Nearly two decades since Cone Beam-Computed Tomography (CBCT) was introduced in dentistry, this technology has been proven to be a useful asset in modern dental practice. The information gleaned from a CBCT scan influ...Nearly two decades since Cone Beam-Computed Tomography (CBCT) was introduced in dentistry, this technology has been proven to be a useful asset in modern dental practice. The information gleaned from a CBCT scan influences treatment decisions and prognostication of challenging endodontic cases. The authors present six cases that utilized CBCT to diagnose vertical root fracture, to assess resorption, to guide the clinician in overcoming anatomical complexities, to hurdle diagnostic dilemmas and to perform pre-surgical evaluation. Initially, a thorough clinical assessment was performed;however, conventional periapical radiographs were not able to provide sufficient information to arrive at a definite diagnosis or a thorough treatment plan. CBCT was therefore deemed helpful for these cases. Clearly, there are advantages to using CBCT. With a better understanding of each case, the clinician can plan a definitive treatment plan and offer a clearer case prognosis to their patient.展开更多
Background:Disaster mental health outcomes of individuals may be affected by the families they inhabit,with effects rippling through the entire family system.Existing research on the experience of children in disaster...Background:Disaster mental health outcomes of individuals may be affected by the families they inhabit,with effects rippling through the entire family system.Existing research on the experience of children in disasters has typically been limited to examining single individuals or,at most,family dyads.Research is needed to explore interactions within families as a whole,including interactions among multiple family members,as well as with community entities in a broad systems approach with dynamic analysis of family systems over time.The purpose of this study was to combine quantitative and qualitative data using structured diagnostic interviews and accompanying open-ended narratives of family members(spouses and children)of survivors of the 9/11 attacks.Methods:This study examined 60 members in 25 families of employees affected by the 9/11 attacks on New York City’s World Trade Center,using a mixed methods approach,collecting quantitative data using full assessments of psychiatric disorders and qualitative data from detailed personal disaster narratives.The employees were a highly 9/11 trauma-exposed group,with about one-fourth developing posttraumatic stress disorder(PTSD).The employees’exposures and PTSD did not regularly appear to propagate straightforwardly to psychopathology in their spouses or children.Based on the impact of disaster experience,4 illustrative families were selected for narrative and family systems analyses.Results:Qualitative analysis of their narratives suggested distinct family system patterns or archetypes that may reflect different ways that families cope with disaster.Conclusion:Findings suggest that family systems and family dynamics may influence not only disaster trauma-exposed members but also other family members in supporting one another and coping with the disaster,with interactions with outside community influences adding further complexity.This information may help guide disaster response efforts to provide psychosocial support targeted to specific family patterns.展开更多
Deuterium is a heavy isotope of hydrogen,with an extra neutron,endowing it with unique biophysical and biochemical properties compared to hydrogen.The ATPase pumps in the mitochondria depend upon proton motive force t...Deuterium is a heavy isotope of hydrogen,with an extra neutron,endowing it with unique biophysical and biochemical properties compared to hydrogen.The ATPase pumps in the mitochondria depend upon proton motive force to catalyze the reaction that produces ATP.Deuterons disrupt the pumps,inducing excessive reactive oxygen species and decreased ATP synthesis.The aim of this review is to develop a theory that mitochondrial dysfunction due to deuterium overload,systemically,is a primary cause of Parkinson’s disease(PD).The gut microbes supply deuterium-depleted short chain fatty acids(SCFAs)to the colonocytes,particularly butyrate,and an insufficient supply of butyrate may be a primary driver behind mitochondrial dysfunction in the gut,an early factor in PD.Indeed,low gut butyrate is a characteristic feature of PD.Mitochondrial dysfunction is a factor in many diseases,including all neurodegenerative diseases.Biological organisms have devised sophisticated strategies for protecting the ATPase pumps from deuterium overload.One such strategy may involve capturing deuterons in bis-allylic carbon atoms present in polyunsaturated fatty acids(PUFAs)in cardiolipin.Cardiolipin uniquely localizes to the inner membrane of the intermembrane space,tightly integrated into ATPase proteins.Bis-allylic carbon atoms can capture and retain deuterium,and,interestingly,deuterium doping in PUFAs can quench the chain reaction that causes massive damage upon lipid peroxidation.Neuronal cardiolipin is especially rich in docosahexaenoic acid(DHA),a PUFA with five bisallylic carbon atoms.Upon excessive oxidative stress,cardiolipin migrates to the outer membrane,where it interacts withα-synuclein(α-syn),the amyloidogenic protein that accumulates as fibrils in Lewy bodies in association with PD.Such interaction leads to pore formation and the launch of an apoptotic cascade.α-syn misfolding likely begins in the gut,and misfoldedα-syn travels along nerve fibers,particularly the vagus nerve,to reach the brainstem nuclei,where it can seed misfolding ofα-syn molecules already present there.Mitochondrial dysfunction in the gut may be a primary factor in PD,and low-deuterium nutrients may be therapeutic.展开更多
Background: Bisphosphonates are compounds similar to inorganic pyrophosphates, with anti-angiogenic, anti-inflammatory, anti-bone resorption, and antitumor effects. They are used to prevent bone metastases in cancer a...Background: Bisphosphonates are compounds similar to inorganic pyrophosphates, with anti-angiogenic, anti-inflammatory, anti-bone resorption, and antitumor effects. They are used to prevent bone metastases in cancer and treat osteoporosis. However, a major side effect is osteonecrosis of the jaw (ONJ), first reported in 2003, which is the exposure of necrotic bone in the mouth, often accompanied by infection. Prevention and treatment of ONJ remain challenging due to a lack of reliable epidemiological data on its incidence and risk factors. The aim of our work is to estimate the prevalence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and to analyze its correlations with different risk factors reported in the literature. Methods: A retrospective observational study was conducted in the Oncology, Rheumatology and Maxillofacial Surgery Department of the Mohamed VI University Hospital;Marrakech, based on complete medical records during the period 2017 to 2022, as well as consultations of patients under bisphosphonates in these departments during July and August 2022. Statistical analysis was performed using IBM SPSS version 16.0. Results: Of the 107 patients included in this study, 60.7% were women, and 56.1% were between 40 and 65 years old. 100% of the patients suffered from a general pathology. Regarding treatment with BP, 103 patients were treated with Zoledronate, 4 with Risedronate, and 5 with Ibandronate. 