Quantitative Variables Research Articles

Comprehension of US Pharmacopeia and South African pictograms by sub-Saharan migrants who newly arrived in Europe

BackgroundPatient understanding of health information is crucial for successful pharmaceutical care. Pharmaceutical pictograms enable communication of medication instructions to patients who may not share a common language or are illiterate. However, cultural factors can impact the accurate interpretation of these visual aids. ObjectivesThis study aimed to assess and compare the comprehensibility of two sets of pictograms from different cultural backgrounds among sub-Saharan migrants recently arrived in Europe. MethodsIn June 2022, a cross-sectional survey was conducted at the Migrant Temporary Stay Center in Melilla, Spain. Participants were randomly assigned to interpret 10 pictograms from either the U.S. Pharmacopeia or South African counterparts, with a minimum of 50 participants per group. Following the International Organization for Standardization's testing comprehensibility criterion, pictograms achieving a 66.7% correct interpretation rate were considered acceptable. Health literacy was measured using a culturally validated sub-Saharan version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). Data analysis included Fisher's exact test or chi-square test (for qualitative variables) and the Mann-Whitney test (for quantitative variables). ResultsA total of 106 participants were included (51 in the U.S. pharmacopeia group and 55 in the South African group). None of the assessed pictograms met the comprehensibility criterion, and both groups exhibited high nonresponse rates. The South African pictograms were better understood than the American ones for all intended messages, with a statistically significant difference in overall comprehension (p = 0.002). Additionally, the participants' country of birth was a statistically significant factor for comprehension (p = 0.019). ConclusionsOur findings indicate that evaluated pharmaceutical pictograms cannot be validly used in newly arrived sub-Saharan immigrants in Europe. However, the significantly better comprehension of South African pictograms compared to North American ones highlights the importance of cultural alignment between pictograms and their prospective users for effective comprehensibility.

Validity of Magnetic Resonance Imaging Report of Meniscal Tear in Relationship to Arthroscopic Findings

Objective: To determine the diagnostic accuracy of magnetic resonance imaging in assessment of meniscal tear taking arthroscopy as gold standard Methodology: This cross-sectional study including 180 participants from different age groups was conducted at Shifa international hospital, Islamabad from June 2021- December 2021. Patients underwent both MRI and Arthroscopy and the results were compared. Data analysis was done using SPSS 22, quantitative variables were represented as mean and standard deviation, for qualitative variables frequencies and percentages were used for representation. Sensitivity, specificity, NPV, PPV and diagnostic accuracy of MRI was determined taking Arthroscopy as gold standard. For data analysis SPSS version 22 was used and the results were depicted using frequencies and percentages. Results: 180 participants were included in the research out of which males were predominant with more than ¾ of the study population. Trauma and sports were the common cause of injuries. Sensitivity and specificity were found to be 95.95% and 69.13% respectively. PPV and NPV were 62.91% and 86.20% respectively. Patients were categorized in three groups with respect to age: middle aged (31-60 years) patients were greater in number and comprised more ¾ of the total. Conclusion: MRI is a good, accurate non-invasive modality for the patients with meniscal tears while arthroscopy Still remains a gold standard.

Evaluation of Dental Professionals' Knowledge and Attitude Regarding the Diagnosis of Oral Cancer Through Histopathological Examination of Granulation Tissue.

The currentcancer trend in India has reported an alarmingincreasein cancer of the lip, throat, and oral cavity.Few dentists are aware that malignant neoplasms can also occur in the form of granulation tissue and periapical granulomas. However, most dentists agree that biopsies are essential to diagnose oral cancer. This makes the timely diagnosis of oral cancer dependent upon the histopathological examination of the granulation tissue by the dentist. The main aim of this study was to evaluate the knowledge and attitudes of dentists regarding the diagnosis of oral cancer through histopathological analysis of granulation tissue. A cross-sectional study was conducted on dentists who were residents of Uttar Pradesh, India. Two hundred and fifty study participants enrolled to complete a self-structured questionnaire containing 15 closed-ended questions. The study was conducted over a period of three months, from June to August 2020.Descriptive statistics were analyzed using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, United States, and the t-test was performed. A significance level of P ≤ 0.05 was used to determine the statistical significance of quantitative variables. The study findings revealed that only a small percentage of dentists (47.2%) were aware of the importance of biopsies in diagnosing oral cancer. Moreover, a minority (14.4%) had conducted biopsies and submitted samples for histopathological analysis. Of them, 10% were aware that in clinical practice, malignant tumors can also manifest as periapical granulomas, granulation tissue, gingivitis, and other conditions. Dentists should proactively submit any granulation tissue for histopathological examination. Oral healthcare providers must maintain a high level of suspicion, develop a range of potential or differential diagnoses for oral cancer, and take necessary measures to attain a definitive diagnosis. This may include considering a referral to a specialist for the treatment of oral cancer.

