Mild-moderate Degree Research Articles

Clinical Practice Guideline on Acupuncture and Moxibustion: Adult Major Depressive Disorder (Mild-Moderate Degree): Determination of clinical questions: 《针灸临床实践指南: 成人轻中度抑郁症》: 临床问题的确定

Determining clinical questions is fundamental to the development of clinical practice guidelines (CPGs), which bridges the initial phases and the final recommendations. It is essential for evidence retrieval and the formulation of recommendations. The scientific rigor and precision in determination of clinical questions directly influence the future implementation and applicability of guidelines. In 2020, the World Federation of Acupuncture-Moxibustion Societies initiated the project of clinical practice guideline on acupuncture and moxibustion for adult major depressive disorder (mild-moderate degree) to address clinical and medical decision-making issues in acupuncture treatment for adult mild to moderate major depressive disorder. This CPG provides systematic recommendations based on clinical evidence, patient values, and other factors, aiding decision-makers, clinicians, and patients in selecting appropriate interventions. This paper discusses and analyzes the determination process of clinical questions, and the related issues during the development of this guideline, aiming to provide a reference for determining clinical questions and developing CPGs in the field of acupuncture and exploring more scientific tools and methods for determining clinical questions in future CPGs.

Features of neurocognitive and psychoemotional disorders in young patients with arterial hypertension

The article presents the results of the study of cognitive functions and the psychoemotional state of young patients with arterial hypertension. In total, 91 patients between the ages of 25 and 44, as well as 30 clinically healthy individuals of the appropriate age and article, were involved in the study. All studied patients were divided into two groups depending on the presence of neurocognitive disorders. The condition was assessed using international standardized scales and tests. The study showed that people with AH had mild disorders of verbal memory, counting operations and disorientation, which was manifested by incorrect naming of the date. It was characterized by the presence of disorders of voluntary attention from minor, initial manifestations, which, first of all, was manifested by fatigue, to violations of a mild-moderate degree in the form of narrowing of volumes and insufficiency of the processes of concentration, distribution and switching. The psychoemotional state of young patients with hypertension was characterized by the presence of mild depressive disorders. For patients with neurocognitive disorders against the background of hypertension, the presence of moderate reactive and personal anxiety was characteristic. Key words: arterial hypertension, neurocognitive disorders, anxiety, depression

Results of new-generation balloon vs. self-expandable transcatheter heart valves for bicuspid aortic valve stenosis.

Data comparing new-generation self-expandable (SEV, Evolut R/PRO) vs. balloon-expandable (BEV, SAPIEN 3/3Ultra) transcatheter heart valve replacement (TAVR) in bicuspid aortic valve stenosis (BAV) is limited. Our aim was to compare 30-day results of SEV and BEV implantations in patients with BAV. A total of 2009 patients underwent TAVR between April 2015 and June 2021 at our Centre. From our institutional registry, we identified 106 consecutive patients with BAV who underwent TAVR using SEV and BEV. A 106 patients (n = 68 BEV; n = 38 SEV) were included. Mean age was 74.6 ± 8.8 years (BEV) vs.75.3 ± 8.7 years (SEV) (p = 0.670) and Society of Thoracic Surgeons score was 2.6 ± 1.9 (BEV) vs. 2.6 ± 1.6 (SEV) (p = 0.374), respectively. Device landing zone calcium volume (DLZ-CV) was 1168 ± 811 vs. 945 ± 850 mm3 (p = 0.192). Valve Academic Research Consortium (VARC)-3 device success at 30 days was similar (BEV 80.9% vs. SEV 86.8%; p = 0.433). More post-dilatations were performed in SEVs (23.5% BEV vs. 52.6% SEV; p = 0.002). Overall mean gradient at 30 days follow-up was 11.9 ± 4.6 mmHG (BEV) vs. 9.2 ± 3.0 mmHG (SEV) (p = 0.002). A mild-moderate degree of paravalvular leak (PVL) was detected more often in the SEV group (7.4% vs. 13.2%; p = 0.305). A trend towards higher rate of permanent pacemaker implantation was observed in SEV (11.8% vs. 23.7%; p = 0.109). Treatment of BAV revealed similar performance using BEV and SEV. In this retrospective cohort study, hemodynamics were more favorable with the SEV, although there was a trend toward more PVL and significantly more post-dilations.

Nicotine dependence and visceral adiposity as risk factors for the development and severity of carotid artery stenosis.

