Immediate and six months clinical and angiographic results of intracoronary paclitaxel-coated stent implantation - the Meo:DrugStar-1 study

The study was conducted to evaluate the clinical and angiographic results of the implantation of the paclitaxel-eluting stent Meo:DrugStar ST in patients with symptomatic coronary artery disease. The Meo:DrugStar ST stent has a stainless steel stent platform with a homogenous non-biodegradable coating of paclitaxel mixed with a polyether-based biostable, monophase, and hemocompatible coating. Sixty patients with native coronary artery disease were included in the study. The Meo:DrugStar ST stents were implanted in 60 de novo lesions detected in these patients. Immediate and long-term clinical and angiographic follow-up results were evaluated. There was a high proportion of patients with hypertension (55%) according to JNC-VII. Mean stenosis ratio was 78 +/- 13 %, mean implanted stent diameter was 3.0 +/- 0.4 mm and mean length was 22 +/- 5 mm. Restenosis was detected in 4 (10%) of those patients and 11 (27.5%) of 40 patients had insignificant amount of restenosis. The results of this study indicate a potential benefit of the Meo:DrugStar ST stent for the prevention of stent thrombosis and restenosis in these relatively high-risk patients.     

Can measurement of cervical length,fetal head position and posterior cervical angle be an alternative method to Bishop score in the prediction of successful labor induction?

Aim: The purpose of this study was to evaluate sonographic cervical length, posterior cervical angle and fetal head position in predicting successful induction of labor at term can be an alternative method to Bishop score.

Methods: This prospective observational study recruited 223 women with singleton gestations scheduled for induction of labor at 37–42 weeks. Parity, body mass index, Bishop score, fetal head position, cervical angle measurement and cervical length was investigated to predict successful labor induction. Multiple regression analysis was performed to determine the parameters in the prediction of successful vaginal delivery within 24 hours.

Results: Forty-five patients were excluded because of cesarean section performed for other reasons than arrest of dilation or fetal head descent (43 fetal distress, 2 cord prolapsus). Remaining 178 patients were divided into two groups according to duration of delivery time. 139 patients delivered within 24 hours were classified as group I, 39 patients delivered after 24 hours were classified as group II. Percentage of multiparity was statistically significantly higher in group I than in group II [59 (42.4%), 9 (23.0%) respectively, p?=?0.009]. Cervical length was statistically significantly shorter in group I than in group II [23.1?±?7.42?mm, 31.3?±?6.83?mm respectively, p?<?0.001]. Bishop score was statistically significantly higher in group I than in group II [3 (1–4), 1 (1–4) respectively, p?<?0.001]. Posterior cervical angle was statistically significantly higher in group I than in group II [100.1?±?17.2, 92.7?±?21.4 respectively, p?=?0.007]. According to the fetal head position, there was no statistically significant difference in labor duration between the groups (p?=?0.787). In the multivariate regression analysis of variables, multiparity, cervical length and Bishop score were statistically significantly predictive in successful labor induction.

Conclusion: Multiparity status, cervical length, posterior cervical angle and Bishop score can predict successful labor induction, but fetal head position is not predictive in successful labor induction.     

Tolvaptan treatment in hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH): effects on survival in patients with cancer

Purpose

To investigate the clinical outcomes of patients with hyponatremia who received supportive treatment or tolvaptan plus supportive treatment and the effects of treatment and other variables on overall survival

Methods

This study included oncology patients who were hospitalized at two oncology centers between January 1, 2016 and December 31, 2019 for hyponatremia (sodium levels?<?135 mEq/L) and who received tolvaptan plus supportive treatment (n?=?22) or supportive treatment only (n?=?42).

Results

The median age of all the patients was 59 years (range 26–85) and 64.1% of the patients were male. There was no statistically significant difference between patients in the tolvaptan plus supportive treatment (TpST) group and the supportive treatment only (ST) group in terms of gender and age (p?>?0.05). In the TpST group, recovery days of the hyponatremia after treatment and the length of hospital stay was shorter and hyponatremia symptoms and hospital complications were less frequent compared to the ST group (p?<?0.05). There was no significant difference between the TpST group and the ST group in terms of overall survival (OS). OS was shorter in men who were non-responders to hyponatremia treatment and had recurrent hyponatremia. Multivariable analysis showed that normal sodium levels after treatment decreased the risk of death.

Conclusion

In the treatment of hyponatremia in cancer patients, TpST was found to have more positive effects on blood sodium levels, length of hospital stay, hospital complications, and hyponatremia symptoms compared to ST. A decreased risk of death was observed in patients with normal sodium levels after treatment.

     

Concurrent septic arthritis and urinary tract infection in a patient with nephrocalcinosis and vesicoureteral reflux

An eight-month-old boy who presented with a 15-day history of vomiting was revealed to be suffering from urinary tract infection and nephrocalcinosis caused by vitamin D intoxication. During the treatment of vitamin D intoxication (alendronate, 5 mg/day), he developed urinary tract infection and septic arthritis of the left hip joint. Escherchia coli was isolated from his blood, urine, and joint fluid culture. He was operated, joint drainage was performed and appropriate intravenous antibiotic treatment was given for four weeks. After discharge, a voiding cystoureterogram revealed grade 4 vesicoureteral reflux in the right ureter. Combination of complex urinary anomalies associated with stagnation of urine flow and altered urinary dynamics, and metabolic urinary anomalies, such as hypercalciuria/nephrocalcinosis, may facilitate the occurrence of rare systemic complications of urinary tract infection.     

