Seconds In Patients Research Articles

Risk Factors for Thrombosis, Overshunting and Death in Infants after Modified Blalock-Taussig Shunt.

The Modified Blalock-Taussig shunt procedure can provide increased flow of blood to the lungs for babies born with certain congenital heart defects. We evaluated 44 subjects under 2 years of age who had a Modified Blalock-Taussig shunt (MBTS) procedure performed from 2009-2013, to investigate risk factors for thrombosis, overshunting and death. The study subjects included in our investigation were severely cyanotic newborns with pulmonary stenosis or atresia and duct dependent circulation, and infants having Tetralogy of Fallot with small pulmonary arteries who underwent a MBTS procedure in our facility from 2009-2013. We duly noted patient preoperative characteristics such as hemoglobin, hematocrit, mean platelet volume, prothrombin time and partial thromboplastin time. Our study investigated the risk factors for post-operative overcirculation, thrombosis and death. The age and weight of patients in our study at the time of procedure ranged from 1 day to 20 months old (median 12 days), and 2.4 kg to 12 kg (mean 4.6 kg), respectively. A total of 8 patients died following surgery, and. 4 (9.1%) had shunt thrombosis, of which one died during shunt revision. Partial thromboplastin time was 28.7 seconds in patients with thrombosis, and 35 in all other patients (p = 0.04). Overcirculation was detected in 5 patients; shunt size/body weight was 1.25 in patients who had overcirculation, and 1.06 in all other patients. It is important to assess risk factors associated with the MBTS operation. The results of our study suggest that a preoperative low aPTT value may be an indicator for thrombosis in infants who have undergone MBTS surgery.

Whole-Brain CT Perfusion to Quantify Acute Ischemic Penumbra and Core.

Purpose To validate the use of perfusion computed tomography (CT) with whole-brain coverage to measure the ischemic penumbra and core and to compare its performance to that of limited-coverage perfusion CT. Materials and Methods Institutional ethics committee approval and informed consent were obtained. Patients (n = 296) who underwent 320-detector CT perfusion within 6 hours of the onset of ischemic stroke were studied. First, the ischemic volume at CT perfusion was compared with the penumbra and core reference values at magnetic resonance (MR) imaging to derive CT perfusion penumbra and core thresholds. Second, the thresholds were tested in a different group of patients to predict the final infarction at diffusion-weighted imaging 24 hours after CT perfusion. Third, the change in ischemic volume delineated by the optimal penumbra and core threshold was determined as the brain coverage was gradually reduced from 160 mm to 20 mm. The Wilcoxon signed-rank test, concordance correlation coefficient (CCC), and analysis of variance were used for the first, second, and third steps, respectively. Results CT perfusion at penumbra and core thresholds resulted in the least volumetric difference from MR imaging reference values with delay times greater than 3 seconds and delay-corrected cerebral blood flow of less than 30% (P = .34 and .33, respectively). When the thresholds were applied to the new group of patients, prediction of the final infarction was allowed with delay times greater than 3 seconds in patients with no recanalization of the occluded artery (CCC, 0.96 [95% confidence interval: 0.92, 0.98]) and with delay-corrected cerebral blood flow less than 30% in patients with complete recanalization (CCC, 0.91 [95% confidence interval: 0.83, 0.95]). However, the ischemic volume with a delay time greater than 3 seconds was underestimated when the brain coverage was reduced to 80 mm (P = .04) and the core volume measured as cerebral blood flow less than 30% was underestimated when brain coverage was 40 mm or less (P < .0001). Conclusion Correct threshold setting and whole-brain coverage CT perfusion allowed differentiation of the penumbra from the ischemic core in patients with acute ischemic stroke. (©) RSNA, 2016 Online supplemental material is available for this article.

Study on Liver Dysfunction in Type 2 Diabetic Patients in Bangladesh.