Nicotine dependence (ND) and visceral adiposity are emerging as independent risk factors for cardiovascular diseases, including carotid artery stenosis (CAS). This study aimed to determine the relationship between ND and the contribution of abdominal fat to the onset of CAS, which is indicated by a luminal narrowing of at least 60% as determined by duplex and/or Doppler ultrasound. We prospectively collected data from 60 patients with CAS and 60 age- and gender-matched healthy subjects. The Fagerström Test for Nicotine Dependence (FTND), a common research tool, was used in the study. The original questionnaire was designed to gather social and demographic data. Anthropometric measurements, visceral adiposity index (VAI), and lipid accumulation products (LAP) were used to assess obesity. Most patients showed a high or mild-moderate degree of ND: 46.67% and 35%, respectively. The median visceral adiposity index (VAI) and lipid accumulation product (LAP) in patients was 3.92 and 32.83, respectively. Prolonged smoking duration, increased intensity, and high ND are hallmarks of CAS patients.

Efficacy and safety of high-flow nasal cannula therapy in elderly patients with acute respiratory failure

IntroductionTo assess the efficacy and safety of high-flow nasal cannula (HFNC) in elderly patients with acute respiratory failure (ARF) not due to COVID-19, refractory to treatment with conventional oxygen therapy and/or intolerant to noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) and without criteria for admission to intensive care units (ICU). MethodsProspective observational study of patients with ARF treated with HFNC who presented clinical and arterial blood gas deterioration after 24 h of medical treatment and oxygenation by conventional systems. The degree of dyspnoea, gas exchange parameters (arterial O2 pressure/inspired O2 fraction ratio (PaO2/FiO2); oxygen saturation measured by oximetry/ inspired fraction of oxygen (Sp02/Fi02), ROX index), degree of patient tolerance and mortality were evaluated. These were measured at discharge from the emergency department (ED), 24 h after treatment with conventional oxygenation and 60, 120 min and 24 h after initiation of HFNC. The results were analyzed for all patients as a whole and for patients with hypercapnia (arterial carbon dioxide tension (PaCO2) < 45 mmHg) separately. Results200 patients were included in the study between November 2019 and November 2020, with a mean age of 83 years, predominantly women (61.9%), obese (Body Mass Index (BMI) 31.1), with high comorbidity (Charlson index 4) and mild-moderate degree of dependence (Barthel 60). A number of 128 patients (64%) were hypercapnic. None had respiratory acidosis (pH 7.39). Evaluation at 60 min, 120 min and 24 h showed significant improvement in all patients and in the subgroup of hypercapnic patients with respect to baseline parameters in respiratory rate (RR), dyspnoea, ROX index, PaO2/FiO2, SpO2/FiO2 and patient comfort. No changes in PaCO2 or level of consciousness were observed. HFNC was well tolerated. Ten patients (5%) died due to progression of the disease causing ARF. ConclusionsHFNC is an effective and safe alternative in elderly patients with ARF not due to COVID-19, refractory to treatment with conventional oxygen therapy and/or intolerant to NIV or CPAP and without criteria for admission to ICU.

Correlation between presbycusis with quality of life based on hearing handicap inventory for the elderly screening version (HHIE-S)

Presbycusis is an age-related hearing loss caused by a degeneration process which is a cumulative effect of various risk factors. Hearing Handicap Inventory for the Elderly-Screening version (HHIE-S) questionnaire is a questionnaire that can be used to measure the quality of life in patients with hearing loss. This study aimed to determine the relationship between presbycusis with the quality of life. The research uses cross sectional analytical research methods. The data used in form of primary data is the result of filling in the guided questionnaire and the results of the audiogram, while secondary data is in the form of medical records of presbycusis patients at Dustira Hospital in the period January 2017-December 2018. Data were analyzed by Chi-Square and Spearman Correlation Test. The incidence of presbycusis in the period January 2017-December 2018 at Dustira Hospital was 2,6%. The result showed most of the patients were 65-74 years old (61,8%), male (52,7%), married (58,2%), economic were similar between moderate and low economic status (49.1%), had a history of chronic diseases (76, 4%), had a moderate degree of hearing loss (61,8%) and had a mild-moderate degree of quality of life (52,7%). Based on HHIE-S questionnaire the results showed that there was a significant and strong relationship between presbycusis and patients’ quality of life (p &lt;0.001) and r=0,509. In conclusion, degrees of hearing loss in presbycusis patients will correspond to degrees of decrease in quality of life.

