Monophasic Groups Research Articles

Correlation between Delayed Relief after Microvascular Decompression and Morphology of the Lateral Spread Response in Patients with Hemifacial Spasm-Further Examination with Compound Motor Action Potentials.

Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), postoperative delayed relief is one of its main issues. We previously evaluated the morphology of the lateral spread response (LSR) and reported correlation between delayed relief after MVD and polyphasic morphology of the LSR. This study aimed to investigate the morphology of LSR and the course of recovery of the compound motor action potential (CMAP), to better understand the pathophysiology of delayed healing of HFS. Based on the pattern of the initial LSR morphology on temporal and marginal mandibular branches stimulation, patients were divided into two groups: the monophasic and polyphasic groups. The results of MVD surgery and sequential changes in the CMAP were evaluated 1 week, 1 month, 1 year, and final follow-up after the surgery. Significantly higher rates of persistent postoperative HFS were observed in patients with the polyphasic type of initial LSR at 1 week and 1 month after the surgery (P < 0.05, respectively). In the polyphasic group, the amplitude of the CMAP tended to gradually improve with time, while in the monophasic group, the amplitude of the CMAP decreased on the seventh postoperative day, followed by its gradual improvement. There is a significant correlation between delayed relief after MVD and polyphasic morphology of the initial LSR in patients with HFS. In the polyphasic group, CMAP recovered earlier and showed less reduction in amplitude, suggesting segmental demyelination, with less damage to peripheral nerves.

Significant Correlation between Delayed Relief after Microvascular Decompression and Morphology of the Abnormal Muscle Response in Patients with Hemifacial Spasm.

Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), postoperative delayed relief of persistent HFS is one of the main issues. In patients with hemifacial spasm, stimulation of a branch of the affected facial nerve elicits an abnormal response in the muscles innervated by another branch. Several specific types of waves were found in the abnormal muscle response (AMR). This study aimed to confirm the relationship between the initial morphology of the AMR wave and delayed relief of persistent HFS after MVD. We retrospectively analyzed and compared the data from 47 of 155 consecutive patients who underwent MVD for HFS at our hospital between January 2015 and March 2020. Based on the pattern of the initial AMR morphology on orbicularis oculi and mentalis muscle stimulation, patients were divided into two groups, namely, the monophasic and polyphasic groups. The results of MVD surgery for HFS were evaluated 1 week, 1 month, and 1 year postoperatively, by evaluating whether or not the symptoms of HFS persisted at the time of each follow-up. There were significantly higher rates of persistent postoperative HFS in patients with the polyphasic type of initial AMR at 1 week and 1 month after the surgery (p < 0.05, respectively), as assessed using Yates chi-squared test and Fisher's exact test. A significant correlation was observed between delayed relief after MVD and polyphasic morphology of the AMR in electromyographic analysis in patients with hemifacial spasm.

Recurrence of Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Cohort Study in Central China.

ObjectiveTo investigate factors that could impact or predict the probability of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis recurrence in central China.MethodsFrom November 2014 to October 2020, observational data of anti-NMDAR encephalitis inpatients in our institution were collected and analyzed prospectively. The demographics, clinical characteristics, tumor status, lesion locations on MRI and immunotherapies, etc. had entered into a Cox regression model for the identification of the factors associated with relapse-free survival.ResultsWe enrolled 113 patients in a row (median age: 28 years, range: 1–61 years). The gender distribution was not statistically significant (p = 0.158), with 49 people (43.4%) being female. The median follow-up time was 16 (4–77) months. Among them, 16.8% of patients relapsed. The average interval between recurrences was 8 months (range 3–54 mo). The severity of the initial relapse was less severe than it had been at the start. The first relapse had considerably fewer symptoms (median 2, range 1–6) than the first episode (median 4, range 1–8, p = 0.005). The mRS at first relapse (median 3, mean 2.84, range 1–5) had been significantly lower than that at onset (median 4, mean 3.89, range 3–5, p = 0.004). The length of hospitalization at first relapse (median 17 days, range 5–46) was significantly shorter than the first episode (median 35 days, range 14–102, p = 0.002). In the survival analysis, the risk of recurrence was significantly higher for patients with a brainstem lesion (HR: 4.112, 95% CI: 1.205–14.030; p = 0.024) or ≥3 abnormal sites (HR: 2.926, 95% CI: 1.085–7.896; p = 0.034) on brain MRI at the first episode. There was no significant difference in neurological outcomes between the recurrent and monophasic groups at the most recent follow-up (mRS 0–2 in 17/19 vs. 86/94; p = 0.674).ConclusionsAnti-NMDAR encephalitis can recur in around one out of every six cases, and symptoms are generally milder than when it first appears. Recurrence is not related to the severity in the acute phase or the prognosis at follow-up. Patients with ≥3 abnormal sites on MRI or lesions located in the brainstem at onset must be alert to the possibility of recurrence.

