Period Of Time In Patients Research Articles

On the choice of antiarrhythmic drug in patients with ventricular arrhythmia of mixed character

Background. The choice of an antiarrhythmic drug, proof of its effectiveness and safety in a short period of time in patients with non-coronary ventricular arrhythmia are the most pressing problems of practical arrhythmology. Objective. To resolve the issue of choosing an antiarrhythmic drug in patients with a mixed nature of ventricular arrhythmia, several ectopic foci, and to optimize further tactics for their management. Design and methods. Of 167 patients with ventricular arrhythmia distribution during periods of wakefulness who performed a stress test, 32 individuals with non-coronary arrhythmias of a mixed nature (by the participation of the autonomic nervous system) were selected. All patients underwent an acute pharmacological stress test with a beta-blocker. Antiarrhythmic therapy was selected under the control of multi-day ECG telemonitoring. Results. In the pretest of exercise tests, single ventricular parasystole was recorded in all 32 patients. In 3 patients, the arrhythmia persisted throughout the entire load, in 4 patients it progressed, in 25 patients the parasystole of the initial morphology disappeared, and at the peak of the load/early recovery period, arrhythmia of a different morphology appeared. Indications for drug treatment were determined for all patients with the choice of the drug after acute pharmacological tests. Then, therapy with two antiarrhythmic drugs was initiated using multi-day ECG telemonitoring, the purpose of which was to control the efficacy, safety, choice of doses and time of drug administration. On days 5–6, combination therapy was effective in 25 patients (78 %). Conclusion. With the help of stress tests, it is possible to accelerate not only the search for the cause of ventricular arrhythmia, but also the choice of a personalized method of treatment. Supplementing the examination with pharmacological tests allows predicting the result of combined antiarrhythmic therapy with a beta-blocker and a class IС drug with an anticholinergic effect.

A novel conjugative transposon carrying an autonomously amplified plasmid.

Tetracyclines serve as broad-spectrum antibiotics to treat bacterial infections. The discovery of new tetracycline resistance genes has led to new questions about the underlying mechanisms of resistance, gene transfer, and their relevance to human health. We tracked changes in the abundance of a 55-kbp conjugative transposon (CTn214) carrying tetQ, a tetracycline resistance gene, within a Bacteroides fragilis metagenome-assembled genome derived from shotgun sequencing of microbial DNA extracted from the ileal pouch of a patient with ulcerative colitis. The mapping of metagenomic reads to CTn214 revealed the multi-copy nature of a 17,044-nt region containing tetQ in samples collected during inflammation and uninflamed visits. B. fragilis cultivars isolated from the same patient during periods of inflammation harbored CTn214 integrated into the chromosome or both a circular, multi-copy, extrachromosomal region of the CTn214 containing tetQ and the corresponding integrated form. The tetracycline-dependent mechanism for the transmission of CTn214 is nearly identical to a common conjugative transposon found in the genome of B. fragilis (CTnDOT), but the autonomously amplified nature of a circular 17,044-nt region of CTn214 that codes for tetQ and the integration of the same sequence in the linear chromosome within the same cell is a novel observation. Genome and transcriptome sequencing of B. fragilis cultivars grown under different concentrations of tetracycline and ciprofloxacin indicates that tetQ in strains containing the circular form remains actively expressed regardless of treatment, while the expression of tetQ in strains containing the linear form increases only in the presence of tetracycline.IMPORTANCEThe exchange of antibiotic production and resistance genes between microorganisms can lead to the emergence of new pathogens. In this study, short-read mapping of metagenomic samples taken over time from the illeal pouch of a patient with ulcerative colitis to a Bacteroides fragilis metagenome-assembled genome revealed two distinct genomic arrangements of a novel conjugative transposon, CTn214, that encodes tetracycline resistance. The autonomous amplification of a plasmid-like circular form from CTn214 that includes tetQ potentially provides consistent ribosome protection against tetracycline. This mode of antibiotic resistance offers a novel mechanism for understanding the emergence of pathobionts like B. fragilis and their persistence for extended periods of time in patients with inflammatory bowel disease.