ABSTRACTAimDiabetes mellitus (DM) represents one of the major lifestyle-related pathological conditions; the incidence and prevalence of DM have reached an epidemic level around the world. Diabetes mellitus is usually associated with obesity, coronary diseases, and cerebral pathologies. However, more insights are required to evaluate a temporal relation between DM and hepatic functions. This study assesses whether and to what extent liver functions are modified in DM patients.Materials and methodsA total of 100 patients with type 2 DM and 100 normal healthy controls were enrolled in this study following proper scrutiny of inclusion and exclusion criteria. Different parameters of liver function tests were measured in patients in the two groups. Data were analyzed to assess the extent and magnitude of abnormal liver functions in DM.ResultsThe levels of bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, and prothrombin time were 0.737 ± 0.311 mg/dL, 39.00 ± 24.21 IU/L, 26.42 ± 10.40 IU/L, 4.10 ± 0.513 g/dL, and 16.46 ± 2.78 seconds in patients with DM and 0.506 ± 0.183 mg/dL, 28.26 ± 6.67 IU/L, 18.90 ± 4.75 IU/L, 4.12 ± 0.277 g/dL, and 14.23 ± 1.04 seconds in control subjects. Statistical analyses revealed that most of these parameters of liver function test were significantly different in DM patients compared to control subjects (p < 0.05). Serum alkaline phosphatase level was 89.61 ± 25.59 mg/dL in type 2 DM patients and 96.83 ± 16.34 mg/dL in control subjects (p > 0.05). The prevalence of abnormal values of serum bilirubin, ALT, AST, prothrombin time, and albumin were 5.17, 31.03, 5.17, 5.17, 43.10, and 10.34% respectively in type 2 DM patients and 0, 2, 0, 2, 3, and 0% respectively in control subjects, indicating high prevalence of DM patients with abnormal liver functions.ConclusionAbnormal liver functions of different extents and magnitudes have been found in type 2 DM patients, and the impact of abnormal liver function should be considered during the management of DM patients and also to assess their long-term follow-up prognosis.How to cite this articleRashid MHO, Haque MZ, Rahman MK, Khan MMR, Rahman ASMM, Al-Mahtab M, Rahman MS, Roy PK, Islam MN. Study on Liver Dysfunction in Type 2 Diabetic Patients in Bangladesh. Euroasian J Hepato-Gastroenterol 2016;6(1):1-4.

Acromegaly can be associated with impairment of LES relaxation in the oesophagus.

Although prolonged small intestine and colonic transit time has been demonstrated in acromegaly patients, the influence of acromegaly on oesophagus motility and the pathological mechanisms involved are still not clarified. We aimed to investigate manometric measurements to ascertain whether oesophagus motility is affected in active acromegaly patients. The study was performed in an institutional referral centre at a tertiary care hospital. Twenty-three acromegaly patients (mean age 43.2 ± 13.2 years) and 25 sex- and age-matched healthy control subjects (mean age 48.6 ± 7.9 years) were recruited to a case-control study. Oesophageal manometry was performed using MMS (Medical Measurement Systems, Netherlands) Solar GI - Air Charged Intelligent Gastrointestinal Conventional Manometry. In manometric measurements the lower oesophageal sphincter pressure was 18 ± 7 mmHg in acromegaly patients and 15.6 ± 4.4 mm Hg in controls, and there was no significant difference (p = 0.17). The percentage of relaxation was 64.8% and 81.8%, respectively, and it was significantly lower in acromegaly patients than in controls (p < 0.001). Additionally, the duration of relaxation was found to be 4 ± 1.9 seconds and 5 ± 1.7 seconds in patients and controls, respectively (p = 0.049). Our study has demonstrated a significant reduction in the percentage and duration of lower oesophageal sphincter relaxation in oesophagus motility even in acromegaly patients without any gastrointestinal symptoms. Further clinical and pathophysiological studies are required to clarify the underlying mechanisms of gastrointestinal motility disorders in acromegaly.

Neyrodoz in the treatment of secondary premature ejaculation in patients with chronic prostatitis

Premature ejaculation (PE) is the type of sexual dysfunction, which is characterized by constant or nearly constant uncontrolled ejaculation before vaginal penentration or within minutes of the start of sexual intercourse, that causing a feeling of sexual dissatisfaction and leading to sexual frustration among the partners. It has been shown that the antimicrobial and antiinflammatory therapy of chronic prostatitis (CP) increases the duration of sexual intercourse and improves the control over the ejaculation. PE in the patients with CP may be an independent sexual disorder that may require a specific correction. Antidepressants are the first line of drugs in the treatment of PE according to the recommendations of the European Association of Urology. However, some patients refuse to intake this medicine. The aim of our study was to evaluate the clinical efficacy and safety of Neyrodoz in the treatment of PE in patients with CP. Materials and methods. The study included 32 patients (mean age 37.5 years) who have had complains on PE after the treatment of CP. All the patients were randomly selected into two groups. 1 st – basic group (n = 15) and 2 nd – control group (n = 17). The first group patients intook Neyrodoz 2 capsules twice a day. The second group got placebo in the same dose during 30 days. Results . The time of intravaginal latency increased from 40,8 ± 9,9 (25–56) to180,1± 41,2 (120–240) seconds in patients of the 1 st group after the therapy. The score of tool-PEDT decreased from 15,8 ± 3,1 (11–20) to 3,9 ± 2,9 (0–8). The visual analogue scale (VAS) symptoms improved from 8,6 ± 1,4 (6–10) to 2,5 ± 2,1 (0–5). The time of intravaginal latency increased from 38,4 ± 10,0 (25–59) to 40,7 ± 7,4 (35–59) seconds in 14 of 17 men in the second group of patients. The score of tool-PEDT decreased from 15,6 ± 2,8 (11–20) to 14,3 ± 2,7 (12–19). The VAS symptoms improved from 8,9 ± 1,3 (6–10) to 8,5 ± 1,7 (6–10). Conclusions. Neyrodoz is an effective and safe medicine to the correction of PE in patients with CP, who did not get an effect after the treatment of CP.

