Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute ill...Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute illnesses. Clinical diagnosis of VTE in the elderly patient is particularly difficult and, as such, adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE. Omission of VTE prophylaxis is, however, very common despite continuous education. A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual＇ s risk of VTE. Although pharmacological VTE prophylaxis is effective for most patients, a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate. Mechanical VTE prophylaxis, including calf and thigh compression devices and/or an inferior vena cava filter, are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE. Because pneumatic compression devices and thigh length stockings are virtually risk free, mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients, regardless of their bleeding and VTE risk. Although the cost-effectiveness of this Multimodality Universal STat （＇MUST＇） VTE prophylaxis approach for hospitalized elderly patients remains uncertain, this strategy appears to offer some advantages over the traditional ＇selective and single-modal＇ VTE prophylaxis approach, which often becomes ＇hit or miss＇ or not implemented promptly in many hospitalized elderly patients. A large clustered randomized controlled trial is, however, needed to assess whether early, multimodality, universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.展开更多
BACKGROUND Survival in patients with autoimmune liver disease overlap syndromes(AILDOS)compared to those with single autoimmune liver disease is unclear.AIM To investigate the survival of patients with AILDOS and asse...BACKGROUND Survival in patients with autoimmune liver disease overlap syndromes(AILDOS)compared to those with single autoimmune liver disease is unclear.AIM To investigate the survival of patients with AILDOS and assess the accuracy of non-invasive serum models for predicting liver-related death.METHODS Patients with AILDOS were defined as either autoimmune hepatitis and primary biliary cholangitis overlap(AIH-PBC)or autoimmune hepatitis and primary sclerosing cholangitis overlap(AIH-PSC)and were identified from three tertiary centres for this cohort study.Liver-related death or transplantation(liver-related mortality)was determined using a population-based data linkage system.Prognostic scores for liver-related death were compared for accuracy[including liver outcome score(LOS),Hepascore,Mayo Score,model for end-stage liver disease(MELD)score and MELD incorporated with serum sodium(MELD-Na)score].RESULTS Twenty-two AILDOS patients were followed for a median of 3.1 years(range,0.35-7.7).Fourteen were female,the median age was 46.7 years(range,17.8 to 82.1)and median Hepascore was 1(range,0.07-1).At five years post enrolment,57%of patients remained free from liver-related mortality(74%AIH-PBC,27%AIH-PSC).There was no significant difference in survival between AIH-PBC and AIH-PSC.LOS was a significant predictor of liver-related mortality(P<0.05)in patients with AIH-PBC(n=14)but not AIH-PSC(n=8).A LOS cut-point of 6 discriminated liver-related mortality in AIH-PBC patients(P=0.012,log-rank test,100%sensitivity,77.8%specificity)(Harrell's C-statistic 0.867).The MELD score,MELD-Na score and Mayo Score were not predictive of liver-related mortality in any group.CONCLUSION Survival in the rare,AILDOS is unclear.The current study supports the LOS as a predictor of liver-related mortality in AIH-PBC patients.Further trials investigating predictors of survival in AILDOS are required.展开更多
BACKGROUND Type 1 diabetes(T1D) is associated with major chronic microvascular complications which contribute significantly to diabetes associated morbidity.The protein primarily responsible for glucose reabsorption i...BACKGROUND Type 1 diabetes(T1D) is associated with major chronic microvascular complications which contribute significantly to diabetes associated morbidity.The protein primarily responsible for glucose reabsorption in the kidney is sodium glucose co-transporter 2(SGLT2). Presently, SGLT2 inhibitors are widely used in diabetic patients to improve blood glucose levels and prevent cardiovascular and renal complications. Given the broad therapeutic application of SGLT2 inhibitors, we hypothesised that SGLT2 inhibition may exert its protective effects via alterations of the gut microbiome and tested this in a type 1 diabetic mouse model of diabetic retinopathy.AIM To determine whether the treatment with two independent SGLT2 inhibitors affects gut health in a type 1 diabetic mouse model.METHODS The SGLT2 inhibitors empagliflozin or dapagliflozin(25 mg/kg/d) or vehicle dimethylsulfoxide(DMSO) were administered to C57 BL/6 J, Akita, Kimba and Akimba mice at 10 wk of age for 8 wk via their drinking water. Serum samples were collected and the concentration of succinate and the short chain fatty acid(SCFA) butyric acid was measured using gas chromatography-mass spectrometry. Enzyme-linked immunosorbent assay(ELISA) was performed to determine the concentration of insulin and leptin. Furthermore, the norepinephrine content in kidney tissue was determined using ELISA. Pancreatic tissue was collected and stained with haematoxylin and eosin and analysed using brightfield microscopy.RESULTS Due to the presence of the Akita allele, both Akita and Akimba mice showed a reduction in insulin production compared to C57 BL/6 J and Kimba mice.Furthermore, Akita mice also showed the presence of apoptotic bodies within the pancreatic islets. The acinar cells of Akita and Akimba mice showed swelling which is indicative of acute injury or pancreatitis. After 8 wk of SGLT2 inhibition with dapagliflozin, the intermediate metabolite of gut metabolism known as succinate was significantly reduced in Akimba mice when compared to DMSO treated mice. In addition, empagliflozin resulted in suppression of succinate levels in Akimba mice. The beneficial SCFA known as butyric acid was significantly increased in Akita mice after treatment with dapagliflozin when compared to vehicle treated mice. The norepinephrine content in the kidney was significantly reduced with both dapagliflozin and empagliflozin therapy in Akita mice and was significantly reduced in Akimba mice treated with empagliflozin.In non-diabetic C57 BL/6 J and Kimba mice, serum leptin levels were significantly reduced after dapagliflozin therapy.CONCLUSION The inhibition of SGLT2 reduces the intermediate metabolite succinate, increases SCFA butyric acid levels and reduces norepinephrine content in mouse models of T1 D. Collectively, these improvements may represent an important mechanism underlying the potential benefits of SGLT2 inhibition in T1 D and its complications.展开更多
OBJECTIVE: To investigate the use of Aloe vera(A.vera) for the treatment of gastroesophageal reflux disease(GERD) symptoms and compare its effects with those of omeprazole and ranitidine.METHODS: In this pilot, random...OBJECTIVE: To investigate the use of Aloe vera(A.vera) for the treatment of gastroesophageal reflux disease(GERD) symptoms and compare its effects with those of omeprazole and ranitidine.METHODS: In this pilot, randomized controlled trial, 79 subjects were allocated to A. vera syrup(standardized to 5.0 mg polysaccharide per m L of syrup)at a dose of 10 m L/d, omeprazole capsule(20 g/d)or ranitidine tablet(150 mg in a fasted state in the morning and 150 mg 30 min before sleep at night)for a period of 4 weeks. The frequencies of eight main symptoms of GERD(heartburn, food regurgitation, flatulence, belching, dysphagia, nausea,vomiting and acid regurgitation) were assessed at weeks 2 and 4 of the trial.RESULTS: A. vera was safe and well tolerated and reduced the frequencies of all the assessed GERD symptoms, with no adverse events requiring withdrawal.CONCLUSION: A. vera may provide a safe and effective treatment for reducing the symptoms of GERD.展开更多