Serial Changes in Cardiopulmonary Exercise Testing Parameters in Untreated Patients With Transthyretin Cardiac Amyloidosis

BackgroundTransthyretin amyloid cardiomyopathy (ATTR-CM) is associated with a progressive reduction of functional capacity. The progression of cardiopulmonary exercise testing (CPET) parameters over time is still unknown. MethodsIn this study, 55 patients with ATTR-CM underwent 2 serial cardiologic evaluations and CPETs in a national referral center for cardiac amyloidosis (Careggi University Hospital, Florence). ResultsForty-three patients (78%) had wild-type ATTR. Median age was 80 years (interquartile range [IQR] 76-83 years), and 50 of the patients (91%) were men. At baseline, median peak oxygen consumption (pVO2) was 15 mL/kg/min (IQR 12-18 mL/kg/min), percentage of predicted pVO2 (%ppVO2) was 71% (IQR 60%-83%) and VE/VCO2 slope was 31 (IQR 26-34). After a median follow-up of 14 months (IQR 13-16 months), pVO2, %ppVO2 and VE/VCO2 slope were significantly worsened (−1.29 mL/kg/min [95% confidence interval (CI): −1.85 to −0.74; P < 0.01], −4.5% [95% CI: −6.9 to −2.02; P < 0.01], and 8.6 [95% CI 6-11; P < 0.01], respectively). Furthermore, exercise time (−39 s, 95% CI: −59 to −19; P < 0.01), exercise tolerance (−0.47 metabolic equivalents, 95% CI: −0.69 to −0.2; P < 0.01), and peak systolic pressure (−10.8 mm Hg, 95% CI: −16.2 to −5.4; P < 0.01) were significantly reduced. The worsening in CPET variables did not correspond with a significant change in echocardiographic parameters. ConclusionsCardiorespiratory response to exercise significantly worsened over a short period of time in patients with ATTR-CM. Serial CPET may be useful to identify early disease progression.

The benefit of complete resection of contrast enhancing tumor in glioblastoma patients: A population-based study.

New treatment modalities have not been widely adopted for patients with glioblastoma (GBM) after the addition of temozolomide to radiotherapy. We hypothesize that increased extent of resection (EOR) has resulted in improved survival for surgically treated patients with glioblastoma at the population level. Retrospective analysis of adult patients operated for glioblastoma in the population of South-Eastern Norway. Patients were stratified into Pre-temozolomide- (2003-2005), temozolomide- (2006-2012), and resection-focused period (2013-2019) and evaluated according to age and EOR. The study included 1657 adult patients operated on for supratentorial glioblastoma. The incidence of histologically confirmed glioblastoma increased from 3.7 in 2003 to 5.3 per 100 000 in 2019. The median survival was 11.4 months. Complete resection of contrast-enhancing tumor (CRCET) was achieved in 386 patients, and this fraction increased from 13% to 32% across the periods. Significant improvement in median survival was found between the first 2 periods and the last (10.5 and 10.6 vs. 12.3 months; P < .01), with a significant increase in 3- and 5-year survival probability to 12% and 6% (P < .01). Patients with CRCET survived longer than patients with non-CRCET (16.1 vs. 10.8 months; P < .001). The median survival doubled in patients ≥70 years and (12.1 months). Survival was similar between the time periods in patients where CRCET was achieved. We demonstrate an improved survival of GBM patients at the population level associated with an increased fraction of patients with CRCET. The data support the importance of CRCET to improve glioblastoma patient outcomes.

Factors Influencing the Time to Return to Work After Occupational Hand Injuries

Purpose: Returning to work requires a certain period of time for patients who have suffered a hand injury as a result of a work accident. Evaluating the factors influencing the time to return to work (time off work) is aimed. Methods: A total of 111 patients were involved in the study. Data collected from medical records and phone reviews. Independent variables such as age, gender, Hand Injury Severity Scale (HISS) score, fracture on plain radiography, treatment method (surgical/conservative), physical demand of the occupation, mechanism of injury, and physiotherapy were reviewed. Afterwards, the relationship between these variables and time to return to work has been evaluated. Results: In 111 subjects, 107 were able to resume their previous jobs after the injury. Average time to return to work was 58.6 days among patients who were able to return to work. It took more time for patients to return to work which were considered heavy/very heavy. Patients with fractures, higher HISS scores, who were treated surgically and undergone physiotherapy returned to work later. The effect of age, gender and mechanism of injury was statistically insignificant. Conclusion: HISS score and fracture on radiography can be used to predict time off work following surgery. If the necessary counseling is given to the patients with these conditions, it will be easier to plan the return of the patients to their lives.