Correlation between presbycusis with quality of life based on hearing handicap inventory for the elderly screening version (HHIE-S)

Presbycusis is an age-related hearing loss caused by a degeneration process which is a cumulative effect of various risk factors. Hearing Handicap Inventory for the Elderly-Screening version (HHIE-S) questionnaire is a questionnaire that can be used to measure the quality of life in patients with hearing loss. This study aimed to determine the relationship between presbycusis with the quality of life. The research uses cross sectional analytical research methods. The data used in form of primary data is the result of filling in the guided questionnaire and the results of the audiogram, while secondary data is in the form of medical records of presbycusis patients at Dustira Hospital in the period January 2017-December 2018. Data were analyzed by Chi-Square and Spearman Correlation Test. The incidence of presbycusis in the period January 2017-December 2018 at Dustira Hospital was 2,6%. The result showed most of the patients were 65-74 years old (61,8%), male (52,7%), married (58,2%), economic were similar between moderate and low economic status (49.1%), had a history of chronic diseases (76, 4%), had a moderate degree of hearing loss (61,8%) and had a mild-moderate degree of quality of life (52,7%). Based on HHIE-S questionnaire the results showed that there was a significant and strong relationship between presbycusis and patients’ quality of life (p &lt;0.001) and r=0,509. In conclusion, degrees of hearing loss in presbycusis patients will correspond to degrees of decrease in quality of life.

Correlation between presbycusis with quality of life based on hearing handicap inventory for the elderly screening version (HHIE-S)

Presbycusis is an age-related hearing loss caused by a degeneration process which is a cumulative effect of various risk factors. Hearing Handicap Inventory for the Elderly-Screening version (HHIE-S) questionnaire is a questionnaire that can be used to measure the quality of life in patients with hearing loss. This study aimed to determine the relationship between presbycusis with the quality of life. The research uses cross sectional analytical research methods. The data used in form of primary data is the result of filling in the guided questionnaire and the results of the audiogram, while secondary data is in the form of medical records of presbycusis patients at Dustira Hospital in the period January 2017-December 2018. Data were analyzed by Chi-Square and Spearman Correlation Test. The incidence of presbycusis in the period January 2017-December 2018 at Dustira Hospital was 2,6%. The result showed most of the patients were 65-74 years old (61,8%), male (52,7%), married (58,2%), economic were similar between moderate and low economic status (49.1%), had a history of chronic diseases (76, 4%), had a moderate degree of hearing loss (61,8%) and had a mild-moderate degree of quality of life (52,7%). Based on HHIE-S questionnaire the results showed that there was a significant and strong relationship between presbycusis and patients’ quality of life (p &lt;0.001) and r=0,509. In conclusion, degrees of hearing loss in presbycusis patients will correspond to degrees of decrease in quality of life.

Pterygium excision with rotational conjunctival flap - a simple and effective method

Purpose: To find out the effectiveness of rotational conjunctival flap in pterygium excision by analyzing intra/postoperative complications and recurrence rates. Study Design: Interventional case series Place and Duration of study: Al-Baseer Eye Hospital, Karachi from October 2019 to May 2022. Methods: All patients who had primary pterygium excision with rotational conjunctival flap in the hospital were included. Data collection was done using medical records regarding patient’s age, sex, laterality and location of pterygium, intra-operative and post-operative complications. Patients were examined for recurrence at or more than 3 months follow-up. For data analysis, IBM SPSS Statistics 23 was used. Results: A total of 36 patients underwent pterygium excision with rotational conjunctival flap under topical anesthesia by a single surgeon. Mean age at the time of surgery was 52.85±12.66 years. Male : female ratio was 5:4. Ninety four percent were nasally located. Major intraoperative complication (corneal perforation) occurred in one patient. Post-operative significant flap congestion was noted in 2 (5.5%), while partial flap retraction and sub-conjunctival hemorrhage was seen in 1 (2.7%) patient. Twenty six patients completed at least 3 months follow-up. Two (8%) patients had recurrence of mild-moderate degree within 6 months of surgery. Conclusion: Pterygium excision with conjunctival rotational flap is simple and effective method in selected patients. Harvesting, positioning and suturing of flap can be carried out single handedly. The method requires less surgical expertise, and has good post-operative results.