Hypertension is a risk factor for a large number of vision-threatening eye disorders.In this study,we investigated for the first time the retinal neural structure of the hypertensive BPH/2J mouse(Schlager mouse)and co...Hypertension is a risk factor for a large number of vision-threatening eye disorders.In this study,we investigated for the first time the retinal neural structure of the hypertensive BPH/2J mouse(Schlager mouse)and compared it to its control counterpart,the normotensive BPN/3J strain.The BPH/2J mouse is a selectively inbred mouse strain that develops chronic hypertension due to elevated sympathetic nervous system activity.When compared to the BPN/3J strain,the hypertensive BPH/2J mice showed a complete loss of outer layers of the neural retina at 21 weeks of age,which was indicative of a severe vision-threatening disease potentially caused by hypertension.To elucidate whether the retinal neural phenotype in the BPH/2J strain was attributed to increased BP,we investigated the neural retina of both BPN/3J and BPH/2J mice at 4 weeks of age.Our preliminary results showed for the first time that the BPH/2J strain develops severe retinal neural damage at a young age.Our findings suggest that the retinal phenotype in the BPH/2J mouse is possibly due to elevated blood pressure and may be contributed by an early onset spontaneous mutation which is yet to be identified or a congenital defect occurring in this strain.Further characterization of the BPH/2J mouse strain is likely to i)elucidate gene defects underlying retinal disease;ii)understand mechanisms leading to neural retinal disease and iii)permit testing of molecules for translational research to interfere with the progression of retinal disease.The animal experiments were performed with the approval of the Royal Perth Hospital Animal Ethics Committee(R535/17-18)on June 1,2017.展开更多
Hypertriglyceridaemia(HTG) is a risk factor for cardiovascular disease(CVD) in type 2 diabetes and is caused by the interaction of genes and non-genetic factors, specifically poor glycaemic control and obesity. In spi...Hypertriglyceridaemia(HTG) is a risk factor for cardiovascular disease(CVD) in type 2 diabetes and is caused by the interaction of genes and non-genetic factors, specifically poor glycaemic control and obesity. In spite of statin treatment, residual risk of CVD remains high in type 2 diabetes, and this may relate to HTG and atherogenic dyslipidemia. Treatment of HTG emphasises correcting secondary factors and adverse lifestyles, in particular, diet and exercise. Pharmacotherapy is also required in most type 2 diabetic patients. Statins are the first-line therapy to achieve recommended therapeutic targets of plasma low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. Fibrates, ezetimibe and n-3 fatty acids are adjunctive treatment options for residual and persistent HTG. Evidence for the use of niacin has been challenged by non-significant CVD outcomes in two recent large clinical trials. Further investigation is required to clarify the use of incretin-based therapies for HTG in type 2 diabetes. Extreme HTG, with risk of pancreatitis, may require insulin infusion therapy or apheresis.New therapies targeting HTG in diabetes need to be tested in clinical endpoint trials. The purpose of this review is to examine the current evidence and provide practical guidance on the management of HTG in type 2 diabetes.展开更多
AIM:To study if impaired renal function is associated with increased risk of peri-infarct heart failure (HF) in patients with preserved ejection fraction (EF).METHODS:Patients with occluded infarct-related arteries (I...AIM:To study if impaired renal function is associated with increased risk of peri-infarct heart failure (HF) in patients with preserved ejection fraction (EF).METHODS:Patients with occluded infarct-related arteries (IRAs) between 1 to 28 d after myocardial infarction (MI) were grouped into chronic kidney disease (CKD) stages based on estimated glomerular filtration rate (eGFR).Rates of early post-MI HF were compared among eGFR groups.Logistic regression was used to explore independent predictors of HF.RESULTS:Reduced eGFR was present in 71.1% of 2160 patients,with significant renal impairment (eGFR < 60 mL/min every 1.73 m2) in 14.8%.The prevalence of HF was higher with worsening renal function:15.5%,17.8% and 29.4% in patients with CKD stages 1,2 and 3 or 4,respectively (P < 0.0001),despite a small absolute difference in mean EF across eGFR groups:48.2 ± 10.0,47.9 ± 11.3 and 46.2 ± 12.1,respectively (P=0.02).The prevalence of HF was again higher with worsening renal function among patients with preserved EF:10.1%,13.6% and 23.6% (P < 0.0001),but this relationship was not significant among patients with depressed EF:27.1%,26.2% and 37.9% (P= 0.071).Moreover,eGFR was an independent correlate of HF in patients with preserved EF (P=0.003) but not in patients with depressed EF (P=0.181).CONCLUSION:A significant proportion of post-MI patients with occluded IRAs have impaired renal function.Impaired renal function was associated with an increased rate of early post-MI HF,the association being strongest in patients with preserved EF.These findings have implications for management of peri-infarct HF.展开更多
Background and Purpose - Epidemiological and laboratory studies suggest that increasing concentrations of plasma homocysteine (total homocysteine [tHcy]) accelerate cardiovascular disease by promoting vascular inflamm...Background and Purpose - Epidemiological and laboratory studies suggest that increasing concentrations of plasma homocysteine (total homocysteine [tHcy]) accelerate cardiovascular disease by promoting vascular inflammation, endothelial dysfunction, and hypercoagulability. Methods - We conducted a randomized controlled trial in 285 patients with recent transient ischemic attack or stroke to examine the effect of lowering tHcy with folic acid 2 mg, vitamin B12 0.5 mg, and vitamin B6 25 mg compared with placebo on laboratory markers of vascular inflammation, endothelial dysfunction, and hypercoagulability. Results - At 6 months after randomization, there was no significant difference in blood concentrations of markers of vascular inflammation (high- sensitivity C- reactive protein [P=0.32]; soluble CD40L [P=0.33]; IL- 6 [P=0.77]), endothelial dysfunction (vascular cell adhesion molecule- 1 [P=0.27]; intercellular adhesion molecule- 1 [P=0.08]; von Willebrand factor [P=0.92]), and hypercoagulability (P- selectin [P=0.33]; prothrombin fragment 1 and 2 [P=0.81]; D- dimer [P=0.88]) among patients assigned vitamin therapy compared with placebo despite a 3.7- μ mol/L (95% CI, 2.7 to 4.7) reduction in total homocysteine (tHcy). Conclusions - Lowering tHcy by 3.7 μ mol/L with folic acidbased multivitamin therapy does not significantly reduce blood concentrations of the biomarkers of inflammation, endothelial dysfunction, or hypercoagulability measured in our study. The possible explanations for our findings are: (1) these biomarkers are not sensitive to the effects of lowering tHcy (eg, multiple risk factor interventions may be required); (2) elevated tHcy causes cardiovascular disease by mechanisms other than the biomarkers measured; or (3) elevated tHcy is a noncausal marker of increased vascular risk.展开更多