The selection of hyaluronic acid when treating with the nasolabial fold: A meta-analysis.

Hyaluronic acid (HA) gel is a widely used dermal filler for the correction of facial volume loss. The relationship between the characteristics of HA and clinical efficacy remains unclear. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of monophasic and biphasic HA in the treatment of nasolabial folds (NLFs). Studies were identified by searching the electronic databases PubMed, Embase, and Web of Science from inception to May 2021. Randomized controlled trials (RCTs) were selected according to the inclusion criteria. Outcomes included the Wrinkle Severity Rating Scale (WSRS) score, Global Aesthetic Improvement Scale score, and incidence of adverse events. A total of 1190 patients from 14 RCTs were included in the meta-analysis. The mean WSRS score improvement in the biphasic HA group was much lower than that in the monophasic HA group (MD=0.18, 95% CI: 0.16-0.20, p<0.00001). The subject satisfaction percentage was significantly higher for monophasic than biphasic HA (RR=1.95, 95% CI: 1.09-3.48, p=0.02). There was no significant difference in the adverse event rate between the monophasic and biphasic HA groups (RR=0.96, 95% CI: 0.75-1.24, p=0.77). Regardless of whether improvement in NLFs or patient satisfaction is considered, monophasic HA is better than biphasic HA. Regarding the adverse event rate, there is no difference between monophasic and biphasic HA.

Intrarenal Doppler ultrasonography reflects hemodynamics and predicts prognosis in patients with heart failure

We aimed to clarify clinical implications of intrarenal hemodynamics assessed by intrarenal Doppler ultrasonography (IRD) and their prognostic impacts in heart failure (HF). We performed a prospective observational study, and examined IRD and measured interlobar renal artery velocity time integral (VTI) and intrarenal venous flow (IRVF) patterns (monophasic or non-monophasic pattern) to assess intrarenal hypoperfusion and congestion in HF patients (n = 341). Seven patients were excluded in VTI analysis due to unclear imaging. The patients were divided into groups based on (A) VTI: high VTI (VTI ≥ 14.0 cm, n = 231) or low VTI (VTI < 14.0 cm, n = 103); and (B) IRVF patterns: monophasic (n = 36) or non-monophasic (n = 305). We compared post-discharge cardiac event rate between the groups, and right-heart catheterization was performed in 166 patients. Cardiac index was lower in low VTI than in high VTI (P = 0.04), and right atrial pressure was higher in monophasic than in non-monophasic (P = 0.03). In the Kaplan–Meier analysis, cardiac event rate was higher in low VTI and monophasic groups (P < 0.01, respectively). In the Cox proportional hazard analysis, the combination of low VTI and a monophasic IRVF pattern was a predictor of cardiac events (P < 0.01). IRD imaging might be associated with cardiac output and right atrial pressure, and prognosis.

Clinical features and outcomes in relapsing and monophasic patients with anti-leucine-rich glioma-inactivated 1 encephalitis

