Cohort-controlled Study Research Articles

Comparison of the efficacy of spinal cord stimulation and dorsal root ganglion stimulation in the treatment of painful diabetic peripheral neuropathy: a prospective, cohort-controlled study.

The aim of this study was to compare the clinical outcomes of spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRG-S) in the treatment of painful diabetic peripheral neuropathy (PDPN). In this prospective cohort study, 55 patients received dorsal column spinal cord stimulation (SCS group) and 51 patients received dorsal root spinal cord stimulation (DRG-S group). The primary outcome was a Numerical Rating Scale (NRS) remission rate of ≥50%, and secondary outcomes included the effects of SCS and DRG-S on quality of life scores (EQ-5D-3L), nerve conduction velocity, and HbA1c, respectively. The percentage of NRS remission rate ≥ 50% at 6 months was 80.43 vs. 79.55%, OR (95% CI): 1.06 (0.38-2.97) in the SCS and DRG-S groups, respectively, and the percentage of VAS remission rate ≥ 50% at 12 months was 79.07 vs. 80.95%, OR (95% CI): 0.89 (0.31-2.58). Compared with baseline, there were significant improvements in EQ-5D and EQ-VAS at 6 and 12 months (p < 0.05), but there was no difference in improvement between the SCS and DRG-S groups (p > 0.05). Nerve conduction velocities of the common peroneal, peroneal, superficial peroneal, and tibial nerves were significantly improved at 6 and 12 months compared with the preoperative period in both the SCS and PND groups (p < 0.05). However, at 6 and 12 months, there was no difference in HbA1c between the two groups (p > 0.05). Both SCS and DRG-S significantly improved pain, quality of life, and lower extremity nerve conduction velocity in patients with PDPN, and there was no difference between the two treatments at 12 months.

How long is Long-COVID? Symptomatic improvement between 12 and 18 months in a prospective cohort study

IntroductionCOVID-19 infection can precede, in a proportion of patients, a prolonged syndrome including fatigue, exercise intolerance, mood and cognitive problems. This study aimed to describe the profile of fatigue-related, exercise-related,...

P-392 Controlled ovarian hyperstimulation applied before unilateral oophorectomy improves fertility preservation in cancer patients

Abstract Study question Can ovarian tissue cryopreservation (OTC) be performed after controlled ovarian hyperstimulation (COH)? Summary answer Unilateral oophorectomy after transvaginal oocyte retrieval is feasible on stimulated ovaries during one surgical step. What is known already In the fertility preservation (FP) field, the timeframe between patient referral and start of curative treatment is limited. Combining oocyte pick-up with ovarian tissue (OT) extraction has been reported to improve FP but COH applied before OT extraction is not currently recommended. Study design, size, duration This retrospective cohort-controlled study involved 58 patients who underwent oocyte cryopreservation immediately followed by OTC between September 2009 and November 2021. The exclusion criteria were a delay between oocyte retrieval and OTC of greater than 24 hours (n = 5) and in vitro maturation (IVM) of oocytes obtained ex-vivo in the ovarian cortex (n = 2). This FP strategy was performed either after COH (stimulated group, n = 18) or after IVM (unstimulated group, n = 33). Participants/materials, setting, methods Oocyte retrieval followed by OT extraction on the same day was performed either without previous stimulation or after COH. Adverse effects of surgery and ovarian stimulation, mature oocyte yield and pathology findings of fresh OT were retrospectively analysed. Thawed OTs were analysed prospectively, for vascularisation and apoptosis using immunohistochemistry, when patient consent was obtained. Main results and the role of chance No surgical complication occurred after OTC surgery in either group. In particular, no severe bleeding was associated with COH. The number of mature oocytes obtained increased after COH (8.5 [5.3–12.0] MII oocytes) compared to the unstimulated group (2.0 [1.0–5.3] MII oocytes, p &amp;lt; 0.001). Neither ovarian follicle density nor cell integrity was affected by COH. Fresh OT analysis showed congestion in half of the stimulated OT which was higher than in the unstimulated OT (3.1%, p &amp;lt; 0.001). COH also increased haemorrhagic suffusion (COH+OTC: 66.7%; IVM+OTC: 18.8%, p=0.002) and oedema (COH+OTC: 55.6%; IVM+OTC: 9.4%, p &amp;lt; 0.001). After thawing, the pathological findings were similar between both groups. No statistical difference in the number of blood vessels was observed between the groups. The oocyte apoptotic rate in thawed OT was not statistically different between the groups (ratio of positive cleaved caspase-3 staining oocytes/total number of oocytes equal to median 0.50 [0.33-0.85] and 0.45 [0.23-0.58] in unstimulated and stimulated groups respectively, p = 0.720). Limitations, reasons for caution The study reports FP from a small number of women following OTC. Follicle density and other pathology findings are an estimate only. Wider implications of the findings This approach could be proposed to post pubertal patients when the number of mature oocytes expected is low or when the risk of residual pathology is high. The reduction of surgical steps for cancer patients also has positive implications for introducing this approach into clinical practice. Trial registration number not applicable

