AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).
Dear editor,Patients with supraventricular tachycardia(SVT)commonly present to the emergency department(ED).Current guidelines[1,2]do not recommend routine pathology testing and a report on the topic has questioned th...Dear editor,Patients with supraventricular tachycardia(SVT)commonly present to the emergency department(ED).Current guidelines[1,2]do not recommend routine pathology testing and a report on the topic has questioned their role.A systematic review concluded that troponin testing is commonly performed with a high proportion of positive fi ndings,but these results were not associated with major adverse cardiac events.[3]The conclusions of this review were limited by paucity of data and heterogeneity among studies.展开更多
Application of surgical endoscope, used alone or in combination with the surgical microscope, for the operative management of ear and temporal bone conditions may allow improved access and clearance of disease. Preser...Application of surgical endoscope, used alone or in combination with the surgical microscope, for the operative management of ear and temporal bone conditions may allow improved access and clearance of disease. Preservation of normal structures may also be improved.As the use of this tool is increasing, the need for better understanding of the anatomy of the ear is becoming evident. This is particularly so for endoscopic surgery aiming at removal of lesions involving the infra-cochlear corridor and/or petrous apex.Human temporal bone-derived labyrinth casts(molds), originally made for endolymphatic duct and sac analysis which genuinely represent the membranous labyrinth and its adjacent soft tissues, were morphometrically analyzed in terms of the anatomic relations between structures in and around the infra-cochlear corridor. The distance between the petrous carotid artery(PCA) and the basal turn of the cochlea, the distance between PCA and infra-cochlear vein(ICV)/cochlear aqueduct(CA), and the distance between the lower surface of basal cochlear turn and the point where the carotid artery and jugular vein(JV) meet close to the jugular foramen, were measured to be around 1.3 mm, 6 mm and 8 mm respectively, thus constituting an approximate 6?8 mm2 infra-cochlear corridor. This analysis and further study with larger samples might be helpful for operation via this corridor led to the petrous apex where cholesterol granuloma, cholesteatoma and other lesions are not uncommon.展开更多
In the last 15 years the management of inflammatory bowel disease has evolved greatly,largely through the increased use of immunomodulators and,especially,anti-tumor necrosis factor(anti-TNF) biologic agents. Within t...In the last 15 years the management of inflammatory bowel disease has evolved greatly,largely through the increased use of immunomodulators and,especially,anti-tumor necrosis factor(anti-TNF) biologic agents. Within this time period,confidence in the use of anti-TNFs has increased,whilst,especially in recent years,the efficacy and safety of thiopurines has been questioned. Yet despite recent concerns regarding the risk: benefit profile of thiopurines,combination therapy with an immunomodulator and an anti-TNF has emerged as the recommended treatment strategy for the majority of patients with moderate-severe disease,especially those who are recently diagnosed. Concurrently,therapeutic drug monitoring has emerged as a means of optimizing the dosage of both immunomodulators and antiTNFs. However the recommended therapeutic target levels for both drug classes were largely derived from studies of monotherapy with either agent,or studies underpowered to analyze outcomes in combination therapy patients. It has been assumed that these target levels are applicable to patients on combination therapy also,however there are few data to support this. Similarly,the timing and duration of treatment with immunomodulators when used in combination therapy remains unknown. Recent attention,including post hoc analyses of the pivotal registration trials,has focused on the optimization of anti-TNF agents,when used as either monotherapy or combination therapy. This review will instead focus on how best to optimize immunomodulators when used in combination therapy,including an evaluation of recent data addressing unanswered questions regarding the optimal timing,dosage and duration of immunomodulator therapy in combination therapy patients.展开更多