103 patients received this treatment intravenously, while 4 patients received it orally. Regarding Oral health, only 12.1% of patients reported a poor oral health. 99.1% of patients were informed of the need for oral preparation prior to BP treatment, but only 71.02% received dental treatment, mainly tooth extraction. None of the patients were diagnosed with BRONJ. Conclusions: While the global incidence of ONJ ranges from 0.8% to 12%, our finding is zero. Most previous studies are retrospective with limited patient numbers like our study. To accurately assess the prevalence of ONJ, further prospective epidemiological studies with standardized protocols and thorough follow-up over several years are essential.展开更多
BACKGROUND Dysfunctional beliefs about sleep may influence academic performance through their impact on sleep quality.Differences in chronotype can further moderate this relationship,particularly among students with i...BACKGROUND Dysfunctional beliefs about sleep may influence academic performance through their impact on sleep quality.Differences in chronotype can further moderate this relationship,particularly among students with irregular sleep patterns.AIM To examine the indirect effects of dysfunctional beliefs about sleep on academic performance through sleep quality while considering individual differences in chronotypes among medical students.METHODS The participants were categorized by chronotype and administered the Dysfunctional Beliefs and Attitudes about Sleep Scale and the Pittsburgh Sleep Quality Index and reported their grade point averages(GPAs).Mediation analysis was performed to examine indirect pathways through sleep quality.RESULTS Dysfunctional sleep beliefs did not directly affect academic success but indirectly impaired GPA via reduced sleep quality,especially in evening-type students.CONCLUSION Chronotype moderates the relationship between sleep quality and academic performance, highlighting the need for targeted cognitive interventions.展开更多
Background Relative energy deficiency in sport(REDs)results from exposure to problematic low energy availability.It is a serious condition affecting the health and athletic performance of up to 80%of elite female athl...Background Relative energy deficiency in sport(REDs)results from exposure to problematic low energy availability.It is a serious condition affecting the health and athletic performance of up to 80%of elite female athletes.REDs is established to have negative short-term effects on reproductive function,but the long-term impact of this condition is unknown.Therefore,we examined the impact of secondary amenorrhea with or without a concurrent diagnosis of REDs on perinatal health outcomes.Methods Postpartum individuals(≥18 years of age)completed an online questionnaire that covered demographics,reproductive history(including a diagnosis of REDs or secondary amenorrhea),and maternal/fetal health outcomes.Logistic regression was used to determine the relationship between previously diagnosed REDs or secondary amenorrhea with perinatal health outcomes.Results A total of 1025 previously pregnant participants completed the survey(33.1±3.4 years,mean±SD).Prior to pregnancy,6.1%had been previously diagnosed with REDs and 20.5%had a history with secondary amenorrhea.Individuals diagnosed with REDs had 3.5-times higher odds of having premature labor(odds ratio,(OR)=3.52,95%confidence interval(95%CI):1.26–9.81)and 2.6-times higher odds of preterm delivery(OR=2.62,95%CI:1.05–6.58)compared to those who had not experienced REDs or secondary amenorrhea.However,in individuals who did not have a history of REDs,secondary amenorrhea did not increase the odds of adverse pregnancy or delivery outcomes.Conclusion A history of REDs,but not secondary amenorrhea,may increase the odds of premature labor and preterm delivery.展开更多
BACKGROUND Traumatic brain injury(TBI)is a significant public health issue,leading to long-term neurological impairments.Current treatments offer limited recovery,particularly in restoring lost functions.Mesenchymal s...BACKGROUND Traumatic brain injury(TBI)is a significant public health issue,leading to long-term neurological impairments.Current treatments offer limited recovery,particularly in restoring lost functions.Mesenchymal stem cell-derived exosomes(MSCdE)have shown potential for promoting neuroprotection and regeneration.This study evaluates the safety and efficacy of MSCdE therapy in TBI patients.AIM To evaluate the safety and efficacy of MSCdE therapy in TBI patients.METHODS Five patients(mean age 27.00±4.06 years)with TBI from combat injuries were treated with six rounds of MSCdE therapy(3 mL intrathecally and 3 mL intramuscularly per round).The patients were followed for one year.Adverse events were assessed using the Common Terminology Criteria for Adverse Events version 5.0(CTCAE v5.0),and functional outcomes were evaluated with the functional independence measure(FIM),Modified Ashworth Scale(MAS),and Karnofsky Performance Scale(KPS).RESULTS No serious adverse events occurred,and only mild side effects[subfebrile fever(37.5°C-37.9°C),pain]were reported(CTCAE Grade 1).FIM motor scores improved significantly(46.20±16.39 to 64.20±18.20,P<0.01),and FIM cognitive scores also showed significant improvement(30.60±4.56 to 34.00±1.41,P<0.001).While MAS scores improved(right/left:4.60/3.60 to 2.20/1.60),these changes were not statistically significant(P>0.05),possibly due to low baseline spasticity.KPS scores significantly improved(46.00±11.40 to 72.00±8.37,P<0.001),indicating enhanced overall functional status and quality of life.CONCLUSION MSCdE therapy is safe and effective in improving motor function,cognition,and quality of life in TBI patients.Larger,controlled trials are needed to further validate these findings and optimize MSCdE therapy for TBI treatment.展开更多
治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童...治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童、孕妇、老年患者、智障患者、药物滥用者、涉法精神病患者、已知或怀疑药代动力学异常的患者以及合并躯体疾病影响药代动力学的患者。常规剂量下治疗无效,用药依从性难以判断,药物耐受性不佳,以及可能存在药代动力学方面的药物-药物相互作用等情况都是治疗药物监测的典型指征。然而,只有将TDM充分整合到临床治疗过程中,才能发挥其优化药物治疗的潜在优势。为了向临床医生和实验室提供有效的TDM信息,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了第一版《精神科治疗药物监测指南》。2011年进行了更新之后,现在再次更新。遵循新版指南,可能会改善神经精神药物治疗的效果,加快很多患者的康复,并降低医疗费用。展开更多