Complete Sino Atrial Block in Acute Coronary Syndrome with ST Segment Elevation: Incidence, Predictive Factors and Related Mortality

Background: Sino atrial block in acute coronary syndrome with ST segment elevation is not rare and may be dangerous by causing severe bradycardia. Its incidence was reported in the literature, but no data about its predictive factors or related mortality, also its epidemiological data is lacking in Algeria. Aims: The main objective of our study is the determination of the frequency of Sino Atrial Block in acute coronary syndrome with ST segment elevation, the secondary objective was the analysis of predictive factors of this Brady arrhythmia, and related mortality. Methods and materials: In this prospective study, conducted in the cardiology department of Hussein Dey hospital (Algiers-Algeria), 467 patients with acute coronary syndrome with elevated ST segment (87 women and 380 men) were enrolled between 28 February 2014 and 16 July 2015. The average age is 60 ± 13 years; at admission, a Holter recorder was attached for continuous ECG monitoring during 48 hours Kruskal’s ANNOVA or H tests were used for comparison of quantitative variables, χ2 test or Fisher’s exact test, were used for qualitative variables, all tests were performed with 1st species risk of 5%. Results: The frequency of complete Sino atrial block is 2.6 % (12 patients), CI 95%: [1.2%-4%], multivariate analysis identified the following independent predictors: right ventricular acute coronary syndrome, infero basal acute coronary syndrome, and large right atrium surface. The risk of mortality expressed by Hazard Ration (HR) is 5.4. (CI95%: [1.2-24], p = 0.024); right acute coronary syndrome is the only predictive factor of mortality identified in our study. Conclusion: Sino atrial block is not rare in acute coronary syndrome with elevated ST segment, its predictive factors according to our study are: right ventricular acute coronary syndrome, infero basal acute coronary syndrome, and large surface of right atrium, its occurrence increases the risk of hospital mortality.

The longitudinal buffering effects of resilience on alcohol use outcomes.

Traumatic events (TE) are a risk factor for alcohol use disorder (AUD). Resilience may be protective of the effects of TE exposure, but few studies have longitudinally tested the buffering hypothesis. Thus, the present study aimed to fill this gap. Participants (N = 6,015) were from a longitudinal investigation into substance use and health outcomes at a large, urban university. Participants completed self-report measures on precollege internalizing symptoms and lifetime trauma load. Resilience was calculated as a quantitative variable. At each of the follow-up assessments, participants reported on past month consumption, AUD symptoms, and new onset TEs. Longitudinal path modeling was used to test interactions. Higher new onset TE load was associated with greater AUD symptoms, and higher consumption at one time-point. Results demonstrate a significant main effect of resilience at Y1S and Y3S, and a significant interaction between resilience and new onset TE at the last time-point, whereby higher levels of new onset TE were associated with higher levels of AUD symptoms at low (β = .19, p < .001), and average (β = .20, p = .001) levels of resilience. This effect was attenuated at high levels of resilience (β = .07, p = .051). No significant main nor interaction effects of resilience on consumption were found. Findings suggest resilience as an important protective factor in relation to the development of AUD symptoms after exposure to a TE, though perhaps less so in relation to consumption. Findings are consistent with prior work demonstrating that AUD symptoms are more clinically relevant than consumption in this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emergence Patterns from General Anesthesia after Epilepsy Surgery: An Observational Pilot Study.

