Durable Physiological Changes and Decreased Syncope Burden 12 Months After Unifocal Right-Sided Ablation Under Computed Tomographic Guidance in Patients with Neurally Mediated syncope or Functional Sinus Node Dysfunction

Background - Cardio-neuromodulation (CardNM) is a cardioneuroablative approach aiming to create adequate vagolysis of the sinoatrial node through partial ablation of the anterior right ganglionated plexus. Methods - We performed an interventional study in patients with recurrent neurally mediated syncope (group A) or functional sinus node (SN) dysfunction (group B). Syncope burden, electrocardiogram, 24-h rhythm data, tilt table test, exercise test, and pharmacological challenge with atropine were assessed at baseline and at regular intervals to 12-months. Results - Fifty patients (31 in group A, 19 in group B) underwent CardNM. Mean number of syncopes during the previous 12 months was 9.7±18.2. The procedure was associated with a lower rate of syncope (−95%) and presyncope (−95%) at 12 months versus baseline ( P <0.001). Thirty-seven patients remained entirely free of syncope at 12 months, and the syncope-free survival curve remained stable between 12- and 30-month follow-up. After a mean ablation time of 8±4 min, P-P interval shortened by 247±146 ms ( P <0.001). Basal heart rate (HR) increased by 18% ( P <0.001) and remained stable between 6 and 12 months. At 12 months, mean HR increased by 12% in the entire cohort ( P <0.001), reached 23% in patients with baseline mean HR <70 bpm ( P <0.01), and did not increase in patients with baseline HR >70 bpm. Maximum HR during exercise decreased by 10 bpm at 1 month ( P <0.001) and was restored at 12 months. Conclusions - CardNM is a safe and fast treatment giving rise to a long-term partial SN vagolysis with no apparent short- or long-term safety concerns or undesirable persisting modifications of the intracardiac autonomous nervous system. The impact on vasoplegia is less clear. CardNM is associated with a good clinical outcome in most patients with neurally mediated syncope or functional SN dysfunction. These promising data require confirmation in a multicenter randomized trial.

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The Impact of Visual Aids on the Retention of English Word Stress Patterns

International Journal of Applied Linguistics & English Literature ◽

10.7575/aiac.ijalel.v.7n.2p.225 ◽

2018 ◽

Vol 7 (2) ◽

pp. 225 ◽

Cited By ~ 1

Author(s):

Farid Ghaemi ◽

Fahimeh Rafi

Keyword(s):

English Word ◽

Placement Test ◽

Visual Aids ◽

Word Stress ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Impact ◽

Stress Patterns

The present study aimed at comparing the effectiveness of three different techniques on learners’ long term memorization of English word stress patterns. After administering a quick placement test, 67 Iranian EFL elementary learners at language institutes were selected to participate in the study. Then they were divided into three groups. Before starting the instruction, a pretest was conducted to classify the participants’ abilities on word stress patterns. Then the new techniques were used to teach English word stress patterns. In all three groups, words were printed largely on a piece of paper and the syllables were clearly specified by dots. In group ‘A’, pronunciation and stress pattern of new words were taught aurally through the repetition of the words. In group ‘B’, all the procedure was exactly similar to that of group ‘A’, the only difference was that the stressed syllables were printed in bold. In group ‘C’, all the procedure was exactly similar to that of group ‘B’, except that the stressed syllables were not only printed in bold, but also introduced by teacher’s hand gesture. After two weeks, a delayed posttest was conducted to check long term memorization of the word stress patterns. The results of the study indicated that there was a significant difference between pretest and delayed posttest in all three groups. But the most meaningful difference belonged to group ‘C’. That is, the participants in the third group (gesture group) outperformed those in the other groups. Finally, some implications and suggestions provided for further research.

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Reevaluation of Acromegalic Patients in Long-Term Remission according to Newly Proposed Consensus Criteria for Control of Disease

International Journal of Endocrinology ◽

10.1155/2014/581594 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Elisa Verrua ◽

Emanuele Ferrante ◽

Marcello Filopanti ◽

Elena Malchiodi ◽

Elisa Sala ◽

...

