with PVC-CMP displayed a significantly wider QRS duration (143?±?14 ms vs. 132?±?17 ms, P?<?0.01) and higher peak deflection index (PDI; 0.60?±?0.07 vs. 0.55?±?0.08, P?<?0.01). A multivariate analysis demonstrated that the QRS duration (odds ratio (OR) 1.130, 95% confidence interval (CI) 1.020–1.253, P?=?0.02) and PDI (OR 1.240, 95% CI 1.004–1.532, P?=?0.04) were independently associated with RVOT PVC-CMP. Based on the receiver-operating characteristic analysis, a QRS duration >?139 ms and PDI >?0.57 could predict RVOT PVC-CMP (area under the curve (AUC) 0.710 and AUC 0.690, respectively). The elimination and suppression of PVCs by RFCA resulted in the recovery of the LVEF in RVOT PVC-CMP.Conclusions
The ECG parameters, including a wider QRS duration and higher PDI, could predict the development of RVOT PVC-CMP, which could be effectively treated by RFCA.12.
Mattia Barbot Filippo Ceccato Marialuisa Zilio Nora Albiger Riccardo Sigon Giuseppe Rolma Marco Boscaro Carla Scaroni Franca Bilora 《Pituitary》2018,21(1):50-55
Introduction
Central diabetes insipidus (DI) is a rare disease characterized by the excretion of excessive volumes of dilute urine due to reduced levels of the antidiuretic hormone arginine vasopressin (AVP), caused by an acquired or genetic defect in the neurohypophysis. The aim of this study was to identify any autonomic dysfunction (AD) in patients with DI as a possible cofactor responsible for their reportedly higher mortality.Methods
The study involved 12 patients (6 females) with central idiopathic DI and a well-controlled electrolyte balance, and 12 controls matched for age, sex and cardiovascular risk factors, who were assessed using the tilt, lying-to-standing, hand grip, deep breath, Valsalva maneuver and Stroop tests.Results
The tilt test showed a significantly more pronounced decrease in both systolic (??20.67?±?18 vs. ??1.92?±?6.99 mmHg, p?=?0.0009) and diastolic blood pressure (??10.5?±?14.29 vs. ??1.5?±?5 mmHg, p?=?0.012) in patients than in controls. Three patients with DI had to suspend the test due to the onset of syncope. The lying-to-standing test also revealed a marked reduction in blood pressure in patients with DI (1.05?±?0.13 vs. 1.53?±?0.14, p?=?0.0001). Similar results emerged for the Valsalva maneuver (Valsalva ratio, 1.24?±?0.19 vs. 1.79?±?0.11, p?<?0.0001) and deep breath test (1.08?±?0.11 vs. 1.33?±?0.08, p?<?0.0001).Conclusions
All the principal autonomic tests performed in the study were concordant in indicating that patients with central DI have an impaired autonomic nervous system function despite a normal hydroelectrolytic balance under desmopressin therapy. This impairment may reflect damage to the autonomic system per se and/or the absence of any vasoactive effect of AVP on vascular smooth muscle. In our opinion, patients with central DI should be educated on how to prevent orthostatic hypotension, and pharmacological treatment should be considered for patients with a more marked impairment.13.
E. G. Rybakov D. Yu Pikunov O. Yu Fomenko S. V. Chernyshov Yu A. Shelygin 《International journal of colorectal disease》2016,31(8):1419-1426
Aim
The aim of this study is to compare surgical, functional, physiologic outcomes and QOL after low anterior resection (LAR) with andside-to-end or straight colorectal anastomosis.Method
Between 2012 and 2015, 86 patients with mid and low rectal tumors were enrolled into randomized trial. Wexner score, number of defecations, use of antidiarrheal medicine or laxatives, enemas, pads, episodes of nocturnal incontinence, and urgency were recorded. The Fecal Incontinence Quality of Life (FIQL) scale was used for assessment of QOL. Anal manometry and volumetric examination were performed.Results
Six patients were excluded from the study. There was no mortality. The morbidity rate was 6 (14.6 %) for side-to-end vs. 8 (20.0 %) for straight anastomosis (p?=?0.57). The median Wexner score was 5 vs. 6 (p?=?0.033), 4 vs. 5 (p?=?0.006), and 2 vs. 3 (p?=?0.1) at 1, 3, and 6 months after stoma reversal, respectively. Side-to-end anastomosis resulted in a fewer mean numbers of bowel movements per day at the same check points of follow-up: 5.8?±?0.14 vs. 6.4?±?0.15 (p?=?0.006), 3.7?±?0.1 vs. 4.2?±?0.1 (p?=?0.003), and 2.5?±?0.1 vs. 3.0?±?0.10 (p?=?0.0002), correspondingly. Maximal tolerated volume was higher for side-to-end anastomosis at 3 and 6 months of follow-up: 152.0 vs. 137.8 cm3 (p?=?0.002) and 180.5 vs. 167.0 cm3 (p?=?0.006), respectively. Better FIQL score was found at 1 and 3 months in the side-to-end group.Conclusion
Better functional outcomes and QOL were observed in a short period after stoma closure, but at 6 months of follow-up, the only benefit of side-to-end anastomosis was a lower number of bowel movements.14.