Analysis of the dynamics of the daily variability of the sinus rhythm according to Holter monitoring to assess the effectiveness of treatment of patients with pulmonary hypertension

Purpose: search for criteria for assessing the relationship between the dynamics of the patient’s condition with pulmonary hypertension according to clinical and instrumental examination with the dynamics of the daily variability of his sinus rhythm. Material and methods. The study included 25 patients with idiopathic pulmonary hypertension (IPH) and 25 patients with chronic thromboembolic pulmonary hypertension (CTPH), who were examined twice at two different hospitalizations: before treatment and after 6–18 months to assess the effectiveness of treatment (50 pairs of examinations). In all examinations, the daily HRV was evaluated according to the Holter ECG data. The functional state was determined comprehensively taking into account the FCLH and the distance covered in the 6-minute walk test. In all patients, the right atrium area (RAA) was determined according to EchoCG data. In 15 out of 50 patients, catheterization of the right parts of the heart (CRPH) was performed during two examinations with determination of pressure in the right atrium (PRA), in the right ventricle, in the pulmonary artery and jamming pressure in the pulmonary artery, as well as oximetry with determination of oxygen saturation of mixed venous blood (SvO2) and cardiac index (CI).The parameters of the daily HRV were determined using a modifi cation of the VSRA-SSR method, taking into account the presence of double fractures (DFR) on the rhythmogram. The dynamics of the parameters of the daily HRV were compared with the dynamics of the functional state, ARA, and also (in 15 cases) — with the dynamics of the average PRA (aPRA), SI and SvO2. Results 1. The connection between the dynamics of the results of a comprehensive assessment of the functional state of patients with PH and the dynamics of the parameters of their daily HRV is traced. A reflection of this is both a large percentage of cases with unidirectional dynamics of the functional state and HRV, and a small number of cases with multidirectional dynamics. These trends are especially evident in the treatment of patients with IPH. There is a high percentage of coincidences of HRV dynamics and right atrium area (RAA) according to EchoCG data, and this percentage is the highest (with a small number of cases with multidirectional dynamics) in the CTPH group. In most cases, CRPH revealed the correspondence of HRV dynamics to the dynamics of oxygen saturation of SvO2 and SI. Conclusion. HRV analysis over long periods of time in patients with hypertension can be used not only to assess the functional state of the patient, but also to assess the dynamics of the functional state of the patient, reflecting the effectiveness of the treatment.

Continuous glycemia monitoring in perioperative period in patients undergoing total knee or hip arthroplasty: A protocol for a prospective observational study.

In every surgical subspecialty surgical site infection (SSI) or implant infections, although occur seldom, pose a threat to patients' health. Risk factors of such states is diabetes mellitus (DM), considered one of the most widespread health-related problems of the 21st century. Orthopedists perform big joint replacements that usually concern older adults and therefore often deal with patients suffering from comorbidities. DM is frequently one of them and can furthermore often remain underdiagnosed. The other risk for complication is a rapid beginning of the rehabilitation which starts on the day following the surgery. To eliminate the debilitating impact of DM and hypoglycemia on surgical patients, we aim to investigate the relationship between the glycemia values and the postoperative outcomes in certain periods of time in patients undergoing orthopedic surgeries. Participants meeting inclusion criteria will have inserted a glycemia measuring device (Dexcom G5, Inc., San Diego, CA) in the periods of time. First time it will take place 14 days prior to the surgery and right after the surgery for the second time for the period of another 14 days. All patients will undergo standard total knee arthroplasty or total hip arthroplasty procedures. Patients will be assessed preoperatively and 14 days, 1, 3, 6, 12, and 24 months postoperatively. The assessment of the joint condition will consist of: patient-reported outcomes (The Knee injury and Osteoarthritis Outcome Score, Harris Hip Score, the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]); assessment of potential SSI and cardiovascular complications (the Finnish Diabetes Risk Score [FINDRISC], the Systematic Coronary Risk Evaluation [SCORE]) and the clinical examination. To investigate the influence of orthopedic surgery (anesthesia) on glycemia and the significance and safety of early patients mobilization after the big joints surgeries. To investigate changes of glycemia in patients with normal glycemia metabolism, potentially protecting them from hypoglycemia during hospital stay and increasing their awareness of potential development of DM in the future. Additionally, this study will correlate perioperative glycemic levels with risk of cardiovascular events in one year follow-up, and its influence on SSI and implant complications.

Intensive Olfactory Training in Post-COVID-19 Patients: A Multicenter Randomized Clinical Trial.