Flavonoids are phytochemicals which can regulate the activity of the intestinal immune system. In patients with chronic inflammatory bowel disease(IBD) there is an overexpression and imbalance of the components of the...Flavonoids are phytochemicals which can regulate the activity of the intestinal immune system. In patients with chronic inflammatory bowel disease(IBD) there is an overexpression and imbalance of the components of the inflammatory immune reactions which are chronically activated. Suppression of inflammation can be achieved by anti-inflammatory drugs which are used in clinical medicine but these can cause serious side effects. Flavonoids can have natural immunosuppressive properties and inhibit the activation of immune cells and its effectors(chemokines, TNF-, cytokines). Phytochemicals such as flavonoids bind to the nuclear Ah(aryl hydrocarbon)-receptor thereby stimulating protective enzyme activities. As shown by clinical evidence in patients and by experimental work some flavonoids(apigenin, epigallocatechin gallate) were effective in the inhibition of inflammation. Instead of or additionally to anti-inflammatory drugs flavonoids can be used in IBD patients to treat the over-reactive immunologic system. This is accomplished by upregulation of the Ah-receptor. Flavonoids interact with toll-like receptors expressing on the surface of immune cells, then they were internalized to the cytosol and transferred into the nucleus, where they were attached to the Ah-receptor. The Ah-receptor binds to the Ah-R nuclear translocator and via Ah response element beneficial protective enzymes and cytokines are induced, leading to upregulation of the anti-inflammatory system.展开更多
AIM: To report the long-term outcome of patients after complete ablation of non-neoplastic Barrett's esophagus (BE) with respect to BE relapse and development of intraepithelial neoplasia or esophageal adenocarcin...AIM: To report the long-term outcome of patients after complete ablation of non-neoplastic Barrett's esophagus (BE) with respect to BE relapse and development of intraepithelial neoplasia or esophageal adenocarcinoma. METHODS: In 70 patients with historically proven non neoplastic BE, complete BE ablation was achieved by argon plasma coagulation (APC) and high-dose proton pump inhibitor therapy (120 mg omeprazole daily). Sixty-six patients (94.4%) underwent further surveillance endoscopy. At each surveillance endoscopy four-quadrant biopsies were taken from the neo-squamous epithelium at 2 cm intervals depending on the pre-treatment length of BE mucosa beginning at the neo-Z-line, and from any endoscopically suspicious lesion. RESULTS: The median follow-up of 66 patients was 51 mo (range 9-85 mo) giving a total of 280.5 patient years. A mean of 6 biopsies were taken during surveillance endoscopies. In 13 patients (19.7%) tongues or islands suspicious for BE were found during endoscopy. In 8 of these patients (12.1%) non-neoplastic BE relapse was confirmed histologically giving a histological relapse rate of 3% per year. In none of the patients, intraepithelial neoplasia nor an esophageal adenocarcinoma was detected. Logistic regression analysis identified endoscopic detection of islands or tongues as the only positive predictor of BE relapse (P= 0.0004). CONCLUSION: The long-term relapse rate of non neoplastic BE following complete ablation with high-power APC is low (3% per year).展开更多
Colorectal cancer(CRC) is a common health problem,representing the third most commonly diagnosed cancer worldwide and causing a significant burden in terms of morbidity and mortality,with annual deaths estimated at 70...Colorectal cancer(CRC) is a common health problem,representing the third most commonly diagnosed cancer worldwide and causing a significant burden in terms of morbidity and mortality,with annual deaths estimated at 700000. The western way of life,that is being rapidly adopted in many regions of the world,is a well discussed risk factor for CRC and could be targeted in terms of primary prevention. Furthermore,the relatively slow development of this cancer permits drastic reduction of incidence and mortality through secondary prevention. These facts underlie primary care physicians(PCPs) being assigned a key role in health strategies that enhance prevention and prompt diagnosis. Herein,we review the main topics of CRC in the current literature,in order to better understand its pathogenesis,risk and protective factors,as well as screening techniques. Furthermore,we discuss preventive and screening policies to combat CRC and the crucial role served by PCPs in their successful implementation. Relevant articles were identified through electronic searches of MEDLINE and through manual searches of reference lists.展开更多
Supernumerary marker chromosome 15 （sSMC[15]） is the most frequent marker chromosome, and it is generally regarded as unimportant if it does not contain the Prader-Willi/Angelman syndrome critical region （PWACR）. ...Supernumerary marker chromosome 15 （sSMC[15]） is the most frequent marker chromosome, and it is generally regarded as unimportant if it does not contain the Prader-Willi/Angelman syndrome critical region （PWACR）. The clinical importance of the larger markers in association with the critical region is mentioned in almost all reports related to marker chromosome 15, and smaller markers are solely associated with minor dysmorphic features, azoospermia and recurrent miscarriages. However, these small sSMC（15）s without the PWACR may also determine a specific phenotype. A dysmorphic examination of an azoospermic patient in a genetics clinic was performed and was followed by a peripheral blood lymphocyte chromosomal analysis according to standard cytogenetic methods. Nucleolar region （NOR） banding, C-banding, fluorescence in situ hybridization and a molecular investigation of Y-microdeletions were also performed. The clinical evaluation identified dysmorphic features accompanied with azoospermia and severe ‘Angle Class Ⅱ, Division 1 Open Bite Deformity＇. The molecular cytogenetic study revealed the small sSMC（15）. In addition, a Y-microdeletion analysis showed that the azoospermia was not the result of a deletion. Although the presented case might represent a coincidental example of supernumerary marker 15 and mandibular anomaly association, the condition may also define a specific phenotype that may be more than azoospermia. This condition may be characterized by infertility, malar hypoplasia, mandibular anomaly, keloid formation and minor dysmorphic features.展开更多
AIM:To document the prognosis of laser treatment in patients with exudative age-related macular degeneration(AMD).· METHODS:Efficacy of the intervention was evaluated using a before-after method.· RESULTS:A ...AIM:To document the prognosis of laser treatment in patients with exudative age-related macular degeneration(AMD).· METHODS:Efficacy of the intervention was evaluated using a before-after method.· RESULTS:A total of 392 eyes of 341 patients with exudative AMD were examined.77.6% had choroideal neovascularisation(CNV).Before the use of indocyanine green(ICG) angiography,occult CNV was detected in only 1.8% of the eyes,but after the use of ICG angiography,this increased to 19.5%(P<0.001).Of the 349 eyes which were followed up,visual acuity had remained stable in 68.2% of the eyes.There was a statistically significant relationship between localisation of lesion and visual acuity changes on pre-and post-laser treatment(P<0.001).Also there was a statistically significant relationship between localisation of lesion and recurrence(P<0.05).The recurrence was less in subfoveal lesions than that in juxtafoveal and extrafoveal lesions.· CONCLUSION:ICG angiography is highly important in the treatment of occult CNV.展开更多