Эффективность усовершенствованного артроскопического метода лечения пациентов с эпикондилитами плечевой кости

Background One of the most common reasons of patients’ visits with complaints in the area of the elbow joint is epicondylitis of the elbow joint. Surgical treatment is recommended if conservative treatment fails after 6-12 months. Arthroscopy of the elbow joint is one of the current surgical methods of minimally invasive interventions on the elbow joint. Purpose To conduct a comparative assessment of the effectiveness of treating epicondylitis of the elbow joint using modified arthroscopic and open techniques Methods A prospective cohort-controlled study was performed on 120 patients. The patients were divided into two groups: group 1 – patients operated on by the open method (control), group 2 – patients operated on by the arthroscopic method. Additionally, depending on the nosology, the patients were divided into four subgroups. Functional results were assessed using VAS, DASH, MEPS; additionally, dynamometry was performed before surgery, and 1, 3 and 12 months after surgery. Results There is a significant improvement in the function of the elbow joint one month after surgical treatment, mainly in III and IV subgroups according to the MEPS scale, p = 0.0001. According to the VAS scale, a pronounced and persistent decrease in pain in the long-term period compared with the preoperative period was revealed in patients of the arthroscopic subgroup p = 0.0001. According to the DASH questionnaire, the functional results in patients of arthroscopic group in the postoperative period significantly exceeded over the open method p &lt; 0.001. Discussion The use of the open surgical method provides good or excellent functional outcomes of treatment in 75-85 %. However, it has a number of disadvantages, including infectious complications and the inability of the surgeon to identify and completely remove the pathological altered tissues. The arthroscopic technique allows leveling these shortcomings and obtaining up to 95‑100 % excellent functional results. Conclusion Based on the data obtained in this study, the reatment of patients with epicondylitis of the distal humerus according to the developed arthroscopic technique significantly improves the functional state of patients, which, in turn, improves their quality of life.

Ovarian tissue cryopreservation can be combined simultaneously with oocyte retrieval after controlled ovarian hyperstimulation.

Can ovarian tissue cryopreservation (OTC) be performed after controlled ovarian hyperstimulation (COH)? Unilateral oophorectomy after transvaginal oocyte retrieval is feasible on stimulated ovaries during one surgical step. In the fertility preservation (FP) field, the timeframe between patient referral and start of curative treatment is limited. Combining oocyte pick-up with ovarian tissue (OT) extraction has been reported to improve FP but COH applied before OT extraction is not currently recommended. This retrospective cohort-controlled study involved 58 patients who underwent oocyte cryopreservation immediately followed by OTC between September 2009 and November 2021. The exclusion criteria were a delay between oocyte retrieval and OTC of >24 h (n = 5) and IVM of oocytes obtained ex vivo in the ovarian cortex (n = 2). This FP strategy was performed either after COH (stimulated group, n = 18) or after IVM (unstimulated group, n = 33). Oocyte retrieval followed by OT extraction on the same day was performed either without previous stimulation or after COH. Adverse effects of surgery and ovarian stimulation, mature oocyte yield and pathology findings of fresh OT were retrospectively analysed. Thawed OTs were analysed prospectively, for vascularization and apoptosis using immunohistochemistry, when patient consent was obtained. No surgical complication occurred after OTC surgery in either group. In particular, no severe bleeding was associated with COH. The number of mature oocytes obtained increased after COH (median = 8.5 (25% = 5.3-75% = 12.0)) compared to the unstimulated group (2.0 (1.0-5.3), P < 0.001). Neither ovarian follicle density nor cell integrity was affected by COH. Fresh OT analysis showed congestion in half of the stimulated OT which was higher than in the unstimulated OT (3.1%, P < 0.001). COH also increased haemorrhagic suffusion (COH + OTC: 66.7%; IVM + OTC: 18.8%, P = 0.002) and oedema (COH + OTC: 55.6%; IVM + OTC: 9.4%, P < 0.001). After thawing, the pathological findings were similar between both groups. No statistical difference in the number of blood vessels was observed between the groups. The oocyte apoptotic rate in thawed OT was not statistically different between the groups (ratio of positive cleaved caspase-3 staining oocytes/total number of oocytes equal to median 0.50 (0.33-0.85) and 0.45 (0.23-0.58) in unstimulated and stimulated groups respectively, P = 0.720). The study reports FP from a small number of women following OTC. Follicle density and other pathology findings are an estimate only. Unilateral oophorectomy can be successfully performed after COH with limited bleeding risk and an absence of impact on thawed OT. This approach could be proposed to post pubertal patients when the number of mature oocytes expected is low or when the risk of residual pathology is high. The reduction of surgical steps for cancer patients also has positive implications for introducing this approach into clinical practice. This work was made possible through the support of the reproductive department of Antoine-Béclère Hospital and of the pathological department of Bicêtre Hospital (Assistance Publique Hôpitaux de Paris, France). The authors have no conflict of interest to disclose in this study. N/A.