Keyword(s):

Disease Control ◽

Significant Decline ◽

Intensive Monitoring ◽

Gh Secretion ◽

Igf I ◽

Group A ◽

Group B ◽

The Impact

Acromegaly guidelines updated in 2010 revisited criteria of disease control: if applied, it is likely that a percentage of patients previously considered as cured might present postglucose GH nadir levels not adequately suppressed, with potential implications on management. This study explored GH secretion, as well as hormonal, clinical, neuroradiological, metabolic, and comorbid profile in a cohort of 40 acromegalic patients considered cured on the basis of the previous guidelines after a mean follow-up period of 17.2 years from remission, in order to assess the impact of the current criteria. At the last follow-up visit, in the presence of normal IGF-I concentrations, postglucose GH nadir was over 0.4 μg/L in 11 patients (Group A) and below 0.4 μg/L in 29 patients (Group B); moreover, Group A showed higher basal GH levels than Group B, whereas a significant decline of both GH and postglucose GH nadir levels during the follow-up was observed in Group B only. No differences in other evaluated parameters were found. These results seem to suggest that acromegalic patients considered cured on the basis of previous guidelines do not need a more intensive monitoring than patients who met the current criteria of disease control, supporting instead that the cut-off of 0.4 mcg/L might be too low for the currently used GH assay.

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Clinical, surgical characteristics and long-term outcomes of lumbar hernia

BMC Surgery ◽

10.1186/s12893-021-01328-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chaoyong Shen ◽

Guixiang Zhang ◽

Sen Zhang ◽

Yuan Yin ◽

Bo Zhang ◽

...

Keyword(s):

Local Anesthesia ◽

Lumbar Hernia ◽

Consecutive Series ◽

Entire Cohort ◽

Anesthesia Group ◽

History Of ◽

Group A ◽

Group B

Abstract Background/Aim Lumbar hernia is caused by a defect in the abdominal wall. Due to its rarity, there is no established consensus on optimal treatment for lumbar hernia yet. Thus, we here investigated the clinical, surgical characteristics and outcomes of lumbar hernia by collecting 28 such patients from our hospital. Methods Patients diagnosed with lumbar hernia from our institution between April 2011 and August 2020 were retrospectively collected in this study. Demographics, clinical characteristics and surgical information were recorded. Results A consecutive series of 28 patients with lumbar hernia were retrospectively collected, including 13 males (46%) and 15 females (54%). The ages of the patients ranged from 5 to 79 years (median: 55 years), with a mean age of 55.6 ± 14.9 years. A total of 7 cases had a history of previous lumbar trauma or surgery. There were 11 (39%), 15 (54%) and 2 (7.1%) cases had right, left and bilateral lumbar hernia, respectively. Superior and inferior lumbar hernia were found in 25 (89%) and 3 (11%) patients. General anesthesia was adopted in 16 cases (group A), whereas 12 patients received local anesthesia (group B). Patients in the group B had a shorter hospital stay than that of the group A (3.5 ± 1.3 days vs. 7.1 ± 3.2 days, p = 0.001), as well as total hospitalization expenses between the two groups (2989 ± 1269 dollars vs. 1299 ± 229 dollars, p < 0.001). With a median follow-up duration of 45.9 months (range: 1–113 months), only 1 (3%) lumbar hernias recurred for the entire cohort. Conclusions Lumbar hernia is a relatively rare entity, and inferior lumbar hernia is rarer. It is feasible to repair lumbar hernia under local anesthesia.

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The impact of mild renal dysfunction on isolated cardiopulmonary coronary artery bypass grafting: a retrospective propensity score matching analysis

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-0998-4 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Xian Wang ◽

Yifan Zhu ◽

Wen Chen ◽

Liangpeng Li ◽

Xin Chen ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Artery Bypass ◽

Term Survival ◽

Group A ◽

Group B ◽

The Impact ◽

New Onset

Abstract Background Mild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG. Methods After propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60–89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria. Results The 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09–2.90, p = 0.035; 95%CI 1.14–2.49, p = 0.027). Conclusions Comparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.

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Survival Outcomes Of Very Young (<40 years) Myeloma Patients

Blood ◽

10.1182/blood.v122.21.2136.2136 ◽

2013 ◽

Vol 122 (21) ◽

pp. 2136-2136 ◽

Cited By ~ 1

Author(s):

Utkarsh Painuly ◽

Shivlal Pandey ◽

Shaji K Kumar ◽

Robert Kyle ◽

Martha Q Lacy ◽

...