Objective: To assess effects of multifactorial lifestyle modifi-cation on antihypertensive drug needs in treated hypertensive individuals. Design: Randomized controlled trial. Setting:Research studies unit. Participan...Objective: To assess effects of multifactorial lifestyle modifi-cation on antihypertensive drug needs in treated hypertensive individuals. Design: Randomized controlled trial. Setting:Research studies unit. Participants: Overweight hypertensive patients, receiving one or two antihypertensive drugs, were recruited by advertising, and allocated randomly to a usual care group(controls; n=118) or a lifestyle modification group(programme group; n=123). Intervention: A 4-month programme of weight loss, a low-sodium ‘Dietary Approaches to Stop Hypertension’-type diet with added fish, physical activity and moderation of alcohol intake. After 4 months, if mean 24-h ambulatory blood pressure(ABP) was less than 135/85 mmHg, antihypertensive drugs were withdrawn over 4 weeks and long-term home blood pressure monitoring was begun. Main outcome measures: Antihypertensive drug requirements, ABP, weight, waist girth at 4 months and 1-year follow-up. Results: Ninety control group and 102 programme group participants completed the study. Mean 24-h ABP changed after 4 months by-1.0/-0.3±0.5/0.4 mmHg in controls and-4.1/-2.1±0.7/0.5 mmHg with the lifestyle programme(P< 0.01). At follow-up, changes in the two groups were not significantly different(4.1/1.3±1.1/1.0 mmHg in controls; 2.5/-0.1±1.1/0.8 mmHg in the programme group; P=0.73). At 4 months, drug withdrawal differed significantly between the groups(P=0.038) in men(control 44%; programme 66%) but not in women(65 and 64%, respectively; P=0.964). At follow-up, sex-related differences were not significant, and 41%in the control group and 43%in the programme group maintained drug-withdrawal status. With the programme, net weight loss was 3.3 kg(P< 0.001) at 4 months and 3.0 kg(P< 0.001) at follow-up; respective net decreases in waist girth were 3.3 cm(P< 0.001) and 3.5 cm(P< 0.001). Conclusions: A 4-month multifactorial lifestyle modification in patients with treated hypertension reduced blood pressure in the short-term. Decreased central obesity persisted 1 year later and could reduce overall cardiovascular risk.展开更多
Norepinephrine(NE;also known as noradrenaline)is the body’s primary adrenergic neurotransmitter which belongs to the catecholamine family.Norepinephrine has pharmacologic effects on theα1(Suita et al.,2015),α2(Schw...Norepinephrine(NE;also known as noradrenaline)is the body’s primary adrenergic neurotransmitter which belongs to the catecholamine family.Norepinephrine has pharmacologic effects on theα1(Suita et al.,2015),α2(Schwartz,1997),β1,β2 andβ3(Tsukada et al.,2003)adrenoceptors.In the brain,norepinephrine increases arousal and alertness,promotes vigilance,enhances formation and retrieval of memory,and focuses attention.It also increases restlessness and anxiety.In the remainder of the body,norepinephrine increases heart rate and blood pressure,triggers the release of glucose from energy stores,increases blood flow to skeletal muscle and increases muscle contraction,reduces blood flow to the gastrointestinal system and its motility and lastly,inhibits voiding of the bladder(Goldstein,2010).This last point is particularly interesting in the context of this perspective piece.展开更多
Objective:This study aimed to evaluate the safety and efficacy outcomes of percutaneous radiofrequency ablation(RFA)for localised renal cell carcinoma(RCC)in a tertiary hospital patient who remained unfit for surgical...Objective:This study aimed to evaluate the safety and efficacy outcomes of percutaneous radiofrequency ablation(RFA)for localised renal cell carcinoma(RCC)in a tertiary hospital patient who remained unfit for surgical intervention.Methods:We retrospectively analysed survival outcomes for patients with biopsy proven RCC treated by RFA at Royal Perth Hospital between September 2009 and May 2018.Complication data were gathered for all patients that underwent renal RFA along with 2-and 5-year recurrence-free survival(RFS)rate and compared the outcomes with data from previous studies.Results:A total of 69 patients(73 procedures)were eligible for the study,and those patients had biopsy-proven RCC with a minimum of 2-year follow-up.The complication rate was 8.2%(6/73)and local recurrence rate 9.6%(7/73).Two-year RFS is 95.7% and 5-year RFS is 78.8% on a median 3.82-year follow-up(interquartile range 1.90-5.75 years).Conclusion:RFA performed at our centre was found to be safe and effective with low complication rates and durable RFS in line with expectations from existing research.Our study demonstrated that RFA is an alternative modality of treatment for small renal tumours in patients unfit for surgical approach.展开更多
Lung transplantation has been a method for treating end stage lung disease for decades. Despite improvements in the preoperative assessment of recipients and donors as well as improved surgical techniques, lung transp...Lung transplantation has been a method for treating end stage lung disease for decades. Despite improvements in the preoperative assessment of recipients and donors as well as improved surgical techniques, lung transplant recipients are still at a high risk of developing postoperative complications which tend to impact negatively the patients' outcome if not recognised early. The recognised complications post lung transplantation can be broadly categorised into acute and chronic complications. Recognising the radiological features of these complications has a significant positive impact on patients' survival post transplantation. This manuscript provides a comprehensive review of the radiological features of post lung transplantations complications over a time continuum.展开更多
Delivery of a peptide(APP96-110),derived from amyloid precursor protein(APP),has been shown to elicit neuroprotective effects following cerebral stroke and traumatic brain injury.In this study,the effect of APP96-110 ...Delivery of a peptide(APP96-110),derived from amyloid precursor protein(APP),has been shown to elicit neuroprotective effects following cerebral stroke and traumatic brain injury.In this study,the effect of APP96-110 or a mutant version of this peptide(mAPP96-110)was assessed following moderate(200 kdyn,(2 N))thoracic contusive spinal cord injury(SCI)in adult Nude rats.Animals received a single tail vein injection of APP96-110 or mAPP96-110 at 30 minutes post-SCI and were then assessed for functional improvements over the next 8 weeks.A cohort of animals also received transplants of either viable or non-viable human mesenchymal stromal cells(hMSCs)into the SC lesion site at one week post-injury to assess the effect of combining intravenous APP96-110 delivery with hMSC treatment.Rats were perfused 8 weeks post-SCI and longitudinal sections of spinal cord analyzed for a number of factors including hMSC viability,cyst size,axonal regrowth,glial reactivity and macrophage activation.Analysis of sensorimotor function revealed occasional significant differences between groups using Ladderwalk or Ratwalk tests,however there were no consistent improvements in functional outcome after any of the treatments.mAPP96-110 alone,and APP96-110 in combination with both viable and non-viable hMSCs significantly reduced cyst size compared to SCI alone.Combined treatments with donor hMSCs also significantly increased βIII tubulin^(+),glial fibrillary acidic protein(GFAP^(+))and laminin+expression,and decreased ED1^(+)expression in tissues.This preliminary study demonstrates that intravenous delivery of APP96-110 peptide has selective,modest neuroprotective effects following SCI,which may be enhanced when combined with hMSC transplantation.However,the effects are less pronounced and less consistent compared to the protective morphological and cognitive impact that this same peptide has on neuronal survival and behaviour after stroke and traumatic brain injury.Thus while the efficacy of a particular therapeutic approach in one CNS injury model may provide justification for its use in other neurotrauma models,similar outcomes may not necessarily occur and more targeted approaches suited to location and severity are required.All animal experiments were approved by The University of Western Australia Animal Ethics Committee(RA3/100/1460)on April 12,2016.展开更多