BackgroundOlfactory dysfunction (OD)—including anosmia and hyposmia—is a common symptom of COVID-19. Previous studies have identified olfactory training (OT) as an important treatment for postinfectious OD; however, little is known about its benefits and optimizations after SARS-CoV-2 infection.ObjectiveThis study aimed to assess whether olfactory training performance can be optimized using more fragrances over a shorter period of time in patients with persistent OD after COVID-19. In addition, we determined the presence of other variables related to OD and treatment response in this population.MethodsThis multicenter randomized clinical trial recruited 80 patients with persistent OD and prior COVID-19 infection for less than 3 months. The patients were divided into 2 groups receiving either 4 or 8 essences over 4 weeks. Subjective assessments and the University of Pennsylvania Smell Identification Test (UPSIT) were performed before and after the treatment.ResultsSignificant olfactory improvement was measured subjectively and using the UPSIT in both groups; however, no significant differences between the groups were observed. Additionally, the presence of olfactory fluctuations was associated with higher UPSIT scores.ConclusionThese data suggest that training intensification by increasing the number of essences for 4 weeks does not show superiority over the classical method. Moreover, fluctuant olfaction seems to be related to a higher score on the UPSIT.

The use of interferon-α2a as monotherapy in stage IB patients with mycosis fungoides: A retrospective chart review of patient outcomes.

The aim of this study was to evaluate the response to IFN-α2a treatment as monotherapy in stage IB patients with mycosis fungoides (MF) in second-line therapy. Twenty-five patients with recurrent or persistent MF were included in the study. The diagnosis of MF was established according to clinical and histopathological signs. Clinical staging was made using TNMB classification. IFN-α2a as monotherapy was used as treatment. IFN-α2a was administered at a dose of 3 x 106 units thrice a week subcutaneously as initially described. According to clinical tolerance, the dose was increased every 4 weeks to 6 - 9 x 106 units. IFN-α2a was used more frequently for at least 3months after complete remission. Treatment success was evaluated with Clinical Response (disappearance of all clinical evidence= Complete Remission [CR], ≥50% decrease in extent or severity=Partial Remission [PR], unresponsiveness to treatment=Stable Disease [SD], progression of MF = Progressive Disease [PD]). The average age was 51.3± 9.1. CR and PR were achieved in 11 (44%) and 12 (48%) patients, respectively. PD was observed in two (8%) patients. CR was accomplished at 16.1± 9.8 weeks. Recurrences were mostly observed within 1year (10.4± 7.7months). The recurrence rate was 45.4%. The mean duration of CR was 33.3± 7.9months. Side effects were seen in 36% of the patients (18.2% in CR). The most common side effect was fatigue (12%). The patients received 11 different types of treatment before IFN-α2a treatment. The most frequent therapy prior to IFN-α2a treatment was narrow-band ultraviolet-B (NB-UVB) phototherapy (15 [60%] patients). CR can be achieved in a relatively short period of time in patients receiving IFN-α2a in MF. The duration of CR is reasonable. The side effects of IFN-α2a are acceptable. Therefore, IFN-α2a as monotherapy is a good option in stage IB second-line MF therapy.

Early clinical performance of an adaptive self-assembling barrier scaffold in nonhealing chronic wounds: a review of six cases

Chronic nonhealing wounds pose a serious concern for patient health and the health care system. Management of chronic wounds becomes especially challenging in the setting of systemic comorbidities and patient nonadherence. Authors evaluated the performance of a proprietary adaptive self-assembling barrier scaffold (aSABS) in the management and healing of complex chronic wounds. Six patients with anatomically and etiologically diverse chronic wounds were considered for treatment with aSABS, which is for prescription use under the supervision of a licensed health care professional. The wounds had been unresponsive to various treatment regimens for 8 weeks to more than 20 years. The adaptive self-assembling barrier scaffold was applied in the clinic weekly, with the exception of 1 case in which it was applied every 2 weeks. Institutional Review Board approval was not required because use of aSABS was in accordance with the US Food and Drug Administration-cleared indications for use. After only 3 to 6 applications of aSABS, these wounds showed notable improvement in healing, accompanied by suppression of both inflammation and infection, granulation tissue formation, and reepithelialization. The adaptive self-assembling barrier scaffold also facilitated aggressive debridement to remove inflamed, infected, and necrotic tissues, providing effective wound management and bleeding control while functioning as a protective barrier. Furthermore, use of aSABS reduced the at-home burden of wound care for patients and caretakers. Additionally, use of this aSABS may offer clinicians an alternative to high acuity operating rooms by facilitating debridement and management of some complex wounds in a low acuity outpatient clinic setting-a particularly crucial product attribute during the COVID-19 pandemic that helped ensure timely and effective treatment. In this study, aSABS demonstrated clinical benefit in a short period of time in patients with significant comorbidities and nonhealing wounds. Use of aSABS may offer clinicians an alternative to high-acuity operating rooms by facilitating debridement and management of some complex wounds in a low-acuity outpatient clinic setting. These outcomes can be used to make a compelling argument for use of aSABS as a central aspect of treatment at the onset of wound care and as a rescue product for wounds for which prior standard and advanced treatment protocols were unsuccessful.

