ABC goal achievement predicts microvascular but not macrovascular complications over 6-years in adults with type 1 diabetes: The Coronary Artery Calcification in Type 1 Diabetes Study

HypothesisVascular complications of type 1 diabetes are thought to cluster. We examined the prevalence and incidence of vascular complications and American Diabetes Association's ABC goal achievements in a prospective cohort of adults with type 1 diabetes. We hypothesized that ABC achievement at baseline would predict both micro- and macrovascular complications over 6-years.MethodsParticipants (N = 652) were 19–56 year old at baseline and re-examined 6-years later. Microvascular complications included diabetic nephropathy (DN), defined as incident albuminuria (AER ≥ 20 μg/min) or rapid GFR decline (> 3.3%/year) by CKD-EPI cystatin C and proliferative diabetic retinopathy (PDR), defined as laser eye-therapy. Macrovascular complications were defined as coronary artery calcium progression (CACp), measured by electron-beam computed-tomography. ABC goals were defined as HbA1c < 7.0%, BP < 130/80 mmHg and LDL-C < 100 mg/dL.ResultsABC control was suboptimal with only 6% meeting all goals. Meeting no ABC goals at baseline compared to meeting all goals was associated with increased odds of developing microvascular complications (OR: 8.5, 2.3–31.5, p = 0.001), but did not reach significance for CACp (OR: 1.7, 0.8–3.9, p = 0.19).ConclusionABC achievement at baseline strongly predicted microvascular but not macrovascular complications over 6-years in adults with type 1 diabetes, suggesting a need for novel therapeutic targets to complement conventional risk factors in treating macrovascular complications.     

CLINICAL AND DEMOGRAPHIC PREDICTORS OF UNILATERAL SPATIAL NEGLECT RECOVERY AFTER PRISM THERAPY AMONG STROKE SURVIVORS IN THE SUB-ACUTE PHASE OF RECOVERY

Background and AimsUnilateral Spatial Neglect (USN) affects rehabilitation process and leads to poor outcomes after stroke. Intervention for USN treatment has been suggested such as prism therapy (PA). However, factors that influence USN recovery has not been investigated. This study investigated the predictors of USN recovery after prism therapy.MethodsThis study was a single-blinded randomised controlled trial. USN was assessed with the conventional subset of the behavioural inattention test (BIT-C). A total of 74 USN patients who presented with USN following right-brain damage were divided into prism (n = 37) and control (n = 37) groups. Prism group used 20 dioptre prism lenses for repeated aiming, for 12 sessions, the control group used neutral lenses for similar aiming training. Clinical recovery was defined as BIT-C score>129: recovery, BIT-C score< 129: No recovery. Logistic regression was done to establish significant variable in the prediction recovery after PA.ResultsThere were significantly greater improvement of BIT-C in the intervention group post treatment (P≤0.001). Predictor variables considered in this study was cognitive ability (assessed using the mini-mental scale), gender, age, years of education, race, employment status, handedness, type of stroke, site of stroke and site of stroke. Cognitive ability (OR =1.52, CI=1.08-2.14, p= 0.016) was found to significantly influence recovery following PA treatment.ConclusionsThis study highlights the characteristics of stroke patient that will most likely benefit from a PA treatment regimen. Higher cognitive ability was implicated to be a factor for USN recovery after PA treatment post-stroke.     

Optical coherence tomography angiography of the peripapillary region and macula in normal, primary open angle glaucoma, pseudoexfoliation glaucoma and ocular hypertension eyes

AIM: To introduce a modified technique of internal limiting membrane (ILM) centripetal dragging and peeling to treat idiopathic macular hole (IMH) and to observe the ILM-retina adhesive forces. METHODS: Twenty-six consecutive patients with stage 3 to 4 IMH and followed up at least six months were enrolled. All patients underwent complete par plana vitrectomy, ILM dragging and peeling, fluid and gas exchange, 15% C3F8 tamponade and 2-week prone position. The best corrected visual acuity, macular hole evaluation by optical coherence tomography, and complications were evaluated. RESULTS: The mean diameter of IMH was 524.2±147.9 μm (range: 201-683 μm), with 21 cases (80.7%) greater than 400 μm. ILM dragging and peeling were successfully performed in all cases. Most of the ILM-retina adhesive forces are severe (43.3%, 11/26), followed by mild (38.46%, 10/26), and moderate (19.23%, 5/26). The mean follow-up duration was 21.2±6.1mo. The IMH was closed in 25 (96.2%) eyes. Visual acuity (logMAR) improved significantly from 1.2±0.6 preoperatively to 0.7±0.5 postoperatively (P<0.001). CONCLUSION: Preexisting ILM-retina adhesive force is found in IMH patients. With assistance of this force, this modified technique may help to release the IMH edges and improve the closure rate of large IMH.     