Effects of prophylactic indomethacin on morbidity and mortality in infants

ObjectiveTo determine if prophylactic indomethacin (PINDO) decreases death or bronchopulmonary dysplasia-grades 2 and 3 (death/BPD) in newborns <25 weeks.Study designIntention-to-treat, cohort-controlled study of 106 infants admitted during three alternating epochs of PINDO or Expectant patent ductus arteriosus (PDA) management.ResultsAt 7–8 days 85% of Expectant Management epoch infants had a moderate/large PDA (median exposure was 23 days). Among PINDO epoch infants only 24% still had a PDA at 7–8 days. There were no significant differences in the incidence of death/BPD or of secondary outcomes (BPD, death, necrotizing enterocolitis/spontaneous perforations, or intraventricular hemorrhage (grades 3 or 4)) in either unadjusted or adjusted comparisons between infants born in a PINDO epoch and those born in the Expectant Management epoch.ConclusionDespite being at high risk for PDA-related morbidities, PINDO did not appear to alter the rates of our primary and secondary outcomes in infants <25 weeks.

PATHOBIOME TRANSFORMATION AND FEATURES OF ENTERAL INSUFFICIENCY IN PATIENTS WITH PERITONITIS DURING THE COVID-19 PANDEMIC

We studied the features of acute enteral failure in patients with peritonitis in the setting of COVID-19 by studying the properties of the enteral pathobiome, biochemical, functional, pro-inflammatory and anti-apoptotic markers in diffuse peritonitis. A retrospective randomized cohort controlled study was conducted; it included 84 patients divided into two groups. Stratified randomization was used. The species composition and properties of the enteral luminal pathobiome were studied. 699 inoculations were made, resulting in 3024 isolates. The enteral morphofunctional coefficient, the level of alkaline phosphatase and its intestinal isoform were dynamically studied. In immunohistochemical studies, we studied the expression of CD-3 and Bcl-2. Patients with COVID-19 in addition to a decrease in the level of saprophytic microflora, showed a significant increase in Klebsiella spp., Candida, Clostridium spp. and Citrobacter (p≤0.05). The rate of antibiotic resistance in the comparison group was 8.3%, in the main group - 36.9%. MRSA pathogens were noted in 86.4% of cases, VRSA strains were found in 20.6% of cases. Patients with COVID-19 had a deficiency of intestinal alkaline phosphatase, which persisted even on the day 5 of treatment. Macro- and microscopic studies showed pronounced inflammatory and apoptotic changes in the intestinal wall of patients in the main group. A specific enteral pathobiome that is multiresistant to antibiotics, pronounced inflammatory and apoptotic changes in the intestinal wall, and a predisposition to perforation of the small intestine are characteristics of enteral failure in diffuse peritonitis in the setting of COVID-19.