Objective Emergence from anesthesia starts from the limbic structures and then spreads outwards to brainstem, reticular activating systems, and then to the cortex. Epilepsy surgery often involves resection of limbic structures and hence may disrupt the pattern of emergence. The aim of this study was to explore the pattern of emergence from anesthesia following epilepsy surgery and to determine associated variables affecting the emergence pattern. Setting and Design Tertiary care center, prospective observational study. Materials and Methods We conducted a prospective observation pilot study on adult patients undergoing anterior temporal lobectomy and amygdalohippocampectomy for epilepsy. Anesthesia management was standardized in all patients, and they were allowed to wake up with "no touch" technique. Primary outcome of the study was the pattern of emergence (normal emergence, agitated emergence, or slow emergence) from anesthesia. Secondary outcomes were to explore the differences in preoperative neuropsychological profile and limbic structure volumes between the different patterns of emergence. Quantitative variables were analyzed using Student's t -test. Qualitative variables were analyzed using chi-square test. Results Twenty-nine patients completed the study: 9 patients (31%) had agitated emergence, and 20 patients had normal emergence. Among the agitated emergence, 2 patients had Riker scale of 7 indicating violent emergence. Patient demographics, anesthetic used, neuropsychological profile, and limbic structure volumes were similar between normal emergence and agitated emergence groups. However, two patients who had severe agitation (Riker scale of 7) had the lowest intelligence quotient. Conclusion Our pilot study showed that emergence agitation is not uncommon in patients undergoing epilepsy surgery. However, due to smaller sample size, the role of preoperative neuropsychologic profile and hippocampal volumes in predicting the pattern of emergence is inconclusive.

Proposal of descriptors to study the variability of Vaccinium meridionale Swartz

Agraz, mortiño, or Andean blueberry (Vaccinium meridionale Swartz) is a fruit tree with high potential for national consumption since it is considered a functional food due to its high content of anthocyanins and antioxidants. The morphological description in plants involves both characterization variables that are highly heritable and easily detectable, as well as evaluation variables influenced by the environment and useful for genetic breeding that, together, are called descriptors and allow knowing the variability of the species. The aim of this study was to develop a list of morphological descriptors with the inclusion of variables to characterize and evaluate Vaccinium meridionale Swartz. Observations were made in natural populations of 11 municipalities in Antioquia, three in Boyacá, one in Cundinamarca, two in Nariño, and one in Santander, Colombia, as well as in the ex situ collection established in Rionegro Antioquia, between 2005 to 2011. A descriptor with 38 quantitative, binary, and multi-state variables was developed. Seven of these variables were obtained at the plant level, 10 from the leaf, six from the flower, 14 from the fruit, and one from the seed. The application of the morphological descriptors in in situ and ex situ conditions reported high polymorphism in the qualitative traits and high variation between individuals for the quantitative variables in the collections under study. These variables are of taxonomic and agronomic importance in the knowledge of the species and are essential for producing and marketing the fruit.

How tax reforms impact unemployment: Evidence from Azerbaijan

This study investigates the effects of tax reforms carried out by the state to maximize the economic and welfare benefits on the unemployment rate in Azerbaijan from 2000 to 2021. An Autoregressive Distributed Lag (ARDL) empirical model is developed to measure the relationship between unemployment level and major indicators characterizing tax reforms. Initial estimations consider this linkage in both the short-term and the long-run periods, however, further analysis shows that only short-run estimations are statistically significant. The empirical analysis proves that qualitative and quantitative variables that characterize tax reform significantly affect unemployment rate in the short term. Research findings suggest that higher tax burden and application of concessions (after a year) may cause increased unemployment, while implementation of numerous allowances and concessions (within the year), application of an automated tax information system, and changes in legislation can be effective in reducing unemployment in Azerbaijan.

A Cross-Sectional Study Exploring the Relationship Between BMI and Nursing Students' Emotional Well-Being During the COVID-19 Pandemic.