Monitoring the Harm Associated with Use of Anticoagulants in Pediatric Populations Through Trigger-Based Automated Adverse-Event Detection

The safety profile of anticoagulants, which are being used with increasing frequency in pediatric populations, is not well studied. Automatic triggers built into electronic health record systems (EHR) have been shown to be an effective way to monitor for and identify medication errors. Anticoagulant-associated adverse events were examined through the use of an anticoagulant trigger panel. In a retrospective, five-year (September 2007-September 2012) observational study, four automated triggers were used to detect anticoagulant-related adverse events: activated partial thromboplastin time (aPTT) > 100 seconds in patients on an unfractionated heparin (UFH) infusion, International Normalized Ratio (INR) > 4, anti-factor Xa (anti-FXa) >1.5U/mL for patients on enoxaparin, and the documented use of protamine. For the 1,664 triggers evaluated, 12 were associated with the aPTT trigger, only 1 of which was preventable. Receiver operator characteristic curve analysis indicated that increasing the aPTT trigger > 140 seconds would optimize sensitivity and specificity. The INR trigger identified four outpatients with adverse events. No adverse events were associated with the anti-FXa trigger. The protamine trigger identified 12 adverse events and was associated with more severe events. Minimal overlap was found with protamine and aPTT triggers. Laboratory- and medication-based triggers can be effective monitoring tools for anticoagulants. For patients receiving a UFH infusion, an aPTT cutoff value of > 140 seconds is more precise. We also found that protamine use as a trigger adds value to a trigger-based anticoagulant monitoring system. Continued improvement in the logic algorithms associated with the EHR-based trigger tool will allow expanded use of this tool in a clinical manner.

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME): Characteristics of Responders to Rintatolimod

Background: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a debilitating disease of unknown pathogenesis consisting of a variety of flu-like symptoms including severe fatigue. Initial analysis of the use of rintatolimod (Poly I: Poly C 12U), a selective TLR3 agonist, in a Phase III, double-blind, randomized, placebo-controlled trial of CFS/ME demonstrated statistical significance (p 9 minutes. Analysis of improvement in exercise performance at the ≥ 25% and ≥ 50% levels using ET at 40 weeks compared to baseline was performed for the intent-to-treat (ITT) population (n=208) using the pre-specified baseline exercise stratum (baseline ET duration >9 minutes). For this subset of patients (n=126), 33% (n=20), and 12% (n=8) of rintatolimod vs. placebo patients, respectively, improved ET duration by ≥ 25% (p=0.004) while 23% (n=14) compared to 4.5% (n=3) of rintatolimod vs. placebo patients, respectively improved ET duration by ≥ 50% (p=0.003). This corresponds to increases of ≥ 186 and ≥ 373 seconds for patients receiving rintatolimod, respectively, at ≥ 25% and ≥ 50% improvement responses. A frequency distribution analysis of ≥ 25% improvement, 9 minutes cohort showed net improvement to be 18.3% for the rintatolimod cohort vs. 4.6% deterioration for placebo (p=0.015). A continuous responder analysis using 5% increments from ≥ 25% to ≥ 50% provided a robust clinical enhancement in ET effect in the rintatolimod cohorts as compared to placebo. The KPS and Vitality (SF-36 subscale) quality of life secondary endpoints demonstrated similar clinically significant improvements for the rintatolimod cohort as a function of the same ET dichotomization. Rintatolimod was generally well-tolerated in this CFS/ME population. Conclusions: Using a modified Bruce ET protocol with reduced physical exertion allowed clear identification of patient responders to rintatolimod with severe CFS/ME syndrome. Rintatolimod produced significant enhancement in ET and quality of life indicators in patients able to complete >9 minutes in a modified Bruce ET test. Rintatolimod also reduced deterioration in ET compared to placebo in patients with the poorest initial ET. Exercise endurance >9 minutes in a Bruce protocol modified for patients with CFS/ME provides a method to identify patients most likely to respond to rintatolimod.

