NSS Group Research Articles

Acute Implantation of a Bioresorbable Polymer Scaffold in Patients With Complete Thoracic Spinal Cord Injury: A Randomized Controlled Trial (INSPIRE 2.0).

Traumatic spinal cord injury (SCI) remains a devastating condition with no proven effective treatment options available. In a prior single-arm study of patients with thoracic complete SCI (INSPIRE; ClinicalTrials.gov, NCT02138110), acute implantation of an investigational bioresorbable polymer scaffold (Neuro-Spinal Scaffold [NSS]) appeared to be safe through 24 months postimplantation and was associated with an American Spinal Injury Association Impairment Scale (AIS) conversion rate that exceeded historical controls. Here, we evaluated whether NSS implantation demonstrates probable benefit for safety and neurological recovery in patients with thoracic complete SCI vs standard-of-care spine surgery. INSPIRE 2.0 was a randomized, controlled, parallel, multicenter study conducted at Level I trauma centers in the United States (ClinicalTrials.gov, NCT03762655; funded by InVivo Therapeutics Corporation). Patients with AIS grade A, thoracic (T2-T12), nonpenetrating SCI requiring spine surgery ≤7 days postinjury were randomized (1:1, computer-generated allocation) to undergo NSS implantation or spine surgery alone (control group). Patients and follow-up International Standards for Neurological Classification of SCI assessors were blinded. A predefined study success criterion required the proportion of patients with improvement of ≥1 AIS grade at 6 months postsurgery (primary endpoint) to be ≥20% higher in the NSS group than in the control group. Target enrollment was reached (N = 20) with 10 patients randomized and analyzed in each group. At 6 months postsurgery, an improvement in the AIS grade was reported in 2 NSS patients (20%; both to AIS C) and 3 control group patients (30%; to AIS B [n = 2] or AIS C [n = 1]). No serious or unanticipated adverse device effects were reported. The study was closed to further follow-up because of not meeting its primary endpoint. In this small group of patients with thoracic complete (AIS A) SCI, implantation of an intraparenchymal bioresorbable scaffold did not produce probable clinical benefit. However, this study provides evidence that surgical intervention in an injured spinal cord parenchyma may be performed safely.

Predicting septic shock in obstructive pyelonephritis associated with ureteral stones: A retrospective study.

To identify the best combination of potential predictors of septic shock in patients with obstructive acute pyelonephritis associated with ureteral stones (OAPN-US) according to Sepsis-3 criteria. Patients who underwent percutaneous nephrostomy (PCN) with OAPN-US were retrospectively evaluated. Recursive feature elimination (RFE) was applied to patients with and without septic shock to identify factors associated with the prediction of progression to septic shock. We compared combinations of the selected features based on area under the receiver operating curve (AUROC) to determine which combination was most effective. This study included 81 patients who were treated with PCN due to OAPN-US. A comparison was made between 37 patients with septic shock (SS) and 44 patients without septic shock (NSS). SS group had a higher age, poorer Eastern Cooperative Oncology Group status, and significantly higher levels of positivity in urine cultures and blood cultures. There were also differences in laboratory tests between the 2 groups. Procalcitonin (PCT), international normalized ratio (INR), and absolute lymphocyte count (ALC) were selected based on RFE. We compared the predictive power for SS when each marker was used alone, when 2 markers were combined, and when all 3 markers were combined. Among these combinations, using all 3 variables together yielded the highest AUROC of 0.942. Of the 3 variables, PCT had the highest Gini importance score, indicating that it was the most influential factor. Clinical characteristics were different between the SS and the NSS groups. In patients with OAPN-US, the combination of PCT, ALC, and INR was an excellent predictor of septic shock.