Objective: To analyze the differences of clinical characteristics and outcomes between relapsing and monophasic patients with anti-leucine-rich glioma-inactivated 1 (anti-LGI1) encephalitis. Methods: Medical records of confirmed anti-LGI1 encephalitic patients who underwent immunotherapy were retrospectively collected from January 2015 to January 2019 in the first affiliated hospital of Zhengzhou University. Clinical data, treatment methods, duration of treatment and outcomes were analyzed between the relapsing and monophasic groups. Results: Among the 33 anti-LGI1 encephalitic patients, there were 12 and 21 cases in the relapsing and monophasic groups, respectively. No difference was found in age, sex, precipitating factors, intensive care unit (ICU) admission, symptoms and modified Rankin Scale (mRS) score in the acute phase (P>0.05). As to the lab test and image examination, no statistic difference was found in serum and cerebral spinal fluid (CSF) positive rate, hyponatremia, abnormal rate of electrocardiogram (ECG), electroencephalogram (EEG), CSF and magnetic resonance imaging (MRI) and lesion locations (P>0.05). No difference was found in time to diagnose the disease between the 2 groups (P>0.05). The median immunotherapy period was 102.5 days in relapsing group and 194.0 days in monophasic group, with a statistic difference (P=0.001). No patients had bad outcomes in the monophasic group at the last follow-up, while 6 patients had poor outcomes in the relapsing group (4 patients died). The patients in relapsing group had a worse prognosis compared to those in the monophasic group (P=0.007). Conclusions: Relapse is common in anti-LGI1 encephalitis. Patients in the relapsing group received a shorter term of immunotherapy and had worse outcomes than those in the monophasic group.

The Effect of Prior Gestational Diabetes on the Shape of the Glucose Response Curve during an Oral Glucose Tolerance Test 3 Years after Delivery.

Objective Monophasic glucose response (MGR) during an oral glucose tolerance test (OGTT) and gestational diabetes mellitus (GDM) are predictors of type 2 diabetes mellitus (T2DM). We investigated the association between current MGR and (1) glucose tolerance during a pregnancy 3 years before and (2) current glucose tolerance status. We also sought (3) other determinants of MGR. Research Design and Methods. We conducted a nested case-control study of GDM (n = 47 early GDM, diagnosed between 16 and 20 weeks of gestation; n = 40 late GDM, diagnosed between 24 and 28 weeks of gestation) and matched healthy controls (n = 37, normal glucose tolerance during pregnancy) all free from diabetes at follow-up 3.4 ± 0.6 years after delivery. Glucose tolerance was determined by 2-hour 75 g OGTT. Monophasic and biphasic groups were defined based on serum glucose measurements during OGTT. Results The biphasic group was younger, had lower triglyceride levels and area under the OGTT glucose curve, and was less frequently diagnosed with early GDM (25 vs. 45%, all p < 0.05). Women with a biphasic response also tended to have lower systolic blood pressure (p < 0.1). No differences were found in fasting and 2-hour glucose and insulin levels, or BMI. According to multiple logistic regression, MGR was associated with prior early GDM (OR 2.14, 95% CI 0.92-4.99) and elevated triglyceride levels (OR 2.28, 95% CI 1.03-5.03/log (mmol/l)). Conclusions We found that more severe, early-onset GDM was an independent predictor of monophasic glucose response suggesting that monophasic response may represent an intermediate state between GDM and manifest type 2 diabetes.

Distinct metabolic profile according to the shape of the oral glucose tolerance test curve is related to whole glucose excursion: a cross-sectional study

BackgroundThe shapes of the plasma glucose concentration curve during the oral glucose tolerance test are related to different metabolic risk profiles and future risk of type 2 DM. We sought to further analyze the relationship between the specific shapes and hyperglycemic states, the metabolic syndrome and hormones involved in carbohydrate and lipid metabolism, and to isolate the effect of the shape by adjusting for the area under the glucose curve.MethodsOne hundred twenty one adult participants underwent a 2-h oral glucose tolerance test and were assigned to either the monophasic (n = 97) or the biphasic (n = 24) group based upon the rise and fall of their plasma glucose concentration. We evaluated anthropometric measures, blood pressure, lipid profile, high-sensitivity C-reactive protein, glycated hemoglobin, insulin sensitivity, beta-cell function, C-peptide, glucagon, adiponectin and pancreatic polypeptide.ResultsSubjects with monophasic curves had higher fasting and 2-h plasma glucose levels, while presenting lower insulin sensitivity, beta-cell function, HDL cholesterol, adiponectin and pancreatic polypeptide levels. Prediabetes and metabolic syndrome had a higher prevalence in this group. Glycated hemoglobin, total cholesterol, triglycerides, high-sensitivity C-reactive protein and glucagon were not significantly different between groups. After adjusting for the area under the glucose curve, only the differences in the 1-h and 2-h plasma glucose concentrations and HDL cholesterol levels between the monophasic and biphasic groups remained statistically significant.ConclusionsRates and intensity of metabolic dysfunction are higher in subjects with monophasic curves, who have lower insulin sensitivity and beta-cell function and a higher prevalence of prediabetes and metabolic syndrome. These differences, however, seem to be dependent on the area under the glucose curve.

