Development and Testing of a Hybrid Measure of Muscle Strength in Juvenile Dermatomyositis for Use in Routine Care

Objective

To develop and test a hybrid measure of muscle strength for juvenile dermatomyositis (JDM), which is based on the combination of the Manual Muscle Testing in 8 muscles (MMT‐8) and the Childhood Myositis Assessment Scale (CMAS) but is more comprehensive than the former and more feasible than the latter.

Methods

The hybrid MMT‐8/CMAS (hMC) is composed of all 8 items of the MMT‐8 and 3 items of the CMAS: time of head lift, assessment of abdominal muscles, and floor rise. The score ranges 0–100, with 100 indicating normal muscle strength. Validation procedures were conducted using 3 large multinational patient samples, including a total of 810 JDM patients.

Results

The hMC revealed face and content validity, good construct validity, excellent test–retest reliability (intraclass correlation coefficient = 0.99), and internal consistency (Cronbach's α = 0.94), strong responsiveness to clinical change over time (standardized response mean = 0.8 among patients judged as improved by the caring physician), and satisfactory capacity to discriminate patients judged as being in the states of inactive disease or low, moderate, or high disease activity by the physician (P < 0.001) or patients whose parents were satisfied or not satisfied with the illness course (P < 0.001).

Conclusion

The hMC was found to possess good measurement properties in a large population of patients with a wide range of disease activity and severity. The new tool, which is primarily intended for use in routine clinical care, should be further tested in other populations of patients evaluated prospectively.

     

Use of the Wearable Cardioverter Defibrillator in High-Risk Populations

The United States Food and Drug Administration has approved the wearable cardioverter defibrillator (WCD) for use in patients who are at high risk for sudden cardiac arrest (SCA) and who do not yet have an established indication for an implantation cardioverter defibrillator (ICD) or have contraindications for device implantation for various reasons. The WCD is typically used for primary prevention in (1) high-risk patients with reduced left ventricular ejection fraction (LVEF) ≤35 % after recent acute myocardial infarction (MI) during the 40-day ICD waiting period, (2) before and after coronary artery bypass graft or percutaneous coronary intervention during the 90-day ICD waiting period, (3) after recently diagnosed nonischemic dilated cardiomyopathy (NICM) during the 3- to 9-month medical therapy optimization period, or (4) for those with inherited proarrhythmic conditions such as long QT syndrome or hypertrophic cardiomyopathy. Unlike the automatic external defibrillator, the WCD does not require assistance from bystanders for therapy and conscious patients can delay or avert therapy with the use of response buttons. The WCD exhibits a small risk of inappropriate shock, mostly due to supraventricular tachycardia and/or electrical noise. Multiple non-randomized observational studies have shown high efficacy in detection and appropriate shock therapy for sustained ventricular tachyarrhythmias. This paper discusses the use of the WCD for prevention of SCA in patients with various cardiac substrates.     

Identification of Alcohol Abuse: Thoracic Fractures on Routine Chest X-Rays as Indicators of Alcoholism

In a retrospective study, rib and thoracic vertebral fractures were found to be present on postero-anterior and lateral routine chest x-rays of 57 (28.9%) of 198 alcoholic male patients and in 4 (1.8%) of 218 nonalcoholic male control subjects. The magnitude of the increased prevalence (16-fold; p < 0.001) of rib and vertebral fractures in alcoholics suggest that routine chest x-rays should be useful in the identification of problem drinking and may be used, along with other indices, in population screening for alcoholism.     

Routine Activities and Alcohol Use: Constraints on Outlet Utilization

Studies of consumers' use of alcohol beverage outlets have provided a basis for understanding drinking behaviors in different drinking environments. These studies have shown that drinking environments are related to both demographic and drinking pattern measures. Absent from these studies has been a theoretical basis on which to make predictions regarding drinking patterns and choices of drinking environments under the various social, economic, and environmental constraints typically confronting alcohol consumers. This study presents one such theoretical approach.
The approach assumes that, in the context of individual preferences for alcohol, drinking choices are constrained by consumers' economic and time-energy budgets for consumption. All other things being equal, it is suggested that greater budgets for consumption will be related to greater alcohol use, quality of beverages purchased, amenity values of purchase locations, or all three. Because on-premise drinking entails greater economic costs, greater drinking levels will be related to lower utilization of on-premise establishments.
The predictions of this approach were tested using data obtained from telephone surveys of consumers conducted in 1990 and 1991. The results showed that controlling for income, variables related to greater time-energy budgets for consumption (i.e., marital status and household composition) were related to greater consumption levels and greater utilization of on-premise establishments. Controlling for demographic measures, greater income was related to greater utilization of restaurants and increased beverage quality. Controlling for all other measures, frequencies of consumption were inversely related to consumption at on-premise establishments, reflecting the expected moderation in costs for heavier consumers on a limited alcohol budget.     