Coronary artery disease(CAD)screening and diagnosis are core cardiac specialty services.From symptoms,autopsy correlations supported reductions in coronary blood flow and dynamic epicardial and microcirculatory corona...Coronary artery disease(CAD)screening and diagnosis are core cardiac specialty services.From symptoms,autopsy correlations supported reductions in coronary blood flow and dynamic epicardial and microcirculatory coronaries artery disease as etiologies.While angina remains a clinical diagnosis,most cases require correlation with a diagnostic modality.At the onset of the evidence building process much research,now factored into guidelines were conducted among population and demographics that were homogenous and often prior to newer technologies being available.Today we see a more diverse multi-ethnic population whose characteristics and risks may not consistently match the populations from which guideline evidence is derived.While it would seem veryunlikely that for the majority,scientific arguments against guidelines would differ,however from a translational perspective,there will be populations who differ and importantly there are cost-efficacy questions,e.g.,the most suitable first-line tests or what parameters equate to an adequate test.This article reviews non-invasive diagnosis of CAD within the context of multi-ethnic patient populations.展开更多
Patients presenting with abdominal pain and diarrhea are often labelled as suffering from irritable bowel syndrome,and medications may be used often without success. Advances in the understanding of the causes of the ...Patients presenting with abdominal pain and diarrhea are often labelled as suffering from irritable bowel syndrome,and medications may be used often without success. Advances in the understanding of the causes of the symptoms(including pelvic floor weakness and incontinence,bile salt malabsorption and food intolerance) mean that effective,safe and well tolerated treatments are now available.展开更多
Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie’s disease.Currently,there is a variety of options for the correction of residual curvature,i...Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie’s disease.Currently,there is a variety of options for the correction of residual curvature,including penile modeling,plication techniques,as well as tunical incision/excision with or without grafting.A literature search of PubMed and Medline databases was conducted from 1964 until 2020,using search terms for all articles in the English language.In this article,we provide a review of the techniques and the outcomes,according to the published literature.展开更多
Background:A greater prevalence of arrhythmias has been described in endurance athletes,but it remains unclear whether this risk persists after detraining.We aimed to evaluate the prevalence of arrhythmias and their r...Background:A greater prevalence of arrhythmias has been described in endurance athletes,but it remains unclear whether this risk persists after detraining.We aimed to evaluate the prevalence of arrhythmias and their relationship with cardiac remodeling in lifelong and retired master endurance athletes compared to non-athletic controls.Methods:We performed a cross-sectional analysis of observational studies that used echocardiography and cardiac magnetic resonance to detail cardiac structure and function,and Holter monitors to identify atrial and ventricular arrhythmias in 185 endurance athletes and 81 non-athletic controls aged≥40 years.Athletes were categorized as active lifelong(n=144)or retired(n=41)based on hours per week of high-intensity endurance exercise within 5 years of enrollment and validated by percentage of predicted maximal oxygen consumption(VO_(2max)).Athletes with overt cardiomyopathies,channelopathies,pre-excitation,and/or myocardial infarction were excluded.Results:Lifelong athletes(median age=55 years(interquartile range(IQR):46-62),79%male)were significantly fitter than retired athletes(median age=66 years(IQR:58-71),95%male)and controls(median age=53 years(IQR:48-60),96%male),respectively(predicted VO_(2max):131%±18%vs.99%±14%vs.98%±15%,p<0.001).Compared to controls,athletes in our cohort had a higher prevalence of atrial fibrillation((AF):32%vs.0%,p<0.001)and non-sustained ventricular tachycardia((NSVT):9%vs.1%,p=0.007).There was no difference in prevalence of any arrhythmia between lifelong and retired athletes.Lifelong athletes had larger ventricular volumes than retired athletes,who had ventricular volumes similar to controls(left ventricular end-diastolic volume indexed to body surface area(LVEDVi):101±20 m L/m^(2)vs.86±16 mL/m^(2)vs.94±18 mL/m^(2),p<0.001;right ventricular end-diastolic volume indexed to body surface area(RVEDVi):117±23 mL/m^(2)vs.101±19 mL/m^(2)vs.100±19 mL/m^(2),p<0.001).Athletes had more scar(40%vs.18%,p=0.002)and larger left atria(median volume=45m L/m^(2)(IQR:38-52)vs.31 mL/m^(2)(IQR:25-38),p<0.001)than controls,with no difference in atrial volumes and non-ischaemic scar between the athlete groups.Conclusion:Master endurance athletes have a higher prevalence of AF and NSVT than non-athletic controls.Whereas ventricular remodeling tends to reverse with detraining,the propensity to arrhythmias persists regardless of whether they are actively exercising or retired.展开更多