AIM:To examined the efficacy and safety of treatment with boceprevir,PEGylated-interferon and ribavirin(PR)in hepatitis C virus genotype 1(HCVGT1) PR treatmentfailures in Asia.METHODS:The Boceprevir Named-Patient Prog...AIM:To examined the efficacy and safety of treatment with boceprevir,PEGylated-interferon and ribavirin(PR)in hepatitis C virus genotype 1(HCVGT1) PR treatmentfailures in Asia.METHODS:The Boceprevir Named-Patient Program provided boceprevir to HCVGT1 PR treatment-failures.Participating physicians were invited to contribute data from their patients:baseline characteristics,ontreatment responses,sustained virological response at week 12(SVR12),and safety were collected and analysed.Multivariate analysis was performed to determine predictors of response.RESULTS:150 patients were enrolled from Australia,Malaysia,Singapore and Thailand(Asians = 86,Caucasians = 63).Overall SVR12 was 61%(Asians= 59.3%,Caucasians = 63.5%).SVR12 was higher in relapsers(78%) compared with non-responders(34%).On-treatment responses predicted SVR,with undetectable HCVRNA at week 4,8 and 12 leading to SVR12 s of 100%,87%,and 82%respectively,and detectable HCVRNA at week 4,8 and 12,leading to SVR12 s of 58%,22%and 6%respectively.Asian patients were similar to Caucasian patients with regards to on-treatment responses.Patients with cirrhosis(n= 69) also behaved in the same manner with regards to on-treatment responses.Those with the IL28 B CC genotype(80%) had higher SVRs than those with the CT/TT(56%) genotype(P = 0.010).Multivariate analysis showed that TW8 and TW12 responses were independent predictors of SVR.Serious adverse events occurred in 18.6%:sepsis(2%),decompensation(2.7%) and blood transfusion(14%).Discontinuations occurred in 30.7%,with 18.6%fulfilling stopping rules.CONCLUSION:Boceprevir can be used successfully in PR treatment failures with a SVR12 > 80%if they have good on-treatment responses;however,discontinuations occurred in 30%because of virological failure or adverse events.展开更多
Objective:To determine the incidence of culture-positive urinary tract infection(UTI)after micturating cystourethrogram(MCUG).We further wanted to identify risk factors for developing a culture-positive UTI following ...Objective:To determine the incidence of culture-positive urinary tract infection(UTI)after micturating cystourethrogram(MCUG).We further wanted to identify risk factors for developing a culture-positive UTI following MCUG.Methods:A retrospective review of the available medical records of 500 paediatric patients who underwent MCUG in Perth,Western Australia was performed.Results:Seven(1.4%)patients comprised of four females and three males developed a febrile,culture-positive UTI within 14 days following MCUG.Significant association was found for female patients,patients with neurogenic bladder,and patients with previous culture-positive UTI as developing a culture-positive UTI following MCUG.Multivariate logistic regression determined that patients were more likely to develop culture-positive UTI within 14 days following MCUG if they had a known history of UTI(odds ratio:5.0,95%confidence interval:1.5-17.3,p=0.010)or had a neurogenic bladder(odds ratio:4.2,95%confidence interval:1.0-17.9,p=0.049).Conclusion:The incidence of patients who developed a febrile,culture-positive UTI following MCUG was low at 1.4%.Statistically significant and independent associations for the development of culture positive UTI were found in patients with neurogenic bladder and patients with previous culture-positive UTI.Further prospective studies are necessary to determine necessity of prophylactic antibiotics for high-risk patients,e.g.,patients with neurogenic bladder or previous culture-positive UTI.展开更多
Introduction: An observation was made that when removing self-tapping cortical screws from patients bones, stripping or shearing of the head of the screw occurred more often in screws whose cutting flutes sat in corti...Introduction: An observation was made that when removing self-tapping cortical screws from patients bones, stripping or shearing of the head of the screw occurred more often in screws whose cutting flutes sat in cortical bone compared with screws that had penetrated the distal cortex with flutes exposed. Method: A model was designed to simulate screws with their cutting flutes either in contact with cortical bone or deep to cortical bone. Screws were grouped depending on the location of their cutting flutes and removal torque was measured. Results: Eighteen screws were included in final analysis. There was a statistically significant difference in average initial removal torque and average maximal removal torque with screws with their cutting flutes in substrate requiring significantly more torque to remove. Conclusion: We conclude that self-tapping cortical screws whose cutting flutes sit in cortical substrate require more torque to remove and are therefore more likely to fail. This finding may be used as a guide in pre-operative planning for removal of metalwork from patients.展开更多
New surgical techniques for coronary artery bypass graft （CABG） have been explored in order to minimize disfiguring scars, avoid cardiopulmonary bypass and decrease hospital residence and costs etc. Improved surgica...New surgical techniques for coronary artery bypass graft （CABG） have been explored in order to minimize disfiguring scars, avoid cardiopulmonary bypass and decrease hospital residence and costs etc. Improved surgical expense can perform the procedures in some high-risk patients such as poor left ventricular function, redo CABG, advanced age and renal dysfunction etc. Intraoperatively there is an obligatory period of myocardial ischemia, which may lead to significant hemodynamic consequences. It is a quite challenge to anesthetist in managing the intraoperative patient.展开更多
With the advancement of medical technique and application of the new immunosuppressant agents, cardiac transplantation has become an effective treatment for end-stage heart disease caused by different reasons. The ort...With the advancement of medical technique and application of the new immunosuppressant agents, cardiac transplantation has become an effective treatment for end-stage heart disease caused by different reasons. The orthotopic procedure has been performed in many countries nowadays. Whether it is successful or not mainly depends on harvesting the denoted heart, operative technique and perioperative management.展开更多