Assessment of surgical outcomes of tongue in groove technique vs cartilage resection technique in management of caudal septal dislocation

Background Caudal septal deviation is a major cause of nasal obstruction. This problem affects normal nasal breathing by narrowing the external valve area and the nasal valve angle, in addition to aesthetic deformity of the nose. Treatment of midseptal and posterior deviations is rather straightforward, but treatment of the caudal septal deviation can be a more challenging problem. Aim To assess the aesthetic and functional satisfaction for patients with tongue in groove technique vs cartilage resection technique in managing caudal septal dislocation. Patients and methods This is a prospective, cohort controlled study of 25 patients divided into two groups: group A consisted of 13 patients who underwent tongue in groove technique and group B consisted of 12 patients who underwent cartilage resection technique. Results In managing caudal end septal dislocations, both tongue in groove and cartilage resection techniques have valuable aesthetic and functional outcomes. Conclusion The tongue in groove technique has a better outcome as there is no residual postoperative caudal dislocation or sublaxation. Also, it is usually used in combination with other septoplasty maneuvers to achieve the desired functional and cosmetic result. The cartilage resection technique does not add any other incision or scar except for the same ones used for septoplasty.

How Ovarian Reserve Changes after Deep Infiltrative Endometriosis Surgery?

Study Objective To study the ovarian response to surgical treatment of deep infiltrative endometriosis (DIE) in women of reproductive age. Design Prospective cohort-controlled study. Setting Surgical treatment of patients was performed by laparoscopic access using a standard closed technique under conditions of endotracheal anesthesia. Patients or Participants The main cohort was 70 women of reproductive age who underwent surgery for DIE. The comparison group consisted of 50 fertile women who underwent plastic surgery on the uterus. Interventions Surgical treatment of the patients of the main group consisted in maximum excision of foci of DIE and enucleation of endometrioid ovarian cysts. Measurements and Main Results Before and 6 months after surgery underwent determination of the level of anti-Müllerian hormone (AMH), follicle-stimulating hormone and estradiol in the blood by enzyme immunoassay, as well as counting the number of antral follicles (AFC) in the ovaries by transvaginal ultrasound. The baseline AMH level was significantly lower in patients with DIE (2.4±2.1 ng/ml) than in the comparison group (3.8±3.2 ng/ml), p<0.05. Surgical treatment of DIE led to a significant decrease in the level of AMH, the average level of AMH in patients of the main group 6 months after surgery was 1.6±1.6 ng/ml compared with the initial level of 2.4 ng/ml, p<0,05. In the patients of the comparison group after surgery the AMH level remained at the initial level (3.8±3.2 ng/ml). The initial AFC according to transvaginal ultrasound was also significantly lower in the main group (8.3±4.5) than in the comparison group (11.8±4.1), p<0.001. After surgical treatment of DIE, there was a slight decrease in the AFC according to ultrasound (7.2±3.5), but the difference with the preoperative level did not reach statistical significance. Conclusion Surgical treatment of DIE leads to a decrease in the initially compromised ovarian reserve in patients of reproductive age. To study the ovarian response to surgical treatment of deep infiltrative endometriosis (DIE) in women of reproductive age. Prospective cohort-controlled study. Surgical treatment of patients was performed by laparoscopic access using a standard closed technique under conditions of endotracheal anesthesia. The main cohort was 70 women of reproductive age who underwent surgery for DIE. The comparison group consisted of 50 fertile women who underwent plastic surgery on the uterus. Surgical treatment of the patients of the main group consisted in maximum excision of foci of DIE and enucleation of endometrioid ovarian cysts. Before and 6 months after surgery underwent determination of the level of anti-Müllerian hormone (AMH), follicle-stimulating hormone and estradiol in the blood by enzyme immunoassay, as well as counting the number of antral follicles (AFC) in the ovaries by transvaginal ultrasound. The baseline AMH level was significantly lower in patients with DIE (2.4±2.1 ng/ml) than in the comparison group (3.8±3.2 ng/ml), p<0.05. Surgical treatment of DIE led to a significant decrease in the level of AMH, the average level of AMH in patients of the main group 6 months after surgery was 1.6±1.6 ng/ml compared with the initial level of 2.4 ng/ml, p<0,05. In the patients of the comparison group after surgery the AMH level remained at the initial level (3.8±3.2 ng/ml). The initial AFC according to transvaginal ultrasound was also significantly lower in the main group (8.3±4.5) than in the comparison group (11.8±4.1), p<0.001. After surgical treatment of DIE, there was a slight decrease in the AFC according to ultrasound (7.2±3.5), but the difference with the preoperative level did not reach statistical significance. Surgical treatment of DIE leads to a decrease in the initially compromised ovarian reserve in patients of reproductive age.