Flavonoids,secondary plant products which could be essential for normal physiology in humans and animals,may be the vitamins of the next century.Flavonoids belong to the polyphenols and possess antioxidative,anti-infl...Flavonoids,secondary plant products which could be essential for normal physiology in humans and animals,may be the vitamins of the next century.Flavonoids belong to the polyphenols and possess antioxidative,anti-inflammatory,antimutagenic and anticarcinogenic properties.Among the various flavonoid species,tea flavonoids such as apigenin (from camomile) and epigallocatechin gallate (EGCG from green tea) can be used for the prevention of intestinal neoplasia,especially for adenoma and cancer prevention in the gastrointestinal tract.Numerous experimental studies with molecular and biological end points support the therapeutic efficacy of bioflavonoids.Clinical studies with cohorts and case-control trials suggest that flavonoids are effective in tertiary bioprevention but,as yet,there are no controlled randomized clinical trials.Flavonoids can inhibit inflammatory pathways and could be useful for chronic inflammatory bowel diseases.Flavonoid deficiency syndromes could be therapeutic targets in the future.展开更多
This study was conducted to verify the results of a preceding retrospective pilot study by means of a prospective controlled investigation including a larger sample size. Therefore, the aim of this clinical investigat...This study was conducted to verify the results of a preceding retrospective pilot study by means of a prospective controlled investigation including a larger sample size. Therefore, the aim of this clinical investigation was to analyze the relationship between sleep bruxism and several functional and occlusal parameters. The null hypothesis of this study was that there would be no differences among sleep bruxism subjects and non-sleep bruxism controls regarding several functional and occlusal parameters. Fifty-eight sleep bruxism subjects and 31 controls participated in this study. The diagnosis sleep bruxism was based on clinical criteria of the American Academy of Sleep Medicine. Sixteen functional and occlusal parameters were recorded clinically or from dental study casts. Similar to the recently published retrospective pilot study, with a mean slide of 0.77 mm （s.d., 0.69 mm） in the sleep bruxism group and a mean slide of 0.4 mm （s.d., 0.57 mm） in the control group, the evaluation of the mean comparison between the two groups demonstrated a larger slide from centric occlusion to maximum intercuspation in sleep bruxism subjects （Mann-Whitney U-test; P=O.O08）. However, following Bonferroni adjustment, none of the 16 occlusal and functional variables differed significantly between the sleep bruxism subjects and the non-sleep bruxism controls. The present study shows that the occlusal and functional parameters evaluated do not differ between sleep bruxism subjects and non-sleep bruxism subjects. However, as the literature reveals a possible association between bruxism and certain subgroups of temporomandibular disorders, it appears advisable to incorporate the individual adaptive caoacitv of the stomatognathic svstem into future investigations.展开更多
We inquired the impact of reduced therapy discontinuation in diabetic macular edema(DME) on physician's revenue considering anti-vascular endothelial growth factor(VEGF) monotherapy and its combination with Navila...We inquired the impact of reduced therapy discontinuation in diabetic macular edema(DME) on physician's revenue considering anti-vascular endothelial growth factor(VEGF) monotherapy and its combination with Navilas treatment. Data were collected on injection frequency, treatment discontinuation and reimbursement fees for DME treatment with anti-VEGF compared to anti-VEGF in combination with navigated laser. Based on these data an economic model was built to compare physicians revenue over a 5y period using either therapy for 4 European countries and the USA. Due to patients' higher therapy adherence, physicians using navigated laser therapy with anti-VEGF generate similar or higher revenues compared to VEGF monotherapy in all analyzed countries. The use of Navilas decreases the patient's injection burden at the same clinical outcome, while the physician's revenue remained stable or increased. Therewith, therapy discontinuation in DME can be reduced using the combination therapy with Navilas.展开更多
Pityriasis rosea(PR) is a common erythemato-squamous dermatosis which almost always, is easily diagnosed. Mostly the disease presents in its classical form. However, clinical dermatology is all about variations and PR...Pityriasis rosea(PR) is a common erythemato-squamous dermatosis which almost always, is easily diagnosed. Mostly the disease presents in its classical form. However, clinical dermatology is all about variations and PR is not an exception. Variants of the disease in some cases may be troublesome to diagnose and confuse clinicians. Prompt diagnosis and treatment of the condition becomes necessary to avoid unnecessary investigations. We hereby review and illustrate atypical presentations of the disease, including diverse forms of location and morphology of the lesions, the course of the eruption, and its differential diagnoses.展开更多
AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients wh...AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. · RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P <0.001, Paired t -test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye(2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. · CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.展开更多