Normal Saline or Sodium Hypochlorite Irrigation for Vital Pulp Therapy? A Non-Inferiority Randomized Controlled Trial.

criteria were randomized to each irrigant, 65 in the NaOCl and 60 in the NSS groups. ProRoot® MTA was used as a pulp dressing material in both groups and teeth were followed for 12 months. The primary outcome was the success of VPT; requiring both clinical and radiographic success to be considered as success. The hypothesis was that the absolute difference of VPT success in the NSS group was not worse than that in the NaOCl group, by a margin of 5%. The secondary outcome was discoloration; percentages of discolorations between both groups were compared. Results: Using a per protocol analysis, the absolute difference of VPT success between the NSS and NaOCl groups was 2.08% (95% CI: -1.95, 6.1). Perceptible gray discolorations were 80% and 63% in NaOCl and NSS groups (difference -17%; 95% CI: -40.0, 6.2; p=0.15). Conclusions: For MTA-VPT procedure, irrigation with NSS was not worse than that with NaOCl. However, both irrigants caused discoloration. (EEJ-2023-05-065).

Early Predictors and Outcomes of American Spinal Injury Association Conversion at Discharge in Surgical and Nonsurgical Management of Sports-Related Spinal Cord Injury

This study aims to evaluate the rate of improvement in neurologic recovery of patients with sports-related spinal cord injury (SRSCI) who had surgical intervention (SS) and those who did not (NSS). We aimed to 1) evaluate the rate of American Spinal Injury Association (ASIA) conversion in patients with and without surgery, and 2) assess predictors of conversion in ASIA grade. The National Spinal Cord Injury Model Systems Database (SCIMS) was used from 1973 to 2016. Patients with SRSCI were included. The primary outcome was rate of conversion in ASIA grade. Multivariate logistic regression was performed with separate subgroup analysis on patients with cervical injury (represented by odds ratio [OR]; 95% confidence interval [CI]). A total of 1647 patients had SRSCI with 1502 (91%) SSs. Most patients (88%) were male, white (87%), and between the ages of 15 and 29 years (63%). Patients undergoing SS had significantly longer inpatient rehabilitation length of stay (LOS) (P < 0.001) and a more patients undergoing SS had complete motor or sensory loss compared with the NSS group. Multivariate logistic regression showed that injury at the thoracic level (OR,0.41; 95% CI, 0.21-0.78), age 15-29 years (OR, 0.44; 95% CI,0.20-0.97]), water-based injury (OR, 0.45; 95% CI, 0.21-0.95), and ASIA impairment grades of B, C, and D at admission were significantly associated with ASIA SCORE conversion. We found that patients undergoing SS had longer LOS and a higher prevalence of complete injuries. Surgical intervention was not associated with conversion in ASIA grade to an improved status at time of discharge in a large cohort of patients with SRSCI and in a subcohort of patients with cervical SRSCI.

Clinical Impact of Sarcopenia 1 Year After Surgery for Patients with Early-Stage Non-small Cell Lung Cancer

Sarcopenia is associated with prognostic outcomes for patients with various solid tumors, whereas the clinical significance of sarcopenia 1 year after surgery (post-sarcopenia) for non-small cell lung cancer (NSCLC) has not been investigated. This study aimed to clarify the clinical impact of post-sarcopenia and factors associated with post-sarcopenia in NSCLC patients without preoperative sarcopenia. This study enrolled 443 patients with clinical stage 1 or 2 NSCLC (234 patients without preoperative sarcopenia [NS group] and 209 patients with preoperative sarcopenia [S group]) who underwent computed tomography (CT) at two time points (before surgery and a year afterward) or more. The study assessed CT images at the L3 level to calculate the psoas muscle area index (PAI). The PAI cutoff value for sarcopenia was defined as 6.36 cm2/m2 for the men and 3.92 cm2/m2 for the women. In the NS group, the diagnosis for 40.1% of the women and 52.6% of the men was post-sarcopenia (NS-S group). The overall survival (OS) for the S and NS-S cohorts was worse than for the non-sarcopenic patients before and after surgery (p < 0.001 and p = 0.017, respectively). In the multivariable analysis, sarcopenia, either before or after surgery (hazard ratio, 3.272; p = 0.002), in the NS group was independently associated with OS, whereas the factors associated with post-sarcopenia were male sex (p = 0.002), aging (p < 0.001), and low body mass index (p < 0.001). Sarcopenia, either before or after surgery, is prognostic in early-stage NSCLC. Male sex, aging, and low body mass index (BMI) are associated with post-sarcopenia.

