Hypertension is not a typical feature of steroid sensitive nephrotic syndrome (SSNS) and the presence of persistent hypertension is suggestive of significant renal lesion. There is paucity of data regarding occurrence and severity of hypertension in SSNS in pediatric population during remission and was the main objective of this study. In addition, correlation with factors like family history, BMI, and lipid profile was studied.
Methods
Cross-sectional study conducted at tertiary care center in India including 81 children of infrequent relapsing SSNS between 1 and 10 years in remission and was off steroids. Grading and severity of hypertension were assessed. Statistical analysis was done using SPSS version 21.0.
Results
Median age of presentation was 5 years, with male:female ratio of 1.3:1. Out of 81 infrequent relapsing SSNS children, 23.45% (19) had hypertension. Among those children with hypertension (n?=?19), 73.68% (14) had positive family history compared to 32.25% (20) in those without hypertension. Positive correlation was found between BP and serum cholesterol and LDL. Of the hypertensive patients, 1 (5.26%) had fundus changes, 2 (10.52%) had features of left ventricular hypertrophy, and 13 (68.42%) had non-nephrotic range proteinuria.
Conclusion
There is high incidence of hypertension in NS children during remission. Though significant positive correlation was found with positive family history of hypertension and deranged lipid profile highlighting possibility of essential hypertension in them, there is need for close active monitoring and management of hypertension in them as untreated cases may have significant target organ damage.
There are no significant differences in outcomes between patients receiving inpatient and day-case lumbar microdiscectomy, but the latter is still underused in the NHS. Here we aimed to identify factors contributing to successful same-day discharge in day-case patients.
Methods
This was a retrospective observational study of patients undergoing elective lumbar microdiscectomy between August 2012 and December 2014. Age, gender, day of surgery, distance to hospital, ASA grade, regular opiate use, smoking status, order on the operating list, and side and level of surgery were examined by logistic regression to assess their influence on same-day discharge.
Results
28/95 (29.5%) patients were discharged on the day of surgery. Age (p = 0.041), ASA grade (p = 0.016), distance to hospital (p = 0.011), and position on the list (p = 0.004) were associated with day-case discharge by univariate analysis. ASA grade (p = 0.032; OR 0.176), distance to hospital (p = 0.003; OR 0.965), and position on the operating list (morning case; p = 0.011; OR 8.901) remained significant in multivariate analysis. Thirteen (13.7%) patients were identified who could have been managed as day cases had they been listed for morning operations.
Conclusions
Day-case lumbar microdiscectomy is viable when patients are carefully selected. Younger, fit patients living close to the hospital and operated on in the morning are more likely to be discharged on the same day. Knowledge of these factors while planning elective lists can help optimise bed space and improve spinal services. 相似文献
Acetabulum has a complex anatomy due to which anatomical acetabular plates are still under developmental phase. Although intra-operative contouring of reconstruction plate is done as a standard practice, it is associated with increased operative time and morbidity of patient. We have designed an acetabular plate for posterior fixation from experience of previous studies performed in our institute on acetabular fracture fixation which should be appropriate for most of the patient of Indian origin. Apart from avoiding intra-operative contouring of acetabular plates it also helps in preventing intra articular screw penetration.
Methods
We selected five consecutive patients with acetabular fracture needed to be operated from posterior approach and designed patient specific plate template from virtual surgical planning and 3D printing. These plate templates were then matched with our acetabular plate design and were used intra-operatively. Many parameters were assessed to evaluate accuracy of our plate design in those five patients.
Result
All the plate templates appear to match our designed plate and no intra-operative contouring was required with our plate design.
Conclusion
This was a pilot study and we need a large sample size to study accuracy of our acetabular plate design which might avoid intra-operative contouring, decreasing morbidity of patient and prevent wastage of resources in pre-operative planning and computer designing. 相似文献
The optimal treatment for isolated fractures of ulnar shaft is debatable. The purpose of this study was to compare functional outcomes and radiological union in patients treated for isolated fractures of the ulnar shaft by open reduction and internal fixation and a long arm cast.