The shape of the glucose concentration curve during an oral glucose tolerance test predicts risk for type 1 diabetes.

We aimed to examine: (1) whether specific glucose-response curve shapes during OGTTs are predictive of type 1 diabetes development; and (2) the extent to which the glucose-response curve is influenced by insulin secretion. Autoantibody-positive relatives of people with type 1 diabetes whose baseline OGTT met the definition of a monophasic or biphasic glucose-response curve were followed for the development of type 1 diabetes (n=2627). A monophasic curve was defined as an increase in OGTT glucose between 30 and 90min followed by a decline of ≥0.25mmol/l between 90 and 120min. A biphasic response curve was defined as a decrease in glucose after an initial increase, followed by a second increase of ≥0.25mmol/l. Associations of type 1 diabetes risk with glucose curve shapes were examined using cumulative incidence curve comparisons and proportional hazards regression. C-peptide responses were compared with and without adjustments for potential confounders. The majority of participants had a monophasic curve at baseline (n=1732 [66%] vs n=895 [34%]). The biphasic group had a lower cumulative incidence of type 1 diabetes (p<0.001), which persisted after adjustments for age, sex, BMI z score and number of autoantibodies (p<0.001). Among the monophasic group, the risk of type 1 diabetes was greater for those with a glucose peak at 90min than for those with a peak at 30min; the difference persisted after adjustments (p<0.001). Compared with the biphasic group, the monophasic group had a lower early C-peptide (30-0min) response, a lower C-peptide index (30-0min C-peptide/30-0min glucose), as well as a greater 2h C-peptide level (p<0.001 for all). Those with biphasic glucose curves have a lower risk of progression to type 1 diabetes than those with monophasic curves, and the risk among the monophasic group is increased when the glucose peak occurs at 90min than at 30min. Differences in glucose curve shapes between the monophasic and biphasic groups appear to be related to C-peptide responses.

Diffusion tensor imaging in multiple sclerosis at different final outcomes.

Methods to evaluate the relative contributions of demyelination vs axonal degeneration over the long-term course of MS are urgently needed. We used magnetic resonance diffusion tensor imaging (DTI) to estimate degrees of demyelination and axonal degeneration in the corpus callosum (CC) in cases of MS with different final outcomes. We determined DTI measures mean diffusivity (MD), fractional anisotropy (FA), and axial (AD) and radial (RD) diffusivities in the CC of 31 MS patients, of whom 13 presented a secondary progressive course, 11 a non-progressive course, and seven a monophasic course. The study participants were survivors from an incidence cohort of 254 attack-onset MS patients with 50years of longitudinal follow-up. As reference, we included five healthy individuals without significant morbidity. In patients with secondary progression, compared to all other groups, the corpus callosum showed increased RD and reduced FA, but no change in AD. None of the parameters exhibited differences among non-progressive and monophasic course groups and controls. Increased RD was observed in secondary progressive MS, indicating significant myelin loss. Normal RD values observed in the clinically isolated syndrome and non-progressive groups confirm their benign nature. AD was not a characterizing parameter for long-term outcome. Demyelination revealed by increased RD is a distinguishing trait for secondary progression.