Findings in 1656 patients referred for evaluation of Ehlers-Danlos syndrome, 710 evaluated systematically using novel history and physical forms, defined a characteristic clinical pattern termed arthritis-adrenaline d...Findings in 1656 patients referred for evaluation of Ehlers-Danlos syndrome, 710 evaluated systematically using novel history and physical forms, defined a characteristic clinical pattern termed arthritis-adrenaline disorder, a genus that provides immediate therapy while delineation of particular tissue laxity/dysautonomia species is underway. Preliminary diagnoses, clinical findings, and laboratory results were entered into an MS Excel? database with IRB approval and correlations or statistical significance analyzed using Excel? functions. Frequencies of 80 findings by history and 40 on physical were similar among EDS groups, females paralleling males with more total history (35 versus 23) and physical (18 versus 15) findings. Finding frequencies in joint-skeletal (6.2 of 15) and dysautonomia (11 of 20) subcategories were substantial regardless of age, EDS diagnosis, or referral source, the latter was shown by 6.4 and 13 average findings for cardiology, 5.3 and 8.3 for orthopedic referrals. Early affliction evidenced by history findings averaging 19.5 in those under 12 increased dramatically to 25 for teens and 32 for adults with plateauing at older ages arguing against degenerative disease. Frequent neuromuscular symptoms in females emphasize surrounding muscle support and protection of joint-connective tissue as a key factor in decreased male severity. The congruent clinical profile suggests operation of an articulo-autonomic dysplasia cycle where lax vessels and lower body pooling elicit sympathetic response, autonomic imbalance in turn affecting small nerve fibers and enhancing connective tissue laxity. Recognition of this arthritis-adrenalin disorder can guide management strategies while underlying causes are pursued, among them, physical therapy, exercise, and vitamin D to build muscle/bone strength;lower gluten/dairy and antihistamine protocols for low bowel motility/mast-cell activation;hydration, salt, and exercise for postural orthostatic tachycardia syndrome.展开更多
文摘Nearly two decades since Cone Beam-Computed Tomography (CBCT) was introduced in dentistry, this technology has been proven to be a useful asset in modern dental practice. The information gleaned from a CBCT scan influences treatment decisions and prognostication of challenging endodontic cases. The authors present six cases that utilized CBCT to diagnose vertical root fracture, to assess resorption, to guide the clinician in overcoming anatomical complexities, to hurdle diagnostic dilemmas and to perform pre-surgical evaluation. Initially, a thorough clinical assessment was performed;however, conventional periapical radiographs were not able to provide sufficient information to arrive at a definite diagnosis or a thorough treatment plan. CBCT was therefore deemed helpful for these cases. Clearly, there are advantages to using CBCT. With a better understanding of each case, the clinician can plan a definitive treatment plan and offer a clearer case prognosis to their patient.
基金supported by National Institute of Mental Health(NIMH)Grant MH68853the National Memorial Institute for the Prevention of Terrorism(MIPT)and Office of State and Local Government Coordination and Preparedness,US Department of Homeland Security MIPT106-113-2000-020.
文摘Background:Disaster mental health outcomes of individuals may be affected by the families they inhabit,with effects rippling through the entire family system.Existing research on the experience of children in disasters has typically been limited to examining single individuals or,at most,family dyads.Research is needed to explore interactions within families as a whole,including interactions among multiple family members,as well as with community entities in a broad systems approach with dynamic analysis of family systems over time.The purpose of this study was to combine quantitative and qualitative data using structured diagnostic interviews and accompanying open-ended narratives of family members(spouses and children)of survivors of the 9/11 attacks.Methods:This study examined 60 members in 25 families of employees affected by the 9/11 attacks on New York City’s World Trade Center,using a mixed methods approach,collecting quantitative data using full assessments of psychiatric disorders and qualitative data from detailed personal disaster narratives.The employees were a highly 9/11 trauma-exposed group,with about one-fourth developing posttraumatic stress disorder(PTSD).The employees’exposures and PTSD did not regularly appear to propagate straightforwardly to psychopathology in their spouses or children.Based on the impact of disaster experience,4 illustrative families were selected for narrative and family systems analyses.Results:Qualitative analysis of their narratives suggested distinct family system patterns or archetypes that may reflect different ways that families cope with disaster.Conclusion:Findings suggest that family systems and family dynamics may influence not only disaster trauma-exposed members but also other family members in supporting one another and coping with the disaster,with interactions with outside community influences adding further complexity.This information may help guide disaster response efforts to provide psychosocial support targeted to specific family patterns.
基金funded in part by Quanta Computer,Inc.,in Tanyuan,Taiwan,under contract number 6950759,as part of the AIR project.
文摘Deuterium is a heavy isotope of hydrogen,with an extra neutron,endowing it with unique biophysical and biochemical properties compared to hydrogen.The ATPase pumps in the mitochondria depend upon proton motive force to catalyze the reaction that produces ATP.Deuterons disrupt the pumps,inducing excessive reactive oxygen species and decreased ATP synthesis.The aim of this review is to develop a theory that mitochondrial dysfunction due to deuterium overload,systemically,is a primary cause of Parkinson’s disease(PD).The gut microbes supply deuterium-depleted short chain fatty acids(SCFAs)to the colonocytes,particularly butyrate,and an insufficient supply of butyrate may be a primary driver behind mitochondrial dysfunction in the gut,an early factor in PD.Indeed,low gut butyrate is a characteristic feature of PD.Mitochondrial dysfunction is a factor in many diseases,including all neurodegenerative diseases.Biological organisms have devised sophisticated strategies for protecting the ATPase pumps from deuterium overload.One such strategy may involve capturing deuterons in bis-allylic carbon atoms present in polyunsaturated fatty acids(PUFAs)in cardiolipin.Cardiolipin uniquely localizes to the inner membrane of the intermembrane space,tightly integrated into ATPase proteins.Bis-allylic carbon atoms can capture and retain deuterium,and,interestingly,deuterium doping in PUFAs can quench the chain reaction that causes massive damage upon lipid peroxidation.Neuronal cardiolipin is especially rich in docosahexaenoic acid(DHA),a PUFA with five bisallylic carbon atoms.Upon excessive oxidative stress,cardiolipin migrates to the outer membrane,where it interacts withα-synuclein(α-syn),the amyloidogenic protein that accumulates as fibrils in Lewy bodies in association with PD.Such interaction leads to pore formation and the launch of an apoptotic cascade.α-syn misfolding likely begins in the gut,and misfoldedα-syn travels along nerve fibers,particularly the vagus nerve,to reach the brainstem nuclei,where it can seed misfolding ofα-syn molecules already present there.Mitochondrial dysfunction in the gut may be a primary factor in PD,and low-deuterium nutrients may be therapeutic.