Efficacy of supervised vestibular rehabilitation on functional mobility in patients with chronic vestibular hypofunction.

[Purpose] This study aimed to compare the effects of different intervention frequencies on walking ability and balance in patients with chronic unilateral vestibular hypofunction. [Participants and Methods] Participants included in this case-control study were assigned to one of two groups: the multiple-intervention (once a week) and single-intervention groups. Results for the Timed Up and Go test, Dynamic Gait Index, Functional Gait Assessment, and Activities-specific Balance Confidence scale were determined at baseline and four weeks after initiating the vestibular rehabilitation program. Thereafter, intra- and inter-group differences in the rates of change of these parameters were determined. [Results] The Timed Up and Go test values, Dynamic Gait Index, and Functional Gait Assessment scores improved significantly after four weeks in the multiple-intervention group. The improvement rate in the Timed Up and Go test differed significantly between the two groups. The Activities-specific Balance Confidence scale scores did not significantly change in either group after four weeks. [Conclusion] Compared to a single intervention, multiple interventions by a physical therapist produced significantly greater benefits in a relatively shorter period of time in patients with chronic unilateral vestibular hypofunction.

Analysis of Duration of Response, Exposure-Adjusted Safety and Progression to Acute Myeloid Leukemia (AML) for Patients with Lower-Risk Myelodysplastic Syndromes (LR-MDS) Receiving Luspatercept in the MEDALIST Study

Analysis of Duration of Response, Exposure-Adjusted Safety and Progression to Acute Myeloid Leukemia (AML) for Patients with Lower-Risk Myelodysplastic Syndromes (LR-MDS) Receiving Luspatercept in the MEDALIST Study

All-cause hepatocellular carcinoma survival in the era of direct-acting antiviral therapy.

Hepatitis C virus (HCV) cure with direct-acting antiviral (DAA) therapy improves survival in patients with HCV-related hepatocellular carcinoma (HCC). We hypothesized that HCV-HCC survival has increased in the DAA era, more than other aetiologies of HCC. We aimed to evaluate survival following HCC diagnosis in the pre-DAA and DAA eras, across each aetiology of HCC. Patients with HCC at three tertiary referral hospitals were included retrospectively (January 2008 to December 2019). Patients were categorized as HCV-HCC, hepatitis B virus (HBV)-HCC, or non-viral HCC. For each aetiology, the risk of death following incident HCC among patients diagnosed in the DAA era (2015-2019) was compared with patients diagnosed in the pre-DAA era (2008-2014). Among 1161 patients, there were 422 (36%) patients with HCV-HCC, 227 (20%) with HBV-HCC, and 512 (44%) with non-viral HCC. In adjusted analysis, the risk of death was lower in patients with HCV-HCC diagnosed in 2015-2019, compared with patients diagnosed in 2008-2014 (adjusted hazard ratio [aHR]: 0.68; 95% confidence interval [CI]: 0.52-0.89; P=0.005). In contrast, there was no difference in the risk of death between time periods for patients with HBV-HCC (HR: 0.91; 95% CI: 0.64-1.29; P=0.602) or non-viral HCC on adjusted analysis (aHR: 0.92; 95% CI: 0.74-1.15; P=0.476). Although patients with HBV-HCC had better survival compared with patients with HCV-HCC in 2008-2014 (aHR: 0.74; 95% CI: 0.55-0.98; P=0.037), this difference disappeared in 2015-2019 (aHR: 1.26; 95% CI: 0.90-1.77; P=0.175). Hepatitis C virus-related HCC survival has increased in the DAA era, whereas adjusted survival remained stable for HBV-HCC and non-viral HCC.