Willem Staels Yannick Verdonck Yves Heremans Gunter Leuckx Sofie De Groef Carlo Heirman Eelco de Koning Conny Gysemans Kris Thielemans Luc Baeyens Harry Heimberg Nico De Leu 《Diabetologia》2018,61(8):1804-1810
Aims/hypothesis
The initial avascular period following islet transplantation seriously compromises graft function and survival. Enhancing graft revascularisation to improve engraftment has been attempted through virus-based delivery of angiogenic triggers, but risks associated with viral vectors have hampered clinical translation. In vitro transcribed mRNA transfection circumvents these risks and may be used for improving islet engraftment.Methods
Mouse and human pancreatic islet cells were transfected with mRNA encoding the angiogenic growth factor vascular endothelial growth factor A (VEGF-A) before transplantation under the kidney capsule in mice.Results
At day 7 post transplantation, revascularisation of grafts transfected with Vegf-A (also known as Vegfa) mRNA was significantly higher compared with non-transfected or Gfp mRNA-transfected controls in mouse islet grafts (2.11- and 1.87-fold, respectively) (vessel area/graft area, mean?±?SEM: 0.118?±?0.01 [n?=?3] in Vegf-A mRNA transfected group (VEGF) vs 0.056?±?0.01 [n?=?3] in no RNA [p?<?0.05] vs 0.063?±?0.02 [n?=?4] in Gfp mRNA transfected group (GFP) [p?<?0.05]); EndoC-bH3 grafts (2.85- and 2.48-fold. respectively) (0.085?±?0.02 [n?=?4] in VEGF vs 0.030?±?0.004 [n?=?4] in no RNA [p?<?0.05] vs 0.034?±?0.01 [n?=?5] in GFP [p?<?0.05]); and human islet grafts (3.17- and 3.80-fold, respectively) (0.048?±?0.013 [n?=?3] in VEGF vs 0.015?±?0.0051 [n?=?4] in no RNA [p?<?0.01] vs 0.013?±?0.0046 [n?=?4] in GFP [p?<?0.01]). At day 30 post transplantation, human islet grafts maintained a vascularisation benefit (1.70- and 1.82-fold, respectively) (0.049?±?0.0042 [n?=?8] in VEGF vs 0.029?±?0.0052 [n?=?5] in no RNA [p?<?0.05] vs 0.027?±?0.0056 [n?=?4] in GFP [p?<?0.05]) and a higher beta cell volume (1.64- and 2.26-fold, respectively) (0.0292?±?0.0032 μl [n?=?7] in VEGF vs 0.0178?±?0.0021 μl [n?=?5] in no RNA [p?<?0.01] vs 0.0129?±?0.0012 μl [n?=?4] in GFP [p?<?0.001]).Conclusions/interpretation
Vegf-A mRNA transfection before transplantation provides a promising and safe strategy to improve engraftment of islets and other cell-based implants.15.