Abstract P369: Impact of Enhanced External Counterpulsation on Exercise Duration in Patients With Chronic Stable Angina: A Meta-analysis

Introduction: Enhanced External Counterpulsation (EECP) is a non-invasive Food and Drug Administration approved treatment for patients with chronic stable angina and heart failure. Typical treatment regimen comprises of 35, 1-hour sessions of synchronized compressions of the calf, thigh, and sacral muscles over a seven-week period. Exercise duration measured using an exercise tolerance test is a commonly utilized marker of worsening ischemic disease and is predictive of cardiovascular mortality. Several studies have evaluated the impact of EECP on exercise duration with conflicting results. We sought to determine the magnitude of benefit of EECP on exercise duration. Methods: A literature search was performed in MEDLINE, CINAHL, and the Cochrane database along with hand searching of relevant articles limited to those published in the English language. Studies were included for analyses if assessing patients with stable angina and reporting exercise duration data using either the Bruce or modified Bruce exercise treadmill test. Appropriate data were extracted at baseline and after completion of the full course of EECP. Studies were excluded if presenting duplicate data or using a non-Bruce protocol. A weighted mean difference from baseline along with 95% confidence interval was calculated using the DerSimonian-Laird random-effects model. Sub-group analyses, the Cochran Q statistic, and JADAD scores were utilized to assess for heterogeneity, non-combinability, and quality of published studies respectively. Publication bias was assessed using visual inspection of funnel plots and the Egger bias statistic. Results: Our search strategy identified 1117 independent studies of which 15 were included for analyses. A total of 484 individual subjects were incorporated in the primary analysis. Exercise duration improved by 55.5 seconds (95%CI 36.1 to 74.9; Cochran Q, p=0.246) from baseline. The benefits were maintained when using a fixed-effects model, excluding small studies and limiting to studies using the Bruce protocol only. While the Egger statistic showed a lack of publication bias (p=0.121), it cannot be ruled out based on visual inspection of funnel plots. Conclusion: EECP significantly increases exercise duration by 56 seconds in patients with chronic stable angina. Further studies are needed to determine the impact of EECP on long-term outcomes. The views expressed in this material are those of the authors, and do not reflect the official policy or position of the U.S. Government, the Department of Defense or the Department of the Air Force.

Patent Foramen Ovale Is Not Associated with Hypoxemia in Severe Chronic Obstructive Pulmonary Disease and Does Not Impair Exercise Performance

Patent foramen ovale (PFO) may be disadvantageous in chronic obstructive pulmonary disease (COPD). It is unknown whether right-to-left shunting through PFO increases during exercise impairing exercise performance. To determine whether (1) PFO prevalence is greater in hypoxemic versus less hypoxemic patients with COPD, (2) PFO is associated with clinically relevant impairment, and (3) right-to-left shunting increases during exercise and impairs exercise performance. Patients with COPD and age-matched control subjects underwent contrast transthoracic echocardiography and transcranial Doppler to identify PFO. Patients with COPD with no shunt and patients with large PFO underwent cardiopulmonary exercise tests with contrast transcranial Doppler, esophageal, and gastric balloon catheters. PFO prevalence was similar in 50 patients with COPD and 50 healthy control subjects (46% vs. 30%; P = 0.15). Large shunts were more common in patients with COPD (26% vs. 6%; P = 0.01). In an expanded COPD cohort, PFO prevalence was similar in 31 hypoxemic (Pao2 ≤ 7.3 kPa) and 63 less hypoxemic (Pao2 > 8.0 kPa) patients with COPD (39% vs. 52%; P = 0.27). Patients with intrapulmonary shunting had lower Pao2 than both patients with PFO and those with no right-to-left shunt (7.7 vs. 8.6 vs. 9.3 kPa, respectively; P = 0.002). Shunting significantly increased during exercise in patients with COPD with PFO. Endurance time at 60% Vo2max was 574 (178) seconds for patients with PFO and 534 (279) seconds for those without (P = ns). Hypoxemic patients with COPD do not have a higher prevalence of PFO. Patients with COPD with PFO do not perform less well either on a 6-minute walk or submaximal exercise testing despite increased right-to-left shunting during exercise.