Postoperative complications observed with robotic versus laparoscopic surgery for the treatment of rectal cancer: An updated meta-analysis of recently published studies.

Background:This is an updated meta-analysis comparing the postoperative complications observed with robotic versus laparoscopic surgery (LS) for the treatment of rectal cancer.Methods:Cochrane central, MEDLNE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), Google Scholar, Web of Science and http://www.ClinicalTrials.gov were searched for studies (published after the year 2015), comparing robotic versus LS for the treatment of rectal cancer. The postoperative outcomes were considered as the endpoints in this analysis. RevMan 5.4 was used to carry out the statistical analysis. Risk ratio (RR) with 95% confidence intervals (CI) were used to represent the results following data analysis.ResultsA total number of 22,744 participants were included in this study whereby 9178 participants were assigned to the robotic surgery and 13,566 participants were assigned to the LS group. The time period of patients’ enrollment varied from years 2007 to 2017. Our results showed that overall complications (RR: 0.91, 95% CI: 0.71–1.17; P = .45), wound complications (RR: 0.81, 95% CI: 0.64–1.04; P = .09), anastomotic leak (RR: 1.12, 95% CI: 0.88–1.42; P = .37), anastomotic bleeding (RR: 0.88, 95% CI: 0.29–2.64; P = .82), stoma-related complications (RR: 0.88, 95% CI: 0.24–3.21; P = .85), intra-abdominal abscess (RR: 0.53. 95% CI: 0.22–1.31; P = .17), urinary tract infection (RR: 0.94, 95% CI: 0.53–1.66; P = .83), enterocolitis (RR: 1.35, 95% CI: 0.38–4.71; P = .64), reoperation (RR: 0.85, 95% CI: 0.46–1.54; P = .58), and mortality (RR: 0.75, 95% CI: 0.34–1.62; P = .46) were not significantly different between robotic-assisted versus LS for rectal cancer. Postoperative ileus (RR: 1.21, 95% CI: 0.81–1.81; P = .34), readmission (RR: 1.17, 95% CI: 0.75–1.83; P = .48), and urinary retention (RR: 0.51, 95% CI: 0.21–1.23; P = .14) were also similarly manifested.Conclusions:In this updated meta-analysis, both robotic and laparoscopic surgeries were equally effective for the treatment of rectal cancer. Similar postoperative complications were observed. However, our analysis was restricted only to postoperative outcomes, parameters such as duration of surgery were not taken into consideration.

Short-Latency Covert Saccades - The Explanation for Good Dynamic Visual Performance After Unilateral Vestibular Loss?

Background: Functional head impulse test (fHIT) tests the ability of the vestibulo-ocular reflex (VOR) to allow visual perception during head movements. Our previous study showed that active head movements to the side with a vestibular lesion generated a dynamic visual performance that were as good as during movements to the intact side.Objective: To examine the differences in eye position during the head impulse test when performed with active and passive head movements, in order to better understand the role of the different saccade properties in improving visual performance.Method: We recruited 8 subjects with complete unilateral vestibular loss (4 men and 4 women, mean age 47 years) and tested them with video Head Impulse Test (vHIT) and Functional Head Impulse Test (fHIT) during passive and active movements while looking at a target. We assessed the mean absolute position error of the eye during different time frames of the head movement, the peak latency and the peak velocity of the first saccade, as well as the visual performance during the head movement.Results: Active head impulses to the lesioned side generated dynamic visual performances that were as good as when testing the intact side. Active head impulses resulted in smaller position errors during the visual perception task (p = 0.006) compared to passive head-impulses and the position error during the visual perception time frame correlated with shorter latencies of the first saccade (p < 0.001).Conclusion: Actively generated head impulses toward the side with a complete vestibular loss resulted in a position error within or close to the margin necessary to obtain visual perception for a brief period of time in patients with chronic unilateral vestibular loss. This seems to be attributed to the appearance of short-latency covert saccades, which position the eyes in a more favorable position during head movements.