文摘Background: Bisphosphonates are compounds similar to inorganic pyrophosphates, with anti-angiogenic, anti-inflammatory, anti-bone resorption, and antitumor effects. They are used to prevent bone metastases in cancer and treat osteoporosis. However, a major side effect is osteonecrosis of the jaw (ONJ), first reported in 2003, which is the exposure of necrotic bone in the mouth, often accompanied by infection. Prevention and treatment of ONJ remain challenging due to a lack of reliable epidemiological data on its incidence and risk factors. The aim of our work is to estimate the prevalence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and to analyze its correlations with different risk factors reported in the literature. Methods: A retrospective observational study was conducted in the Oncology, Rheumatology and Maxillofacial Surgery Department of the Mohamed VI University Hospital;Marrakech, based on complete medical records during the period 2017 to 2022, as well as consultations of patients under bisphosphonates in these departments during July and August 2022. Statistical analysis was performed using IBM SPSS version 16.0. Results: Of the 107 patients included in this study, 60.7% were women, and 56.1% were between 40 and 65 years old. 100% of the patients suffered from a general pathology. Regarding treatment with BP, 103 patients were treated with Zoledronate, 4 with Risedronate, and 5 with Ibandronate. 103 patients received this treatment intravenously, while 4 patients received it orally. Regarding Oral health, only 12.1% of patients reported a poor oral health. 99.1% of patients were informed of the need for oral preparation prior to BP treatment, but only 71.02% received dental treatment, mainly tooth extraction. None of the patients were diagnosed with BRONJ. Conclusions: While the global incidence of ONJ ranges from 0.8% to 12%, our finding is zero. Most previous studies are retrospective with limited patient numbers like our study. To accurately assess the prevalence of ONJ, further prospective epidemiological studies with standardized protocols and thorough follow-up over several years are essential.
文摘BACKGROUND Dysfunctional beliefs about sleep may influence academic performance through their impact on sleep quality.Differences in chronotype can further moderate this relationship,particularly among students with irregular sleep patterns.AIM To examine the indirect effects of dysfunctional beliefs about sleep on academic performance through sleep quality while considering individual differences in chronotypes among medical students.METHODS The participants were categorized by chronotype and administered the Dysfunctional Beliefs and Attitudes about Sleep Scale and the Pittsburgh Sleep Quality Index and reported their grade point averages(GPAs).Mediation analysis was performed to examine indirect pathways through sleep quality.RESULTS Dysfunctional sleep beliefs did not directly affect academic success but indirectly impaired GPA via reduced sleep quality,especially in evening-type students.CONCLUSION Chronotype moderates the relationship between sleep quality and academic performance, highlighting the need for targeted cognitive interventions.
基金funded by a Christenson Professorship in Active Healthy Livingfunded by the Health Sciences TD Bank Undergraduate Research Awardsupport from the FIFA Female Athlete Project
文摘Background Relative energy deficiency in sport(REDs)results from exposure to problematic low energy availability.It is a serious condition affecting the health and athletic performance of up to 80%of elite female athletes.REDs is established to have negative short-term effects on reproductive function,but the long-term impact of this condition is unknown.Therefore,we examined the impact of secondary amenorrhea with or without a concurrent diagnosis of REDs on perinatal health outcomes.Methods Postpartum individuals(≥18 years of age)completed an online questionnaire that covered demographics,reproductive history(including a diagnosis of REDs or secondary amenorrhea),and maternal/fetal health outcomes.Logistic regression was used to determine the relationship between previously diagnosed REDs or secondary amenorrhea with perinatal health outcomes.Results A total of 1025 previously pregnant participants completed the survey(33.1±3.4 years,mean±SD).Prior to pregnancy,6.1%had been previously diagnosed with REDs and 20.5%had a history with secondary amenorrhea.Individuals diagnosed with REDs had 3.5-times higher odds of having premature labor(odds ratio,(OR)=3.52,95%confidence interval(95%CI):1.26–9.81)and 2.6-times higher odds of preterm delivery(OR=2.62,95%CI:1.05–6.58)compared to those who had not experienced REDs or secondary amenorrhea.However,in individuals who did not have a history of REDs,secondary amenorrhea did not increase the odds of adverse pregnancy or delivery outcomes.Conclusion A history of REDs,but not secondary amenorrhea,may increase the odds of premature labor and preterm delivery.
文摘BACKGROUND Traumatic brain injury(TBI)is a significant public health issue,leading to long-term neurological impairments.Current treatments offer limited recovery,particularly in restoring lost functions.Mesenchymal stem cell-derived exosomes(MSCdE)have shown potential for promoting neuroprotection and regeneration.This study evaluates the safety and efficacy of MSCdE therapy in TBI patients.AIM To evaluate the safety and efficacy of MSCdE therapy in TBI patients.METHODS Five patients(mean age 27.00±4.06 years)with TBI from combat injuries were treated with six rounds of MSCdE therapy(3 mL intrathecally and 3 mL intramuscularly per round).The patients were followed for one year.Adverse events were assessed using the Common Terminology Criteria for Adverse Events version 5.0(CTCAE v5.0),and functional outcomes were evaluated with the functional independence measure(FIM),Modified Ashworth Scale(MAS),and Karnofsky Performance Scale(KPS).RESULTS No serious adverse events occurred,and only mild side effects[subfebrile fever(37.5°C-37.9°C),pain]were reported(CTCAE Grade 1).FIM motor scores improved significantly(46.20±16.39 to 64.20±18.20,P<0.01),and FIM cognitive scores also showed significant improvement(30.60±4.56 to 34.00±1.41,P<0.001).While MAS scores improved(right/left:4.60/3.60 to 2.20/1.60),these changes were not statistically significant(P>0.05),possibly due to low baseline spasticity.KPS scores significantly improved(46.00±11.40 to 72.00±8.37,P<0.001),indicating enhanced overall functional status and quality of life.CONCLUSION MSCdE therapy is safe and effective in improving motor function,cognition,and quality of life in TBI patients.Larger,controlled trials are needed to further validate these findings and optimize MSCdE therapy for TBI treatment.
