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1.
Purpose:To evaluate the rate of compliance and the reasons for loss to follow-up in Indian patients with diabetic macular edema (DME), age-related macular degeneration (AMD), and retinal vein occlusion (RVO) being treated with anti-vascular endothelial growth factor (VEGF) therapy.Methods:This was a retrospective single-center study. Patients with DME, AMD, or RVO were eligible if they initiated anti-VEGF therapy between January 2013 and December 2017. Patients'' data were obtained from hospital electronic records, including the number of injections received, visits, details of follow-up, missed appointments, and reasons for loss to follow-up (>365 days).Results:A total of 648 patients were eligible for the study, of which 334 (51.54%) patients were lost to follow-up. Overall, 343 (64.96%) were males and the overall mean (SD) age was 66.40 (7.44) years. A total of 376 (58.0%) patients had a history of diabetes and 364 (56.2%) patients had a history of hypertension. Further, 127 (38.0), 112 (33.5), and 95 (28.4) had DME, AMD, and RVO, respectively and were lost to follow-up. The most commonly reported reason for loss to follow-up was “non-affordability” (n = 120; 41.1%) followed by “no improvement in vision” (n = 83; 28.4%). “No improvement in vision” (42.2%) and “non-affordability” (37.5%) were higher among patients with DME. No association was found in gender- and treatment-wise distribution of reasons for loss to follow-up.Conclusion:The results showed that around half of the patients with DME, AMD, and RVO were lost to follow-up to intravitreal anti-VEGF therapy, and the most common factors were “non-affordability” and “no improvement in vision.”  相似文献   
2.
Jaw tremor can be seen as a component of various neurological disorders such as essential tremor, Parkinson's disease, dystonia, branchial myoclonus, hereditary geniospasm, task-specific tremor, and Whipple's disease, as well as in normal situations such as shivering, and subclinical physiological jaw tremor. In most of these conditions, the jaw tremor is usually associated with tremor or other abnormal involuntary movements affecting additional body parts, and its frequency is lower than 12 Hz. Schrag and colleagues reported a patient with a high-frequency idiopathic jaw tremor, and they speculated it could be related to orthostatic tremor affecting the masseter muscles. We encountered a similar patient with intermittent rapid focal jaw tremor that was successfully treated with botulinum toxin injections to the masseters.  相似文献   
3.
Spirometry can be used as an objective tool for measuring nasal patency. it is sensitive, easy to perform, comfortable to patient The only limitation being that it only can be done in institution.  相似文献   
4.
Impedance plethysmographic observations have been correlated with aortographic observations in 57 patients suspected of aortic occlusive diseases. Aortic occlusions have been characterised by marked decrease in blood flow index and significant increase in differential pulse arrival time at thigh level bilaterally. Atherosclerotic affection of the aorta has been featured by a bilateral decrease in the value of blood flow index as well as differential pulse arrival time at thigh level. Leriche's syndrome, however, has been found to decrease the blood flow index moderately at thigh in both the legs without any significant change in differential pulse arrival time. Aortography in all the patients has confirmed the diagnosis made by impedance plethysmography.  相似文献   
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Essentials

  • The role of von Willebrand factor (VWF) domains in regulating platelet adhesion was studied in vivo.
  • Multimeric VWF with spacers at the N‐ and C‐terminus of VWF‐A1 were systematically tested.
  • N‐terminal modified VWF avidly bound platelet GpIbα, causing VWD Type2B like phenotype in mice.
  • Novel anti‐D'D3 mAbs suggest that changes at the D'D3‐A1 interface may be biologically relevant.

Summary

Background

Previous ex vivo studies using truncated VWF (von Willebrand factor) suggest that domain‐level molecular architecture may control platelet‐GpIbα binding function.

Objective

We determined if this is the case with multimeric VWF in vivo.