Oral contraceptives and cognition: A role for ethinyl estradiol

This article is part of a Special Issue "Estradiol and cognition".Estrogens have been seen to play a role in human cognitive abilities, but questions remain about the cognitive impact of ethinyl estradiol, which is contained in many oral contraceptives (OCs). Inconsistencies in past studies likely reflect small samples and heterogeneous groups of OC users. The aims of the present work were to examine OC effects on sex-typed spatial and verbal abilities by (a) comparing mental rotations and expressional fluency in normally-cycling (NC) women and men to OC users considered as a heterogeneous group and then to homogeneous groups of OC users created by classifying pills according to their active constituents, and (b) determining the relation between synthetic hormone doses in OCs and mental rotations and expressional fluency. Participants were 136 men, 93 NC women, and 148 OC users, including homogeneous monophasic (n=55) and triphasic (n=43) OC groups, aged 18 to 30years. Significant effects of OC use were seen in homogeneous group comparisons but not when OC users were considered as a heterogeneous group. On mental rotations, men outperformed women, and monophasic OC users outperformed NC women. The latter difference may be attributable to estradiol, as ethinyl estradiol was inversely related to spatial ability among OC users and was lower in monophasic than in triphasic users. On expressional fluency, NC women and monophasic OC users outperformed men, and monophasic users outperformed triphasic users. Thus, results show the importance of ethinyl estradiol and of considering pill constituents when studying the cognitive effects of OCs.

What can we learn from shamans’ dreaming? A cross-cultural exploration.

Shamanism is a worldwide social phenomenon consisting of a set of practices (e.g., ritualistic drumming, sensory deprivation, the ingestion of entheogens and dream incubation) designed to obtain knowledge from alternative realities for the purpose of benefiting one’s social group. The aim of this paper is to provide a cross-cultural exploration of dreaming in the context of shamanism. We proceed by addressing 2 fundamental questions: What is meant by the terms shaman and shamanic principle, and what is the distinction between monophasic and polyphasic social groups with regards to the veridicality and cultural significance of dreams? It will be demonstrated that the kind of society in which shamanism arises (groups having polyphasic cultures) is quite different compared to modern materialistic/technocratic society (those having monophasic cultures). Subsequently, our cross-cultural investigation of shamanic dreaming focuses on the shamanic call, initiation and healing. Finally, we elucidate the major elements of core shamanism as they appear to influence dreaming, dream interpretation and dream culture, and suggest that in fact dreaming invites shamanism.

Efficacy of Biphasic Transcranial Electric Stimulation in Intraoperative Motor Evoked Potential Monitoring for Cervical Compression Myelopathy

Retrospective analysis of prospectively collected data from consecutive patients undergoing 2 methods of transcranial electrical motor evoked potential (TCE-MEP) monitoring during cervical spine surgery. To investigate the efficacy of biphasic transcranial electric stimulation, the deviation rate, amplitude of TCE-MEPs, complications, and sensitivity and specificity of TCE-MEP monitoring were compared between the biphasic and conventional monophasic stimulation methods. With biphasic stimulation, unlike monophasic stimulation, measurement time can be reduced considerably because a single stimulation elicits bilateral responses almost simultaneously. However, no study has yet reported a detailed comparison of the 2 methods. Examination 1: Amplitude and derivation rate of TCE-MEPs was compared for monophasic and biphasic stimulation in the same 31 patients with cervical compression myelopathy. Examination 2: Sensitivity, specificity, and complications of TCE-MEP monitoring were compared in 200 patients with cervical compression myelopathy who received monophasic or biphasic stimulation (100 patients each) during intraoperative monitoring. Examination 1: Derivation rates of biphasic stimulation in the deltoid, biceps brachii, abductor digiti minimi, and flexor hallucis brevis muscles were the same or higher than for monophasic stimulation. TCE-MEP amplitudes elicited by biphasic stimulation compared with monophasic stimulation were significantly larger in the biceps (paired t, P < 0.0001), but similar in the other 3 muscles. Examination 2: In the biphasic and monophasic stimulation groups, warnings were issued to surgeons in 10 and 11 cases, for a sensitivity of 100% for both groups and specificity of 97.8% and 96.7%, respectively. No complications related to stimulation were observed in any of the 200 patients. Biphasic stimulation had similar or higher derivation rates and equivalent sensitivity and specificity than monophasic stimulation. No complications were observed for either stimulation method. Biphasic stimulation is an effective TCE-MEP monitoring method for cervical spine surgery that may also reduce measurement time. 4.

