Single-center Investigation Research Articles

Clinical-Reported Outcomes Of Deferoxamine Versus Deferasirox In The Treatment Of Homozygous BetaThalassemia

Iron chelation therapy with deferoxamine (DFO),the current standard for the treatment of iron overload in patients with betathalassemia,requires regular subcutaneous or intravenous infusions. This can lead to reduced quality of life and poor adherence,resulting in increased morbidity and mortality in iron-overloaded patients with beta-thalassemia. Deferasirox (DFX) is an orally administered iron chelator that has been approved for use in many countries. The requirement of an effective,well tolerated iron chelator with a less demanding mode of administration has led to the development of deferasirox. The present study was aimed to compare the satisfaction and compliance with deferoxamine versus deferasirox (Exjade®),a novel oral iron chelator in patients with transfusion - dependent beta- thalassemia. A cross-sectional,single-center investigation study was carried out in the Thalassemia Center of Ibn-Atheer Teaching Hospital in Nineveh province,Iraq. One hundred and eight thalassemic patients aged between 2- 20 years old having received multiple blood transfusions and a serum ferritin greater than 1500 ng/ml. Patients were randomised into two groups. Group 1 received deferoxamine at a dose of 20-50mg/kg/day and group 2 received deferasirox at the dose of 10-30 mg/kg/day. Another 56 apparently healthy volunteers were used as a control group. The assessment of chelation was done during the period between November 2013 and February 2014 by measurement of serum ferritin. Satisfaction and compliance was assessed by using a special questionnaire prepared by the researcher. Out of the 108 thalassemic patients enrolled there was no discontinuation in treatment with the two drugs under study. The serum ferritin did not change significantly in any of the chelation groups. In comparison with the patients who were treated with DFO,those receiving DFX reported a significantly higher rate of compliance and satisfaction (P < 0.05). However,no significant difference was observed between the two groups regarding their satisfaction (P > 0.05).Compliance with deferasirox (50 %) was more than that with deferoxamine (20 %). Satisfaction with deferoxamine was significantly lower than deferasirox (p= 0.00).

Risk factors for pterygium recurrence after limbal-conjunctival autografting: a retrospective, single-centre investigation.

To determine the risk factors related to recurrence of pterygium after pterygium excision with limbal-conjunctival autograft. Retrospective, observational case series. The current study included 310 patients who underwent surgical removal of pterygium using limbal-conjunctival autografting. All surgery was performed by the same surgeon at a single Hospital from 2006 to 2011. Preoperative and postoperative patient data were collected. The patients were summoned to follow-up examinations. Procedures with at least 12months of follow-up were included in the final analysis. Potential risk factors for pterygium recurrence were determined by Cox proportional-hazard linear analysis and recurrence-free survival time was evaluated using Kaplan-Meier method. The overall recurrence rate was 5.2% during an average follow-up time of 20.1±8.6months (range, 12-37months). According to Kaplan-Meier evaluation, the estimated time to recurrence was 34.2 ± 0.5months (95% confidence interval 33.3-35.0months) for the whole population. Multivariate analysis showed that age < 45years old (RR = 3.582, 95% CI 1.984-13.044, P = 0.047), recurrent type of pterygia (RR = 4.856, 95% CI 1.794-13.142, P = 0.002), and vertical size of pterygium > 6.7mm (RR = 2.529, 95% CI 1.053-6.075, P = 0.038) were significantly associated with increased risk of recurrence. Our findings suggest that young age, recurrent type of pterygia, and larger pterygial tissue are risk factors for pterygium recurrence after surgical excision. Hence, early excision of pterygium is recommended to decrease the recurrence rate.

The Ross-Konno procedure in neonates and infants less than 3 months of age.