正电子发射计算机断层显像影像组学在非小细胞肺癌治疗中的应用

原发性肺癌是我国乃至全世界发病率和死亡率位居首位的恶性肿瘤,且死亡率呈上升趋势,严重危害着人类健康。影像组学(radiomics)通过挖掘高维影像特征与病理生理特征之间的深层关系,进而建立鉴别病理类型、肿瘤分期、远处转移和生存的预测模型,指导个体化诊疗策略,改善预后。正电子发射计算机断层显像(PET/CT)可通过反映肿瘤组织代谢而具有较高的诊断准确性和特异性。本文就PET/CT影像组学在非小细胞肺癌(NSCLC)治疗中的应用进行综述。     

Dual mobility articulation total hip arthroplasty for displaced neck fracture in elderly with neuromuscular disorder

PurposeNeuromuscular disease is well known to be at increased risk of complications following hip replacement surgeries. This study is prospectively conducted to investigate clinical performance and survivorship of total hip arthroplasty (THA) using dual mobility articulation in femoral neck fractures of elderly with neuromuscular disease.Materials and MethodsWe prospectively enrolled 162 patients (162 hips) with displaced femoral neck fracture who gave informed consent for dual mobility articulation THA. Of the 162 patients, 35 patients had neuromuscular disease including cerebral palsy, poliomyelitis, hemiplegia, and Parkinson disease (NM group). The other 127 patients had no history of neuromuscular disease (non-NM group). The mean age was 76.5 years (range, 60 – 95) and female ratio was 71.0% (115/162). Clinical outcomes including Harris hip score (HHS), University of California Los Angles activity (UCLA) score were compared between the two groups. Computed tomography and serial radiographs were obtained after surgery. Postoperative complications and reoperation including revision were recorded.ResultsPain-VAS and all clinical scores of the NM group were comparable to those of the non-NM group. The incidence of dislocation in the NM group did not differ from that in Non-NM group (2/35, 5.7% versus 5/127, 3.9%, p = 0.645). Reoperation was performed in 3 hips (3/35, 8.6%) of the NM group and in 4 hips (4/127, 3.1%) of the non-NM group (p = 0.173). Kaplan-Meier survivorship with an end point of revision for any reason was 97.1% (95% confidence interval [CI], 0.92 to 1.03) in the NM group and 98.4% (95% CI, 0.96 to 1.01) in the non-NM group at 7.3 years after surgery.ConclusionsIn elderly with neuromuscular disease, THA with dual mobility articulation is a reasonable option as a treatment for femoral neck fractures.     

Is preoperative balloon aortic valvuloplasty of interest for severe aortic stenosis in hip fracture surgery?

PurposeIn elderly patients, the discovery and management of a severe aortic stenosis (AS) prior to emergency non-cardiac surgery is a frequent and controversial issue. The objective of this study was to evaluate preoperative balloon aortic valvuloplasty (BAV) for severe AS in hip fracture surgery.MethodsWe conducted an observational, monocentric, retrospective study from 2011 to 2018. Survival (30-day, 90-day and 180-day mortality) and the occurrence of perioperative complications were analyzed and compared between control (i.e. no BAV prior to surgery) and preoperative BAV groups in patients with hip fracture surgery and a formal transthoracic echocardiographic diagnosis of severe AS (aortic valve area < 1 cm²). Patients' allocation to the intervention and control groups was after a discussion between cardiologist, anesthesiologist and the surgeon.ResultsAmong the 8506 patients who underwent hip fracture surgery, 29 patients in the control group and 30 patients in the BAV group were finally included. Kaplan-Meier survival analysis demonstrated a significant decrease in mortality in the BAV group (p=0.014) despite an increase in median time to operation of about 48 hours (p<0.0001). Multivariate analysis (stepwise logistic regression) showed that postoperative delirium (OR [95%CI]: 17.5 [1.8-168]; p=0.013) and postoperative acute congestive heart failure (OR [95%CI]: 59.4 [5.0-711.1]; p=0.0013) were predictive factors of 30-day mortality with an area under ROC curve of 0.90 (95%CI: 0.80-0.97; p<0.0001).Conclusionspreoperative BAV for severe AS could reduce the mortality of hip fracture patients despite an increase in time to operation. This improved survival could be linked to the decrease in cardiologic and neurologic adverse events. A larger prospective randomized study is necessary before generalizing our results.     

Trauma patients with tibia/fibula fractures are associated with an increased risk of torso,severe head,and severe spine injuries compared to patients with femur fractures

BackgroundAlthough previous studies have demonstrated an association between lower extremity fractures and concomitant torso (thorax and abdomen) injuries in trauma patients, they do not compare different types of fractures. Therefore, we investigated the risk of associated torso injuries between femur and tibia/fibula fractures, hypothesizing that trauma patients with femur fractures are at higher risk of torso injuries compared to patients with tibia/fibula fractures.MethodsThe Trauma Quality Improvement Program database (2010-2016) was queried for patients presenting with either femur or tibia/fibula fractures. Patients with ground-level falls and penetrating injuries were excluded. Univariable and multivariable logistic regression analyses were performed.ResultsFrom 162,354 patients, 104,075 (64.1%) patients had femur fractures and 58,279 (35.9%) had tibia/fibula fractures. Compared to those with femur fractures, patients with tibia/fibula fractures had a higher incidence of torso injuries (32.2% vs. 17.7%, p<0.001). The tibia/fibula fracture group was also associated with an increased risk of torso (OR 2.22, CI 2.17-2.27, p<0.001), severe (abbreviated injury scale grade > 3) head (OR 2.38, CI 2.30-2.46, p<0.001), and severe spine injuries (OR 2.33, CI 2.07-2.62, p<0.001) compared to the femur fracture group. Additionally, patients with tibia/fibula fractures had a higher rate of deep vein thrombosis (2.5% vs. 1.8%, p<0.001) than patients with femur fractures.ConclusionsContrary to previous studies, we demonstrate patients with tibia/fibula fractures have a higher associated risk of torso, severe head and severe spine injuries than patients with femur fractures. Therefore, trauma surgeons should manage tibia/fibula fracture patients with similar clinical vigilance as femur fracture patients.