Use of the SAPIEN 3 Transcatheter Heart Valve in High-Risk Scenarios

The transcatheter aortic valve replacement procedure is used in patients with aortic stenosis. Transcatheter aortic valve replacement devices are quite versatile; thus, they are increasingly being used for nonaortic applications, such as tricuspid valve-in-valve implantation. This case series describes a transcatheter aortic valve replacement procedure in 4 patients with anatomic challenges (eg, aortic tortuosity, high valvular calcium burden, highly calcified bicuspid valve, low coronary artery takeoff, left main coronary artery occlusion, and large aortic annulus) and a fifth patient who had a failed tricuspid bioprosthesis and underwent a tricuspid valve-in-valve implantation with the Edwards SAPIEN 3 transcatheter heart valve (Edwards Lifesciences). All procedures required adjustments to the standard protocol, and each procedure was successful. The critical, technical adjustments in the deployment technique and preprocedural planning of the procedures are detailed to provide a road map for other cardiologists who encounter similar challenges.     

Cardiac Surgery in Germany during 2011: A Report on Behalf of the German Society for Thoracic and Cardiovascular Surgery

All cardiac surgical procedures performed in 78 German cardiac surgical units throughout the year 2011 are presented in this report, based on a voluntary registry which is organized by the German Society for Thoracic and Cardiovascular Surgery. In 2011, a total of 100,291 cardiac surgical procedures (implantable cardioverter defibrillator and pacemakers procedures excluded) have been collected in this registry. More than 13.4% of the patients were older than 80 years compared with 12.4% in 2010. Hospital mortality in 41,976 isolated coronary artery bypass graft procedures (14.7% off-pump) was 2.9%. In 26,972 isolated valve procedures (including 5,210 catheter-based procedures), an in-hospital mortality of 5.2% has been observed.This voluntary registry of the German Society for Thoracic and Cardiovascular Surgery will continue to be an important tool enabling quality control and illustrating current facts and the development of cardiac surgery in Germany.     

平板运动试验在胸外科手术前的评估价值

目的 研究胸外科术前常规进行平板运动试验评估心血管风险的有效性。方法 回顾性入选2016.1~2016.6期间我院273例拟接受胸外科手术的的患者,常规进行运动平板评估,并随访至围手术期结束。结果 273名患者中,231名患者平板运动阴性,35人阳性,7人可疑阳性,阳性及可疑阳性患者均接受冠脉造影检查。其中8人接受预防性PCI手术,1人放弃后续治疗,14人存在冠脉非显著病变,19人完全正常。共有264名患者接受了胸外科手术,围术期心梗1人。平板运动试验的敏感性为95.8%,特异性为92.4%,阳性预测价值54.8%,阴性预测价值99.6%,准确率92.7%。 结论 胸外科手术是一种高危或中高危手术,术前常规平板运动试验敏感性较高,能识别绝大多数潜在心血管风险的患者,而且临床应用简便经济,可以得到进一步推广。     

Standardization of Bromelin for Use in Routine One-Stage Antibody Screening

A simple standardization method for bromelin used in routine one-stage antibody screening is described. Bromelin proteinase activity was assayed using casein as the substrate, and converted to units. The use of proteinase activity units for standardization of bromelin resolves differences between commercial preparations.     

Comparison of the Quality of Life after Skeletonized versus Pedicled Grafts in Coronary Artery Bypass Graft Surgery

It remains a controversial issue whether internal thoracic artery (ITA) should be dissected in skeletonized or pedicled manner during coronary artery bypass graft (CABG) surgery. The main objective of this cohort study was to compare skeletonized versus pedicled grafts on the basis of patients'' perceptions of their physical and mental well-being. Isolated nonemergent CABG patients were divided into two groups according to the type of graft used; skeletonized or pedicled. The quality of life (QOL) was measured preoperatively, 6 months postoperatively, and 12 months postoperatively for each patient using the 36-Item Short Form Health Survey tool. The main outcome variables were physical component summary (PCS) score and mental component summary (MCS) score. A total of 140 patients were included in the study with 70 patients in each group. The PCS (p-value = 0.235) and MCS (p-value = 0.239) scores of patients were similar in both the groups before CABG. The PCS and MCS scores were significantly (p-values < 0.0001) improved after CABG at 6 months in both the groups. However, the PCS and MCS scores in the skeletonized group were significantly higher (p-values < 0.0001) than the scores in the pedicled group at 6 and 12 months post-CABG. Both the harvesting techniques improve QOL significantly after CABG. However, skeletonization results in significantly better PCS and MCS scores compared with pedicled harvesting technique.     

糖尿病患者胸部手术围术期血糖控制50例分析

目的探讨糖尿病患者胸部手术围术期血糖的控制及其对手术的影响。方法回顾性分析50例胸部肿瘤并糖尿病患者接受胸科术治疗围术期的血糖调控情况。50例患者分别接受肺叶切除术、全肺切除术、肺楔形切除术、支气管袖形切除术、余肺切除术、食管贲门癌切除胃代食管术、纵隔肿瘤切除术及全胸骨切除术等复杂胸科手术治疗,术前、术中及术后分别控制血糖。结果50例患者入院时空腹血糖平均(9·2±1·4)mmol/L,术后第1、2、3d平均血糖分别为(11·6±1·0)mmol/L、(10·2±1·0)mmol/L、(9·5±0·7)mmol/L;并发术后感染5例次,吻合口瘘1例,肺功能不全、呼吸机支持2例,并发症发生率为16·0%,死亡率为2·0%。结论糖尿病患者经正确的围术期处理,将血糖维持至基本正常水平,可耐受复杂的胸部手术。