Having a weight problem can cause emotional distress, especially in students, who suffer from both issues at a high rate. As a result of the COVID-19 pandemic's negative impact on society, these problems can be significantly impacted. The study aims to investigate the relationship between nursing students' BMI and their mental well-being. A cross-sectional study was conducted on 423 students from the second through fourth baccalaureate years of Science of Nursing program - KSA. The instrument for the study was an online questionnaire distributed to the students via Google Forms during the academic year 2021-2022 to collect data on the emotional state of students directly as a result of COVID-19 restrictions and limitations. The statistical analysis was carried out through Chi-square test was used to compare categorical data between groups and the Pearson coefficient is used to determine the correlation between two quantitative variables with normal distribution. There is a significant correlation between BMI with depression score, anxiety score and stress score. Higher BMI indicated 6.4 times more likeliness to have depression than lower BMI (OR = 6.4). Students who had higher BMI were 2.7 times more likely to have anxiety than those who had lower BMI (OR = 2.7), and 9.4 times more likely to have stress than those who had lower BMI (OR = 9.4). Study findings indicate that nursing students' BMI increases as depression, anxiety, and stress increase. During the COVID-19 pandemic, participants reported increased weight due to increased stress levels and increased eating. Students in nursing should be aware of the importance of adopting healthy habits and following a healthy lifestyle.

A Bibliometric and Scientific Knowledge Map Study of Migraine Treatment from 2013 to 2022.

Migraine treatment research has made much great progress over the past decade. However, there have been few bibliometric studies conducted so far. In this study, bibliometric analysis was used to explore the current status and future trends of migraine treatment research. Migraine treatment-related articles were retrieved from the Web of Science Core Collection on December 7, 2022. Quantitative variables were analyzed by the R-tool bibliometrix and Excel 2020. VOS viewer and CiteSpace software were used to visualize citation, co-authorship, co-occurrence, and co-citation analysis of countries/regions, organizations, authors, references, and keywords. A total of 3294 articles were included with the global publication output showing a slow upward trend. The United States was the most productive country with 1116 papers and gained the most citations. Albert Einstein College of Medicine was the most active institution with 176 papers. Headache published the most articles in this domain, while Cephalalgia was the most commonly co-cited journal. Lipton, RB published the most articles and had the most citations. Tepper S, 2017, Lancet neurology and Silberstein S, 2004, Cephalalgia were defined as classic articles. The current research mainly focuses on CGRP-related therapeutics, such as fremanezumab, erenumab and ubrogepant. Based on the analysis of bibliometric data on migraine treatment over the past decade, the trends and the knowledge graph of the country, organization, author, reference, and the keyword were identified, providing accurate and quick positioning of the critical information in the domain.

Relationship of vitamin D with the anthropometric indicators and lifestyle of adults. Medellín. Colombia

Introduction: Serum vitamin D levels depend on sunlight, diet, and other factors. Objective: We aimed to determine serum vitamin D levels and evaluate their relationship with anthropometric indicators and lifestyle habits in apparently healthy volunteers. Materials and Methods: In this cross-sectional study (n=75), socio-demographic, anthropometric, and lifestyle habit-related data were collected. Serum vitamin D levels were determined with high performance liquid chromatography, food intake was measured by semiquantitative frequency and nutritional status was assessed by anthropometry. Chi-square test and also principal component analysis were used to analyze the relationship between some variables and vitamin D status. Spearman’s test was used to determine correlations between quantitative variables. Results: 73% were women and 61% belonged to medium socio-economic level. Median vitamin D intake was 137 (83.1–227.3) IU/day. Based on body mass index (BMI), 44% individuals had overweight/obesity. The 68% exhibited deficient/insufficient vitamin D levels (Hypovitaminosis D). BMI classification and waist circumference (CW) were not related with vitamin D status; however, activities with higher sun exposure were highly related (p = 0.013). Sun exposure time explained variation in component 2 (16.60%), where most of the individuals with normal level were grouped. Sun exposure time was positively correlated with vitamin D status (r = 0.263; p = 0.023). Discussion: Excess weight and abdominal obesity are not always associated with hypovitaminosis D. Conclusions: The majority of individuals showed hypovitaminosis D but their status was not related with anthropometric indicators. A Sun exposure time was the only factor positively correlated with vitamin D status.

Prospective study of consecutive patch testing in patients with contact dermatitis using an adapted Latin American baseline series.