The Effect of Hypericum perforatum (St. John’s Wort) and Nigella sativa (Black Cumin) Oils on Wound Healing in Type-1 Diabetic Mice

Wound healing is a well-known therapeutic challenge in animal and human medicine. This study aimed to investigate the effect of topical application of Nigella sativa (black cumin, NS) and Hypericum perforatum (St. John’s Wort, HP) on wound healing in streptozotocin (STZ) induced diabetic mice. For this aim, 25 male BALB/c mice were divided into five groups: i. Hypericum perforatum (HP), ii. Nigella sativa (NS), iii. Standard saline solution 0.9% NaCl (NSS), iv. Natural extra virgin olive oil (OL), and v. Fusidic acid-Centella asiatica cream (FM). A single dose (200 mg/kg) of STZ was intraperitoneally administered to induce type-1 diabetes. After diabetes was induced, six symmetrical excision wounds were performed on the dorsal areas of mice using a dermal biopsy punch. Wound areas were photographed every three days for 21 days, and the images were analyzed using software to achieve the daily wound closure rate in pixel values. On day one and day 21, wound tissues were dissected, total protein and hydroxyproline levels were measured by ELISA. Statistically significant differences were found in hydroxyproline change rates between the NS group with HP, NSS, and FM groups (P&amp;lt;0.05). The only significant difference was found between NS with OL groups (P&amp;lt;0.05) on wound closure rate. This study illustrated that topically administered HP and NS may not have wound-healing effects in type-1 diabetic conditions in mice.

Intermittent hypoxia in rat enhancing peritoneal membrane thickening through HIF-1α-induced cytokines in peritoneum.

Due to the high prevalence of both obstructive sleep apnea syndrome (OSA) and end-stage renal disease (ESRD), the co-existence of both conditions in peritoneal dialysis is demonstrated. Because OSA-induced chronic intermittent hypoxia is well-known, the hypoxia might worsen peritoneal membrane. We tested the influence of chronic intermittent hypoxia upon peritoneal membrane in a Sprague-Dawley rat model. Normal saline or 3.86% glucose peritoneal dialysis fluid (PDF) were intra-peritoneally administered twice a day as negative (NSS group) and positive controls (PDF group), respectively. Intermittent hypoxia was induced by using a hypoxic chamber with 10% O2 for 8 hours a day plus twice-daily NSS injection (IH group). At 12 weeks of the experiments, high serum TNF-α and IL-6 (but not IL-10) with normal renal and liver functions were demonstrated in the IH group (but not the PDF group). In parallel, local cytokines (TNF-α, IL-6, and IL10 in peritoneal membrane) and peritoneal membrane thickness were increased whereas peritoneal membrane hypoxia (hypoxyprobeTM and hypoxia-inducible factor-1α; HIF-1α) was induced in both PDF and IH groups (more prominent in the PDF group). However, the increased vascular density in submesothelial area was established only in the PDF group. Intermittent hypoxia model induced local peritoneal membrane inflammation and enhanced peritoneal membrane thickness, at least in part, through a mechanism of hypoxia-induced HIF-1α. Although peritoneal membrane alterations from PDF were more prominent than intermittent hypoxia, the combination between intermittent hypoxia with PDF utilization might facilitate peritoneal membrane failure, which will need more study.

Efficacy of Hypertonic Saline Irrigation for Nasal Symptoms in Children with Perennial Allergic Rhinitis: A Randomized Double-Blind Study