Comparison of Immune Response and Immunobiology in COVID-19 (Coronavirus Disease 2019) Mild-Moderate Degree and Severe Degree

The difference in immunological profiles between mild-moderate and severe cases of COVID-19 can be seen in lower lymphocyte counts, leukocytes, and higher neutrophil-lymphocyte ratios. And lower percentages of monocytes, eosinophils, and basophils in severe COVID-19 cases. Proinflammatory cytokines such as TNF-α, IL-1, and IL-6, as well as IL-8 and infection markers such as procalcitonin, ferritin, and C-reactive protein, were also found to be higher in severe clinical cases. T Helper, T suppressor, and T regulatory were found to be decreased in COVID-19 patients with lower numbers of T helper and T regulatory in severe cases.

Adolescents and dual pathology. Assessment of treatment with paliperidona palmitato long-term injectables

IntroductionToday cocaine use is very frequently associated with adolescents with maladaptive personality traits and impulse control disorder. It requires a multidisciplinary approach and individualized treatments to improve the clinic and achieve the abandonment of consumption.Objectives1. To assess the efficacy of monthly injectable paliperidone palmitate treatment in controlling impulsivity. 2. Determine the consumption of toxins after treatment.MethodsSample: Adolescents, 14-17 years old, with a diagnosis of Personality Limit T and cocaine consumption who start treatment with Paliperidone Palmitate LD IM (50-100mg / month) in monotherapy, with Diazepam 5mg if significant anxiety. Retrospective data collection. Plutchik impulsivity scale (IE) before starting treatment and at 3 months. Statistical analysis SPSS 20.0ResultsTwelve adolescents who met the inclusion criteria were included and 12 adolescents, 83% male, 16% female, completed the questionnaires. After its application and correction through non-parametric tests (N &lt;30), scores in the EI questionnaire of a mean of 37.42 points in the pretest were observed, corresponding to a severe level of impulsivity; and a mean of 26.28 points in the post-test, compatible with a mild-moderate degree of impulsive symptoms. A decrease in the consumption of toxins was observed in 65% of the cases.ConclusionsIn our experience, the management of toxic consumption in adolescent population with severe impulsivity symptoms has great limitations due to the scarce resources available. The Palpitate of Paliperidone long-term treatment has been useful in the approach of serious registered cases, being associated with symptomatic improvement and decrease in consumption.

P318 Left atrial dysfunction assessed by echocardiography in relation to left atrial fibrosis in patients undergoing ablation for atrial fibrillation

Abstract PURPOSE Left atrial (LA) fibrosis is the hallmark of LA remodeling in atrial fibrillation (AF), alters LA function and may predict poor catheter ablation (CA) outcome. LA fibrosis may be assessed invasively using electroanatomical mapping (EAM) during electrophysiological study. The aim was to assess LA function parameters in relation to degree of LA fibrosis derived from EAM in patients with AF. METHODS Patients (pts) n = 39 (79% males, mean age 56+/-10) with non-valvular AF were studied with TTE and TEE before first CA during sinus rhythm. LA strain (LAS) and strain rate (LASR) were analyzed in reservoir (r), conduit (cd) and contractile (ct) phases. The velocities of mitral A, E" and A" were measured with Doppler. E/E" and LA stiffness index - the ratio of E/E" to LASr were assessed. LA appendage flow velocity (LAAv) was measured in TEE. LA volume using biplane area-length method was calculated. The EAM of LA was build using Carto System before CA. Low amplitude potentials area (LAPA) was quantitatively analyzed and expressed as a percentage of LA surface using the cut-off &amp;lt;0.5 mV to detect sites of fibrosis. LA parameters were compared between mild (LAPA &amp;lt;10%) moderate (LAPA 10-40%) and extensive degree of LA fibrosis (LAPA &amp;gt;40%) (table). RESULTS The mean LA volume was 35 ± 11 mL/m². The LAPA ranged from 2 to 78 % of LA surface. Reduced LA function was observed in the LAPA &amp;gt;40% group. Extensive LAPA altered mainly LA compliance parameters. Traditional LA systolic function parameters did not differ in relation to degree of LAPA. CONCLUSION LA compliance is mostly affected by LA fibrosis, thus LA diastolic parameters may be useful in the noninvasive assessment of LA fibrosis. Whether these parameters should be a part of the proper selection of candidates for CA requires further studies. LA function parameters LA parameters Group 1 LAPA &amp;lt;10% n = 13 Group 2 LAPA &amp;gt;10% &amp;lt;40% n = 13 Group 3 LAPA &amp;gt;40% n = 13 P-value Group 1 + 2 vs 3 Mitral A 0.55 ± 0.10 0.55 ± 0.24 0.73 ± 0.32 0.077 A" 9.19 ± 1.74 7.85 ± 1.43 7.92 ± 2.40 0.376 LASr 31.48 ± 4.52 26.48 ± 8.79 19.63 ± 6.76 &amp;lt;0.001 LAScd 17.30 ± 3.05 15.44 ± 6.93 10.91 ± 4.04 0.003 LASct 14.18 ± 5.36 11.05 ± 3.67 8.72 ± 4.78 0.024 LASRr 1.22 ± 0.19 1.24 ± 0.21 0.92 ± 0.20 &amp;lt;0.001 LASRct -1.71 ± 0.46 -1.37 ± 0.34 -1.04 ± 0.33 &amp;lt;0.001 LA stiffness 0.20 ± 0.07 0.34 ± 0.17 0.63 ± 0.29 &amp;lt;0.001 LAAv 0.83 ± 0.18 0.55 ± 0.17 0.60 ± 0.16 0.178