Patients with severe left ventricular outflow tract obstruction often suffer from impaired left ventricular function, endocardial fibroelastosis and borderline-sized structures. The early Ross-Konno operation can offer complete repair due to outflow tract stenosis and enable the functional recovery and growth of small structures. Between 2008 and March 2017, 44 early Ross-Konno procedures were performed at our centre. Thirty-five patients were neonates, and 9 were infants less than 3 months of age. A retrospective single-centre investigation was carried out analysing early and late deaths, postoperative complications and reoperations during the follow-up period. Potential prognostic influence factors as previous fetal intervention, associated lesions as presence of a VSD or hypoplastic aortic arch or severe endocardial fibroelastosis were examined. The in-hospital mortality rate was 7% (3 of 44), and the late mortality rate was 2%. There were no deaths in the group with ventricular septal defects (9 cases), and there was 1 death in the group with critical aortic stenosis without arch repair (1 of 24; 4%). The most deaths occurred in patients with critical aortic stenosis and aortic arch repair (3 of 11; 27%) (P = 0.012). Fifteen patients with foetal intervention had a mid-term survival rate of 87%. Reoperations were necessary in 19 of 40 surviving patients during a mean follow-up period of 5.9 years. The early Ross-Konno procedure can enable biventricular repair even in borderline left ventricles with good long-term outcome. Thus far, there were no reoperations at the level of the autograft or the left ventricular outflow tract in our cohort. The highest operative risk was observed in patients with critical aortic stenosis and aortic arch hypoplasia.

Особенности диафрагмальной функции радужки при фемтосекундном лазерном сопровождении факоэмульсификации на фоне применения различных нестероидных противовоспалительных средств

Purpose. To compare the efficacy of two different nonsteroidal anti- the conventional phacoemulsification (CPE) was performed using the inflammatory drugs for maintenance of intraoperative mydriasis and to same preoperative instillations. Pupil diameter was registered at 5 surgical define causative factors for laser-induced miosis. steps before FLACS (first pupil diameter – I ∅ ), before phacoemulsification Material and methods. The prospective single center investigation (II ∅ ), after viscoinjection (III ∅ ), at А/I of the lens cortex (IV ∅ ), at the end included the groups I and II (35 and 30 eyes) where femtosecond laser- of the surgery (V ∅ ). Pupil diameter was calculated in the Image J program assisted cataract surgery was carried out with bromfenac 0.09% and version 2.0. Correlation analysis was performed by uniting the groups I indomethacin 0.1% instillations. In the groups III and IV (28 and 34 eyes) and II between intraoperative parameters and pupil diameter. Results. The second degree clinical significant miosis (CSM 2) (postcapsulotomy margin of the capsule was under the iris) was detected in one patient of the group I. In the group II – 5 patients had CSM 2 on the different steps of FLACS, the smallest diameter was 4.0 mm (one case – IV ∅ and one –V ∅ ). There were correlations between II ∅ with IOP measured after 15 minutes (r=-0.42, p<0.05), III ∅ with IOP that was measured right after femtosecond laser procedure and 15 minutes later (r=-0.38, p<0.05; r=0.35, p<0.05 consecutively). V ∅ correlated with IOP measured right after femtosecond laser step and IOP after 15 minutes (r=-0.45, p<0.001; r=0.43, p<0.001, respectively). Low negative correlations of intraoperative miosis were observed with age of the patients. Conclusion. The maintenance of intraoperative mydriasis was more stable in case of bromfenac 0.09% preoperative instillations than using indomethacin 0.1%. The patients who were older and had small pupils prior to the surgery showed a higher reduction of the pupil size. The risk factors for the intraoperative miosis were IOP spikes that occurred in the time period of 15 minutes after femtosecond laser procedure.