Background. Contact dermatitis is characterized by pruritic skin lesions with high prevalence rates. Our objective is to describe the clinical and epidemiological characteristics of a population with suspected contact dermatitis who underwent to a patch testing using an adapted Latin American baseline series.Methods. Observational, descriptive, analytical clinical study with prospective data collection was performed. 208 participants who underwent patch testing using an adapted Latin American baseline series containing 40 allergens were analyzed. The prevalence of contact allergies was compared with data from the literature. Pearson's chi-square test was used for qualitative variables. Quantitative variables were compared using the Mann-Whitney U test. The significance of the regression parameters was tested using the Wald statistical test. Results. A total of 69.7% had one or more positive tests. Among those, 82.8% were women (OR 1.371; p = 0.398). The hands were the most commonly affected site at 43%. An occupational history was detected in 19.2%. The most common allergens were nickel sulfate (32.2%), sodium tetrachloropalladate (19.7%), fragrance mix I (15.4%), and methylisothiazolinone (13.5%). In multivariate logistic regression models, nickel was significantly related to female sex, as well as palladium. Fragrance mix I was related to a family history of allergy (p less than 0.05). Methylisothiazolinone was statistically significantly related to face and hand lesions. Conclusions. This study demonstrated a detailed profile of a population with suspected allergic contact dermatitis. Our patch test results, using an adapted Latin American baseline series, represent a significant update of this important diagnostic tool.

Genetic analysis of the content of palmytic acid glycerides in the carriers of maize mutation shrunken-1

Aim. The influence of corn shrunken-1 (sh1) mutation on the content of palmitate in corn oil establishing and genetic analysis of this trait. Methods. The effects of the sh1 mutation on the content of palmitate were determined by comparing the inbreds – carriers of this mutation with inbreds of the common type, as well as in the top-crosses of common type inbreds with the mutant inbreds. The genetic components of the variance in terms of the content of palmitate were analyzed in the diallel crosses of mutant inbreds according to the second Griffing method. The determination of oil fatty acid composition was carried out by the Peisker gas chromatographic method. Results. It has been established that the corn inbreds – carriers of sh1 mutation exceed the common type inbreds by an average of 29.2 % in terms of palmitate content. The level of the trait in the inbreds based on the sh1 mutation was notable as having the quantitative variability and varied within 12.2-15.6 %. The content of palmitate in the carriers of sh1 mutation was inherited as incomplete dominance with a predominant contribution of additive effects to the variance. A higher level of the trait was controlled by recessive alleles of polygenes. Conclusions. The obtained results suggests the possibility of spatial linkage of the sh1 mutant gene with palmitate-coding locus, the effect of which is modified by the polygenic complex. It has been confirmed, that the carriers of sh1 mutation expands the genetic diversity of corn in terms of palmitate content.

Energy efficiency training’s effect on fatigue scores of children with a cancer diagnosis†

Abstract Objective Fatigue is the most common complication of cancer treatment procedure during chemotherapy, leading to limited daily activities, mood swings, and ultimately impaired functional status. This study aimed to determine the effect of energy efficiency training on the fatigue scores of children with a cancer diagnosis. Methods In the present clinical trial study, 30 children with a cancer diagnosis were randomly assigned variously to the control and testing groups. The cancer-related fatigue questionnaire for children with cancer was employed as the data collection tool. The intervention of the testing group was conducted in 4 sessions of 45–60 min of face-to-face interaction, group sessions, and question-and-answer sessions. Meanwhile, routine interventions were employed in the control group. Quantitative variables were reported as mean and standard deviation, and qualitative variables as frequency and percentage. Stata 11 statistical software and a change score approach were used to analyze the data. Results The mean fatigue score of the testing group increased from 72.12 to 77.53. There was a statistically significant difference between the mean fatigue scores of the testing group before and after the intervention (P = 0.013), and the children’s fatigue score decreased. There was a statistically significant difference between the mean fatigue scores of the testing and control groups before and after the intervention (P = 0.001), and the fatigue score of the children in the testing group had decreased compared to the control group. Conclusions Energy efficiency techniques can be employed to increase energy and reduce fatigue during pediatric chemotherapy.

Development of normalized quantitative measures of lumbar disc degeneration.