Factors associated with stigma in community-dwelling stroke survivors in China: A cross-sectional study

BackgroundAlthough stigma is considered to be present in stroke patients, the factors that influence its level are ambiguous. The aim of this study was to investigate whether certain demographic, clinical, and psychosocial characteristics are related to higher levels of stigma among stroke patients in China. MethodsA total of 200 stroke patients in the community were investigated using the Stigma Scale for Chronic Illness (SSCI), Barthel Index, Self-Rating Depression Scale, Medical Moping Questionnaire, and Social Support Rating Scale. Potential determinants were evaluated with univariate statistical analyses for their contributions to total, felt and enacted stigma. Important findings were further evaluated with multiple regression models. ResultsThe mean total stigma, felt stigma, and enacted stigma scores were 45.21 ± 16.68, 27.93 ± 10.95, and 17.27 ± 6.93, respectively. Most participants reported experiencing felt stigma (90%), while 72.5% reported experiencing enacted stigma. Multiple regression analysis showed that stroke patients' depression, functional status, an avoiding coping strategy, subjective support and recurrence of stroke were factors impacting the SSCI score. ConclusionThe stigma level among stroke patients in China was of a mild-moderate degree. Among stroke patients, a higher level of stigma was influenced by a higher degree of depression, a higher degree of an avoiding coping strategy, lower functional ability, lower subjective support and recurrence of stroke. Further work should focus on developing intervention strategies to decrease the amount of stigma and promote quality of life as well as psychosocial rehabilitation among stroke patients.

Risk factors for cataracts in a cohort of Egyptian systemic lupus erythematosus patients

Aim of the workThis study was undertaken to evaluate cataract risk factors in Egyptian systemic lupus erythematosus (SLE) patients. Patients and methodsA cohort of 150 consecutive adult SLE patients was included. None of the patients was diabetic or had cataract before steroids treatment for SLE. Detailed medical and ophthalmological histories were taken. Thorough clinical examination was performed with assessment of SLE disease activity index (SLEDAI) and systemic lupus international collaborating clinics damage index (SLICC DI), along with routine blood tests. Slit lamp examination was done to assess the anterior segment of the eye especially the lens to detect the type and degree of cataract. Results150 SLE patients were studied with a mean age of 37.16 ± 11 years; 129 females and 21 males and a mean disease duration of 11 ± 5.7 years. Their mean SLEDAI was 4.1 ± 3.78 and SLICC/DI 2.1 ± 1.3. The frequency of cataract was 18% (n = 27); 22.2% of them were cortical and 77.8% were posterior subcapsular with mild-moderate degree. Glaucoma was present in only 2%. A significant increase in age, disease duration, age at onset, SLICC/DI, cumulative steroid dose and hydroxychloroquine (HCQ) dose was found in those with cataract compared to non-cataract patients (p < 0.05). The age, age at onset, disease duration, SLICC/DI and cumulative steroid dose were significant independent factors increasing the probability of cataract occurrence among SLE patients (p < 0.01). ConclusionAlthough corticosteroids are prescribed to control SLE symptoms, these results highlight potential risks associated with their use, especially cataracts, which require careful and routine ophthalmologic examination and follow up.