CLINICAL CHARACTERISTICS OF CORYNEBACTERIUM PNEUMONIA PATIENTS: A RETROSPECTIVE, SINGLE CENTER INVESTIGATION

RespirologyVolume 22, Issue S3 p. 35-35 Respiratory Infections (non-tuberculosis) 2 CLINICAL CHARACTERISTICS OF CORYNEBACTERIUM PNEUMONIA PATIENTS: A RETROSPECTIVE, SINGLE CENTER INVESTIGATION First published: 23 November 2017 https://doi.org/10.1111/resp.13206_81Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume22, IssueS3Supplement: 22nd Congress of the Asian Pacific Society of Respirology, International Convention Centre, Sydney, Australia, 23–26 November 2017November 2017Pages 35-35 RelatedInformation

Frequency of enuresis and related factors among school children in Guilan province; a single center investigation

Introduction: Enuresis is one of the most common diseases in children that has several physical and psychosocial effects on children and their parents. Enuresis is classified in primary and secondary groups which depends on various factors such as genetic predisposition, biological and developmental, psychological, social and economic factors. Objectives: This study aimed to determine the prevalence of enuresis in primary school-aged children and the role of related personal and family factors in Rasht. Patients and Methods: In this cross-sectional study, samples were randomly selected from Rasht’s primary schools. Questionnaires were selected for each student and then completed by a health expert with invitation of a parent. Results: In this study, 1125 questionnaires were completed that 568 (50.5%) were boys and 557 (49.5%) were girls. The study showed that the prevalence of enuresis was 7.5% (n = 43) in boys and 4.1% (n = 23) in girls and overall is 5.9% (n = 66). The gender difference was statistically significant. There was statistically significant relation in two groups about personal factors such as history of urinary tract infections (UTIs), snoring, computer games and eating fast food and family factor such as family history of enuresis and the place of residence. Conclusion: The results showed that the prevalence of this disorder was lower than other studies, which it may be because of ethnic and cultural differences among the communities. Our results with enuresis prevalence and associated factors were comparable to other epidemiological studies from various countries.

Unplanned cardiac reoperations and interventions during long-term follow-up after the Norwood procedure†.

Patients with hypoplastic left heart syndrome or related malformations are predominantly treated with a 3-stage palliation. Anatomic or physiologic problems can lead to unplanned additional surgical or catheter interventions during single ventricle palliation. Changes in operative technique may have an impact on the reoperation rate. Between 1997 and 2014, 317 Norwood procedures were performed at our centre. A retrospective single centre investigation was carried out concerning incidence, timing, indication and type of unplanned interstage cardiac reoperations and catheter interventions during follow-up of Norwood patients. Patients were followed from birth until the end of 2015. Cardiac procedures taking place at the time of the bidirectional Glenn or Fontan procedure or heart transplantation were not included. Sixty-five of the Norwood patients (20.5%) had at least one additional surgical cardiac procedure. Nine patients (2.8%) needed open procedures prior to the Norwood operations, 11.0% had procedures in the interstage I, 3.5% in the interstage II and 9.1% of the Fontan patients had cardiac reoperations afterwards. Main indications for unplanned surgery were insufficient pulmonary perfusion and tricuspid regurgitation. Eighty-one patients (25.6%) had at least one interstage catheter intervention during follow-up mainly addressing stenosis of the pulmonary arteries, aortic arch stenosis or aortopulmonary collaterals. The number of unplanned reoperations and interventions during staged palliation is remarkably high showing surgical peaks in the interstage I and after the Fontan procedure and an interventional peak in the interstage II. Thorough early information of the parents about possibly anticipated additional procedures is necessary.

Treatment of recalcitrant port-wine stains (PWS) using a combined pulsed dye laser (PDL) and radiofrequency (RF) energy device