Intra-articular disorders of the hip in the elite athlete are common and potentially career threatening. Hip arthroscopy has been shown to be a safe and successful method of treating these conditions. This study exami...Intra-articular disorders of the hip in the elite athlete are common and potentially career threatening. Hip arthroscopy has been shown to be a safe and successful method of treating these conditions. This study examines the effectiveness of hip arthroscopy in facilitating an early return to professional level sport. We prospectively followed 65 professional athletes (mostly Australian Rules Football players) before and after hip arthroscopy using the Modified Harris Hip Score (MHS) and the Non-Arthritic Hip (NAH) Score. We followed them to the 1 year mark and recorded the time required for them to return to sport. Follow-up was achieved in 100% of patients. Intraoperative findings included femoroacetabular impingement, labral pathology and ligamentumteres injuries. Both MHS and NAH Scores showed highly statistically significant improvements up to the 1 year mark. All but 3 athletes returned to professional level sport. The mean return to sport time was 11.9 weeks. The use of arthroscopy to manage common intra-articular hip disorders in elite athletes is safe, effective and facilitates an early return to sport.展开更多
文摘Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute illnesses. Clinical diagnosis of VTE in the elderly patient is particularly difficult and, as such, adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE. Omission of VTE prophylaxis is, however, very common despite continuous education. A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual＇ s risk of VTE. Although pharmacological VTE prophylaxis is effective for most patients, a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate. Mechanical VTE prophylaxis, including calf and thigh compression devices and/or an inferior vena cava filter, are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE. Because pneumatic compression devices and thigh length stockings are virtually risk free, mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients, regardless of their bleeding and VTE risk. Although the cost-effectiveness of this Multimodality Universal STat （＇MUST＇） VTE prophylaxis approach for hospitalized elderly patients remains uncertain, this strategy appears to offer some advantages over the traditional ＇selective and single-modal＇ VTE prophylaxis approach, which often becomes ＇hit or miss＇ or not implemented promptly in many hospitalized elderly patients. A large clustered randomized controlled trial is, however, needed to assess whether early, multimodality, universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.
文摘BACKGROUND Survival in patients with autoimmune liver disease overlap syndromes(AILDOS)compared to those with single autoimmune liver disease is unclear.AIM To investigate the survival of patients with AILDOS and assess the accuracy of non-invasive serum models for predicting liver-related death.METHODS Patients with AILDOS were defined as either autoimmune hepatitis and primary biliary cholangitis overlap(AIH-PBC)or autoimmune hepatitis and primary sclerosing cholangitis overlap(AIH-PSC)and were identified from three tertiary centres for this cohort study.Liver-related death or transplantation(liver-related mortality)was determined using a population-based data linkage system.Prognostic scores for liver-related death were compared for accuracy[including liver outcome score(LOS),Hepascore,Mayo Score,model for end-stage liver disease(MELD)score and MELD incorporated with serum sodium(MELD-Na)score].RESULTS Twenty-two AILDOS patients were followed for a median of 3.1 years(range,0.35-7.7).Fourteen were female,the median age was 46.7 years(range,17.8 to 82.1)and median Hepascore was 1(range,0.07-1).At five years post enrolment,57%of patients remained free from liver-related mortality(74%AIH-PBC,27%AIH-PSC).There was no significant difference in survival between AIH-PBC and AIH-PSC.LOS was a significant predictor of liver-related mortality(P<0.05)in patients with AIH-PBC(n=14)but not AIH-PSC(n=8).A LOS cut-point of 6 discriminated liver-related mortality in AIH-PBC patients(P=0.012,log-rank test,100%sensitivity,77.8%specificity)(Harrell's C-statistic 0.867).The MELD score,MELD-Na score and Mayo Score were not predictive of liver-related mortality in any group.CONCLUSION Survival in the rare,AILDOS is unclear.The current study supports the LOS as a predictor of liver-related mortality in AIH-PBC patients.Further trials investigating predictors of survival in AILDOS are required.
基金Supported by the Royal Perth Hospital Medical Research Foundation,No.VMMRF2018。
文摘BACKGROUND Type 1 diabetes(T1D) is associated with major chronic microvascular complications which contribute significantly to diabetes associated morbidity.The protein primarily responsible for glucose reabsorption in the kidney is sodium glucose co-transporter 2(SGLT2). Presently, SGLT2 inhibitors are widely used in diabetic patients to improve blood glucose levels and prevent cardiovascular and renal complications. Given the broad therapeutic application of SGLT2 inhibitors, we hypothesised that SGLT2 inhibition may exert its protective effects via alterations of the gut microbiome and tested this in a type 1 diabetic mouse model of diabetic retinopathy.AIM To determine whether the treatment with two independent SGLT2 inhibitors affects gut health in a type 1 diabetic mouse model.METHODS The SGLT2 inhibitors empagliflozin or dapagliflozin(25 mg/kg/d) or vehicle dimethylsulfoxide(DMSO) were administered to C57 BL/6 J, Akita, Kimba and Akimba mice at 10 wk of age for 8 wk via their drinking water. Serum samples were collected and the concentration of succinate and the short chain fatty acid(SCFA) butyric acid was measured using gas chromatography-mass spectrometry. Enzyme-linked immunosorbent assay(ELISA) was performed to determine the concentration of insulin and leptin. Furthermore, the norepinephrine content in kidney tissue was determined using ELISA. Pancreatic tissue was collected and stained with haematoxylin and eosin and analysed using brightfield microscopy.RESULTS Due to the presence of the Akita allele, both Akita and Akimba mice showed a reduction in insulin production compared to C57 BL/6 J and Kimba mice.Furthermore, Akita mice also showed the presence of apoptotic bodies within the pancreatic islets. The acinar cells of Akita and Akimba mice showed swelling which is indicative of acute injury or pancreatitis. After 8 wk of SGLT2 inhibition with dapagliflozin, the intermediate metabolite of gut metabolism known as succinate was significantly reduced in Akimba mice when compared to DMSO treated mice. In addition, empagliflozin resulted in suppression of succinate levels in Akimba mice. The beneficial SCFA known as butyric acid was significantly increased in Akita mice after treatment with dapagliflozin when compared to vehicle treated mice. The norepinephrine content in the kidney was significantly reduced with both dapagliflozin and empagliflozin therapy in Akita mice and was significantly reduced in Akimba mice treated with empagliflozin.In non-diabetic C57 BL/6 J and Kimba mice, serum leptin levels were significantly reduced after dapagliflozin therapy.CONCLUSION The inhibition of SGLT2 reduces the intermediate metabolite succinate, increases SCFA butyric acid levels and reduces norepinephrine content in mouse models of T1 D. Collectively, these improvements may represent an important mechanism underlying the potential benefits of SGLT2 inhibition in T1 D and its complications.