Acute cardiomyocyte necrosis in the infarcted heart generates damage-associated molecular patterns, activating complement and toll-like receptor/interleukin-1 signaling, and triggering an intense inflammatory response...Acute cardiomyocyte necrosis in the infarcted heart generates damage-associated molecular patterns, activating complement and toll-like receptor/interleukin-1 signaling, and triggering an intense inflammatory response. Iuflammasomes also recognize danger signals and mediate sterile inflammatory response following acute myocardial infarction （AMI）, Inflammatory response serves to repair the heart, but excessive inflammation leads to adverse left ventricular remodeling and heart failure. In addition to local inflammation, profound systemic inflammation response has been documented in patients with AMI, which includes elevation of circulating inflammatory cytokines, chemokines and cell adhesion molecules, and activation of peripheral leukocytes and platelets. The excessive inflammatory response could be caused by a deregulated immune system. AMI is also associated with bone marrow activation and spleen monocytopoiesis, which sustains a continuous supply of monocytes at the site of inflammation. Accumulating evidence has shown that systemic inflammation aggravates atherosclerosis and markers for systemic inflammation are predictors of adverse clinical outcomes （such as death, recurrent myocardial in- farction, and heart failure） in patients with AMI.展开更多
Immune and inflammatory responses have been known to play an important role in the initiation, progression and destabilization of atherosclerosis. Chronic inflammatory diseases such as rheumatoid arthritis and probabl...Immune and inflammatory responses have been known to play an important role in the initiation, progression and destabilization of atherosclerosis. Chronic inflammatory diseases such as rheumatoid arthritis and probably inflammatory bowel diseases such as Crohn＇s disease which are associated with systemic inflammation also appear to increase the likelihood of clinically manifest atherosclerotic vascular disease. Acute myocardial infarction （AMI） triggers an intense acute inflammatory response both locally and systemically. However, the differences in systemic immune and inflammatory response between AMI and chronic phase of atherosclerosis are not fully understood.展开更多
Gastrointestinal ultrasound is a practical,safe,cheap and reproducible diagnostic tool in inflammatorybowel disease gaining global prominence amongst clinicians.Understanding the embryological processes of the intesti...Gastrointestinal ultrasound is a practical,safe,cheap and reproducible diagnostic tool in inflammatorybowel disease gaining global prominence amongst clinicians.Understanding the embryological processes of the intestinal tract assists in the interpretation of abnormal sonographic findings.In general terms,the examination principally comprises interrogation of the colon,mesentery and small intestine using both lowfrequency and high-frequency probes.Interpretation of findings on GIUS includes assessment of bowel wall thickness,symmetry of this thickness,evidence of transmural changes,assessment of vascularity using Doppler imaging and assessment of other specific features including lymph nodes,mesentery and luminal motility.In addition to B-mode imaging,transperineal ultrasonography,elastography and contrast-enhanced ultrasonography are useful adjuncts.This supplement expands upon these features in more depth.展开更多
Severe traumatic brain injury remains a major health-care problem worldwide. Although major progress has been made in understanding of the pathophysiology of this injury,this has not yet led to substantial improvement...Severe traumatic brain injury remains a major health-care problem worldwide. Although major progress has been made in understanding of the pathophysiology of this injury,this has not yet led to substantial improvements in outcome. In this report,we address present knowledge and its limitations,research innovations,and clinical implications. Improved outcomes for patients with severe traumat- ic brain injury could result from progress in pharmacological and other treatments,neural repair and regeneration,optimisation of surgical indications and techniques,and combination and individually targeted treatments. Expanded classification of traumatic brain injury and in- novations in research design will underpin these advances. We are optimistic that further gains in outcome for patients with severe traumat- ic brain injury will be achieved in the next decade.展开更多