Pulsed dye laser (PDL) is the treatment of choice for port-wine stains (PWS). Some PWS are recalcitrant to this modality. A number of reasons for PDL treatment resistance have been described, including inadequate heat generation. We evaluated PDL combined with radiofrequency (RF) energy into a single device to target larger and deeper blood vessels and overcome PDL resistance. This was an open-label, prospective, single-center investigation of a novel device combining RF energy with PDL conducted to treat recalcitrant PWS. Ten patients with 11 recalcitrant PWS were enrolled. Each PWS was divided into 5 treatment areas: PDL alone, RF alone, PDL+RF, RF+PDL, and untreated control. Patients underwent a maximum of 6 treatments, scheduled 4 to 6weeks apart with follow-up evaluation at 4 and 12weeks after the final treatment. Colorimetry and standardized digital photography were performed at all visits. Lesional biopsy specimens were collected for selected patients. Areas treated with RF followed by PDL and PDL followed by RF showed the greatest improvement based on blinded review of digital photographs, reaching statistical significance (P value<.05) at the 12-week follow-up evaluation when compared with baseline. Adverse events, including purpura, erythema, edema, scabbing, crusting, and blistering, resolved without sequelae; a small residual scar was noted in 1 patient. Small sample size and short follow-up period are limitations. Combined RF/PDL technology is promising for the treatment of recalcitrant PWS.

Blood Components Consumption Model in China: A Single-center Investigation with-in 11-years Interval

Background: With the global demand increasing in blood transfusion, and the advancing of medical technology, transfusion safety and efficacy are great challenge all over the world. However, because of lagging information technologies, transfusion consumption in certain hospital and analysis in developing nations are invalid and inaccuracy, thus constrained further progress in transfusion medicine in these countries. Methods and Findings: We respectively recorded the actual consumption amounts of red blood cells (RBC), plasma, platelets, and cryoprecipitate were collected in Xijing Hospital from 2003 to 2013. Then, we developed our consumption predict model (CPM) to estimate the needs of RBC, plasma, PLT, cryoprecipitate in 2014. Last, for testing our CPM capability, we compared the predicted volume with the actual consumption amounts of blood transfusion. After a long period of increasing, the red blood cell usage decreased from 2012 in this hospital. With a 19% decrease compared with that of in 2013, the total utilization of red blood cell is 11271800 ml in 2014, Plasma usage almost maintained stable dnuring the past years, and this trend seemed will continue. However, platelet and cryoprecipitate consumption were opposite to RBCs or platelets. Inconceivably, compared with platelet’s annual growth rate of 22%, cryoprecipitate annual growth was 58%. The demand for blood components over an 11-year interval is representative and indicative for the administration of blood components consumption in one of the most large scale hospital in China. Conclusions: Our CPM represented a basis for developing a standard blood management strategy, and allowing blood transfusion services in being better prepared for future consumption requirements.

External validity of a contemporaneous primary percutaneous coronary intervention trial in patients with acute ST-elevation myocardial infarction: insights from a single-centre investigation

Randomised controlled trials (RCTs) represent the most robust source of evidence-based medicine. However, the generalisability of RCTs is limited by the inclusion of selected populations. We sought to assess the external validity of a contemporary trial including patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Patients presenting to Bern University Hospital during the inclusion period of the COMFORTABLE AMI trial were divided into three groups: RCT participants (41%), eligible not included (17.5%), and excluded patients (41.5%). Major adverse cardiac events (MACE) were defined as one-year death and myocardial infarction. RCT participants compared with RCT-eligible patients had comparable baseline characteristics and outcomes; however, excluded patients differed in risk and had higher rates of MACE (HR 3.63, 95% CI: 2.03-6.48, p<0.001), death (HR 6.23, 95% CI: 2.93-13.24, p<0,001) and definite/probable stent thrombosis (HR 3.63, 95% CI: 1.79-7.36, p<0.001). Inability to provide consent was the most frequent exclusion criterion and was independently associated with an increased risk for MACE (HR 6.85, 95% CI: 3.97-11.81, p<0.001). In this single-centre investigation, results from the COMFORTABLE AMI trial appeared applicable to a broad representation of RCT-eligible patients. However, patients excluded from the trial represented a higher-risk population with impaired clinical outcomes and a lower adherence to cardiovascular medication.