Indecision in the Clinical Practice of Anticoagulation for Brief Atrial Arrhythmias after Cryptogenic Stroke

Long-term cardiac monitoring has a substantial yield for paroxysmal atrial fibrillation (PAF) detection in cryptogenic stroke or transient ischemic attack (TIA) patients; however, many of these episodes were brief. We analyzed treatment decisions taken by the clinicians regarding anticoagulation in these short-duration PAF patients. We performed a retrospective analysis on all mobile cardiac outpatient telemetry records between June 2009 and January 2012, initiated by neurologists from a large tertiary care institution stroke center. In all, 39 patients were found to have atrial fibrillation (AF), and their records were reviewed. AF episodes were categorized as less than 30 seconds in 24 (62%) patients and 30 seconds or more in 15 (38%) patients. Among the 16 patients without a cardiology evaluation, the rate of anticoagulation was high and did not differ for patients with short AF (90%, 9 of 10) and long AF (83%, 5 of 6) (P>.99). However, among the 23 patients with a cardiology evaluation, the difference in rates of anticoagulation was significant between patients with short AF (43%, 6 of 14) and long AF (89%, 8 of 9) (P=.039). Our study demonstrates the differences in anticoagulant prescribing practices between neurologists and cardiologists and the inherent indecision these findings have produced. Further study is needed to better define the risks and benefits associated with anticoagulation of brief episodes of atrial arrhythmias lasting less than 30 seconds in patients with cryptogenic stroke or TIA.

Efficacy of a novel moist cool air device in office workers with dry eye disease

To evaluate the efficacy and safety of new moist cool air device (MCAD) for ocular symptoms, tear film stability and ocular surface status in office workers with dry eye disease (DED). In this prospective single-centre clinical trial, 40 eyes of 20 patients with DED were recruited and randomly divided into two groups (group with MCAD exposure and group without MCAD). All subjects are visual display terminals (VDTs) workers spending at least 4 h/day in front of VDTs. Patients using MCAD underwent moist air applications for 4 h/day for a total of five working weekdays during VDT works at their offices. The other group of patients performed their VDT work without moist cool air device exposure. The change in symptoms of ocular surface (OS) dryness, fatigue and discomfort was evaluated using visual analogue scale (VAS) scores. Changes in visual function, tear functions and ocular surface status were evaluated using best-corrected visual acuity (BCVA), the functional visual acuity (FVA) test, blink rate, BUT measurements, strip meniscometry (SM), tear evaporation rate, fluorescein staining and rose bengal staining scores. Tear film lipid layer interferometry was also performed to assess the status of the lipid layer over the tear film. In addition, adverse events were recorded. In group with MCAD, symptoms of OS dryness during VDTs work, and FVA and BUT were significantly improved. SM and tear evaporation rate were significantly improved. There were no statistically significant differences on lipid layer stability and corneal staining scores in both groups. Blink rate was significantly increased in group without MCAD. No adverse events were reported during this trial. Moist cool air device use provided symptomatic relief of ocular dryness and improvement on tear stability in office workers with DED. This new device seems to be a safe and promising alternative in the treatment of DED.

Impression cytology of the ocular surface and tear function in patients with periocular vitiligo

We evaluated the ocular surface and tear function in patients with periocular vitiligo in this prospective, case-control study. Sixty eyes of 30 vitiligo patients with periocular involvement and 100 eyes of 50 control subjects were included in the study. Patients and control subjects were compared for Schirmer test and tear film break-up time (BUT) results and impression cytology findings graded according to Nelson's classification. The mean BUT value was 9.5 ± 4.1 seconds in patients with periocular vitiligo and 13.1 ± 4.2 seconds in the control group. The difference was statistically significant (p=0.005). Thirty-seven eyes (61.7%) in the vitiligo group and 28 eyes (28.0%) in the control group had BUT values less than 10 seconds (p<0.001). The mean Schirmer test value was 14.6 ± 4.3 mm in patients with periocular vitiligo and 15.1 ± 4.4 mm in the control group (p>0.05). Nineteen eyes (31.7%) in patients with periocular vitiligo and 8 eyes (8.0%) in the control group had grade 2-3 changes according to Nelson's classification (p<0.001). Three eyes (5.0%) in the periocular vitiligo group and none of the eyes in the control group had inflammation signs in the impression cytology analysis. In patients with periocular vitiligo, ocular surface and tear function alterations may occur. Further studies on ocular surface involvement in periocular vitiligo patients may help to increase understanding of the pathophysiology of vitiligo.