A Multicenter, Prospective, Observational, Cohort-Controlled Study of Clinical Outcomes Following Coronavirus Disease 2019 (COVID-19) Convalescent Plasma Therapy in Hospitalized Patients With COVID-19.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused high inpatient mortality and morbidity throughout the world. COVID-19 convalescent plasma (CCP) has been utilized as a potential therapy for patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia. This study evaluated the outcomes of hospitalized patients with COVID-19 treated with CCP in a prospective, observational, multicenter trial. From April through August 2020, hospitalized patients with COVID-19 at 16 participating hospitals in Colorado were enrolled and treated with CCP and compared with hospitalized patients with COVID-19 who were not treated with convalescent plasma. Plasma antibody levels were determined following the trial, given that antibody tests were not approved at the initiation of the trial. CCP-treated and untreated hospitalized patients with COVID-19 were matched using propensity scores followed by analysis for length of hospitalization and inpatient mortality. A total of 542 hospitalized patients with COVID-19 were enrolled at 16 hospitals across the region. A total of 468 hospitalized patients with COVID-19 were entered into propensity score matching with 188 patients matched for analysis in the CCP-treatment and control arms. Fine-Gray models revealed increased length of hospital stay in CCP-treated patients and no change in inpatient mortality compared with controls. In subgroup analysis of CCP-treated patients within 7 days of admission, there was no difference in length of hospitalization and inpatient mortality. These data show that treatment of hospitalized patients with COVID-19 treated with CCP did not significantly improve patient hospitalization length of stay or inpatient mortality.

Effects of Mindfulness-Based Stress Reduction on Health and Social Care Education: a Cohort-Controlled Study.

ObjectivesMindfulness practice has been recommended as part of health and social care education and training because of its potential benefits in fostering clinical skills and attitudes, increasing self-care, and reducing the effect of stress in education and occupation. The objectives of this study were to evaluate the effects of a mindfulness-based stress reduction (MBSR) program on stress, physical distress, job burnout, work engagement, and empathy for health and social care education.MethodsStudents (N = 124) from postgraduate programs in social work, counseling, and family therapy were recruited. Sixty-four students participated in an 8-week MBSR program as an elective course. Sixty students were recruited from other elective courses in the same cohort as control group participants. All participants completed self-report assessments.ResultsThe results suggested that MBSR was associated with significant improvements in perceived efficacy and vigor and significant reductions in physical distress, total job burnout, emotional exhaustion, and depersonalization of clients compared with the control group.ConclusionsThis study contributes to the growing body of literature highlighting the potential use of mindfulness practice to improve students’ personal well-being and professional growth in health and social care education. Mindfulness practice should be further promoted in health and social care education and training.

Outcomes of anterior-wedge resection of the middle turbinate in functional endoscopic sinus surgery

Background Chronic rhinosinusitis is a common condition that affects the quality of life of patients. Patients may require sinus surgery in case of failure of medical treatment. One of the important decisions to be made during sinus surgery is middle-turbinate (MT) management. Aim The objective of this study was to evaluate the outcomes of the anterior-wedge excision of the MT in sinus surgery regarding accessibility to the sinuses both intraoperatively and postoperatively and the quality-of-life changes at least 6 months after surgery. Patients and methods This is a prospective, cohort-controlled study. Fifty patients were enrolled into two groups: group A consisted of 25 patients who had anterior-wedge resection of the MT and group B consisted of 25 patients in whom the MT was preserved during sinus surgery for management of chronic rhinosinusitis. Results Anterior-wedge resection of the MT was found to improve access to middle meatus during surgery and postoperative care. There was a significant enhancement of SNOT-22 total score and all its subscale scores. Conclusion Anterior-wedge MT resection is a promising procedure during sinus surgery. It can be a helpful auxiliary procedure to enhance surgical accessibility, facilitate postoperative follow-up and debridement, and reduce the risk of synechiae formation between the MT and lateral nasal wall. This may be associated with improvement of the disease-related quality of life after sinus surgery.