Methods
This prospective study was conducted at level I trauma center from November 2014 to March 2016. 30 patients with isolated fractures of ulnar shaft were randomized to two groups to receive treatment by open reduction and internal fixation by plates and screws and a long arm cast. Outcome assessment was done by Disabilities of Arm Shoulder and Hand (DASH) score, range of motion at wrist and elbow, grip strength and radiological union. Quantitative variables were summarized Mean or Median. Normality was assessed using Kolmogorov-Smirnov test. Independent samples t-test and Mann-Whitney test were used for normally distributed variables and non-normally distributed variables respectively. Categorical variables were summarized as proportions. Effect of the intervention for categorical variables was assessed using Chi-square test
Results
There was no difference between the groups for pain on Visual Analogue Scale (VAS), grip strength, DASH score, and union at the end of 12 months. There was no difference between the groups for range of motion at the elbow and wrist. 12 (85.7%) patients in the ORIF group and 15 (93.7%) in the cast group united at the end of 12 months. The mean time to union was 13 weeks in the ORIF group and 18 weeks in the cast group.
Conclusion
Open reduction and internal fixation results in anatomical restoration of ulna, but this does not translates to better functional outcomes in short term (12 months). 相似文献
Upper limb length discrepancy is a rare occurrence. Humerus shortening may need specialized treatment
to restore the functional and cosmetic status of upper limb. We report a case of humerus lengthening of 9 cm with a monorail external fixator and the result was observed during a 2-year follow-up. Humerus lengthening needs specialized focus as it is not only a cosmetic issue but also a functional demand. The monorail unilateral fixator is more functional and cosmetically acceptable, and thus becomes an effective treatment option. 相似文献
Exosomes are extracellular vesicles that express self-antigens (SAgs) and donor human leukocyte antigens. Tissue-specific exosomes can be detected in the circulation following lung, heart, kidney and islet cell transplantations. We collected serum samples from patients who had undergone lung (n?=?30), heart (n?=?8), or kidney (n?=?15) transplantations to isolate circulating exosomes. Exosome purity was analyzed by Western blot, using CD9 exosome-specific markers. Tissue-associated lung SAgs, collagen V (Col-V) and K-alpha 1 tubulin (Kα1T), heart SAgs, myosin and vimentin, and kidney SAgs, fibronectin and collagen IV (Col-IV), were identified using western blot. Lung transplant recipients diagnosed with bronchiolitis obliterans syndrome had exosomes with higher expression of Col-V (4.2-fold) and Kα1T (37.1-fold) than stable. Exosomes isolated from heart transplant recipients diagnosed with coronary artery vasculopathy had a 3.9-fold increase in myosin and a 4.7-fold increase in vimentin compared with stable. Further, Kidney transplant recipients diagnosed with transplant glomerulopathy had circulating exosomes with a 2-fold increased expression of fibronectin and 2.5-fold increase in Col-IV compared with stable. We conclude that circulating exosomes with tissue associated SAgs have the potential to be a noninvasive biomarker for allograft rejection. 相似文献
A brain-computer interface (BCI) system allows direct communication between the brain and the external world. Common spatial pattern (CSP) has been used effectively for feature extraction of data used in BCI systems. However, many studies show that the performance of a BCI system using CSP largely depends on the filter parameters. The filter parameters that yield most discriminating information vary from subject to subject and manually tuning of the filter parameters is a difficult and time-consuming exercise. In this paper, we propose a new automated filter tuning approach for motor imagery electroencephalography (EEG) signal classification, which automatically and flexibly finds the filter parameters for optimal performance. We have evaluated the performance of our proposed method on two public benchmark datasets. Compared to the existing conventional CSP approach, our method reduces the average classification error rate by 2.89% and 3.61% for BCI Competition III dataset IVa and BCI Competition IV dataset I, respectively. Moreover, our proposed approach also achieved lowest average classification error rate compared to state-of-the-art methods studied in this paper. Thus, our proposed method can be potentially used for developing improved BCI systems, which can assist people with disabilities to recover their environmental control. It can also be used for enhanced disease recognition such as epileptic seizure detection using EEG signals.