The Comparison of Combination SSRI and PDE-5 Inhibitor Therapy to SSRI Monotherapy in Men with Premature Ejaculation

To evaluate whether combination therapy with a selective serotonin reuptake inhibitor (SSRI) and phosphodiesterase-5 (PDE-5) inhibitor is superior to SSRI monotherapy in the treatment of premature ejaculation. A literature search of MEDLINE (January 1980-April 2011) and International Pharmaceutical Abstracts (January 1970-April 2011) was conducted using the search terms premature ejaculation, phosphodiesterase-5 inhibitor, and selective serotonin reuptake inhibitor. All English-language human studies assessing the use of a PDE-5 inhibitor and SSRI in the treatment of premature ejaculation were evaluated. Additional references were retrieved from reference citations. Premature ejaculation is a multi-component disorder with several treatment options. Studies have demonstrated that both SSRIs and PDE-5 inhibitors used as monotherapy can delay time to ejaculation. Four clinical trials have been conducted to compare the efficacy of SSRI monotherapy versus combination SSRI-PDE-5 inhibitor therapy for the treatment of premature ejaculation. All studies focused on the treatments' ability to delay time to ejaculation. A statistically significant delay in time to ejaculation was found in patients using both an SSRI and PDE-5 inhibitor when compared to those on an SSRI alone. Average time to ejaculation was increased by approximately 50-78 seconds in patients using combination therapy when compared to monotherapy. The data also show greater delay in ejaculation with combination therapy in patients previously using SSRI monotherapy but dissatisfied with its effects. Adverse drug reactions including headache and flushing were higher in the combination group. Although a modest delay in ejaculation is seen when using an SSRI and PDE-5 inhibitor together, the combination also comes with increased risks for adverse drug reactions and is more expensive. SSRI monotherapy should continue to be first-line treatment for premature ejaculation due to a better adverse drug reaction profile, lower cost, and high efficacy. Combination therapy may be prescribed for those who fail SSRI monotherapy or have concomitant erectile dysfunction.

FibroScan Evaluation of Liver Fibrosis in Liver Transplantation

Introduction Liver biopsy remains the gold standard to evaluate fibrosis. However, it is invasive and uncomfortable as well as associated with complications. Transient elastography (FibroScan) is a simple and noninvasive method to assess liver fibrosis by measuring liver stiffness in kilopascals. Body mass index (BMI) greater than 28 is associated with high rates of invalid tests. Liver transplant patients show increased rates of obesity. We do not yet have many data about the usefulness of FibroScan in liver transplantation. Aims To analyze the applicability of FibroScan to assess fibrosis in liver transplantation and study the association between obesity and valid tests. Material and Methods We prospectively assessed the performance of transient elastography in 29 liver transplant patients from February to May 2008. We prospectively studied the success rate, the elasticity (stiffness) in kilopascals, and the BMI. Results The BMI was greater than 30 kg/m 2 in four patients; 25 to 30 kg/m 2 in eight; and 17 had BMI < 25 kg/m 2. The overall success of FibroScan was 24/29 (82.7%). However, among patients with BMI > 30 kg/m 2, it was 2/4 (50%), whereas for BMI <25 kg/m 2 it climbed to 100%. The average duration of the procedure was 211.52 seconds for BMI <25 kg/m 2; 236 seconds for BMI between 25 and 30 kg/m 2; and 361 seconds in patients with a BMI > 30 kg/m 2—differences that were statistically significant. Conclusions FibroScan seemed to be a promising approach to assess liver fibrosis.BMI is a limiting factor toward achieving a valid test; FibroScan had limited usefulness in obese patients.

418 H. pylori Stimulated Conventional Dendritic Cells Retained Toleragenicity of Immature Dendritic Cells While Upregulating Proinflammatory Cytokines

Background/Aims: Eosinophilic esophagitis (EE) is being recognized with increasing frequency in both pediatric and adult populations. Esophageal manometry, which measure circular muscle (CM) function, shows normal to non-specific motor abnormalities in EE. We observed & describe dysfunctional longitudinal muscle (LM) in EE. METHODS: High frequency intraluminal ultrasound (HFIUS) imaging andmanometry were recorded simultaneously to assess the LM and the CM contraction during swallow-induced peristalsis in 10 normal and 8 patients with EE (histological diagnosis). The US transducer was axially located close to the side hole. 5 ml water swallow were recorded, 2 cm above the LES. RESULTS: Amplitude and duration of CM contraction (measured by manometry) in the controls and patients were not different, (mean amplitude 101 ± 25 vs 90 ± 13 mmHg, and mean duration 3.7 ± 0.7 vs 3.1 ± 0.3 seconds) and pressure waves were peristaltic in both groups. HFIUS images reveal that the baseline muscle thickness was not different between the 2 groups, however there were major differences in the change in muscle thickness during contraction. The peak muscle thickness was significantly smaller in the EE, (peak thickness 3 ± 0.6 ± mm vs 1.69 ± 0.3 mm and duration of muscle thickness increase 4.6 ± 1.1 vs 1.6 ± 0.2 seconds, (P<0.001). In controls, the muscle thickness from baseline to peak was 121% (range 65% to 214%) , in the EE patients it was increased 37% (range 20% to 49%). In normal subjects the CM and LM contract simultaneously but in patients contractions were asynchronous (delta time 0.03 secs in normal and 0.7 seconds in patients (P<0.01)). In 1 patient there was complete dissociation between the CM and LM contraction (EE 1 in Fig 1). CONCLUSIONS: In patients with EE the LM function is significantly impaired even though the CM function is preserved. The role of LM dysfunction in the pathogenesis of dysphagia in EE requires further investigation.