Changes in the postoperative foveal avascular zone in patients with rhegmatogenous retinal detachment associated with choroidal detachment

Rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) refers to the detachment of the ciliary body and choroid from the sclera along with retinal detachment. The recovery of visual function is often far worse after surgical treatment of RRDCD than following anatomical reduction for complicated reasons. Some scholars have suggested that oxidative stress may cause serious damage to cells when the detached retina becomes reduced to the choroid-retinal pigment epithelium complex and consequentially has an abnormal blood supply, which may limit the recovery of vision after surgery. To observe changes in the blood flow in the macula in patients with RRDCD who underwent pars plana vitrectomy (PPV) for retinal reattachment and silicone oil filling. This retrospective, cohort-controlled study included 35 patients with RRDCD who underwent PPV for the first time and whose retinas were successfully reattached from January 2017 to May 2018. Another 36 patients with rhegmatogenous retinal detachment (RRD) who underwent PPV for the first time and had their retina reattached as well as 40 normal eyes were assessed as controls. The best corrected visual acuity (BCVAs; logMAR) and intraocular pressure were recorded at 1day, 1week, 1month, and 3months after the operation was recorded. Optical coherence tomography angiography was used to measure the area of the foveal avascular zone. At each time point after the operation, the area of the superficial plexus foveal avascular zone was not significantly different between the RRDCD and RRD groups. The area of the deep plexus foveal avascular zone (DFAZ) continued to enlarge after the operation in the RRDCD group but did not significantly change in the RRD group. A comparison of the two groups revealed that the DFAZ area was significantly larger in the RRDCD group than in the RRD group. The changes in DFAZ area in the RRDCD group were significantly different between 1day to 1month postoperatively (t = 0.054, P < 0.001), but there was no significant difference in the change from 1 to 3months postoperatively (t = 0.014, P = 0.063). The correlation between BCVA at 3months and DFAZ area one day after the operation in the RRDCD group was significant. Choroidal lesions in RRDCD patients may have an acute pathological effect on ischaemia of the deep retinal capillary network. The DFAZ area in RRDCD patients can be used to predict and evaluate postoperative visual acuity.

Estimation of seizures prevalence in ischemic strokes after thrombolytic therapy

PurposePost stroke seizures are a complication that occur in 5-20% of acute ischemic stroke (AIS) patients, cause a reduction in quality of life and a greater burden on the health system. There is not enough data regarding an association between today’s standard of care treatment in AIS: recombinant tissue plasminogen activator (r-tPA) and the risk for post stroke seizures. Our aim in this work is to reveal such a connection. MethodA non-randomized retrospective cohort-controlled study of 234 patients, who were hospitalized with acute ischemic stroke at Kaplan Medical Center in the years 2009-2015 and were divided into two different treatment groups: r-tPA and antiaggregant therapy(n = 141) and antiaggregant therapy only (n = 95) was conducted by us. Information regarding demographics, medical history, nature of the event, including NIHSS values on admission, discharge, and post stroke seizures, were obtained for each group. Follow-up was done for one year. ResultsDuring the year of follow-up, 19 patients (8.1%) of the overall cohort, developed seizures: 12 of them (12.6%) belonged to the control group and 7 (5%) to the study group p < 0.05). Results showed a decrease in the risk for developing seizure when treated with r-tpA, comparing to antiaggregants (odds ratio = 0.64). ConclusionThis study suggests there is an association between r-tPA treatment and reduction of the risk for post stroke seizures.

Very high rate programming in primary prevention patients with reduced ejection fraction implanted with a defibrillator: Results from a large multicenter controlled study

Programming implantable cardioverter-defibrillators (ICDs) with a high-rate therapy strategy has proven to be effective in reducing shocks and is associated with a reduced mortality. We sought to determine the impact of a very high rate cutoff programming strategy on outcomes in patients with a primary indication for an ICD due to reduced left ventricular ejection fraction. Using data from the multicenter French DAI-PP registry, this cohort-controlled study compared outcomes in 500 patients programmed with a very high rate cutoff (VH-RATE group: monitor zone 170-219 beats/min; ventricular fibrillation zone ≥220 beats/min with 13 ± 4 detection intervals) with 1500 matched control patients programmed with 1 or 2 therapy zone. All ICDs were implanted for primary prevention in patients with systolic dysfunction. Risks of events were compared after propensity score matching of sex, age, ejection fraction, New York Heart Association class, cardiomyopathy, atrial fibrillation, and type of device. After a mean follow-up of 3.6 ± 2.3 years, VH-RATE programming was associated with a reduction of appropriate therapy risk (hazard ratio [HR] 0.40; 95% confidence interval [CI] 0.31-0.51; P < .0001) and inappropriate shock (HR 0.42; 95% CI 0.27-0.63; P < .0001). It was also associated with a decreased risk of sudden cardiac death (HR 0.43; 95% CI 0.17-0.99; P = .04) as compared with patients programmed with 2 therapy zones. There was no significant difference in overall survival between the groups. In patients implanted with an ICD in primary prevention with left ventricular dysfunction, very high rate cutoff programming (single therapy zone ≥220 beats/min) was associated with a 60% reduction of appropriate therapies as well as inappropriate shocks, without affecting mortality.