Background: Nasal saline irrigation was an adjunctive therapy of allergic rhinitis (AR). It has been suggested that the use of hypertonic saline (HS) is better than normal saline (NSS) in treatment of AR. Reduction of mucosal edema by hypertonicity induced water transport through nasal mucosa, nasal congestion reduction and mucociliary clearance improvement. Objective: To compare total nasal symptom score (TNSS) between 3% HS and NSS irrigation in perennial allergic rhinitis children. Materials and Methods: The present study was conducted at the Allergy Center of Bhumibol Adulyadej Hospital (BAH), Royal Thai Airforce, Bangkok, Thailand between January and March 2021. Sixty-two perennial AR children were enrolled and categorized in severity level, namely mild, moderate or severe. Subjects were randomized into two groups. Each participant was blind-randomized to nasal irrigation of either 3% HS or NSS twice-daily for 4 weeks by the same investigator. The primary outcome was TNSS improvement between both groups. Secondary outcomes were quality of life, nasal congestion severity improvement, nasal cytology change and side effects. Results: TNSS improvement of 3% HS was more than NSS group (4.03±2.36 versus 2.73±3.06, p=0.034). Nasal congestion was the only symptom that differed significantly between the two groups (1.32±1.01 in 3% HS versus 0.70±1.24 in NSS, p=0.024). Reduction of congestion severity by physical examination, nasal cytology changes and side effects were comparable. Conclusion: Nasal irrigation with 3% HS in children with perennial AR had more improvement than NSS in TNSS., especially nasal congestion. Keyword: Hypertonic saline; Nasal irrigation; Allergic rhinitis; Nasal symptom score

Sternal lifting increases the operating space in esophagectomy via mediastinoscopy: a prospective cohort study.

BackgroundEsophagectomy with combined single-port inflatable mediastinoscopy and laparoscopy reduces the risk of postoperative respiratory complications as it obviates the need to pass through the pleural space. However, it has strict indications owing to the narrow space for operation. Therefore, we adopted a sternal lifting method using a retractor that enables the expansion of the operating space, a technique which has not been previously reported. We describe our experience and report the results of an evaluation of this new approach.MethodsThirty-nine patients with esophageal squamous cell carcinomas underwent esophagectomy using combined single-port inflatable mediastinoscopy and laparoscopy from March 2019 to August 2021. Among them, 20 cases received sternal suspension [sternal suspension group (SS group)], and 19 cases did not receive sternal suspension [non-sternal suspension group (NSS group)]. The short-term efficacy of the two groups was observed.ResultsPatients in the SS group had a shorter intramediastinal operation time (82.50 vs. 110.00 minutes; P<0.001), more dissected chest lymph nodes (14 vs. 12; P=0.036), and a lower incidence of postoperative hoarseness (2 vs. 6; P=0.235) than did those in the NSS group. There were no significant differences between the SS group and NSS group in terms of intraoperative blood loss, postoperative hospital stay, post-surgical pathologic TNM classification (pTNM), post-surgical pathologic tumor classification (pT), post-surgical pathologic extent of lymph node involvement (pN), and total number of dissected lymph nodes. There were no statistical differences in the incidence of anastomotic fistula, respiratory complications, arrhythmia, or chylothorax between the two groups. There was no mortality during hospitalization in the two groups.ConclusionsSternal lifting increases the working space in esophagectomy via mediastinoscopy. It can make video-assisted radical esophagectomy by a transmediastinal approach with total pneumomediastinum assistance (VARETT) easier to perform, and sternal suspension in VARETT is safe and effective.

Aerobic Exercise Training Prevents Insulin Resistance and Hepatic Lipid Accumulation in LDL Receptor Knockout Mice Chronically Fed a Low-Sodium Diet.

Background: A low-sodium (LS) diet reduces blood pressure, contributing to the prevention of cardiovascular diseases. However, intense dietary sodium restriction impairs insulin sensitivity and worsens lipid profile. Considering the benefits of aerobic exercise training (AET), the effect of LS diet and AET in hepatic lipid content and gene expression was investigated in LDL receptor knockout (LDLr-KO) mice. Methods: Twelve-week-old male LDLr-KO mice fed a normal sodium (NS) or LS diet were kept sedentary (S) or trained (T) for 90 days. Body mass, plasma lipids, insulin tolerance testing, hepatic triglyceride (TG) content, gene expression, and citrate synthase (CS) activity were determined. Results were compared by 2-way ANOVA and Tukey’s post-test. Results: Compared to NS, LS increased body mass and plasma TG, and impaired insulin sensitivity, which was prevented by AET. The LS-S group, but not the LS-T group, presented greater hepatic TG than the NS-S group. The LS diet increased the expression of genes related to insulin resistance (ApocIII, G6pc, Pck1) and reduced those involved in oxidative capacity (Prkaa1, Prkaa2, Ppara, Lipe) and lipoprotein assembly (Mttp). Conclusion: AET prevented the LS-diet-induced TG accumulation in the liver by improving insulin sensitivity and the expression of insulin-regulated genes and oxidative capacity.