文摘治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童、孕妇、老年患者、智障患者、药物滥用者、涉法精神病患者、已知或怀疑药代动力学异常的患者以及合并躯体疾病影响药代动力学的患者。常规剂量下治疗无效,用药依从性难以判断,药物耐受性不佳,以及可能存在药代动力学方面的药物-药物相互作用等情况都是治疗药物监测的典型指征。然而,只有将TDM充分整合到临床治疗过程中,才能发挥其优化药物治疗的潜在优势。为了向临床医生和实验室提供有效的TDM信息,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了第一版《精神科治疗药物监测指南》。2011年进行了更新之后,现在再次更新。遵循新版指南,可能会改善神经精神药物治疗的效果,加快很多患者的康复,并降低医疗费用。
文摘Flavonoids are phytochemicals which can regulate the activity of the intestinal immune system. In patients with chronic inflammatory bowel disease(IBD) there is an overexpression and imbalance of the components of the inflammatory immune reactions which are chronically activated. Suppression of inflammation can be achieved by anti-inflammatory drugs which are used in clinical medicine but these can cause serious side effects. Flavonoids can have natural immunosuppressive properties and inhibit the activation of immune cells and its effectors(chemokines, TNF-, cytokines). Phytochemicals such as flavonoids bind to the nuclear Ah(aryl hydrocarbon)-receptor thereby stimulating protective enzyme activities. As shown by clinical evidence in patients and by experimental work some flavonoids(apigenin, epigallocatechin gallate) were effective in the inhibition of inflammation. Instead of or additionally to anti-inflammatory drugs flavonoids can be used in IBD patients to treat the over-reactive immunologic system. This is accomplished by upregulation of the Ah-receptor. Flavonoids interact with toll-like receptors expressing on the surface of immune cells, then they were internalized to the cytosol and transferred into the nucleus, where they were attached to the Ah-receptor. The Ah-receptor binds to the Ah-R nuclear translocator and via Ah response element beneficial protective enzymes and cytokines are induced, leading to upregulation of the anti-inflammatory system.
文摘AIM: To report the long-term outcome of patients after complete ablation of non-neoplastic Barrett's esophagus (BE) with respect to BE relapse and development of intraepithelial neoplasia or esophageal adenocarcinoma. METHODS: In 70 patients with historically proven non neoplastic BE, complete BE ablation was achieved by argon plasma coagulation (APC) and high-dose proton pump inhibitor therapy (120 mg omeprazole daily). Sixty-six patients (94.4%) underwent further surveillance endoscopy. At each surveillance endoscopy four-quadrant biopsies were taken from the neo-squamous epithelium at 2 cm intervals depending on the pre-treatment length of BE mucosa beginning at the neo-Z-line, and from any endoscopically suspicious lesion. RESULTS: The median follow-up of 66 patients was 51 mo (range 9-85 mo) giving a total of 280.5 patient years. A mean of 6 biopsies were taken during surveillance endoscopies. In 13 patients (19.7%) tongues or islands suspicious for BE were found during endoscopy. In 8 of these patients (12.1%) non-neoplastic BE relapse was confirmed histologically giving a histological relapse rate of 3% per year. In none of the patients, intraepithelial neoplasia nor an esophageal adenocarcinoma was detected. Logistic regression analysis identified endoscopic detection of islands or tongues as the only positive predictor of BE relapse (P= 0.0004). CONCLUSION: The long-term relapse rate of non neoplastic BE following complete ablation with high-power APC is low (3% per year).
文摘Colorectal cancer(CRC) is a common health problem,representing the third most commonly diagnosed cancer worldwide and causing a significant burden in terms of morbidity and mortality,with annual deaths estimated at 700000. The western way of life,that is being rapidly adopted in many regions of the world,is a well discussed risk factor for CRC and could be targeted in terms of primary prevention. Furthermore,the relatively slow development of this cancer permits drastic reduction of incidence and mortality through secondary prevention. These facts underlie primary care physicians(PCPs) being assigned a key role in health strategies that enhance prevention and prompt diagnosis. Herein,we review the main topics of CRC in the current literature,in order to better understand its pathogenesis,risk and protective factors,as well as screening techniques. Furthermore,we discuss preventive and screening policies to combat CRC and the crucial role served by PCPs in their successful implementation. Relevant articles were identified through electronic searches of MEDLINE and through manual searches of reference lists.
文摘Supernumerary marker chromosome 15 （sSMC[15]） is the most frequent marker chromosome, and it is generally regarded as unimportant if it does not contain the Prader-Willi/Angelman syndrome critical region （PWACR）. The clinical importance of the larger markers in association with the critical region is mentioned in almost all reports related to marker chromosome 15, and smaller markers are solely associated with minor dysmorphic features, azoospermia and recurrent miscarriages. However, these small sSMC（15）s without the PWACR may also determine a specific phenotype. A dysmorphic examination of an azoospermic patient in a genetics clinic was performed and was followed by a peripheral blood lymphocyte chromosomal analysis according to standard cytogenetic methods. Nucleolar region （NOR） banding, C-banding, fluorescence in situ hybridization and a molecular investigation of Y-microdeletions were also performed. The clinical evaluation identified dysmorphic features accompanied with azoospermia and severe ‘Angle Class Ⅱ, Division 1 Open Bite Deformity＇. The molecular cytogenetic study revealed the small sSMC（15）. In addition, a Y-microdeletion analysis showed that the azoospermia was not the result of a deletion. Although the presented case might represent a coincidental example of supernumerary marker 15 and mandibular anomaly association, the condition may also define a specific phenotype that may be more than azoospermia. This condition may be characterized by infertility, malar hypoplasia, mandibular anomaly, keloid formation and minor dysmorphic features.
文摘AIM:To document the prognosis of laser treatment in patients with exudative age-related macular degeneration(AMD).· METHODS:Efficacy of the intervention was evaluated using a before-after method.· RESULTS:A total of 392 eyes of 341 patients with exudative AMD were examined.77.6% had choroideal neovascularisation(CNV).Before the use of indocyanine green(ICG) angiography,occult CNV was detected in only 1.8% of the eyes,but after the use of ICG angiography,this increased to 19.5%(P<0.001).Of the 349 eyes which were followed up,visual acuity had remained stable in 68.2% of the eyes.There was a statistically significant relationship between localisation of lesion and visual acuity changes on pre-and post-laser treatment(P<0.001).Also there was a statistically significant relationship between localisation of lesion and recurrence(P<0.05).The recurrence was less in subfoveal lesions than that in juxtafoveal and extrafoveal lesions.· CONCLUSION:ICG angiography is highly important in the treatment of occult CNV.