Retrospective cohort study of the performance of the Pinnacle metal on metal (MoM) total hip replacement: a single-centre investigation in combination with the findings of a national retrieval centre

ObjectivesTo determine risk factors for revision in patients implanted with a commonly used metal on metal (MoM) hip replacement.DesignRetrospective cohort study in combination with a prospective national retrieval study (Northern...

Postoperative Complications in Patients Undergoing Minimally Invasive Sacroiliac Fusion

Introduction Minimally invasive sacroiliac (SI) fusion has become increasingly popular as a treatment for non-traumatic sacroiliac joint pain in recent years. This has created significant need for reliable data addressing risks associated with the procedure. Initial investigations have focused primarily on efficacy and patient satisfaction with small sample size. Furthermore, the majority of past studies have been primarily single center or case series investigations and as such their findings were limited to their sample populations. The aim of this study was to analyze complications associated with minimally invasive SI fusion using a large medical record database that more closely and accurately models the American population as a whole. Material and Methods Patients undergoing minimally invasive SI fusion from 2007–2014 were selected from records of the nationwide private insurance provider Humana. Using the Pearl Diver patient records database (Pearl Diver Technologies, West Conshohocken, PA, USA), patient data on age, procedure date, and medical diagnoses before and after the procedure was acquired. ICD-9 diagnosis codes (International Classification of Diseases 9th edition) were used to reveal incidence of post-operative complications including infection, pain, osteomyelitis, joint derangement, uterine tract infection (UTI), and nerve pathology. Cases of pre-existing conditions were excluded from the analysis. The data was also examined for incidence of patients with diagnoses of new lumbar pathology following the procedure. Patients undergoing SI fusion for surgical revision, neoplasia, or pelvic ring trauma were excluded from the study. Results Data from 469 patients (305 female; 164 male) showed a substantial increase in the number of minimally invasive sacroiliac fusion procedures performed from 2007–2014 [ p &lt; .05]. Among these patients, an overall complication rate of 13.2% was seen at 90 days and 16.4% at 6 months post-op. Rates of individual complications were as follow. Infection: 30 days = 3.0%, 90 days = 3.6%, 6 months = 4.1%. Pain: 90 days = 2.6%, 6 months = 4.1%. UTI: 90 days = 3.8%, 6 months = 4.9%. Nerve pathology: 90 days = 4.3%, 6 months = 6.2%. Incidence of novel lumbar pathology was 3.6% at 90 days post-op and 5.3% at 6 months. Males experienced diagnoses of novel lumbar pathology at higher rates than females at both 90 days (M=6.7%; F≤3.3%) and 6 months (M=9.1%; F≤3.3%) [ p &lt; .01]. Conclusion The results of this study show that minimally invasive SI joint fusion may carry higher risks of complications than previously stated, including a possible association with the development of lumbar pathology. These finding are critical for physicians and patients considering minimally invasive SI fusion as a treatment for chronic SI joint pain, and should be taken under careful consideration when deciding if surgical treatment is warranted.

Ten years of specialized adult care for phenylketonuria - a single-centre experience.

BackgroundSpecialized adult care of phenylketonuria (PKU) patients is of increasing importance. Adult outpatient clinics for inherited errors of metabolism can help to achieve this task, but experience is limited. Ten years after establishment of a coordinated transition process and specialised adult care for inherited metabolic diseases, adult PKU care was evaluated with respect to metabolic control, therapy satisfaction, life satisfaction, sociodemographic data, economical welfare as well as pregnancy outcome.MethodsAll PKU patients transferred from paediatric to adult care between 2005 and 2015 were identified. A retrospective data analysis and a cross-sectional survey in a sub-cohort of 30 patients including a questionnaire for assessing quality of life (FLZm) were performed as a single-centre investigation at the metabolic department of the University Hospital Leipzig, Germany. For statistical analysis, Mann-Whitney-U-test, t-test for independent samples, ANOVA and chi square test were used as appropriate.Results96 PKU patients (56 females/40 males; median age 32 years, range 18–62) were included. In the last 3-year period, 81 % of the transferred patients still kept contact to the adult care centre. Metabolic control was stable over the evaluation period and dried blood phenylalanine concentrations mostly remained within the therapeutic range (median 673.0 μmol/l, range 213.0–1381.1). Sociodemographic data, economical welfare and life satisfaction data were comparable to data from the general population. However, differences could be revealed when splitting the cohort according to time of diagnosis and to management during childhood. 83 % of the PKU adults were satisfied with the transition process and current adult care. 25 completed pregnancies were supervised; three newborns, born after unplanned pregnancy, showed characteristic symptoms of maternal PKU syndrome.ConclusionsContinuous care for adult PKU patients in a specialized outpatient clinic is successful, leading to good to satisfactory metabolic control and social outcomes. Uninterrupted good metabolic treatment throughout childhood and adolescence positively influences educational, professional and economic success in later life. Further effort in specialized paediatric and adult metabolic care is needed to prevent loss of follow-up and to support the recommended life-long treatment and/or care.