Autonomic Disturbances in Acute Cerebrovascular Disease

Autonomic disturbances often occur in patients with acute cerebrovascular disease due to damage of the central autonomic network. We summarize the structures of the central autonomic network and the clinical tests used to evaluate the functions of the autonomic nervous system.We review the clinical and experimental findings as well as management strategies of post-stroke autonomic disturbances including electrocardiographic changes, cardiac arrhythmias, myocardial damage, thermoregulatory dysfunction, gastrointestinal dysfunction, urinary incontinence, sexual disorders, and hyperglycemia. The occurrence of autonomic disturbances has been associated with poor outcomes in stroke patients. Autonomic nervous system modulation appears to be an emerging therapeutic strategy for stroke management in addition to treatments for sensorimotor dysfunction.     

The relationship between echocardiographic features of mitral valve and elastic properties of aortic wall and Beighton hypermobility score in patients with mitral valve prolapse

The present study was designed to investigate the incidence of benign joint hypermobility syndrome (BJHMS) in mitral valve prolapse (MVP) and the correlation between the echocardiographic features of the mitral valve and elastic properties of the aortic wall and Beighton hypermobility score (BHS) in patients with MVP and BJHMS. Fourty-six patients with nonrheumatic, uncomplicated, and isolated mitral anterior leaflet prolapse (7 men and 39 women, mean age; 26.1 +/- 5.9) and 25 healthy subjects (3 men and 22 women, mean age, 25.4 +/- 4.3) were studied. Patients were divided into two groups according to their BHS (group I, MVP+BJHMS; group II, MVP-BJHMS). Individuals with accompanying cardiac or systemic disease were excluded. Echocardiographic examination was performed in all subjects. The presence of BJHMS was evaluated according to Beighton's criteria. The incidence of BJHMS in patients with MVP was found to be significantly higher than that of controls (45.6%, (21/46) vs 12% (3/25), P < 0.0001). Group I (MVP + BJHMS) had significantly increased anterior mitral leaflet thickness (AMLT, 3.4 +/- 0.4 vs 3.1 +/- 0.3; P < 0.005), maximal leaflet displacement (MLD, 2.4 +/- 0.4 vs 1.7 +/- 0.4; P < 0.005), and degree of mitral regurgitation (DMR, 17.1 +/- 7.2 vs 11.2 +/- 4.4; P < 0.01) compared to group II. However, the index of aortic stiffness (IAOS) was found to be lower (17.6 +/- 6.9 vs 23.9 +/- 7.6; P < 0.005) and aortic distensibility (AOD) to be higher (0.0035 +/- 0.007 vs 0.0024 +/- 0.005; P < 0.005) in group I. There was a significant correlation between AMLT, MLD and DMR, and BHS (r = 0.57/P = 0.007, r = 0.55/P < 0.009, r = 0.51/P < 0.01, respectively). In addition, AOD correlated positively with BHS (r = 0.53/P < 0.005), but the index of aortic stiffness correlated inversely with BHS (r = -0.49/P < 0.007). The incidence of BJHMS in patients with MVP was more frequent than the normal population and there was a significant correlation between the severity of BJHMS (according to BHS) and echocardiographic features of the mitral leaflets and elastic properties of the aortic wall.     

Determination of left ventricular filling pressure by new echocardiographic methods in patients with coronary artery disease

Aim The present study was designed to determine the reliability of the analysis of the time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity and mean systolic strain index, and comparing them with E/E′ in the detection of increased left ventricular end-diastolic pressure (LVEDP) in patients with coronary artery disease. Methods Eighty patients (mean age: 57.2 ± 11.5 years) referred for cardiac catheterization were studied. Patients were divided into 2 groups according to LVEDP (group 1: LVEDP > 20 mmHg, n = 39 patients; group 2: LVEDP ≤20 mmHg, n = 41 patients). From the mitral inflow, peak E velocity was calculated. With tissue Doppler echocardiography, early diastolic velocity (E′) measured from the septal, lateral, inferior and lateral mitral annulus and mean value of E′ and E/E′ ratio were calculated. The time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity (T_E′-E) was calculated. From the apical chambers, the peak systolic strain value of 16 left ventricular (LV) segments was measured and the mean of these 16 segments was calculated and referred to as mean systolic strain index. Results The patients with increased LVEDP (group 1) had a higher E/E′ ratio (13.8 ± 3.4 vs. 9.9 ± 2.8, P < 0.001) and lower mean systolic strain index (11.8 ± 3.4 % vs. 13.5 ± 3.6 %, P = 0.038) than patients in group 2. The sensitivity of E/E′ > 13.42 for identifying LVEDP > 20 mmHg was 71%, with a specificity of 89%. The sensitivity of a mean systolic strain index < 10.57% for identifying LVEDP > 20 mmHg was 44%, with a specificity of 83%. T_E′-E was not significantly different between the two groups. Conclusion The decreased longitudinal function of the left ventricle is related to increased LVEDP. The E/E’ ratio, which in recent years has been used for the prediction of LV filling pressures, was a better predictor for increased LVEDP than the mean systolic strain score index and the time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity in patients with coronary artery disease.     

Epileptic Seizure Detection Using Probability Distribution Based On Equal Frequency Discretization

In this study, we offered a new feature extraction approach called probability distribution based on equal frequency discretization (EFD) to be used in the detection of epileptic seizure from electroencephalogram (EEG) signals. Here, after EEG signals were discretized by using EFD method, the probability densities of the signals were computed according to the number of data points in each interval. Two different probability density functions were defined by means of the polynomial curve fitting for the subjects without epileptic seizure and the subjects with epileptic seizure, and then when using the mean square error criterion for these two functions, the success of epileptic seizure detection was 96.72%. In addition, when the probability densities of EEG segments were used as the inputs of a multilayer perceptron neural network (MLPNN) model, the success of epileptic seizure detection was 99.23%. This results show that non-linear classifiers can easily detect the epileptic seizures from EEG signals by means of probability distribution based on EFD.