Evaluation of early outcome and complications of Lap TARM

LeBlanc and Booth in 1993 first reported application of intra-peritoneal onlay mesh (IPOM) for ventral and incisional hernia. It is based on the principles of Rives-Stoppa technique of repair of ventral hernia in which a large pre-peritoneal mesh is placed and stipulated even distribution of force throughout the mesh area resulting in stronger repair than onlay mesh technique. Laparoscopic technique was adopted in an effort to reduce wound complications, post-operative pain and early return to work. Since then various methods of laparoscopic repair have been performed and studied in an effort to find out the most suitable, least expensive way to deal with ventral hernias. LVHR is a safe alternative to the open method, with the main advantages being minimal postoperative pain, shorter recovery, and decreased wound and mesh infections. This is a retrospective study in which we evaluated the performance of 10 cases of Laparoscopic TARM (Trans Abdominal Retro rectus Mesh repair) from Oct 2018 to Jul 2019. This study is being conducted to evaluate early outcome and complications of this procedure amongst the initial cases at our institute. We chose midline hernias only, both Primary and Incisional, for feasibility to do TARM procedure in retrorectus space. Patients were evaluated for post-operative outcome in terms of pain, local collection and intestinal obstruction. Pain was experienced in mild-moderate degree in four patients, collection in three and small bowel obstruction in two patients. Early results indicate that TARM can be performed as a cheaper alternative to IPOM mesh repair. Further studies are needed to establish this procedure as the preferred method for treatment of midline hernias.

Short-term efficacy of a fixed association of Palmitoylethanolamide and other phytochemicals as add-on therapy in the management of chronic pain in elderly patients: a real-world retrospective study

Phytochemicals are promising adjuvant agents for the treatment of pain. This study aimed to explore the short-term efficacy and safety of a fixed-dose combined therapy with Palmitoylethanolamide and other phytochemicals as add-on therapy in elderly patients. Data on 47 elderly patients with non-oncologic chronic pain of mild-moderate degree were analyzed in a retrospective, descriptive, no-profit, double-center realworld study. Patients were administered the combined phytochemical therapy for 6 weeks, in addition to analgesics administered when needed. Patients showed a reduction in pain intensity both in mixed /nociceptive and in neuropathic pain and improvements in functional abilities, quality of life, and in the subjective belief about the efficacy of treatment. These results were also observed in the small subgroup of patients in monotherapy with phytochemicals (n=13). No adverse event led to treatment withdrawal. This exploratory study suggests that phytochemicals may represent an effective source of analgesics to be added to chemically synthesized drugs, therefore reducing the need of their up-titration and the risk of toxicity. These data must be considered as preliminary and need to be tested in randomized trials.

The different dosages of estrogen affect endometrial fibrosis and receptivity, but not SDF-1/CXCR4 axis in the treatment of intrauterine adhesions

Objective: The study was to evaluate whether fibrotic markers, endometrial receptivity markers and SDF-1/CXCR4 had been changed in the treatment of intrauterine adhesions (IUAs) by different dosages of estrogen.Study design: A total of 39 patients with IUAs were treated with EV 4 mg or 9 mg randomly post-surgery. TGF-β1/MMP-9, VEGF/αvβ3 and SDF-1/CXCR4 were detected in endometrial tissue before and after treatment by real-time PCR and Western blot.Results: TGF-β1 and MMP-9 expression significantly decreased after treatment for 3 months than before (p < .05), the falling range was larger with EV 4 mg than 9 mg in the mild-moderate degree IUAs (p < .05); Integrin avβ3 expression significantly increased after treatment for 3 months than before (p < .05), the variation range was larger with EV 4 mg than 9 mg (p < .05); CXCR4 expression had no significant change after treatment 3 months compared to that before treatment (p > .05). SDF-1 presented an upward tendency at early phase, and it came back to the level of pre-surgery. But there were no significant difference between treatment with 4 mg and 9 mg in the rate of menstrual restoration and pregnancy follow-up 3 months after the treatment.Conclusions: Endometrium fibrosis may be inhibited and endometrium receptivity may be improved by estrogen with moderate dosage therapy. Compared to the large one, it seems to be advantageous.