Predictors for Progression of Atrial Fibrillation in Patients Awaiting Atrial Fibrillation Ablation

BackgroundSuccess rates of atrial fibrillation (AF) ablation have been shown to be significantly lower for patients with persistent AF. However, little is known about the risk factors predicting progression to persistent AF in patients awaiting AF ablation. MethodsWe performed a retrospective, single-centre investigation of patients with paroxysmal AF at the time of placement on the ablation waiting list. Patients were defined as having progressed if they had developed self-reported or electrocardiogram-recorded AF durations more than 7 days while awaiting ablation. After ablation, clinical visits at 3, 6, 9, 12, and 18 months were performed with a minimum of a 48-hour-Holter and electrocardiogram. Baseline characteristics including left atrial diameter (LA) and the HATCH score were analyzed by univariable and multivariable analysis for predicting progression to persistent AF. ResultsDuring a median waiting time of 9.7 (6.1, 14.2) months, 60 of 564 patients (11%) progressed to persistent AF. In patients who progressed, ablation took longer (180 [150, 249] minutes vs 157 [125, 210] minutes; P = 0.009) and was associated with a higher rate of recurrence after a median of 12 months (53.3% vs 39.1%; P < 0.001). The HATCH score was a poor predictor of AF progression (area under the curve 0.54), whereas an LA diameter of more than 45 mm (odds ratio 3.46, P < 0.001) and heart failure (odds ratio 3.11, P = 0.036) were strong and independent predictors of AF progression in multivariable analysis. ConclusionsPatients with an increased LA diameter or heart failure have a significantly increased risk of progression to persistent AF. These characteristics may define patients who should undergo earlier catheter ablation to optimize outcome.

Impact of pregnancy on back pain and body posture in women.

[Purpose] The purpose of this single-center investigation was to study the impact of pregnancy on back pain and body posture. [Subjects] The subjects were 26 pregnant females. [Methods] Data were generated with a spine scanner (Diers® formetric 4D), trunk strength measurement (Diers® myoline), a numeric pain scale (0 to 10), and a biomechanical model. Parameters were compared during each trimester. [Results] The alteration in pain level at rest and lumbar lordosis angle in the females revealed a statistical trend during pregnancy. Spearman’s test showed positive correlations between body weight and trunk inclination during the second trimester, and between body weight and the kyphosis angle in the third trimester. The trunk inclination and the kyphosis angle revealed a negative correlation in the third trimester. Based on our analysis, the highest moments and muscle strength must be expended in the third trimester. The actual muscle strength is greatest in the second trimester. [Conclusion] Pain at rest must be given greater attention in pregnant females, and their increasing lumbar kyphosis must be counteracted. Exercising the deep segmental muscles may serve as a preventive measure.

Building Networks for Global Clinical Research: The Basics.