基金Supported by the Clinical Trial Research CenterTehranIran
文摘OBJECTIVE: To investigate the use of Aloe vera(A.vera) for the treatment of gastroesophageal reflux disease(GERD) symptoms and compare its effects with those of omeprazole and ranitidine.METHODS: In this pilot, randomized controlled trial, 79 subjects were allocated to A. vera syrup(standardized to 5.0 mg polysaccharide per m L of syrup)at a dose of 10 m L/d, omeprazole capsule(20 g/d)or ranitidine tablet(150 mg in a fasted state in the morning and 150 mg 30 min before sleep at night)for a period of 4 weeks. The frequencies of eight main symptoms of GERD(heartburn, food regurgitation, flatulence, belching, dysphagia, nausea,vomiting and acid regurgitation) were assessed at weeks 2 and 4 of the trial.RESULTS: A. vera was safe and well tolerated and reduced the frequencies of all the assessed GERD symptoms, with no adverse events requiring withdrawal.CONCLUSION: A. vera may provide a safe and effective treatment for reducing the symptoms of GERD.
基金generously funded by grants from the Royal Perth Hospital Medical Research Foundation(to VBM and MPS)
文摘Hypertension is a risk factor for a large number of vision-threatening eye disorders.In this study,we investigated for the first time the retinal neural structure of the hypertensive BPH/2J mouse(Schlager mouse)and compared it to its control counterpart,the normotensive BPN/3J strain.The BPH/2J mouse is a selectively inbred mouse strain that develops chronic hypertension due to elevated sympathetic nervous system activity.When compared to the BPN/3J strain,the hypertensive BPH/2J mice showed a complete loss of outer layers of the neural retina at 21 weeks of age,which was indicative of a severe vision-threatening disease potentially caused by hypertension.To elucidate whether the retinal neural phenotype in the BPH/2J strain was attributed to increased BP,we investigated the neural retina of both BPN/3J and BPH/2J mice at 4 weeks of age.Our preliminary results showed for the first time that the BPH/2J strain develops severe retinal neural damage at a young age.Our findings suggest that the retinal phenotype in the BPH/2J mouse is possibly due to elevated blood pressure and may be contributed by an early onset spontaneous mutation which is yet to be identified or a congenital defect occurring in this strain.Further characterization of the BPH/2J mouse strain is likely to i)elucidate gene defects underlying retinal disease;ii)understand mechanisms leading to neural retinal disease and iii)permit testing of molecules for translational research to interfere with the progression of retinal disease.The animal experiments were performed with the approval of the Royal Perth Hospital Animal Ethics Committee(R535/17-18)on June 1,2017.
文摘Hypertriglyceridaemia(HTG) is a risk factor for cardiovascular disease(CVD) in type 2 diabetes and is caused by the interaction of genes and non-genetic factors, specifically poor glycaemic control and obesity. In spite of statin treatment, residual risk of CVD remains high in type 2 diabetes, and this may relate to HTG and atherogenic dyslipidemia. Treatment of HTG emphasises correcting secondary factors and adverse lifestyles, in particular, diet and exercise. Pharmacotherapy is also required in most type 2 diabetic patients. Statins are the first-line therapy to achieve recommended therapeutic targets of plasma low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. Fibrates, ezetimibe and n-3 fatty acids are adjunctive treatment options for residual and persistent HTG. Evidence for the use of niacin has been challenged by non-significant CVD outcomes in two recent large clinical trials. Further investigation is required to clarify the use of incretin-based therapies for HTG in type 2 diabetes. Extreme HTG, with risk of pancreatitis, may require insulin infusion therapy or apheresis.New therapies targeting HTG in diabetes need to be tested in clinical endpoint trials. The purpose of this review is to examine the current evidence and provide practical guidance on the management of HTG in type 2 diabetes.
基金Supported by Award Numbers U01 HL062509 and U01 HL062511 from the National Heart,Lung,And Blood Institute
文摘AIM:To study if impaired renal function is associated with increased risk of peri-infarct heart failure (HF) in patients with preserved ejection fraction (EF).METHODS:Patients with occluded infarct-related arteries (IRAs) between 1 to 28 d after myocardial infarction (MI) were grouped into chronic kidney disease (CKD) stages based on estimated glomerular filtration rate (eGFR).Rates of early post-MI HF were compared among eGFR groups.Logistic regression was used to explore independent predictors of HF.RESULTS:Reduced eGFR was present in 71.1% of 2160 patients,with significant renal impairment (eGFR < 60 mL/min every 1.73 m2) in 14.8%.The prevalence of HF was higher with worsening renal function:15.5%,17.8% and 29.4% in patients with CKD stages 1,2 and 3 or 4,respectively (P < 0.0001),despite a small absolute difference in mean EF across eGFR groups:48.2 ± 10.0,47.9 ± 11.3 and 46.2 ± 12.1,respectively (P=0.02).The prevalence of HF was again higher with worsening renal function among patients with preserved EF:10.1%,13.6% and 23.6% (P < 0.0001),but this relationship was not significant among patients with depressed EF:27.1%,26.2% and 37.9% (P= 0.071).Moreover,eGFR was an independent correlate of HF in patients with preserved EF (P=0.003) but not in patients with depressed EF (P=0.181).CONCLUSION:A significant proportion of post-MI patients with occluded IRAs have impaired renal function.Impaired renal function was associated with an increased rate of early post-MI HF,the association being strongest in patients with preserved EF.These findings have implications for management of peri-infarct HF.