Methods

Full‐length human VWF (‘hV’) was modified with a 22‐amino acid mucinous stretch at either the N‐terminus of VWF‐A1 to create ‘hNV’ or C‐terminus to yield ‘hCV’. This extends the physical distance between VWF‐A1 and the adjacent domains by ~6 nm. Similar mucin inserts were also introduced into a human‐murine chimera (‘h[mA1]V’) where murine‐A1 replaced human‐A1 in hV. This yielded ‘h[mA1]NV’ and ‘h[mA1]CV’, with N‐ and C‐terminal inserts. The constructs were tested ex vivo and in vivo.

Results

Mucin insertion at the N‐terminus, but not C‐terminus, in both types of constructs resulted in >50‐fold increase in binding to immobilized GpIbα. N‐terminal insertion also resulted in greater shear‐induced platelet activation, more thrombus formation on collagen, enhanced platelet accumulation and slower platelet translocation on immobilized VWF in microfluidics assays. Hydrodynamic injection‐based expression of h[mA1]NV, but not h[mA1]V or h[mA1]CV, in VWF?/? mice caused profound thrombocytopenia, reduced plasma VWF concentrations, lower multimer distribution, and incessant tail bleeding that is reminiscent of von Willebrand disease type 2B. Platelet plugs were noted in the portal veins and hepatic arteries. An anti‐D'D3 mAb DD3.3 that displays enhanced binding to VWF containing the N‐terminal mucin insert also exhibited increased binding to wild‐type VWF under shear and upon ristocetin addition.

Conclusion

Conformation changes at the VWF D'D3‐A1 interface may be a key regulator of thrombosis in vivo. Structural features at the A1‐A2 interface are likely of less significance.
  相似文献   
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Background

Incidental gallbladder cancer (IGC) is an infrequent possibility in patients undergoing cholecystectomies. Routine histologic examination of all gallbladder specimens is the current approach to detect this disease. Our study presents the influence of age to perform a selective histologic analysis.

Methods

A retrospective review was conducted of all gallbladder specimens during the last 9 years in our hospital. The medical notes were retrieved for cases of IGC or dysplasia and perioperative data were collected.

Results

A total of 3,330 cholecystectomies were conducted over the study period, 3,041 for gallstone disease. Twelve patients were found with dysplasia and 13 patients with IGC, all of them occurred in gallbladders removed for gallstone diseases. There were 18 men with a median age of 65 years (range 18 to 85). Median age for cancer patients was 70 years (range 51 to 85) and 54 years for dysplasia (range 18 to 75). No patient below the age of 51 years (n = 1,464) experienced IGCs.

Conclusion

Age should be considered as an additional factor for a selective approach to the histologic analysis of all gallbladder specimens following cholecystectomies.  相似文献   
10.
Posterior transversus abdominis plane blocks have been reported to be an effective method of providing analgesia after lower abdominal surgery. We compared the efficacy of a novel technique of providing continuous transversus abdominis plane analgesia with epidural analgesia in patients on an enhanced recovery programme following laparoscopic colorectal surgery. A non‐inferiority comparison was used. Adult patients undergoing elective laparoscopic colorectal surgery were randomly assigned to receive continuous transversus abdominis plane analgesia (n = 35) vs epidural analgesia (n = 35), in addition to a postoperative analgesic regimen comprising regular paracetamol, regular diclofenac and tramadol as required. Sixty‐one patients completed the study. The transversus group received four‐quadrant transversus abdominis plane blocks and bilateral posterior transversus abdominis plane catheters that were infused with levobupivacaine 0.25% for 48 h. The epidural group received an infusion of bupivacaine and fentanyl. The primary outcome measure was visual analogue scale pain score on coughing at 24 h after surgery. We found no significant difference in median (IQR [range]) visual analogue scores during coughing at 24 h between the transversus group 2.5 (1.0–3.0 [0–5.5]) and the epidural group 2.5 (1.0–5.0 [0–6.0]). The one‐sided 97.5% CI was a 0.0 (∞–1.0) difference in means, establishing non‐inferiority. There were no significant differences between the groups for tramadol consumption. Success rate was 28/30 (93%) in the transversus group vs 27/31 (87%) in the epidural group. Continuous transversus abdominis plane infusion was non‐inferior to epidural infusion in providing analgesia after laparoscopic colorectal surgery.  相似文献   
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