The effect of 1-shock protocol using biphasic defibrillators for electrical therapies after out-of-hospital cardiac arrest due to ventricular fibrillation

Background: In recent guidelines for electrical therapy of Cardiopulmonary Resuscitation (CPR), there was insufficient evidence to recommend any specific biphasic waveform. When defibrillation is required, a single shock should be provided with immediate resumption of chest compressions after the shock (1-shock protocol). We investigated the effect of 1-shock protocol using biphasic defibrillators. Methods: From the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest, we extracted the patients who were persons 18 years of age or older with bystander-witnessed shockable cardiac arrest due to cardiac etiology in the years 2005 (the 3-shock protocol era), and 2008, 2009 and 2010 (the 1-shock protocol era). The study patients were divided into 4 groups according to the two shock protocols and the two AED waveforms. The primary endpoint was 30-day favorable neurological outcome after cardiac arrest. Results: Of the 17,199 patients who met the inclusion criteria, 7,539 received CPR by bystanders (CPR group), and 9,580 did not receive CPR by bystanders (No CPR group). Figure showed comparisons of favorable neurological outcome between the 1-shock protocol and the 3-shock protocol groups, and between the biphasic AEDs and the monophasic AEDs groups in both groups. Adjusted odds ratios for favorable neurological outcome were 2.5 (95% CI, 2.2 to 2.8) after 1-shock protocol and 1.3 (95% CI, 1.2 to 1.4) after biphasic AEDs in CPR group, and were 2.5 (95% CI, 2.2 to 2.8) after 1-shock protocol and 1.3 (95% CI, 1.2 to 1.4) after biphasic AEDs in No CPR group. ![Figure][1] Figure 1 Conclusion: Single-shock protocol using biphasic AEDs was superior to the others in terms of neurological benefits. [1]: pending:yes

Abstract 294: The Effect of 1-Shock Protocol using Biphasic Defibrillators for Treatment of Out-of-Hospital Shockable Cardiac Arrest

BACKGROUND In recent guidelines for electrical therapy of cardiopulmonary resuscitation (CPR), there was insufficient evidence to recommend any specific biphasic waveform. When defibrillation is required, a single shock should be provided with immediate resumption of chest compressions after the shock (1-shock protocol). We investigated the effect of 1-shock protocol using biphasic defibrillators. METHODS From the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest, we extracted the patients who were persons 18 years of age or older with bystander-witnessed shockable cardiac arrest due to cardiac etiology in the years 2005 (the 3-shock protocol era), and 2008, 2009 and 2010 (the 1-shock protocol era). The study patients were divided into 4 groups according to the two shock protocols and the two AED waveforms. The primary endpoint was 30-day favorable neurological outcome after shockable arrest. RESULTS Of the 17,297 patients who met the inclusion criteria, 1,626 received 3-shock protocol using biphasic AEDs, 1,960 3-shock protocol using monophasic AEDs, 12,133 1-shock protocol using biphasic AEDs, and 1,578 1-shock protocol using monophasic AEDs. Figure showed comparisons of favorable neurological outcome between the 1-shock protocol and the 3-shock protocol groups, and between the biphasic AEDs and the monophasic AEDs groups. In the subgroups of patients who did not receive bystander CPR, the frequencies were similar to the results of all patients. Adjusted odds ratios for favorable neurological outcome were 2.5 (95% CI, 2.2 to 2.8) after 1-shock protocol and 1.3 (95% CI, 1.2 to 1.4) after biphasic AEDs in the whole cohort. CONCLUSION Single-shock protocol using biphasic AEDs was superior to the others, including 1-shock protocol using monophasic AEDs, 3-shock protocol using biphasic AEDs and 3-shock protocol using monophasic AEDs, in terms of neurological benefits.