Keyword(s):

Mayo Clinic ◽

Research Funding ◽

Age At Diagnosis ◽

Novel Agents ◽

Survival Outcomes ◽

Entire Cohort ◽

Related Data ◽

Group A ◽

Group B ◽

The Impact

Abstract Background Multiple myeloma (MM) is uncommon in patients below 40 years of age. Between 1960 and 1992 when stem cell transplantation (SCT) was rarely performed and novel agents were unavailable, overall survival (OS) was reported to be 54 months in the Mayo Clinic series of patients with MM below forty years of age. The impact of novel agents or SCT in this population is unclear. Herein, we report the outcomes of patients under 40 years of age who were evaluated over a span of more than five decades with a focus on the periods contemporaneous with the introduction of SCT and novel agents, the major therapeutic milestones in the management of MM. Methods We analyzed the medical records of patients with MM under 40 years of age who were evaluated at Mayo Clinic, Rochester, MN between 1/1/1960 and 12/31/2011. SCT and novel agents were utilized infrequently prior to the years 1990 and 2000, respectively. Patients were therefore divided into three cohorts by the year of diagnosis of MM: Group A (1960 -1979), Group B (1980 to 1999) and Group C (2000 –2011) to assess the impact of major therapeutic advances (i.e. Increased utilization of SCT and novel agents compared to conventional chemotherapy). OS was calculated by the Kaplan -Meier method. Results Out of 8063 unique MM patients seen at our institution during this period, 174 (2%) patients were under 40 years of age at diagnosis. The median age at diagnosis was 36 years (range: 19-39). The estimated median follow-up of the entire cohort was 179 months (95% CI: 149-196 months). The median OS of the entire cohort was 76 months (95% CI: 45-80 months) from diagnosis. The median OS of patients in Groups A (n=29, 17%), B (n=93, 53%), and C (n=52, 30% ) was 44 months (95% CI: 20- 76), 79 months (95% CI: 46-97), and 92 months (95% CI: 42-NR), respectively (p=0.005). No significant OS difference was noted between Groups B and C (Figure). Sixty-six (38%) patients underwent at least one SCT (autologous: 56 patients and allogeneic 10 patients). The utilization of SCT increased over the three time periods from Group A 0%, Group B 39% and Group C 58% (p<0.001). Of 153 patients in whom front-line therapy-related data were available 118 (77%) received conventional and 35(23%) received novel agents. The median OS of patients who underwent transplantation (n=66) was 93 months compared to 46 months for those who did not (n=108, p=.01). In the 66 patients who underwent SCT, the median OS was 93 months for conventional agents-based induction (95% CI: 73-143) versus 97 months (95% CI: 41-187) for novel agent based induction (p=.4). Sixty-eight (40%) patients received novel agents at some point during the course of their disease [bortezomib 35 (54%), thalidomide 44 (67%), lenalidomide 47 (71%) and pomalidomide 7(11%)]. The median survival of these patients was 131 (95% CI: 88-161) months versus to 46 (CI: 37-74) months for those (n=106) receiving conventional agents only (p=0.0002). Conclusions OS of patients with MM under 40 years of age in the pre-transplant era (Group A) was significantly shorter than that of patients diagnosed in the era of SCT (Group B) and SCT plus novel agents (Group C). Although improvement of survival outcomes is evident with utilization of novel agents, similar outcomes of Groups B and C indicate lack of incremental benefit over SCT with utilization of novel agents. Maximal survival gain coincides with the introduction of SCT in this unique patient cohort. Disclosures: Kumar: Celgene: Consultancy, Research Funding; Millennium: Consultancy, Research Funding; Onyx: Consultancy, Research Funding.

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The Impact of Preoperative and Postoperative Malnutrition on Outcomes for Ampullary Carcinoma After Pancreaticoduodenectomy

Frontiers in Oncology ◽

10.3389/fonc.2021.748341 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jikuan Jin ◽

Guangbing Xiong ◽

Xiaoxiang Wang ◽

Feng Peng ◽

Feng Zhu ◽

...