Dry Eye and Corneal Sensitivity After High Myopic LASIK

To assess subjective symptoms and objective clinical signs of dry eye and investigate corneal sensitivity after high myopic LASIK. Twenty eyes of 20 patients with a mean age of 34 +/- 7.5 years who had undergone high myopic LASIK 2 to 5 years previously and 10 eyes of 10 controls with a mean age of 39.8 +/- 10.4 years were enrolled in the study. Clinical signs of dry eye and subjective dry eye symptoms were determined. The corneal sensitivity was assessed using non-contact esthesiometer. The preoperative spherical equivalent refraction was -11.40 +/- 1.40 diopters (D) (range: -9.10 to -14.00 D) and the intended spherical equivalent refraction correction was -10.40 +/- 1.10 D (range: -8.30 to -12.50 D). Schirmer's test score was 14.4 +/- 8.9 mm in patients and 9.0 +/- 4.2 mm in controls (P = .066). The break-up time was 15.9 +/- 11.2 seconds in patients and 14.0 +/- 10.0 seconds in controls (P = .505). The mean corneal sensitivity was 73.5 +/- 29.6 mL/min in patients and 78.0 +/- 18.7 mL/min in controls (P = .666). The majority (55%) of patients still reported dry eye symptoms. Ocular surface disease index indicating degree of dry eye symptoms was significantly higher in LASIK patients (18.6 +/- 13.4%) compared to controls (7.5 +/- 5.7%; P = .022). The majority of patients who received LASIK for high myopia reported ongoing dry eye symptoms, although objective clinical signs of tear insufficiency and hypoesthesia were not demonstrable. We assume that symptoms represent a form of corneal neuropathy rather than dry eye syndrome.

Use of the New Indicator Test (Neuropad®) for the Assessment of the Staged Severity of Neuropathy in Type 2 Diabetic Patients

The new indicator test for sudomotor function (Neuropad) has been shown to represent a highly sensitive and reproducible tool for the diagnosis of diabetic peripheral neuropathy. This study aimed to examine the utility of the indicator test in the assessment of the staged severity of neuropathy in patients with type 2 diabetes mellitus. The study included 120 type 2 diabetic patients (58 men) with a mean age of 67.3+/-5.9 years and a mean diabetes duration of 13.1+/-3.2 years. Neuropathy was diagnosed and staged by clinical examination and nerve conduction study, according to the Michigan classification system. Patients were also examined with the indicator test, applied on the plantar aspect of the feet. Time until complete colour change of the test was recorded and stratified into deciles according to the spread of measurements in the study population. Neuropathy was staged as class 0 in 37 patients, class 1 in 44 patients, class 2 in 28 patients and class 3 in 11 patients. Time until complete colour change was 436.5+/-62.9, 740+/-88.1, 1192.5+/-161 and 1817.3+/-127.4 seconds in patients staged as class 0, 1, 2 and 3 respectively (p=0.001). Use of a threshold lower than 530 seconds until complete colour change had 97% sensitivity and 100% specificity for diagnosis of class 0 neuropathy. Use of a threshold lower than 1000 seconds until complete colour change had 100% sensitivity and 97% specificity for class 1 neuropathy. A threshold lower than 1440 seconds had 93% sensitivity and 100% specificity for class 2 neuropathy. A threshold above 1440 seconds had 100% sensitivity and 99% specificity for class 3 neuropathy. A highly significant (Kendall's tau-b=0.848, p=0.001) correlation was shown between time until complete colour change of the test and Michigan class of neuropathy. It appears that the indicator test contributes substantially to the assessment of the staged severity of neuropathy in patients with type 2 diabetes mellitus. There is excellent agreement between the indicator test and the Michigan classification system. These results suggest a role for the indicator test in the assessment of diabetic neuropathy.