Lumbar disc degeneration (DD) is widely regarded as a likely contributor to low back pain (LBP), but the association between DD and LBP is relatively weak. No known studies have normalized quantitative measures of DD severity relative to multiple variables such as age, height, and disc level. This study developed normalized quantitative measures (z-scores) of disc signal intensity (DSI) and disc height (DH) to rate relative severity of DD. Raw (unnormalized) quantitative measures of DSI and DH alongside potential normalization variables were acquired from MRI scans and clinical data of 76 patients. The associations between the raw quantitative measures and potential normalization variables were investigated to develop the normalized quantitative measures (z-scores) of DSI and DH. Construct validity was assessed by comparing the normalized measures to an experienced radiologist's subjective measures of relative severity of DSI and DH loss. CSF signal intensity, age, and disc level were significantly associated with raw DSI (R 2 = 0.06, 0.25, and 0.09, respectively). Lumbar height and disc level were significantly associated with raw DH (R 2 = 0.13 and 0.31). Normalizing DSI and DH by these variables resulted in stronger relationships (R 2 = 0.39 and 0.37) than raw DSI and DH (R 2 = 0.24 and 0.31) with the radiologist's subjective measures. Normalized DSI and DH were both normally distributed (p = 0.32 and 0.12). Construct validity and the distributions suggested that normalized quantitative measures of DSI and DH are better than existing measures of DSI and DH at rating relative DD severity. Determining whether normalized quantitative measures are more predictive of clinical outcomes is important future research.

Результаты работы регионального регистра медико-санитарных последствий дорожно-транспортных происшествий, на примере Ненецкого автономного округа

Summary. The aim of the study is to analyze the results of the work of the regional register of medical and sanitary consequences of road traffic accidents (RTA) in the Nenets Autonomous Okrug (NAO) in 2021 – the first half of 2023. Materials and research methods. Materials of the study are data from the register of medical and sanitary consequences of road traffic accidents in the Nenets Autonomous Okrug, formed on the basis of information extracted from medical records of patients (f.003/u), admitted after road traffic accidents on urgent indications to the Nenets District Hospital named after R.I.Batmanova. Quantitative and categorical variables were used for statistical analysis. Statistical processing of data was performed using the package of applied statistical programs STATA ver. 12. Results of the study and their analysis. Characteristics of the group of victims of road traffic accidents, circumstances of their injuries, medical care of victims in pre-hospital and hospital periods are presented. Based on the results of the regional register of medical and sanitary consequences of road traffic accidents, organizational solutions aimed at improving the provision of medical care to victims of road traffic accidents in the region are proposed.

Variability of Replicates of Intraocular Inflammatory Biomarkers in Ocular Fluid Samples Analyzed with Multiplex Assays.

Certain factors such as instrumental and sample processing errors may contribute to variability of ocular biofluid samples when they are run as replicates with multiplex assays. There is a paucity of literature on the variability of replicates in multiplex assays. This study aims to evaluate whether there is significant variability in replicate analyses of multiplex assays. A total of 152 human ocular biofluid samples (51 aqueous humor and 101 vitreous) were collected and assayed for 27 cytokine biomarker concentrations (pg/mL). Samples were evaluated as replicates (duplicate analysis) at four different time points. Statistical methods including paired samples t-test, 3-way ANOVA, intraclass correlation coefficient (ICC; <0.5-0.75=poor-moderate, 0.75->0.90 =good-excellent reliability), and coefficients of variation (CV) were employed to evaluate for statistical significance, with Bonferroni corrected P=0.002. Among the 4104 biomarker replicate assays for aqueous humor and vitreous, two analytes (PDGF-BB and IL-7) had a statistically significant difference between the sampled concentrations of the replicates in vitreous samples (mean (diff)=2.05, P<0.001, mean (diff)=1.56, P<0.001, respectively). Majority of the ICC values fell within the good-excellent range (86% of samples) with a minority falling in the poor-moderate range (14% of samples). More variability was noted in the vitreous humour, with five analytes (IL-2, IL-10, IL-12(p70), IL-13, IL-17) demonstrating an average ICC of less than 0.5. The CV calculated for each set of replicates suggested that 93% of replicates had an acceptable level of quantitative assay variability (CV<20%). This study demonstrates that the analysis of most biomarkers in ocular fluids may not require the use of replicates. However, certain analytes such as PDGF-BB and IL-7 may require the use of replicates to ensure reliable results. Caution should be taken when applying these findings to other laboratory settings as our study was conducted by an experienced technician using a standardized protocol. In less standardized settings, replicates may be required in order to ensure accuracy of results. These findings may guide researchers with the design of their studies on ophthalmic biomarker analysis.

Outcomes of Transjugular Intrahepatic Portosystemic Shunt and Gastric Coronary Vein Embolization for Variceal Bleeding in Cirrhotic Portal Hypertension.