Investigation and analysis of 3021 cases of occupational hand injury in Xiaoshan District, Hangzhou

Objective: To investigate the causes and characteristics of occupational hand trauma in Xiaoshan District of Hangzhou, and to provide basis for formulating preventive measures and treatment. Methods: In July 2020, 3021 patients with occupational hand injury treated in Xiaoshan District from January 2017 to December 2019 were selected as the research object. The data of gender, age, injury month and time period of patients with occupational hand injury were collected, and their relationship with the causes of injury was analyzed. Results: Among 3021 patients with occupational hand trauma in Xiaoshan District, most of them were men (male to female ratio 2.05∶1) , and the proportion of injuries from 18 to 30 years old was relatively high (1508 cases, 49.92%) . The proportion of patients with cutting injury was high (1208 cases, 39.99%) , most of the injuries were at the distal end of metacarpophalangeal joint (2118 cases, 70.11%) , the proportion of injuries in summer was relatively high (1225 cases, 40.55%) . Most of them were injured from 8:00 to 16:00 every day (1684 cases, 55.74%) , of which 11:00-12:00 accounted for 29.46% (890 cases) . The excellent and good rate of functional recovery in all patients was 85.10% (2571/3021) . There were significant differences in the distribution of injury causes among patients with occupational hand trauma in different gender, age and seasons (P<0.01) . Conclusion: In Xiaoshan District of Hangzhou, there are many cases of cutting injuries in patients with occupational hand injuries, with high incidence in summer and 11:00-12:00. Enterprises should strengthen the supervision and management of relevant time periods, especially to prevent the occurrence of cutting injuries.

Alterations in atrial electrogram amplitude as steady sinus rhythm transitions to paroxysmal atrial fibrillation during continuous monitoring in patients with implantable cardiac devices: Insights from the IMPACT study.

We aimed to evaluate whether device measured amplitudes of atrial electrogram (AEGM) would change when measured in sinus rhythm (SR) transitioning to paroxysmal atrial fibrillation (AF) from previous steady SR, and significance of such change. From the IMPACT trial's database we selected two groups; (A) those who developed AF (n = 164), and (B) propensity-matched control (n = 459) who stayed in SR during continuous Home Monitoring (HM) to compare AEGMs amplitudes at baseline SR and transition phase. During 420.0 ± 349.2 days (mean ± SD) from first postenrollment HM transmission to AF event transmission in Group A, and corresponding 515.3 ± 407.0 days in Group B, baseline and transition AEGM amplitude were 2.88 ± 1.146 and 2.74 ± 1.186 mV, respectively, for Group A (p = .1), and 2.88 ± 1.155 and 2.79 ± 1.145, respectively, for Group B (p < .005). Comparison of differences of AEGM amplitude, 0.14 ± 1.072 mV in Group A and 0.09 ± 0.893 mV in Group B were insignificant (p = .3). Age, sex, and hypertension identified as confounders had no association to AEGM changes (p = NS). Independent of age, sex, and hypertension, AEGMs amplitudes decline over a long period of time in patients with defibrillators and substrate for AF. The significance of such change remains unclear as it occurs whether patients develop AF or not, but raises a possibility of progressive atrial myopathy that patients with substrate for AF may be predisposed to.

Geospatial analysis of multiple cancers in individuals in the US, 2004-2014.

Background:There is a projected rapid increase in cancer survivors in the US population, from 15.5 million in 2016 to 26.1 million by 2040. Improvements in treatment and detection have led to increased survival, however, there is now a risk of developing new cancers as a result of environment toxins, behavioral risk factors, genetic predisposition, and late-term effects of radiation and chemotherapeutic treatments. This study takes a geospatial approach to examining the place of occurrence of multiple cancers originating in the population of four screenable cancers—female breast, colorectal, prostate, and cervical cancers—among the US population.Methods:During 2004–2014, 6,523,532 primary cancer patients with one of these four screenable cancers were examined, and subsequent primary cancers (multiple cancers of any type) were noted. Individual level analyses estimated the odds of diagnosis with multiple cancers controlling for age, sex, and race-ethnicity. Change in effects on odds of multiple cancer diagnoses with age, sex, and race-ethnicity were evaluated controlling separately for late-stage diagnosis of the primary cancer or each primary cancer diagnosis type. County-level spatial cluster analysis was employed to identify and visualize higher than average multiple cancer rates.Results:Over half of the study population were female and almost 30% of the study population were diagnosed at late-stage for their first cancer. Multiple occurrences of all cancers increased during the time period for patients with initial breast or colorectal cancers. Among BC primary cancer cases, subsequent multiple cancers were mostly new breast cancers. By contrast, for CRC primary cancer cases, subsequent multiple cancers were about equally likely to be new CRC cases or other cancer types. Sex, age and race-ethnicity were all significantly associated with multiple cancers. In the model controlling for CRC as the primary type, the age and race-ethnicity effects were somewhat different than for all the other models. Thus, there was something distinctly different about the multiple cancer incidence among patients with CRC as their primary cancer as compared to patients with BC, CVC, or PC primaries. In subsequent analyses by county, there were distinct geospatial patterns in multiple cancer rates with most high-rate clusters occurring in the north- and mid-west US.Conclusions:There were distinct individual level and geospatial disparities in multiple cancer diagnoses for the study population of all primary breast, colorectal, cervical, or prostate cancer patients during the decade studied. It is importance to emphasize continued screening for cancer survivors and research on personal and environmental drivers of multiple primary cancers.