文摘Background and Purpose - Epidemiological and laboratory studies suggest that increasing concentrations of plasma homocysteine (total homocysteine [tHcy]) accelerate cardiovascular disease by promoting vascular inflammation, endothelial dysfunction, and hypercoagulability. Methods - We conducted a randomized controlled trial in 285 patients with recent transient ischemic attack or stroke to examine the effect of lowering tHcy with folic acid 2 mg, vitamin B12 0.5 mg, and vitamin B6 25 mg compared with placebo on laboratory markers of vascular inflammation, endothelial dysfunction, and hypercoagulability. Results - At 6 months after randomization, there was no significant difference in blood concentrations of markers of vascular inflammation (high- sensitivity C- reactive protein [P=0.32]; soluble CD40L [P=0.33]; IL- 6 [P=0.77]), endothelial dysfunction (vascular cell adhesion molecule- 1 [P=0.27]; intercellular adhesion molecule- 1 [P=0.08]; von Willebrand factor [P=0.92]), and hypercoagulability (P- selectin [P=0.33]; prothrombin fragment 1 and 2 [P=0.81]; D- dimer [P=0.88]) among patients assigned vitamin therapy compared with placebo despite a 3.7- μ mol/L (95% CI, 2.7 to 4.7) reduction in total homocysteine (tHcy). Conclusions - Lowering tHcy by 3.7 μ mol/L with folic acidbased multivitamin therapy does not significantly reduce blood concentrations of the biomarkers of inflammation, endothelial dysfunction, or hypercoagulability measured in our study. The possible explanations for our findings are: (1) these biomarkers are not sensitive to the effects of lowering tHcy (eg, multiple risk factor interventions may be required); (2) elevated tHcy causes cardiovascular disease by mechanisms other than the biomarkers measured; or (3) elevated tHcy is a noncausal marker of increased vascular risk.
文摘Objective: To assess effects of multifactorial lifestyle modifi-cation on antihypertensive drug needs in treated hypertensive individuals. Design: Randomized controlled trial. Setting:Research studies unit. Participants: Overweight hypertensive patients, receiving one or two antihypertensive drugs, were recruited by advertising, and allocated randomly to a usual care group(controls; n=118) or a lifestyle modification group(programme group; n=123). Intervention: A 4-month programme of weight loss, a low-sodium ‘Dietary Approaches to Stop Hypertension’-type diet with added fish, physical activity and moderation of alcohol intake. After 4 months, if mean 24-h ambulatory blood pressure(ABP) was less than 135/85 mmHg, antihypertensive drugs were withdrawn over 4 weeks and long-term home blood pressure monitoring was begun. Main outcome measures: Antihypertensive drug requirements, ABP, weight, waist girth at 4 months and 1-year follow-up. Results: Ninety control group and 102 programme group participants completed the study. Mean 24-h ABP changed after 4 months by-1.0/-0.3±0.5/0.4 mmHg in controls and-4.1/-2.1±0.7/0.5 mmHg with the lifestyle programme(P< 0.01). At follow-up, changes in the two groups were not significantly different(4.1/1.3±1.1/1.0 mmHg in controls; 2.5/-0.1±1.1/0.8 mmHg in the programme group; P=0.73). At 4 months, drug withdrawal differed significantly between the groups(P=0.038) in men(control 44%; programme 66%) but not in women(65 and 64%, respectively; P=0.964). At follow-up, sex-related differences were not significant, and 41%in the control group and 43%in the programme group maintained drug-withdrawal status. With the programme, net weight loss was 3.3 kg(P< 0.001) at 4 months and 3.0 kg(P< 0.001) at follow-up; respective net decreases in waist girth were 3.3 cm(P< 0.001) and 3.5 cm(P< 0.001). Conclusions: A 4-month multifactorial lifestyle modification in patients with treated hypertension reduced blood pressure in the short-term. Decreased central obesity persisted 1 year later and could reduce overall cardiovascular risk.
文摘Norepinephrine(NE;also known as noradrenaline)is the body’s primary adrenergic neurotransmitter which belongs to the catecholamine family.Norepinephrine has pharmacologic effects on theα1(Suita et al.,2015),α2(Schwartz,1997),β1,β2 andβ3(Tsukada et al.,2003)adrenoceptors.In the brain,norepinephrine increases arousal and alertness,promotes vigilance,enhances formation and retrieval of memory,and focuses attention.It also increases restlessness and anxiety.In the remainder of the body,norepinephrine increases heart rate and blood pressure,triggers the release of glucose from energy stores,increases blood flow to skeletal muscle and increases muscle contraction,reduces blood flow to the gastrointestinal system and its motility and lastly,inhibits voiding of the bladder(Goldstein,2010).This last point is particularly interesting in the context of this perspective piece.
文摘Objective:This study aimed to evaluate the safety and efficacy outcomes of percutaneous radiofrequency ablation(RFA)for localised renal cell carcinoma(RCC)in a tertiary hospital patient who remained unfit for surgical intervention.Methods:We retrospectively analysed survival outcomes for patients with biopsy proven RCC treated by RFA at Royal Perth Hospital between September 2009 and May 2018.Complication data were gathered for all patients that underwent renal RFA along with 2-and 5-year recurrence-free survival(RFS)rate and compared the outcomes with data from previous studies.Results:A total of 69 patients(73 procedures)were eligible for the study,and those patients had biopsy-proven RCC with a minimum of 2-year follow-up.The complication rate was 8.2%(6/73)and local recurrence rate 9.6%(7/73).Two-year RFS is 95.7% and 5-year RFS is 78.8% on a median 3.82-year follow-up(interquartile range 1.90-5.75 years).Conclusion:RFA performed at our centre was found to be safe and effective with low complication rates and durable RFS in line with expectations from existing research.Our study demonstrated that RFA is an alternative modality of treatment for small renal tumours in patients unfit for surgical approach.
文摘Lung transplantation has been a method for treating end stage lung disease for decades. Despite improvements in the preoperative assessment of recipients and donors as well as improved surgical techniques, lung transplant recipients are still at a high risk of developing postoperative complications which tend to impact negatively the patients' outcome if not recognised early. The recognised complications post lung transplantation can be broadly categorised into acute and chronic complications. Recognising the radiological features of these complications has a significant positive impact on patients' survival post transplantation. This manuscript provides a comprehensive review of the radiological features of post lung transplantations complications over a time continuum.
基金the Neurotrauma Research Program of Western Australia.