Purpose: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastric coronary vein embolization (GCVE) for cirrhotic portal hypertensive variceal bleeding and compare outcomes of first-line with second-line treatment, coil with glue, and single-covered with double stents.Methods: Fifteen patients received TIPS plus GCVE as the first-line treatment for secondary prophylaxis of variceal bleeding, and 45 received it as second-line treatment. Preoperative and postoperative quantitative variables were compared using a paired t test. The incidence of survival rate, re-bleeding, hepatic encephalopathy, and shunt dysfunction were analyzed using the Kaplan-Meier method.Results: The portal venous pressure was significantly decreased from 39.0 ± 5.0 mm Hg to 22.5 ± 4.4 mm Hg (P≤0.001) after TIPS treatment. After 1, 3, 6, 12, 18, and 24 months re-bleeding rates were 1.6%, 3.3%, 6.6%, 13.3%, 0%, and 0%, respectively. Shunt dysfunction rates were 5%, 0%, 10%, 16.6%, 1.6%, and 5%, respectively. Hepatic encephalopathy rates were 3.3%, 1.6%, 3.3%, 6.6%, 0%, and 0%, respectively. And survival rates were 100%, 100%, 100%, 96.6%, 93.3%, and 88.3% respectively. In comparative analysis, statistically significant differences were seen in re-bleeding between the first-line and second-line treatment groups (26.6% vs 24.4%, log-rank P=0.012), and survival rates between single-covered and double stent (3.7% vs 16.1%, log-rang (P=0.043).Conclusion: The results suggest that TIPS combined with GCVE is effective and safer in the treatment of cirrhotic portal hypertensive variceal bleeding. The use of TIP plus GCVE as first-line treatment, may be preferable for high-risk re-bleeding, and more than 25 mm Hg portal venous pressure with repeated variceal bleeding. However, the sample size was small. Therefore, large, randomized, controlled, multidisciplinary center studies are needed for further evaluation.

Randomised, open-label, non-inferiority clinical trial on the efficacy and safety of a 7-day vs 14-day course of antibiotic treatment for uncomplicated enterococcal bacteraemia: the INTENSE trial protocol

IntroductionEnterococcus spp is responsible for 8%–15% of total bacteraemias with an associated global mortality around 23%–30%. Regarding the clinical management of enterococcal bacteraemia, the evidence on the duration of antibiotic...

Differentiation between Chondrosarcoma and Synovial Chondromatosis of the Temporomandibular Joint Using CT and MR Imaging.

Chondrosarcoma and synovial chondromatosis of the temporomandibular joint share overlapping clinical and histopathologic features. We aimed to identify CT and MR imaging features to differentiate chondrosarcoma from synovial chondromatosis of the temporomandibular joint. The CT and MR images of 12 and 35 patients with histopathologically confirmed chondrosarcoma and synovial chondromatosis of the temporomandibular joint, respectively, were retrospectively reviewed. Imaging features including lesion size, center, enhancement, destruction/sclerosis of surrounding bone, infiltration into the tendon of the lateral pterygoid muscle, calcification, periosteal reaction, and osteophyte formation were assessed. A comparison between chondrosarcoma and synovial chondromatosis was performed with a Student t test for quantitative variables and the Fisher exact test or linear-by-linear association test for qualitative variables. Receiver operating characteristic analysis was performed to determine the diagnostic performance for differentiation of chondrosarcoma and synovial chondromatosis based on a composite score obtained by assigning 1 point for each of 9 imaging features. High-risk imaging features for chondrosarcoma were the following: lesion centered on the mandibular condyle, destruction of the mandibular condyle, no destruction/sclerosis of the articular eminence/glenoid fossa, infiltration into the tendon of the lateral pterygoid muscle, absent or stippled calcification, periosteal reaction, internal enhancement, and size of ≥30.5 mm. The best cutoff value to discriminate chondrosarcoma from synovial chondromatosis was the presence of any 4 of these high-risk imaging features, with an area under the curve of 0.986 and an accuracy of 95.8%. CT and MR imaging features can distinguish chondrosarcoma from synovial chondromatosis of the temporomandibular joint with improved diagnostic performance when a subcombination of 9 imaging features is used.