Tear Film Lipid Layer Alterations in Allergic Conjunctivitis

To assess the alterations of the tear film lipid layer and tear functions in patients with seasonal allergic conjunctivitis (SAC) and to compare the results with healthy control subjects. Seventy-eight eyes of 39 consecutive patients diagnosed as SAC (mean age 32.6 years; 11 male, 28 female) as well as 20 eyes of 10 healthy control subjects (mean age 32.5 years; 6 male, 4 female) underwent slit-lamp examinations, tear film breakup time measurements (BUT), corneal fluorescein stain scoring, Schirmer test, and tear film lipid layer interferometry. The 2 groups were then compared for the examined parameters. RAST and serum IgE level evaluations were also carried out in the patients to confirm the diagnosis of allergy. The mean BUT was 3.4 +/- 1.5 seconds in patients with SAC compared with the mean value of 12.4 +/- 2.4 seconds in the controls (P < 0.05). There were no significant differences in relation to Schirmer test values between the 2 groups; 78% of the patients with SAC had grade 3 or above dry eye change in tear film lipid layer interferometry, whereas none of the controls had an interferometry grade greater than 3 (grade 1-2 normal; grade 3-4 dry eye; grade 5 severe dry eye). Eyes with SAC had significantly higher tear film lipid layer thickness ranges compared with the control eyes (P < 0.05). SAC was associated with advanced tear instability and thickening of the tear film lipid layer. Evaluation of the tear film lipid layer thickness might be useful in the assessment of the extent of dry eye disease and the treatment outcomes in patients with allergy.

The Clinical Effectiveness and Selectivity of Radiofrequency Trigeminal Rhizotomy Using a 2 mm Active Tip Electrode for the Treatment of Trigeminal Neuralgia

Background: To minimize the side effects of radiofrequency trigeminal rhizotomy by making a more selective minimal lesion for the target division of a trigeminal rootlet, we performed this study to evaluate the effectiveness and the selectivity of radiofrequency trigeminal rhizotomy using a 2 mm active tip electrode as compared to a 5 mm active tip electrode. Methods: The authors evaluated 36 cases, in which radiofrequency thermocoagulation of a trigeminal rootlet was performed using a 2 mm active tip electrode or a 5 mm active tip electrode at for 60 seconds in patients suffering from trigeminal neuralgia. One month after each operation, we assessed the clinical effects, selectivity, and the side effects of these operations. Results: Of the 36 patients, 34 patients experienced loss of tic pain. In terms of effectiveness, no difference was found between the two groups. In terms of selectivity, some superiority was shown by the 2 mm active tip electrode, but this was not statistically significant. Masseter weakness or dysesthesia occurred in six patients who suffered from tic pain in the V3 region, and who were operated upon with a 5 mm active tip electrode. Major complications like anesthesia dolorosa, and corneal anesthesia were absent in any patients. Conclusions: For target specific lesion generation of trigeminal rootlets, single lesion generation using a 2 mm active tip electrode may be as clinically effective as a 5 mm tip and is more selective in use.

Gelatin Sponge Closure Device versus Manual Compression after Peripheral Arterial Catheterization Procedures

To evaluate the safety and efficacy of the QuickSeal system, which delivers an over-the-wire extravascular porcine gelatin sponge (nonbovine and noncollagen), compared with manual compression in a single interventional radiology practice. This single-institution report involves 141 patients undergoing peripheral diagnostic and interventional procedures in a teaching and private-practice setting. A 3:2 device-to-control ratio was used with randomization stratified by type of procedure, interventional or diagnostic. Primary endpoints included time to hemostasis (TTH), time to ambulation (TTA), and rate of major complications. Sheaths were removed in the device group when activated clotting times (ACTs) were < or =300 seconds for patients without glycoprotein (GP) IIb/IIIa platelet inhibitors and < or =250 seconds for patients with GP IIb/IIIa platelet inhibitors. Sheaths were removed in the control group when ACTs were < or =180 seconds. The mean TTH was significantly shorter (P <.001) in the device group (8.2 minutes) than in the control group (14.12 minutes). Mean TTA was shorter in the device group (2.7 hours) than in the control group (7.1 hours), and the time to discharge was shorter in the device group (23.8 hours) than in the control group (43.6 hours). There were no major complications in either group, and the incidences of minor complications were not significantly different. The tested device reduced TTH, TTA, and eligibility for hospital discharge while maintaining a safety profile equivalent to that of manual compression in diagnostic and interventional procedures.