English

This study was conducted to evaluate the comparative efficacy of hyperosmotic sodium bicarbonate (HSB 8.4%), hypertonic saline (HSS 7.5%) and normal saline (NSS 0.9%) solutions associated with experimentally Salmonella-induced diarrhoea in buffalo neonatal calves. For this purpose, 14–17 days old 18 healthy buffalo calves were reared. After 8–12 h of oral administration of Salmonella broth (6.5 × 108 CFU), diarrhoea was induced successfully. Calves were then randomly divided into three equal groups viz., groups A, B and C and treatment was instituted. Group A received NSS (0.9%) @ 60 mL/kg (body weight) B.W, intravenous (IV) once, group B was administered HSS (7.5%) @ 5 mL/kg B.W, IV once and group C instituted with HSB (8.4%) @ 5 mL/kg B.W, IV once. All three groups were additionally treated with ciprofloxacin @ 7 mg/kg B.W, IV bid and flunixin meglumine @ 2 mg/kg B.W, IV tid. Comparative efficacy of all treatment regimens was assessed through haemodynamic measurements, blood gases determination and serum electrolyte analysis. All parameters were noted at baseline (prior to diarrhoea induction), during neonatal diarrhoea, t=3, t=9, t=18, t=36, t=72, t=120, t=168 h after treatment. The HSB treated calves (group C) revived from diarrhoea quickly (within 9 h) and efficiently than NSS (group A) and HSS (group B), exhibited significantly (P &lt; 0.05) enhancement. At t=18 h, values for central venous partial pressure and systemic vascular resistance were 11.67 ± 0.7, 13.67 ± 0.61 and 13.50 ± 0.56 and 1180. 83 ± 6.94, 1180.83 ± 6.94 and 1465.00 ± 6.76 in groups A, B and C, respectively. HSB treated buffalo neonatal calves also showed significant increase in bicarbonate, blood pH, serum electrolytes and partial pressure of venous oxygen. Basis on the results of this study, it was concluded that small-volume administration of HSB profoundly ameliorated deleterious effects of septicaemia and improve haemodynamic stability in Salmonella-induced bubaline neonatal diarrhoea. It provides a practical and economical method to resuscitate dehydrated diarrhoeic calves thus make it convenient to accomplish in on-farm situation. © 2021 Friends Science Publishers

Continuous Homomorphisms Defined on (Dense) Submonoids of Products of Topological Monoids

We study the factorization properties of continuous homomorphisms defined on a (dense) submonoid S of a Tychonoff product D = ∏ i ∈ I D i of topological or even topologized monoids. In a number of different situations, we establish that every continuous homomorphism f : S → K to a topological monoid (or group) K depends on at most finitely many coordinates. For example, this is the case if S is a subgroup of D and K is a first countable left topological group without small subgroups (i.e., K is an NSS group). A stronger conclusion is valid if S is a finitely retractable submonoid of D and K is a regular quasitopological NSS group of a countable pseudocharacter. In this case, every continuous homomorphism f of S to K has a finite type, which means that f admits a continuous factorization through a finite subproduct of D. A similar conclusion is obtained for continuous homomorphisms of submonoids (or subgroups) of products of topological monoids to Lie groups. Furthermore, we formulate a number of open problems intended to delimit the validity of our results.

Nephron Sparing Surgery: A Run after a Chimera?

NSS showed a significantly higher disease free survival (DFS) (70.2% vs. 93.5%, p < 0.001) and cancer specific survival (CSS) at 10 years (78.4% vs. 97.8%, p = 0.011), whereas the 10 years overall survival (OS) in both groups did not differ significantly (RN 65.3% vs. NSS 71.3%, p = 0.214). Renal function preservation was better in the NSS group and the new onset of chronic kidney diseases was significantly less in the NSS group. Total complication rate was significantly less in the RN group (5.6% vs. 8.9%) but became comparable in the last years of observation.