Comparison of Outcomes After Use of Biphasic or Monophasic Defibrillators Among Out-of-Hospital Cardiac Arrest Patients

The use and popularity of the biphasic waveform defibrillator as a replacement for the monophasic waveform defibrillator are increasing, but it is unclear whether this can improve the rate of survival among out-of-hospital cardiac arrest patients. This study aimed to verify the hypothesis that the outcome of out-of-hospital cardiac arrest patients who received defibrillation shock with the biphasic waveform defibrillator was better than that of patients who received defibrillation shock with the monophasic defibrillator. This prospective, nationwide, population-based, observational study included 21 172 out-of-hospital cardiac arrest patients with initial ventricular fibrillation or pulseless ventricular tachycardia from January 1, 2005, through December 31, 2007. Defibrillation shock was performed by monophasic defibrillator on 8224 (39%) patients and by biphasic defibrillator on 12 948 (61%) patients. The rate of survival at 1 month with minimal neurological impairment was 11.6% (951/8192) in the monophasic defibrillator group and 12.8% (1653/12 928) in the biphasic defibrillator group. Hierarchical logistic regression analysis using a generalized estimation equation showed no significant difference between the biphasic and monophasic groups in 1-month survival with minimal neurological impairment (adjusted odds ratio, 1.07; 95% confidence interval, 0.91-1.26; P=0.42). Confirmatory propensity score analyses showed similar results. Although monophasic defibrillators are being replaced by biphasic defibrillators, our nationwide population-based observational study failed to demonstrate a statistically significant association between defibrillation waveform and 1-month survival rate with minimal neurological impairment.

Glucose Response Curve and Type 2 Diabetes Risk in Latino Adolescents

OBJECTIVEIn adults, the shape of the glucose response during an oral glucose tolerance test (OGTT) prospectively and independently predicts type 2 diabetes. However, no reports have described the utility of this indicator in younger populations. The purpose of this study was to compare type 2 diabetes risk factors in Latino adolescents characterized by either a monophasic or biphasic glucose response during an OGTT.RESEARCH DESIGN AND METHODSA total of 156 nondiabetic Latino adolescents completed a 2-h OGTT. Monophasic and biphasic groups were compared for the following type 2 diabetes risk factors: fasting and 2-h glucose, HbA1c, glucose area under the curve (AUC), insulin sensitivity (Matsuda index), insulin secretion (insulinogenic index), and β-cell function as measured by the disposition index (insulin sensitivity × insulin secretion).RESULTSOf the participants, 107 youth were categorized as monophasic and 49 were biphasic. Compared with the monophasic group, participants with a biphasic response exhibited lower HbA1c (5.4 ± 0.3 vs. 5.6 ± 0.3%, P < 0.01) and lower glucose AUC (14,205 ± 2,382 vs. 16,230 ± 2,537 mg ⋅ dL−1 ⋅ h−1, P < 0.001) with higher insulin sensitivity (5.4 ± 3.2 vs. 4.6 ± 3.4, P ≤ 0.05), higher insulin secretion (2.1 ± 1.3 vs. 1.8 ± 1.3, P = 0.05), and better β-cell function (10.3 ± 7.8 vs. 6.0 ± 3.6, P < 0.001). Differences persisted after adjusting for age, sex, and BMI.CONCLUSIONSThese data suggest that the glycemic response to an OGTT may differentiate risk for type 2 diabetes in youth. This response may be an early marker of type 2 diabetes risk among high-risk youth.

Monophasic versus biphasic defibrillation for pediatric out-of-hospital cardiac arrest patients: a nationwide population-based study in Japan

IntroductionConventional monophasic defibrillators for out-of-hospital cardiac-arrest patients have been replaced with biphasic defibrillators. However, the advantage of biphasic over monophasic defibrillation for pediatric out-of-hospital cardiac-arrest patients remains unknown. This study aimed to compare the survival outcomes of pediatric out-of-hospital cardiac-arrest patients who underwent monophasic defibrillation with those who underwent biphasic defibrillation.MethodsThis prospective, nationwide, population-based observational study included pediatric out-of-hospital cardiac-arrest patients from January 1, 2005, to December 31, 2009. The primary outcome measure was survival at 1 month with minimal neurologic impairment. The secondary outcome measures were survival at 1 month and the return of spontaneous circulation before hospital arrival. Multivariable logistic regression analysis was performed to identify the independent association between defibrillator type (monophasic or biphasic) and outcomes.ResultsAmong 5,628 pediatric out-of-hospital cardiac-arrest patients (1 through 17 years old), 430 who received defibrillation shock with monophasic or biphasic defibrillator were analyzed. The number of patients who received defibrillation shock with monophasic defibrillator was 127 (30%), and 303 (70%) received defibrillation shock with biphasic defibrillator. The survival rates at 1 month with minimal neurologic impairment were 17.5% and 24.4%, the survival rates at 1 month were 32.3% and 35.6%, and the rates of return of spontaneous circulation before hospital arrival were 24.4% and 27.4% in the monophasic and biphasic defibrillator groups, respectively. Hierarchic logistic regression analyses by using generalized estimation equations found no significant difference between the two groups in terms of 1-month survival with minimal neurologic impairment (odds ratio (OR), 1.57; 95% confidence interval (CI), 0.87 to 2.83; P = 0.14) and 1-month survival (OR, 1.38; 95% CI, 0.87 to 2.18; P = 0.17).ConclusionsThe present nationwide population-based observational study could not confirm an advantage of biphasic over monophasic defibrillators for pediatric OHCA patients.