Keyword(s):

Postoperative Complications ◽

Ampullary Carcinoma ◽

Cox Proportional Hazards ◽

Severe Malnutrition ◽

Term Survival ◽

Group A ◽

Group B ◽

The Impact ◽

Malnourished Group

PurposeThe aim of this study was to investigate the effect of preoperative and postoperative malnutrition on postoperative short- and long-term outcomes for ampullary carcinoma after pancreatoduodenectomy (PD).MethodsData were collected retrospectively from 511 patients with ampullary carcinoma who underwent PD between June 2012 and June 2019. Nutritional status before and at 3, 6, and 12 months after operation was assessed by the scored Patient-Generated Subjective Global Assessment (PG-SGA). The patients were classified into well-nourished, moderately malnourished, and severely malnourished group according to the PG-SGA score. Propensity score matching (PSM) was performed to adjust baseline characteristics between preoperative group A (well-nourished and moderately malnourished group) and group B (severely malnourished group). After PSM, clinicopathological variables and postoperative complications were compared between the two groups. Univariate and multivariate Cox analysis was also conducted to investigate the prognostic factors of overall survival of patients with ampullary carcinoma who underwent PD.ResultsPreoperatively, 122 (23.9%) patients were classified into well-nourished group, 189 (37.0%) into moderately malnourished group, and 200 (39.1%) into severely malnourished group. After PSM analysis, the incidence of overall postoperative complications was higher in group B than that in group A (50.5% vs. 32.5%, p < 0.001). Multivariate Cox proportional hazards regression model showed that severe malnutrition (PG-SGA score >9 scores) before operation [hazard ratio (HR) = 1.508; 95% CI, 1.103–2.061; p = 0.01] and at 6 months (HR = 4.148; 95% CI, 2.523–6.820; p < 0.001) and 12 months (HR = 5.272; 95% CI, 3.630–7.656; p < 0.001) after operation was an independent prognostic factor of patients who underwent PD for ampullary carcinoma.ConclusionsSevere malnutrition before and at 6 and 12 months after operation significantly affects the long-term survival of patients with ampullary carcinoma who underwent PD. Additionally, the preoperative malnutrition was closely related to postoperative complications.

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Pelvic Organ Prolapse Repair with and without Concomitant Burch Colposuspension in Incontinent Women: A Randomised Controlled Trial with at Least 5-Year Followup

Obstetrics and Gynecology International ◽

10.1155/2012/967923 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 17

Author(s):

Elisabetta Costantini ◽

Massimo Lazzeri ◽

Vittorio Bini ◽

Michele Del Zingaro ◽

Emanuela Frumenzio ◽

...

Keyword(s):

Controlled Trial ◽

Pelvic Organ ◽

Stage I ◽

Burch Colposuspension ◽

Group A ◽

Group B ◽

Randomised Controlled ◽

The Impact ◽

Pop Repair

The aim of this study was to reevaluate and update the followup of a previously published randomized controlled trial (RCT) on the impact of Burch Colposuspension (BC), as an anti-incontinence procedure, in patients with UI and POP, who underwent POP repair. Forty-seven women were randomly assigned to abdominal POP repair and concomitant BC (24 patients; group A) or POP repair alone without any anti-incontinence procedure (23 patients; group B). Median followup was 82 months (range 60–107); from over 47 patients, 30 reached 6-year followup. Two patients were lost at followup. In group A, 2 patients showed a stage I rectocele. In group B, 2 patients had a stage I rectocele and 1 a stage II rectocele. In group A, 13/23 (56.5%) were still incontinent after surgery compared with 9/22 patients (40.9%) in group B (P=0.298). No significant changes were observed between the first and the current followup. The update of long-term followup confirmed that BC did not improve outcome significantly in incontinent women when they undergo POP repair.