Genome-wide association analysis of salt tolerance QTLs with SNP markers in maize (Zea mays L.).

Salt-tolerant breeding of maize has great significance to the development and utilization of saline-alkaline soil and the maintenance of grain security. Genome-wide association study (GWAS) has been widely used in maize genetics and breeding. To discover new salt-tolerant genes in maize by association analysis, which can provide technical supports for the innovation and genetic improvement of salt-tolerant germplasm resources in maize. Totally 150 maize inbred lines were genotyped with a high-density chip. GWAS was carried out to identify the significant single nucleotide polymorphisms (SNPs) which were associated with maize salt tolerance. Totally 34,972 SNPs with high quality and diversity were selected from 56,110 SNP markers, which were distributed on 10 chromosomes of maize. The GLM algorithm in TASSEL5.2 was used to analyze the five traits related to salt tolerance. Using a strict LOD threshold of 4.5, totally 7 SNP loci were identified, which were significantly correlated with plant height change rate and fresh weight change rate. The high density fingerprints of 150 inbred lines were clustered by TASSEL5.2 software to construct genetic clustering map to estimate the genetic distance and the subgroups. The 150 maize inbred lines were divided into two groups: SS group and NSS group, and the SNP loci of the salt-tolerant index showed difference in chromosome distribution. Based on previous studies, we screened 8 candidate genes for salt tolerance in maize and four of them were further validated by real-time quantitative PCR. Totally 7 SNP loci and 8 candidate genes related to salt tolerance in maize were identified, which will be of special value in molecular breeding of salt-tolerant maize.

Pushing the limits: perinatal outcomes beyond prolonged second stage

Objective: To evaluate whether extremely prolonged second stage of labor in nulliparous women affects mode of delivery and perinatal outcomes.Methods: We performed a retrospective cohort study of nulliparous women with singleton gestations and cephalic presentation who reached 10 cm of cervical dilation at gestational age 36 0/7–41 6/7. Women were stratified by epidural status. Deliveries were compared by length of second stage: 0–179 min (normal second stage, NSS), 180–299 min (prolonged second stage, PSS), and ≥300 min (extremely prolonged second stage, EPSS). Primary outcome was incidence of vaginal delivery. Secondary outcomes were maternal and neonatal morbidities.Results: Six hundred sixty-one women were evaluated; overall, 92.7% (613/661) of the patients delivered vaginally, with 84.6% (559/661) of women undergoing spontaneous vaginal delivery. In women with epidural anesthesia, 90.6% (446/492) delivered vaginally (97.2% of NSS, 95.1% of PSS, and 69.2% of EPSS). In women without epidural anesthesia, 98.8% (167/169) delivered vaginally (99.3% of NSS, 100.0% of PSS, and 87.5% of EPSS). Women with epidural anesthesia and EPSS had a higher rate of postpartum hemorrhage (aOR: 8.52; 95% CI: 3.99–18.19) and third-degree laceration when compared to NSS (aOR: 5.87; 95% CI: 1.71–20.17). EPSS neonates had a higher rate of CPAP use (OR: 3.99; 95% CI: 1.82–8.74) and significantly higher birth weight (p < .0001) and composite neonatal outcomes (OR: 4.98; 95% CI: 2.34–10.59) compared to NSS.Conclusion: In nulliparous women at term with singleton gestations who reached second stage, the chance of vaginal delivery was 92.7%; even after 5 h of second stage, most women delivered via vaginal delivery (70.4%, 81/115). In those with epidural anesthesia, the PSS group had similar perinatal outcomes as the NSS group, whereas the EPSS group had significantly worse perinatal outcomes. Second stage ≥5 h is a potential tipping point for hazardous perinatal outcomes.

Right ventricular basal inflow and outflow tract diameters overestimate right ventricular size in subjects with sigmoid-shaped interventricular septum: a study using three-dimensional echocardiography.