基金Supported by A Grant of the University of Dresden from the Department of Clinical Pharmacology
文摘Flavonoids,secondary plant products which could be essential for normal physiology in humans and animals,may be the vitamins of the next century.Flavonoids belong to the polyphenols and possess antioxidative,anti-inflammatory,antimutagenic and anticarcinogenic properties.Among the various flavonoid species,tea flavonoids such as apigenin (from camomile) and epigallocatechin gallate (EGCG from green tea) can be used for the prevention of intestinal neoplasia,especially for adenoma and cancer prevention in the gastrointestinal tract.Numerous experimental studies with molecular and biological end points support the therapeutic efficacy of bioflavonoids.Clinical studies with cohorts and case-control trials suggest that flavonoids are effective in tertiary bioprevention but,as yet,there are no controlled randomized clinical trials.Flavonoids can inhibit inflammatory pathways and could be useful for chronic inflammatory bowel diseases.Flavonoid deficiency syndromes could be therapeutic targets in the future.
基金supported in part by grants from the German Research Foundation (839/6-1,839/6-2)
文摘This study was conducted to verify the results of a preceding retrospective pilot study by means of a prospective controlled investigation including a larger sample size. Therefore, the aim of this clinical investigation was to analyze the relationship between sleep bruxism and several functional and occlusal parameters. The null hypothesis of this study was that there would be no differences among sleep bruxism subjects and non-sleep bruxism controls regarding several functional and occlusal parameters. Fifty-eight sleep bruxism subjects and 31 controls participated in this study. The diagnosis sleep bruxism was based on clinical criteria of the American Academy of Sleep Medicine. Sixteen functional and occlusal parameters were recorded clinically or from dental study casts. Similar to the recently published retrospective pilot study, with a mean slide of 0.77 mm （s.d., 0.69 mm） in the sleep bruxism group and a mean slide of 0.4 mm （s.d., 0.57 mm） in the control group, the evaluation of the mean comparison between the two groups demonstrated a larger slide from centric occlusion to maximum intercuspation in sleep bruxism subjects （Mann-Whitney U-test; P=O.O08）. However, following Bonferroni adjustment, none of the 16 occlusal and functional variables differed significantly between the sleep bruxism subjects and the non-sleep bruxism controls. The present study shows that the occlusal and functional parameters evaluated do not differ between sleep bruxism subjects and non-sleep bruxism subjects. However, as the literature reveals a possible association between bruxism and certain subgroups of temporomandibular disorders, it appears advisable to incorporate the individual adaptive caoacitv of the stomatognathic svstem into future investigations.
文摘We inquired the impact of reduced therapy discontinuation in diabetic macular edema(DME) on physician's revenue considering anti-vascular endothelial growth factor(VEGF) monotherapy and its combination with Navilas treatment. Data were collected on injection frequency, treatment discontinuation and reimbursement fees for DME treatment with anti-VEGF compared to anti-VEGF in combination with navigated laser. Based on these data an economic model was built to compare physicians revenue over a 5y period using either therapy for 4 European countries and the USA. Due to patients' higher therapy adherence, physicians using navigated laser therapy with anti-VEGF generate similar or higher revenues compared to VEGF monotherapy in all analyzed countries. The use of Navilas decreases the patient's injection burden at the same clinical outcome, while the physician's revenue remained stable or increased. Therewith, therapy discontinuation in DME can be reduced using the combination therapy with Navilas.
文摘Pityriasis rosea(PR) is a common erythemato-squamous dermatosis which almost always, is easily diagnosed. Mostly the disease presents in its classical form. However, clinical dermatology is all about variations and PR is not an exception. Variants of the disease in some cases may be troublesome to diagnose and confuse clinicians. Prompt diagnosis and treatment of the condition becomes necessary to avoid unnecessary investigations. We hereby review and illustrate atypical presentations of the disease, including diverse forms of location and morphology of the lesions, the course of the eruption, and its differential diagnoses.
文摘AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. · RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P <0.001, Paired t -test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye(2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. · CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.
文摘Findings in 1656 patients referred for evaluation of Ehlers-Danlos syndrome, 710 evaluated systematically using novel history and physical forms, defined a characteristic clinical pattern termed arthritis-adrenaline disorder, a genus that provides immediate therapy while delineation of particular tissue laxity/dysautonomia species is underway. Preliminary diagnoses, clinical findings, and laboratory results were entered into an MS Excel? database with IRB approval and correlations or statistical significance analyzed using Excel? functions. Frequencies of 80 findings by history and 40 on physical were similar among EDS groups, females paralleling males with more total history (35 versus 23) and physical (18 versus 15) findings. Finding frequencies in joint-skeletal (6.2 of 15) and dysautonomia (11 of 20) subcategories were substantial regardless of age, EDS diagnosis, or referral source, the latter was shown by 6.4 and 13 average findings for cardiology, 5.3 and 8.3 for orthopedic referrals. Early affliction evidenced by history findings averaging 19.5 in those under 12 increased dramatically to 25 for teens and 32 for adults with plateauing at older ages arguing against degenerative disease. Frequent neuromuscular symptoms in females emphasize surrounding muscle support and protection of joint-connective tissue as a key factor in decreased male severity. The congruent clinical profile suggests operation of an articulo-autonomic dysplasia cycle where lax vessels and lower body pooling elicit sympathetic response, autonomic imbalance in turn affecting small nerve fibers and enhancing connective tissue laxity. Recognition of this arthritis-adrenalin disorder can guide management strategies while underlying causes are pursued, among them, physical therapy, exercise, and vitamin D to build muscle/bone strength;lower gluten/dairy and antihistamine protocols for low bowel motility/mast-cell activation;hydration, salt, and exercise for postural orthostatic tachycardia syndrome.