文摘Delivery of a peptide(APP96-110),derived from amyloid precursor protein(APP),has been shown to elicit neuroprotective effects following cerebral stroke and traumatic brain injury.In this study,the effect of APP96-110 or a mutant version of this peptide(mAPP96-110)was assessed following moderate(200 kdyn,(2 N))thoracic contusive spinal cord injury(SCI)in adult Nude rats.Animals received a single tail vein injection of APP96-110 or mAPP96-110 at 30 minutes post-SCI and were then assessed for functional improvements over the next 8 weeks.A cohort of animals also received transplants of either viable or non-viable human mesenchymal stromal cells(hMSCs)into the SC lesion site at one week post-injury to assess the effect of combining intravenous APP96-110 delivery with hMSC treatment.Rats were perfused 8 weeks post-SCI and longitudinal sections of spinal cord analyzed for a number of factors including hMSC viability,cyst size,axonal regrowth,glial reactivity and macrophage activation.Analysis of sensorimotor function revealed occasional significant differences between groups using Ladderwalk or Ratwalk tests,however there were no consistent improvements in functional outcome after any of the treatments.mAPP96-110 alone,and APP96-110 in combination with both viable and non-viable hMSCs significantly reduced cyst size compared to SCI alone.Combined treatments with donor hMSCs also significantly increased βIII tubulin^(+),glial fibrillary acidic protein(GFAP^(+))and laminin+expression,and decreased ED1^(+)expression in tissues.This preliminary study demonstrates that intravenous delivery of APP96-110 peptide has selective,modest neuroprotective effects following SCI,which may be enhanced when combined with hMSC transplantation.However,the effects are less pronounced and less consistent compared to the protective morphological and cognitive impact that this same peptide has on neuronal survival and behaviour after stroke and traumatic brain injury.Thus while the efficacy of a particular therapeutic approach in one CNS injury model may provide justification for its use in other neurotrauma models,similar outcomes may not necessarily occur and more targeted approaches suited to location and severity are required.All animal experiments were approved by The University of Western Australia Animal Ethics Committee(RA3/100/1460)on April 12,2016.
文摘AIM:To examined the efficacy and safety of treatment with boceprevir,PEGylated-interferon and ribavirin(PR)in hepatitis C virus genotype 1(HCVGT1) PR treatmentfailures in Asia.METHODS:The Boceprevir Named-Patient Program provided boceprevir to HCVGT1 PR treatment-failures.Participating physicians were invited to contribute data from their patients:baseline characteristics,ontreatment responses,sustained virological response at week 12(SVR12),and safety were collected and analysed.Multivariate analysis was performed to determine predictors of response.RESULTS:150 patients were enrolled from Australia,Malaysia,Singapore and Thailand(Asians = 86,Caucasians = 63).Overall SVR12 was 61%(Asians= 59.3%,Caucasians = 63.5%).SVR12 was higher in relapsers(78%) compared with non-responders(34%).On-treatment responses predicted SVR,with undetectable HCVRNA at week 4,8 and 12 leading to SVR12 s of 100%,87%,and 82%respectively,and detectable HCVRNA at week 4,8 and 12,leading to SVR12 s of 58%,22%and 6%respectively.Asian patients were similar to Caucasian patients with regards to on-treatment responses.Patients with cirrhosis(n= 69) also behaved in the same manner with regards to on-treatment responses.Those with the IL28 B CC genotype(80%) had higher SVRs than those with the CT/TT(56%) genotype(P = 0.010).Multivariate analysis showed that TW8 and TW12 responses were independent predictors of SVR.Serious adverse events occurred in 18.6%:sepsis(2%),decompensation(2.7%) and blood transfusion(14%).Discontinuations occurred in 30.7%,with 18.6%fulfilling stopping rules.CONCLUSION:Boceprevir can be used successfully in PR treatment failures with a SVR12 > 80%if they have good on-treatment responses;however,discontinuations occurred in 30%because of virological failure or adverse events.
文摘Objective:To determine the incidence of culture-positive urinary tract infection(UTI)after micturating cystourethrogram(MCUG).We further wanted to identify risk factors for developing a culture-positive UTI following MCUG.Methods:A retrospective review of the available medical records of 500 paediatric patients who underwent MCUG in Perth,Western Australia was performed.Results:Seven(1.4%)patients comprised of four females and three males developed a febrile,culture-positive UTI within 14 days following MCUG.Significant association was found for female patients,patients with neurogenic bladder,and patients with previous culture-positive UTI as developing a culture-positive UTI following MCUG.Multivariate logistic regression determined that patients were more likely to develop culture-positive UTI within 14 days following MCUG if they had a known history of UTI(odds ratio:5.0,95%confidence interval:1.5-17.3,p=0.010)or had a neurogenic bladder(odds ratio:4.2,95%confidence interval:1.0-17.9,p=0.049).Conclusion:The incidence of patients who developed a febrile,culture-positive UTI following MCUG was low at 1.4%.Statistically significant and independent associations for the development of culture positive UTI were found in patients with neurogenic bladder and patients with previous culture-positive UTI.Further prospective studies are necessary to determine necessity of prophylactic antibiotics for high-risk patients,e.g.,patients with neurogenic bladder or previous culture-positive UTI.
文摘Introduction: An observation was made that when removing self-tapping cortical screws from patients bones, stripping or shearing of the head of the screw occurred more often in screws whose cutting flutes sat in cortical bone compared with screws that had penetrated the distal cortex with flutes exposed. Method: A model was designed to simulate screws with their cutting flutes either in contact with cortical bone or deep to cortical bone. Screws were grouped depending on the location of their cutting flutes and removal torque was measured. Results: Eighteen screws were included in final analysis. There was a statistically significant difference in average initial removal torque and average maximal removal torque with screws with their cutting flutes in substrate requiring significantly more torque to remove. Conclusion: We conclude that self-tapping cortical screws whose cutting flutes sit in cortical substrate require more torque to remove and are therefore more likely to fail. This finding may be used as a guide in pre-operative planning for removal of metalwork from patients.
文摘New surgical techniques for coronary artery bypass graft （CABG） have been explored in order to minimize disfiguring scars, avoid cardiopulmonary bypass and decrease hospital residence and costs etc. Improved surgical expense can perform the procedures in some high-risk patients such as poor left ventricular function, redo CABG, advanced age and renal dysfunction etc. Intraoperatively there is an obligatory period of myocardial ischemia, which may lead to significant hemodynamic consequences. It is a quite challenge to anesthetist in managing the intraoperative patient.
文摘With the advancement of medical technique and application of the new immunosuppressant agents, cardiac transplantation has become an effective treatment for end-stage heart disease caused by different reasons. The orthotopic procedure has been performed in many countries nowadays. Whether it is successful or not mainly depends on harvesting the denoted heart, operative technique and perioperative management.
文摘Intra-articular disorders of the hip in the elite athlete are common and potentially career threatening. Hip arthroscopy has been shown to be a safe and successful method of treating these conditions. This study examines the effectiveness of hip arthroscopy in facilitating an early return to professional level sport. We prospectively followed 65 professional athletes (mostly Australian Rules Football players) before and after hip arthroscopy using the Modified Harris Hip Score (MHS) and the Non-Arthritic Hip (NAH) Score. We followed them to the 1 year mark and recorded the time required for them to return to sport. Follow-up was achieved in 100% of patients. Intraoperative findings included femoroacetabular impingement, labral pathology and ligamentumteres injuries. Both MHS and NAH Scores showed highly statistically significant improvements up to the 1 year mark. All but 3 athletes returned to professional level sport. The mean return to sport time was 11.9 weeks. The use of arthroscopy to manage common intra-articular hip disorders in elite athletes is safe, effective and facilitates an early return to sport.