Sigmoid-shaped ventricular septum (SS), a frequently encountered minor abnormality in echocardiographic examinations of the elderly, may have some influence on RV shape. We aimed to determine the influence of SS on the accuracy of the 6 RV linear diameter measurements in the light of three-dimensional echocardiographic (3DE) RV volume. The aorto-septal angle (ASA) was measured in the parasternal long-axis view using two-dimensional echocardiography (2DE) as an index of SS in 70 patients without major cardiac abnormalities who were subdivided into 35 with SS (ASA ≤ 120°) and 35 without SS (NSS). We measured RV end-diastolic volume (RVEDV) using 3DE; in addition, using 2DE, we measured basal RV diameter, mid-cavity diameter, longitudinal diameter and end-diastolic area in the apical four-chamber view; proximal RV outflow tract (RVOT) diameter in the parasternal long-axis view; and proximal and distal RVOT diameters in the parasternal short-axis view. RVEDV did not differ between the SS and NSS groups. The SS group had greater basal RV diameter and proximal and distal RVOT diameters than the NSS group. RV mid-cavity diameter, longitudinal diameter, and end-diastolic area did not differ between the groups. Among the 2DE parameters of RV size, RV end-diastolic area was most strongly correlated with RVEDV (r = 0.67), followed by RV mid-cavity diameter (r = 0.58). When SS is present, the echocardiographic basal RV diameter and RVOT diameters overestimate RV size, and the measurement of RV end-diastolic area and mid-cavity diameter more correctly reflect 3D RV volume.

Is Sjögren's syndrome dry eye similar to dry eye caused by other etiologies? Discriminating different diseases by dry eye tests.

PurposeDry Eye Disease (DED) is part of several conditions, including Sjögren’s syndrome (SS) and no single test to diagnosis DED. The present study intends to evaluate whether a set of signs and symptoms of DED can distinguish: a) SS from other non-overlapping systemic diseases related to DED; b) primary and secondary SS.Methods182 consecutive patients with DED were evaluated under five groups: SS, graft-versus-host disease (GVHD), Graves' orbitopathy (GO), diabetes mellitus (DM), glaucoma under treatment with benzalkonium chloride medications (BAK). Twenty-four healthy subjects were included as control group (CG). The evaluation consisted of Ocular Surface Disease Index (OSDI), Schirmer test (ST), corneal fluorescein staining (CFS) and tear film break up time (TFBUT). Indeed, a subset of DED patients (n = 130), classified as SS1, SS2 and nonSS (NSS) by the American-European Criteria were compared. Quadratic discriminant analysis (QDA) classified the individuals based on variables collected. The area under Receiver Operating Characteristics (ROC) curve evaluated the classification performance in both comparisons.ResultsComparing SS with other diseases, QDA showed that the most important variable for classification was OSDI, followed by TFBUT and CFS. Combined, these variables were able to correctly classify 62.6% of subjects in their actual group. At the discretion of the area under the ROC curve, the group with better classification was the control (97.2%), followed by DM (95.5%) and SS (92.5%). DED tests were different among the NSS, SS1 and SS2 groups. The analysis revealed that the combined tests correctly classified 54.6% of the patients in their groups. The area under the ROC curve better classified NSS (79.5%), followed by SS2 (74.4%) and SS1 (69.4%).ConclusionsDiseases that causes DED, and also SS1, SS2 and NSS are distinguishable conditions, however a single ocular tools was not able to detect the differences among the respective groups.

Dexmedetomidine preserves the endothelial glycocalyx and improves survival in a rat heatstroke model.

Heatstroke causes systemic inflammation, followed by vascular endothelial damage. The normal vascular endothelium is coated by endothelial glycocalyx (EGCX). Dexmedetomidine (DEX) has an anti-inflammatory effect, but there has been little investigation on the influence of heatstroke on EGCX and the effect of DEX on this condition. Therefore, we examined whether EGCX was disrupted in heatstroke and if DEX improved survival and preserves EGCX. Anesthetized Wistar rats were randomly assigned to three groups: a DEX group treated with DEX (5µg/kg/h) and 0.9% saline infused continuously at 10ml/kg/h during heat exposure; a NSS group given 0.9% saline during heat exposure; and a SHAM group given 0.9% saline alone without heat exposure. Heatstroke was induced by exposure to an ambient temperature of 40°C with relative humidity of 60%. The survival rate was assessed up to 2h after the start of heat exposure. Plasma levels of syndecan-1 and the thickness of EGCX using electron microscopy were measured when the systolic blood pressure fell to less than 80mmHg. The survival rate after 2h of heat exposure was significantly higher in the DEX group compared to the NSS group (89% vs. 22%, P = 0.004). Plasma levels of syndecan-1 were 0.6 ± 1.3, 9.7 ± 5.9, and 2.1 ± 3.4ng/ml in the SHAM, NSS and DEX groups, respectively (P = 0.013). The thickness of EGCX was significantly higher in the DEX group compared with the NSS group (P = 0.001). EGCX was disrupted in heatstroke, and DEX improved survival and preserved EGCX.