Temporal lung changes on thin-section CT in patients with COVID-19 pneumonia

We examined characteristics of chest CT across different time periods for patients with COVID-19 pneumonia in Huizhou, China. This study included 56 COVID-19 patients with abnormal CT acquired between January 22 and March 3, 2020. The 141 scans of 56 patients were classified into four groups (Groups 1–4) based on dates on which scans were obtained at the 1st, 2nd, 3rd week or longer than three weeks after illness onset. Forty-five patients with follow-up scans were categorized into four groups (Groups A–D) according to extent that lesions reduced (≥ 75%, 50–75%, 25–50% and < 25%). Ground-glass opacities (GGO) was prevalent in Groups 1–4 (58.1–82.6%), while percentages of consolidation ranged between 9.7% in Group 4 and 26.2% in Group 2. The highest frequency of fibrous stripes occurred in Group 3 (46.7%). Total CT scores were on average higher in Groups 2–3. Among 45 follow-up patients, 11 (24.4%) of them recovered with lesions reducing ≥ 75%, with the lowest median age and total CT scores on admission. There are temporal patterns of lung abnormalities in COVID-19 patients, with higher extent of lesion involvement occurring in the 2nd and 3rd week. Persisting lung changes indicate some patients may need isolation after discharge from hospital.

Cardiovascular Outcomes Post Percutaneous Coronary Intervention in Patients with Obstructive Sleep Apnea and Type2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

IntroductionType 2 diabetes mellitus (T2DM) is a major risk factor for the occurrence of cardiovascular diseases. Similar to T2DM, obstructive sleep apnea (OSA) is also known to be a risk factor for cardiovascular diseases. In this analysis, we aimed to systematically compare the post-interventional cardiovascular outcomes observed in patients with T2DM with versus without OSA.MethodsElectronic databases were searched for relevant publications comparing the cardiovascular outcomes following percutaneous coronary intervention (PCI) in patients with T2DM with OSA. Cardiovascular outcomes were considered as the relevant endpoints. The RevMan software 5.3 was used to carry out the statistical analysis. Odds ratios (OR) with 95% confidence intervals (CI) were used to represent the results following data assessment.ResultsA total of 1168 participants with T2DM were included in this analysis, of whom 614 had co-existing OSA. The time period of patients’ enrollment varied from year 2002 to 2017. Our current analysis showed that major adverse cardiac events (MACEs) (OR 2.28, 95% CI 1.24–4.18; P = 0.008) and all-cause mortality (OR 1.95, 95% CI 1.08–3.54; P = 0.03) were significantly higher in the OSA subgroup. However, major adverse cerebrovascular and cardiovascular (MACCEs) (OR 1.38, 95% CI 0.97–1.98; P = 0.07) and cardiac death (OR 1.79, 95% CI 0.77–4.16; P = 0.18) were not significantly different post PCI. In addition, hospitalization for heart failure (OR 1.99, 95% CI 0.43–9.25; P = 0.38), re-infarction (OR 1.52, 95% CI 0.85–2.70; P = 0.16), stroke (OR 1.81, 95% CI 0.81–4.08; P = 0.15), target vessel revascularization (TVR) (OR 1.54, 95% CI 0.98–2.42; P = 0.06), and target lesion revascularization (TLR) (OR 1.32, 95% CI 0.80–2.18; P = 0.28) were also not significantly different post PCI in the patients with T2DM with versus without OSA.ConclusionOSA was associated with a significant increase in all-cause mortality and MACEs post PCI in these patients with T2DM. Therefore, special care and continuous follow-up might be required for patients with T2DM with associated OSA after PCI. However, as a result of the limited number of participants, further larger studies would be required to confirm these hypotheses.