Clinical characteristics, prognosis, and seropositivity to the anti-aquaporin-4 antibody in Korean patients with longitudinally extensive transverse myelitis

Longitudinally extensive transverse myelitis (LETM) is a syndrome with extensive spinal cord lesions spanning three or more vertebral segments on spinal cord MRI. Although many reports have indicated that LETM is a characteristic feature of neuoromyelitis optica (NMO) in Western countries, the clinical characteristics and risk for development of NMO in Korean patients with LETM is not clear. We retrospectively investigated the clinical, laboratory, radiological features, and prognosis of Korean patients with a first-ever episode of idiopathic LETM. Patients were classified into four subgroups, depending on their clinical course: monophasic LETM, recurrent LETM, NMO, and classic multiple sclerosis (MS). We compared various clinical, laboratory, and radiological features between groups. Of 20 patients with first-ever LETM, 15 (75%) were men, and 13 (65%) experienced clinical relapse over a mean follow-up period of 58 months. Three of 20 patients (two with NMO, one with recurrent myelitis) were seropositive for anti-AQP4 antibodies. The predominance of men in the monophasic and recurrent LETM groups compared to the NMO group was remarkable. In conclusion, Korean patients with LETM are predominantly male and have low seropositivity for anti-AQP4 antibody, which distinguishes them from LETM patients in Western countries. Patients with LETM and seropositivity for anti-AQP4 antibody have a high risk of relapse. The male predominance and the relatively low seropositive rate for anti-AQP4 suggests that rather than being a limited form of NMO, recurrent LETM is a new clinical entity in Koreans.

Biphasic Defibrillation Does not Improve Outcomes Compared to Monophasic Defibrillation in Out-of-Hospital Cardiac Arrest

Study Objective. To compare the outcomes of out-of hospital cardiac arrest (OHCA) victims treated with monophasic truncated exponential (MTE) versus biphasic truncated exponential (BTE) defibrillation in an urban EMS system. Methods. We conducted a retrospective review of electronic prehospital andhospital records for victims of OHCA between August 2000 andJuly 2004, including two years before andafter implementation of biphasic defibrillators by the Fresno County EMS agency. Main outcome measures included: return of spontaneous circulation (ROSC), number of defibrillations required for ROSC, survival to hospital discharge, anddischarge to home versus an extended care facility. Results. There were 485 cases of cardiac arrest included. Baseline characteristics between the monophasic andbiphasic groups were similar. ROSC was achieved in 77 (30.6%, 95% CI 25.2–36.5%) of 252 patients in the monophasic group, andin 70 (30.0% 95% CI 24.5–36.2%) of 233 in the biphasic group (p =. 92). Survival to hospital discharge was 12.3% (95% CI 8.8–17%) for monophasic and10.3% (95% CI 7.0–14.9%) for biphasic (p =. 57). Discharge to home was accomplished in 20 (7.9%, 95% CI 5.1–12.0%) of the monophasic, andin 15 (6.4%, 95% CI 3.9–10.4%) of the biphasic group (p =. 60). More defibrillations were required to achieve ROSC (3.5 vs. 2.6, p =. 015) in the monophasic group. Conclusions. We found no difference in ROSC or survival to hospital discharge between MTE andBTE defibrillation in the treatment of OHCA, although fewer defibrillations were required to achieve ROSC in those treated with biphasic defibrillation.