Characterization and Natural History of Patients with Internal Carotid Occlusion: A Comparative Study

To characterize patients with internal carotid occlusion (ICO) with respect to demographic data, associated diseases, medical management, and risk factors and to compare these patients with those with nonsignificant stenosis (NSS; less than 50% stenosis). Secondary end points were new neurologic events, progression of contralateral degree of stenosis, cardiovascular symptoms, and death during follow-up. Retrospective analysis was performed using data collected from clinical records and added to a prospective database. Missing data were obtained during phone interviews or requested medical appointments. From 2005 to 2013, 213 patients with ICO and 172 with NSS were studied (medium follow-up 37.81months). Among the patients with ICO, a greater proportion were men, had a history of smoking, and presented with peripheral arterial disease and a lower creatinine clearance compared with those with NSS (P<0.05). At the time of diagnosis, 76.1% of the patients with ICO were symptomatic compared with 35.5% of those with NSS (P=0.000001). The patients in the ICO group exhibited significant progression of contralateral stenosis compared with those in the control group with progression on any side (15.0% vs. 2.3%, P=0.00011). In addition, 18 patients in the ICO group (8.5%) exhibited new neurological symptoms compared with 13 (7.6%) in the NSS group (P=0.41). When the ICO and NSS groups were combined, 10.8% of the initially symptomatic patients presented with new symptoms compared with 4.3% of those who were initially asymptomatic (P=0.0218). The number of deaths was significantly higher among the patients in the ICO group (14.1% vs. 6.4%, P=0.0150). Patients presenting with ICO have more risk factors and higher mortality by any cause. Initially, symptomatic patients will likely present with more neurological symptoms during follow-up, independent of carotid morphology, ICO, or NSS. Efforts must be made to identify those at risk before occlusion and to prevent secondary events and death.

A Randomized Controlled Trial on the Outcome in Comparing an Alginate Silver Dressing With a Conventional Treatment of a Necrotizing Fasciitis Wound

Necrotizing fasciitis (NF) is a high morbidity and mortality disease and also demands high economic resources. The standard treatment of NF is surgical debridement and proper dressing for wound bed preparation. The efficacy of silver alginate dressing can inhibit the growth of microorganisms and keep the environment clean for wound bed preparation. However an optimal dressing to manage such wounds has yet to emerge. NF patients who were admitted between April 2013 and May 2016 were randomized to have wound dressing using either silver dressing (Ag group) or normal saline solution gauze (NSS group). The 4 main outcomes for comparison between the 2 groups were the duration of wound bed preparation, total cost during hospital stay, the duration of hospital stay, and the pain score. Thirty-nine patients were included in the study: 19 patients in the NSS group and 20 patients in the Ag group. The mean duration of wound bed preparation in the NSS group was 31.87 days, and in Ag group it was 21.39 days, but this trend was not statistically significant ( P = .057). The mean cost of treatment in the NSS and Ag groups was not significantly different ( P = .434; US$3308.83 and US$2647.82, respectively). The duration of hospital days in the 2 groups was not significantly different either (29.19 days [NSS group] and 20.99 days [Ag group]; P = .222). The pain score was significantly lower in the Ag group than those in the NSS group. Although silver dressing seems to be expensive, the cost of total treatment during hospital stay and the duration of hospital stay were not significantly different between groups. However, the mean duration of wound bed preparation seems to trend favoring toward the silver dressing group.