Over the last several decades, interest in global health across all fields of medicine, including orthopaedic surgery, has grown markedly. Cross-national collaborations are an effective means of conducting high-quality clinical research and offer many advantages over single-center investigations. Successful collaboration requires a well-designed research protocol, development of an effective team structure, and the funding to ensure the project is sustained to completion. Equally important, investigators must consider the social, linguistic, and cultural context in which the study is being undertaken. Although randomized clinical trials are the highest level of evidence, study designs may have to be adapted to accommodate available resources, expertise, and local contextual factors. With appropriate planning, these collaborative endeavors can generate changes in clinical practice and positively impact health policy.

Abstract 14870: Progression of Paroxysmal to Persistent Af in Patients Awaiting AF Ablation

Objective: Atrial fibrillation (AF) is a progressive disease for which ablation has become an important treatment option. Success rates have been shown to be significantly higher while AF has not yet progressed to persistent. In a general AF-population the HATCH-score has been proposed to predict the risk of progression to persistent AF. However, little is known about predictors of progression in patients awaiting AF ablation. Methods/Results: We performed a retrospective, single centre investigation of patients with paroxysmal AF at the time they were placed onto our AF ablation waiting list and evaluated possible risk factors for the progression of AF until the time of the actual ablation. Of 564 patients (median age 60.4 (±15.1) years, 194 (34.4%) female) 60 (11%) progressed from paroxysmal to persistent AF during a median waiting time of 291 (±244.3) days. In patients that progressed to persistent AF, ablation took significantly longer (180±99 min vs. 157±85min; p 0.009), had a tendency to require longer RF-energy delivery (68.9±40 min vs. 61.8±44 min; p 0.052) and was associated with a higher rate of recurrence (53.3% vs. 39.1%; p&lt;0.001). Patients that did progress to persistent AF had tied significantly more antiarrhythmic drugs (1 (±2) vs. 1(±1); p 0,048) and more frequently had a history of amiodaron treatment (21.7% vs. 11.9%; p 0.03). The previously proposed HATCH-score was only a poor predictor of AF progression (AUC 0.54). Furthermore, none of the individual HATCH-score parameters was a significantly predicted the progression of AF in our population. However, a left atrial (LA) diameter of more than 45mm (OR 3.46, p&lt; 0.001) and heart failure (OR 3.11, p 0.036) were strong and independent predictors of AF progression in multivariable analysis. Conclusion: Patients with an increased LA-diameter or heart failure have a significantly increased risk to progress to persistent AF. If ablation is considered in such a patient it should be conducted as soon as possible to prevent progression to persistent AF.

Survival and quality of life after extracorporeal life support for refractory cardiac arrest: A case series

ObjectivesExtracorporeal life support (ECLS) is an emerging option to treat selected patients with cardiac arrest refractory to cardiopulmonary resuscitation (CPR). Our primary objective was to determine the mortality at 30 days and at hospital discharge among adult patients receiving veno-arterial ECLS for refractory cardiac arrest. Our secondary objectives were to determine the 1-year survival and the health-related quality of life, and to examine factors associated with 30-day mortality. MethodsIn a retrospective, single-center investigation within a tertiary referral center, we analyzed the prospectively collected data of 49 patients rescued from refractory cardiac arrest through emergent implantation of ECLS (E-CPR) (18.1% of our overall ECLS activity, 2005-2013), implanted in-hospital and during ongoing external cardiac massage in all cases. A prospective follow-up with administration of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire was performed. ResultsThe mean age was 47.6 ± 1.6 years; out-of-hospital cardiac arrest occurred in 12% of cases; average low-flow time was 47.2 ± 33 minutes; causes of cardiac arrest were heart disease (61.2%), trauma (14.3%), respiratory disease (4.1%), sepsis (2%), and miscellaneous (18.4%). Primary objective: Rates of survival at E-CPR explantation and at 30 days were 42.9% and 36.7%, respectively; brain death occurred in 24.5% of cases. Secondary objectives: Increased simplified acute physiology score; higher serum lactate levels and lower body temperature at the time of implantation were associated with 30-day mortality. Bridge to heart transplantation or implantation of a long-term ventricular assist device was performed in 8.2%. No deaths occurred during the follow-up after discharge (36.7% survival; average follow-up was 15.6 ± 19.2 months). The average Physical Component Summary and Mental Component Summary scores (SF-36 questionnaire) were, respectively, 45.2 ± 6.8 and 48.3 ± 7.7 among survivors. ConclusionsExtracorporeal cardiopulmonary resuscitation is a viable treatment for selected patients with cardiac arrest refractory to CPR. In our series, approximately one third of rescued patients were alive at 6 months and presented quality-of-life scores comparable to those previously observed in patients treated with ECLS.