9. Drop attacks in Lennox–Gastaut Syndrome: Is Rufinamide the answer?

Introduction The purpose of this study is to determine whether Banzel (Rufinamide) improves the control of drop attacks in patients with Lennox–Gastaut Syndrome, and whether it controls other seizure types in LGS. Case report There are 10 patients with Lennox–Gastaut Syndrome who were candidates for participating in the Rufinamide retrospective cohort-controlled study. Presently, four of five patients are prescribed the drug Rufinamide. They are compared with the control group of LGS 4/5 subjects not on Rufinamide. Rufinamide dosage was started at 100–400 mg daily dose, while other anti-epileptic drugs (AEDs) were continued in the treated group. The control group continued on original AEDs without the addition of Rufinamide. The most common AEDs were Valproic acid, Clobazam, Lamotrigine, and Topiramate. Results After a minimal period of six months of Rufinamide, the treated group had fewer drop attacks than the control group. Approximately 80% of patients (4/5) responded positively to Rufinamide. The treated group was more alert by caregiver observation, and had less drug interactions with other AEDs. Overall an improved quality of life was found with the Rufinamide treatment, leading to continuation of the new drug past the study period. One patient dropped out from the study due to severe side effects to Rufinamide: (1/5 or 20%). Discussion Rufinamide at therapeutic doses reduced the frequency of drop attacks or tonic seizures more than other AEDs. There may also be some improvement in control of atypical absences and/or myoclonic seizures in LGS. A subjective presentation of compared quality of life care from Rufinamide for LGS needs to be confirmed in a larger controlled study by quantitative age – specific assessment.

Female third party lymphocytes are effective for immunotherapy of patients with unexplained primary recurrent spontaneous abortion: A retrospective analysis of outcomes

Objectives Allogeneic lymphocytes of paternal origin or supplied by a male third party have been used for the treatment of recurrent spontaneous abortion. Few studies, however, have examined the use of female third party lymphocytes. Our purpose was to determine whether female third party lymphocytes could be used for immunotherapy of women with recurrent spontaneous abortion.Methods In this retrospective non-randomised cohort-controlled study, the medical records of patients with three or more spontaneous abortions who received immunotherapy with lymphocytes from their partner, a male third party or a female third party, as well as those who received no immunotherapy, from 1996 to 2012 were reviewed. All patients were negative for mixed lymphocyte culture reaction (MLR)-blocking antibodies. Immunotherapy was performed in 302 patients in two courses, while 53 patients received no immunotherapy.Results The pregnancy rates in patients who received lymphocytes from their partners, a male third party or a female third party, and in those not immunised, were 85.6%, 87.3%, 89.7%, and 79.3%, respectively (p = 0.523);the live birth rates were 87.3%, 75.8%, 84.6%, and 40.5%, respectively (p < 0.001).Conclusions We conclude that female third party lymphocytes can be used for immunotherapy in patients with recurrent spontaneous abortion.Chinese 摘要目的 父源同种异体淋巴细胞或第三方男性供给淋巴细胞用于复发性自然流产的治疗。少数研究调查了女性第三方淋巴细胞的应用。我们的目的是验证女性第三方淋巴细胞是否可以用于复发性自然流产的免疫治疗。方法 在这项回顾性非随机队列对照研究中回顾了自1996年至2012年,接受配偶淋巴细胞,男性第三方淋巴细胞或接受女性第三方淋巴细胞免疫治疗,或未接受免疫治疗的三次或更多次自然流产的患者病历资料。所有患者的混合淋巴细胞培养反应(MLR)-封闭抗体均为阴性。302名患者接受了两个疗程的免疫治疗,而53名患者未接受免疫治疗。结果 接受配偶淋巴细胞,男性第三方淋巴细胞,女性第三方淋巴细胞和未接受免疫治疗的患者妊娠率分别为85.6%，87.3%，89.7%，和79.3% (p = 0.523)。活产率分别为87.3%, 75.8%, 84.6%和40.5% (p < 0.001) 。结论 我们推断,女性第三方淋巴细胞可用于复发性自然流产患者的免疫治疗。关键词免疫疗法；淋巴细胞；反复自然流产

Ovarian tissue cryopreservation followed by controlled ovarian stimulation and pick-up of mature oocytes does not impair the number or quality of retrieved oocytes.