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Comparative Study of effectiveness of mobilization with movement (MWM) and End range mobilization (ERM) techniques in frozen shoulder

Research in Pharmacy and Health Sciences ◽

10.32463/rphs.2018.v04i04.22 ◽

2018 ◽

Vol 4 (4) ◽

pp. 519-522

Author(s):

Jeyakumar S ◽

Jagatheesan Alagesan ◽

T.S. Muthukumar

Keyword(s):

Range Of Motion ◽

Frozen Shoulder ◽

Type I ◽

Mean Values ◽

Functional Activities ◽

Group A ◽

The Mean ◽

Group B

Background: Frozen shoulder is disorder of the connective tissue that limits the normal Range of motion of the shoulder in diabetes, frozen shoulder is thought to be caused by changes to the collagen in the shoulder joint as a result of long term Hypoglycemia. Mobilization is a therapeutic movement of the joint. The goal is to restore normal joint motion and rhythm. The use of mobilization with movement for peripheral joints was developed by mulligan. This technique combines a sustained application of manual technique “gliding” force to the joint with concurrent physiologic motion of joint, either actively or passively. This study aims to find out the effects of mobilization with movement and end range mobilization in frozen shoulder in Type I diabetics. Materials and Methods: 30 subjects both male and female, suffering with shoulder pain and clinically diagnosed with frozen shoulder was recruited for the study and divided into two groups with 15 patients each based on convenient sampling method. Group A patients received mobilization with movement and Group B patients received end range mobilization for three weeks. The outcome measurements were SPADI, Functional hand to back scale, abduction range of motion using goniometer and VAS. Results: The mean values of all parameters showed significant differences in group A as compared to group B in terms of decreased pain, increased abduction range and other outcome measures. Conclusion: Based on the results it has been concluded that treating the type 1 diabetic patient with frozen shoulder, mobilization with movement exercise shows better results than end range mobilization in reducing pain and increase functional activities and mobility in frozen shoulder.

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Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

Reviews on Recent Clinical Trials ◽

10.2174/1574887114666190201111332 ◽

2019 ◽

Vol 14 (2) ◽

pp. 141-146

Author(s):

Simone Zanella ◽

Enrico Lauro ◽

Francesco Franceschi ◽

Francesco Buccelletti ◽

Annalisa Potenza ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

The Elderly ◽

Long Term Follow Up ◽

Group A ◽

Group B ◽

Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

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Reconstructive Approaches in Surgical Management of Congenital Pseudarthrosis of the Tibia

Journal of Clinical Medicine ◽

10.3390/jcm9124132 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4132

Author(s):

Andrea Laufer ◽

Adrien Frommer ◽

Georg Gosheger ◽

Robert Roedl ◽

Frank Schiedel ◽

...

Keyword(s):

External Fixation ◽

Bone Transport ◽

Bone Union ◽

Complication Rates ◽

Union Rate ◽

Bone Fusion ◽

Group A ◽

Primary Bone ◽

Group B

Treatment of congenital pseudarthrosis of the tibia remains a major challenge in pediatric orthopedics. Ideal timing and preference of surgical procedures are discussed controversially. A variety of reconstructive treatment strategies have been described in literature, but so far none has proven its superiority. The aim of treatment is to obtain long-term bone union, to prevent refracture, and to correct angular deformities and leg length discrepancies. This study retrospectively evaluates the outcome of different reconstructive strategies. Sixty-nine patients were identified who presented to our outpatient department between 1997 and 2019. Twenty-six of these patients underwent reconstructive surgical treatment and were included in this study. The study cohort was divided into three groups. Excision of the pseudarthrosis was performed in all patients in Group A and B, and in two patients of Group C. Group A (six/26 patients) received subsequent bone transport through external fixation maintaining original length. In Group B (15/26 patients), patients underwent either previous, simultaneous, or subsequent extrafocal lengthening through external fixation to reconstitute length. In Group C (five/26 patients), internal fixation with intramedullary nails was applied. Radiological and clinical evaluation was performed to assess bone union and complication rates. Results varied considerably between the study groups. Overall, the primary bone fusion rate was 69.2%. There were four refractures, all occurring in Group B. The long-term bone union rate without refracture was 53.8%. The overall complication rate was 53.8% and 23.1% showed persistent pseudarthrosis. Two secondary amputations were performed due to failed bone fusion. In conclusion, excision of the pseudarthrosis and extrafocal lengthening achieves a satisfying bone union rate and limb reconstruction, while bone transport does not offer significant advantages but shows higher complication rates. Intramedullary stabilization should be applied to maintain bone union, but shows lower bone union rates when used as a stand-alone treatment regimen. Regardless of the primary bone fusion rates, the probability of long-term bone union remains unpredictable.

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