Racial Disparities in Sexual Dysfunction Outcomes After Prostate Cancer Treatment: Myth or Reality?

Among diverse subject areas in the field of prostate cancer management, treatment-related sexual dysfunction complications persist today as a significant potential problem for all men receiving treatment for this disease. The conjecture that African-American men are disproportionately affected by this problem among ethnic groups is not trivial and warrants attention in view of the possibility that its risk profile, whether real or perceived, may influence clinical management decisions impacting survival outcomes in this high-prostate cancer-risk population. A literature review was performed to define the occurrence and significance of sexual dysfunction after prostate cancer treatment in African-American men, with an emphasis on clinically localized treatment. Data retrieved from population-based as well as single-center investigations are conflicting with regard to the extent and quality of life relevance of sexual dysfunction following prostate cancer treatments in African-American men, relative to that of ethnically different counterparts. Some reports suggest a relatively greater trend in African-American men than other ethnic groups toward obtaining clinical management for sexual dysfunction and experiencing psychosocial effects from it, lending additional support for the possibly greater effect of this problem in African-American men. Although further studies are needed to define sexual dysfunction after prostate cancer treatment and ascertain its bother and impact on quality of life in African-American men, survivorship care that encompasses sexual dysfunction management should proceed with appropriate attention given to cultural, educational, and psychosocial variables.

Prostatic arterial embolization for the treatment of lower urinary tract symptoms as a result of large benign prostatic hyperplasia: A prospective single-center investigation.

To evaluate the effectiveness and safety of prostatic arterial embolization as a primary treatment for patients with lower urinary tract symptoms as a result of large benign prostatic hyperplasia. A total of 64 patients with prostates >80 mL were included in the study. Prostatic arterial embolization was carried out using a combination of 50-µm and 100-µm particles. Clinical follow up was carried out using the International Prostate Symptom Score, quality of life, peak urinary flow, postvoid residual volume, International Index of Erectile Function Short Form, prostate-specific antigen, and prostatic volume at 1, 3, 6 and every 6 months thereafter. Prostatic arterial embolization was technically successful in 60 of 64 patients (93.8%). Follow-up data were available for 60 patients with a mean of 18 months. A clinical improvement, defined as reduction of International Prostate Symptom Score and increase of peak urinary flow, at 1 month, 3 months, 6 months, 12 months and 24 months, was achieved in 95.0%, 95.0%, 93.3%, 92.6% and 90.5%, respectively. A total of 42 patients had completed the follow up at 24 months after prostatic arterial embolization. There was an improvement in terms of mean International Prostate Symptom Score (pre-prostatic arterial embolization vs post-prostatic arterial embolization 27.0 vs 8.0; P < 0.01), mean quality of life (5.5 vs 2.0; P < 0.01), mean peak urinary flow (7.0 vs 13.0; P < 0.01), mean postvoid residual volume (130 vs 45.0; P < 0.05) and prostatic volume (121.0 vs 71.5, reduction of 40.9%; P < 0.01) were significantly different with respect to baseline. Prostatic arterial embolization seems to be a safe and effective treatment method for patients with lower urinary tract symptoms as a result of large benign prostatic hyperplasia, and it might play an important role for patients in whom medical therapy has failed, who are not candidates for surgical treatment.