Maria Teresa Barrio-López Eduardo Castellanos Mercedes Ortiz Martín Arceluz Carla Lázaro Jefferson Salas Sergio Madero Jesús Almendral 《Journal of interventional cardiac electrophysiology》2018,53(2):195-205
Background
Finding the conduction gaps in redo PV isolation procedures is challenging, and several maneuvers have been described. In the present study, we analyze the pace and map (P&M) maneuver [atrial mapping during pulmonary vein (PV) pacing] to locate the gaps in redo PV isolation procedures.Methods
Consecutive patients undergoing a second PV isolation procedure at a single institution over a 4-year period were included. For the last 2 years, all the patients (n?=?38) studied underwent PV isolation based on the P&M maneuver and were compared to the previous patients (n?=?45). The atrial side of the ablation line was mapped with the ablation catheter during PV pacing, and the earliest site was considered a gap site.Results
Shorter radiofrequency time was required to obtain PV isolation in the P&M group (485?±?374 vs. 864?±?544 s; p?<?0.001), which remained significant after adjusting for the number of reconnected PVs (p?=?0.01). We did not find significant differences in the procedure duration (106?±?46 vs. 112?±?53 min; p?=?0.57) and arrhythmia recurrence during 1-year follow-up (26.6 vs. 28.9%; p?=?0.82) after adjusting for several confounding factors (HR 1.32; 95% CI 0.5–3.4; p?=?0.57).Conclusions
P&M is a simple maneuver to identify the gaps in ablation lines around the PV. It remains efficacious in redo procedures despite the difficulties in localizing the ablation lines performed in the first procedure. The P&M maneuver reduced the radiofrequency time required to isolate the PV without compromising the efficacy.16.
Yingmei Jia Chang Li Xiaoyan Yang Zhi Dong Kun Huang Yanji Luo Xuehua Li Canhui Sun Shi-Ting Feng Zi-Ping Li 《BMC gastroenterology》2018,18(1):173
Background
Evaluate the possibility of CT enterography (CTE) score system as a predictor in assessing active ulcerative colitis (UC) severity.Methods
Forty-six patients with active UC with CTE and colonoscopy were enrolled. Based on modified Mayo score, patients were divided into three groups: mild (n?=?10), moderate (n?=?17) and severe (n?=?19). A cumulative CTE score was calculated in each patient and its correlation with modified Mayo score was analyzed. The optimal cutoff values of CTE score were determined by receiver operating characteristic (ROC) curves analysis.Results
Significant between-group differences were observed in CTE spectrums of mucosal bubbles, mural stratification, loss of haustration, enlarged mesenteric lymph nodes and engorged mesenteric vessels (P?<?0.05). The cumulative CTE scores were significant difference between three groups (CTE score:4.9?±?2.3, 7.6?±?2.6, and 10.9?±?2.0, respectively, P?<?0.01). The cumulative CTE score showed a positive correlation with modified Mayo score (r?=?0.835, P?<?0.05). The optimal cut-off value for CTE score predicting moderate and severe UC was 9.5 (area under the curve [AUC]:0.847, sensitivity:78.9%, specificity:82.4%).Conclusion
Disease severity assessment by CTE score demonstrates strong positive correlation with severity established modified Mayo score. CTE score system maybe a potential predictor for active UC severity assessment.17.
Adam D. Farmer Anne Grave Pedersen Birgitte Brock Poul Erik Jakobsen Jesper Karmisholt Sahar D. Mohammed S. Mark Scott Asbjørn Mohr Drewes Christina Brock 《Diabetologia》2017,60(4):709-718
Aims/hypothesis
We hypothesised that type 1 diabetic patients with established diabetic sensorimotor polyneuropathy (DSPN) would have segmental and/or pan-enteric dysmotility in comparison to healthy age-matched controls. We aimed to investigate the co-relationships between gastrointestinal function, degree of DSPN and clinical symptoms.Methods
An observational comparison was made between 48 patients with DSPN (39 men, mean age 50 years, range 29–71 years), representing the baseline data of an ongoing clinical trial (representing a secondary analysis of baseline data collected from an ongoing double-blind randomised controlled trial investigating the neuroprotective effects of liraglutide) and 41 healthy participants (16 men, mean age 49 years, range 30–78) who underwent a standardised wireless motility capsule test to assess gastrointestinal transit. In patients, vibration thresholds, the Michigan Neuropathy Screening Instrument and Patient Assessment of Upper Gastrointestinal Symptom questionnaires were recorded.Results
Compared with healthy controls, patients showed prolonged gastric emptying (299?±?289 vs 179?±?49 min; p?=?0.01), small bowel transit (289?±?107 vs 224?±?63 min; p?=?0.001), colonic transit (2140, interquartile range [IQR] 1149–2799 min vs 1087, IQR 882–1650 min; p?=?0.0001) and whole-gut transit time (2721, IQR 1196–3541 min vs 1475 (IQR 1278–2214) min; p?<?0.0001). Patients also showed an increased fall in pH across the ileocaecal junction (?1.8?±?0.4 vs ?1.3?±?0.4 pH; p?<?0.0001), which was associated with prolonged colonic transit (r?=?0.3, p?=?0.001). Multivariable regression, controlling for sex, disease duration and glycaemic control, demonstrated an association between whole-gut transit time and total GCSI (p?=?0.02).Conclusions/interpretation
Pan-enteric prolongation of gastrointestinal transit times and a more acidic caecal pH, which may represent heightened caecal fermentation, are present in patients with type 1 diabetes. The potential implication of delayed gastrointestinal transit on the bioavailability of nutrition and on pharmacotherapeutic and glycaemic control warrants further investigation.Trial registration
EUDRA CT: 2013-004375-1218.