BackgroundThe objective of this study was to evaluate the feasibility of fertility preservation in cancer patients by combined bilateral ovarian cortex cryopreservation and embryo freezing.MethodsThis was a cohort-controlled study in a university hospital center. Sixteen patients with a recent cancer diagnosis were included in the study. They all consented to fertility preservation by a combined technique: ovarian tissue cryopreservation (OTC) followed by ovarian stimulation for in vitro fertilization (IVF) and embryo freezing. The control group included 100 women of the same age undergoing IVF for male factor infertility.ResultsThe mean number of metaphase II oocytes was 8.3 per patient (±7.7) and was not statistically different from the control group (8.1 ± 5.6). The mean number of good quality embryos obtained was not statistically different in the 2 groups (4.2 versus 4.4).ConclusionOTC before embryo freezing does not impair the number or quality of cryopreserved embryos, but increases fertility preservation potential.

Nerve injury and recovery after lateral lumbar interbody fusion with and without bone morphogenetic protein-2 augmentation: a cohort-controlled study

Background contextDespite common use of intraoperative electrophysiologic neuromonitoring, injuries to the lumbar plexus during lateral lumbar interbody fusion (LLIF) have been reported. Emerging data suggest that recombinant human bone morphogenetic protein-2 (rhBMP-2) use during an anterior or transforaminal lumbar interbody fusion may be associated with an increased risk of neurological deficit. Clinical data on the sequelae of rhBMP-2 implantation in close proximity to the lumbosacral plexus during LLIF remains to be understood. PurposeThe purpose of this study was to compare the incidence of neurologic deficits and pain in patients undergoing LLIF with and without rhBMP-2. Study design/settingRetrospective outcome analysis in controlled cohorts undergoing the lateral exposure technique for LLIF with and without rhBMP-2. MethodsThe electronic medical records of patients undergoing LLIF with and without supplemental posterior fusion for degenerative spinal conditions were retrospectively reviewed over a 6-year period. Patients with previous lumbar spine surgery or follow-up of less than 6 months were excluded. Patients were divided into 2 groups, Group 1 (rhBMP-2 use; n=72) and Group 2 (autograft/allograft use; n=72), and were matched according to the age at the time of surgery, gender, weight, body mass index, side of approach, total number of treated spinal segments, use of supplemental posterior fusion, and length of follow-up. ResultsImmediately after surgery, a sensory deficit was recorded in 33 patients in Group 1 and 35 patients in Group 2 (odds ratio [OR] 0.895; 90% confidence interval [CI] 0.516–1.550; p=.739). At last follow-up, a persistent sensory deficit was identified in 29 patients whose LLIF procedure was supplemented by rhBMP-2 and 20 patients in whom autograft/allograft was used (OR 1.754; 90% CI 0.976–3.151; p=.115). A motor deficit was recorded in 37 patients immediately after the rhBMP-2 procedure and 28 patients treated with autograft/allograft (OR 1.661; 90% CI 0.953–2.895; p=.133). A persistent motor deficit was recorded in 35 and 17 patients in Groups 1 and 2, respectively, at last follow-up (OR 3.060; 90% CI 1.681–5.571; p=.002). During the first postoperative examination, 37 patients in Group 1 and 25 patients in Group 2 complained of anterior thigh or groin pain (OR 1.987; 90% CI 1.133–3.488; p=.045). At last follow-up, there was a significantly higher number of patients in Group 1 who complained of persistent anterior thigh or groin pain than Group 2 (8 vs. 0 patients) (OR 16.470; 90% CI 1.477–183.700; p=.006). ConclusionsOur results provide evidence of an increased rate of postoperative neurologic deficit and anterior thigh/groin pain after LLIF using rhBMP-2, when compared with matched controls without rhBMP-2 exposure. This study suggests a potential direct deleterious effect of rhBMP-2 on the lumbosacral plexus.

Patient reported outcome measures in military patients with shoulder instability

ObjectivesThe Oxford Shoulder Instability Score (OSIS) is a measure of functional impairment of the upper limb, but it is unclear how it translates into military patients where lower scores, implying...