Pulmonary vein obstruction after catheter ablation in a patient with partial anomalous pulmonary vein connection

A 75-year-old man with symptomatic atrial fibrillation was referred to our hospital for catheter ablation. Preprocedural echocardiogram showed mild-moderate degree mitral regurgitation (MR) and mild tricuspid regurgitation (TR) with transvalvular peak gradient (TVPG) of 27mmHg. The complete isolation of the pulmonary veins was performed by radiofrequency ablation, and the patient was kept in sinus rhythm after the procedure. However, the exertional dyspnea had gradually developed one year after the procedure. Echocardiogram showed severe TR with TVPG 60mmHg. MDCT showed partial anomalous pulmonary vein connection (PAPVC) of the left upper pulmonary vein and the occlusion of left lower pulmonary vein ostium: pulmonary venous flow of the left upper lung was drained into the brachiocephalic vein. The patient underwent surgical correction of PAPVC and annuloplasty of the mitral and tricuspid valve. Although it is unclear whether there is direct causal relationship between PAPVC and PV obstruction, anatomical evaluation of PVs is important in patients undergoing catheter ablation.<Learning objective: Partial anomalous pulmonary vein connection (PAPVC) is rare and often asymptomatic in adults. In the present case, pulmonary vein obstruction occurred after radiofrequency catheter ablation in a patient with PAPVC. Although pulmonary venous flow from only left upper lobe drained into the brachiocephalic vein before ablation, occlusion of the left lower pulmonary vein resulted in right heart failure one year after ablation.>

Munitions integrity and corrosion features observed during the HUMMA deep-sea munitions disposal site investigations

An evaluation of the current condition of sea-disposed military munitions observed during the 2009 Hawaii Undersea Military Munitions Assessment Project investigation is presented. The 69km2 study area is located south of Pearl Harbor, Oahu, Hawaii, and is positioned within a former deep-sea disposal area designated as Hawaii-05 or HI-05 by the United States Department of Defense. HI-05 is known to contain both conventional and chemical munitions that were sea-disposed between 1920 and 1951. Digital images and video reconnaissance logs collected during six remotely operated vehicle and 16 human-occupied vehicle surveys were used to classify the integrity and state of corrosion of the 1842 discarded military munitions (DMM) objects encountered. Of these, 5% (or 90 individual DMM objects) were found to exhibit a mild-moderate degree of corrosion. The majority (66% or 1222 DMM objects) were observed to be significantly corroded, but visually intact on the seafloor. The remaining 29% of DMM encountered were found to be severely corroded and breached, with their contents exposed. Chemical munitions were not identified during the 2009 investigation. In general, identified munitions known to have been constructed with thicker casings were better preserved. Unusual corrosion features were also observed, including what are termed here as ‘corrosion skirts’ that resembled the flow and cementation of corrosion products at and away from the base of many munitions, and ‘corrosion pedestal’ features resembling a combination of cemented corrosion products and seafloor sediments that were observed to be supporting munitions above the surface of the seafloor. The origin of these corrosion features could not be determined due to the lack of physical samples collected. However, a microbial-mediated formation hypothesis is presented, based on visual analysis, which can serve as a testable model for future field programs.

Discrepancy Between Duplex Sonography and Digital Subtraction Angiography When Investigating Extra- and Intracranial Ulcerated Plaque

Noninvasive color-coded duplex sonography has become a good, convenient, and reproducible screening tool for the general population when studying cerebral hemodynamics and atherosclerotic disease. Digital subtraction angiography (DSA) is still the gold standard for the diagnosis of carotid stenosis, although other noninvasive imaging tools are also available. At present, ultrasound scanning, followed by confirmatory DSA, is a cost-effective way to survey patients suspected of suffering from cerebral arterial stenosis. We report two patients who had cerebral ischemic symptoms due to high-grade stenosis of either the cervical internal carotid artery (ICA) or the middle cerebral artery (MCA), combined with an ulcerated plaque. Ultrasonographic Doppler analysis identified high-grade stenotic lesions as marked elevations in the turbulent flow of the cervical ICA in one patient and of the middle cerebral artery in the other patient. Subsequently, huge plaque ulceration was found by color B-mode scanning of the patient with cervical ICA stenosis. However, DSA was able to demonstrate only a mild–moderate degree of stenosis associated with the lesions. High-grade stenotic lesions of the ICA and the middle cerebral artery were reconfirmed by computed tomography angiography and magnetic resonance angiography. An atheromatous plaque with ulceration is believed to be the cause of this discrepancy between ultrasonography and DSA.