Background
There is some controversy concerning the prognosis of patients with left ventricular hypertrabeculation/noncompaction (LVHT). LVHT is frequently associated with neuromuscular disorders (NMDs). The aim of this study was to assess cardiac and neurological findings as predictors of mortality in patients with LVHT.Patients and methods
The study included patients with LVHT diagnosed between June 1995 and January 2014 in one echocardiographic laboratory. They underwent a baseline cardiologic examination and were invited for a neurological examination. Between January and February 2014, their survival status was assessed.Results
LVHT was diagnosed in 220 patients (68 female, aged 52?±?17 years) with a prevalence of 0.35?%/year. During a follow-up of 72?±?61 months, 65 patients died. The mortality was 5?%/year. A neurological investigation was performed on 173 patients (79?%) and revealed specific NMDs in 31 (14?%), NMD of unknown etiology in 103 (47?%), and normal findings in 39 (18?%) patients. In multivariate analysis, the predictors of mortality were increased age (p?=?0.0001), presence of a specific NMD (p?=?0.0062) or NMD of unknown etiology (p?=?0.0062), heart failure NYHA III (p?=?0.0396), atrial fibrillation (p?=?0.0022), and sinus tachycardia (p?=?0.0395).Conclusions
LVHT patients should undergo systematic neurological examinations. Whether an optimal therapy of heart failure and atrial fibrillation will improve the prognosis of LVHT patients needs to be addressed in further studies.19.
Zhi-Xiong Li Xiao-Hua Wu Hai-yan Wu Wen-Ju Chang Xiu-juan Chang Tuo Yi Qiang Shi Jing-Wen Chen Qing-Yang Feng De-Xiang Zhu Ye Wei Yun-Shi Zhong Jian-Min Xu 《International journal of colorectal disease》2016,31(3):561-570
Backgroud
The efficacy and safety of self-expandable metallic stents (SEMSs) as a bridge for patients with acute malignant colorectal obstructions (AMCOs) are still controversial. We conducted this study to evaluate the outcomes of patients with AMCOs treated by different strategies.Methods
From January 2010 to March 2014, a total of 171 patients with AMCOs from Zhongshan Hospital were retrospectively enrolled in this study. One hundred twenty patients successfully received stent placement followed by one-stage laparoscopic or open resection in the stent group, and 51 patients received emergency operations in the emergency group.Results
The operation duration and postoperative hospital stay were significantly shorter in the stent group (114.51?±?28.65 vs. 160.39?±?58.94 min, P?<?0.001; 8.00?±?3.97 vs. 12.59?±?9.07 days, P?=?0.001). The stent group also had significantly reduced intraoperative blood loss and the incidence of postoperative complications compared with the emergency group (61.00?±?43.70 vs. 121.18?±?85.90 ml, P?<?0.001; 16.7 vs. 37.3 %, P?=?0.003). Kaplan–Meier survival curves showed that the median survival time in the stent group was significantly longer than that in the emergency group (53 vs. 41 months, P?=?0.034). In subgroup analysis of stent group, the stent laparoscopy group had significantly decreased postoperative complications (P?=?0.025), and similar long-term survival (P?=?0.81).Conclusions
Stent placement as a bridge to surgery is a safe and feasible procedure and provides significant advantages in terms of short-term outcomes and favorable prognoses for patients with AMCOs. Laparoscopic surgery could be considered as an optimal treatment after stent placement.20.
Anne-Sofie Graae Mette Hollensted Julie T. Kloppenborg Yuvaraj Mahendran Theresia M. Schnurr Emil Vincent R. Appel Johanne Rask Tenna R. H. Nielsen Mia Ø. Johansen Allan Linneberg Marit E. Jørgensen Niels Grarup Haja N. Kadarmideen Birgitte Holst Oluf Pedersen Jens-Christian Holm Torben Hansen 《Diabetologia》2018,61(8):1769-1779