BACKGROUND:The use of staged liver resections for colorectal metastases has been increasing in recent times.The aim of this study was to determine the practices and outcomes of those surgeons attending the Australia a...BACKGROUND:The use of staged liver resections for colorectal metastases has been increasing in recent times.The aim of this study was to determine the practices and outcomes of those surgeons attending the Australia and New Zealand Hepatic, Pancreatic and Biliary Association(ANZHPBA)meeting in 2008 who perform staged resections. METHODS:A questionnaire was sent to all members of the ANZHPBA and the international faculty who were invited to attend the annual meeting held in Coolum,Queensland, Australia in October 2008. RESULTS:There were 30 responses from 7 centres across the UK,Germany and Australia.Twenty-eight patients completed treatment.The study population was predominantly male (n=20,67%),with an average age of 59.4 years.All patients had bilobar disease.A right-sided first resection was planned in 39%of cases.Seventeen percent of patients underwent portal vein embolization prior to first resection.A second operation was performed at an average of 2.8 months from the first resection.Overall,50%(n=14)of patients eventually achieved a complete(R0)staged procedure.Twelve complications after the first resection were seen in 32%patients(n=9).Twenty- three patients underwent a second liver resection.Twenty-five complications after the second resection were present in 57% (n=13). CONCLUSIONS:Two-stage liver resections are beneficial if both stages are completed and an R0 resection is achieved. While there is increased morbidity and mortality,we believe that staged liver resection for colorectal metastases is a valuable strategy in selected cases.展开更多
Purpose:Injuries are one of the leading causes of death and lead to a high social and financial burden.Injury patterns can vary significantly among different age groups and body regions.This study aimed to evaluate th...Purpose:Injuries are one of the leading causes of death and lead to a high social and financial burden.Injury patterns can vary significantly among different age groups and body regions.This study aimed to evaluate the relationship between mechanism of injury,patient comorbidities and severity of injuries.Methods:The study included trauma patients from July 2016 to June 2018,who were admitted to Sina Hospital,Tehran,Iran.The inclusion criteria were all injured patients who had at least one of the following:hospital length of stay more than 24 h,death in hospital,and transfer from the intensive care unit of another hospital.Data collection was performed using the National Trauma Registry of Iran minimum dataset.Results:The most common injury mechanism was road traffic injuries(49.0%),followed by falls(25.5%).The mean age of those who fell was significantly higher in comparison with other mechanisms(p<0.001).Severe extremity injuries occurred more often in the fall group than in the vehicle collision group(69.0%vs.43.5%,p<0.001).Moreover,cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls(27.8%vs.12.9%,p=0.003).Conclusion:Comparing falls with motor vehicle collisions,patients who fell were older and sustained more extremity injuries.Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls.Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.展开更多
AIM To systematically review reports on deceased-donor-lobar lung transplantation(dd LLTx) and uniformly describe sizematching using the donor-to-recipient predicted-total lung-capacity(pT LC) ratio. METHODS We set ou...AIM To systematically review reports on deceased-donor-lobar lung transplantation(dd LLTx) and uniformly describe sizematching using the donor-to-recipient predicted-total lung-capacity(pT LC) ratio. METHODS We set out to systematically review reports on ddL LTx and uniformly describe size matching using the donorto-recipient pT LC ratio and to summarize reported oneyear survival data of ddL LTx and conventional-LTx. We searched in Pub Med, CINAHL via EBSCO, Cochrane Database of Systematic Reviews via Wiley(CDSR),Database of Abstracts of Reviews of Effects via Wiley(DARE), Cochrane Central Register of Controlled Trials via Wiley(CENTRAL), Scopus(which includes EMBASE abstracts), and Web of Science for original reports on ddL LTx. RESULTS Nine observational cohort studies reporting on 301 ddL LTx met our inclusion criteria for systematic review of size matching, and eight for describing one-year-survival. The dd LLTx-group was often characterized by high acuity;however there was heterogeneity in transplant indications and pre-operative characteristics between studies. Data to calculate the pT LC ratio was available for 242 ddL LTx(80%). The mean pT LCratio before lobar resection was1.25 ± 0.3 and the transplanted pT LCratio after lobar resection was 0.76 ± 0.2. One-year survival in the ddL LTxgroup ranged from 50%-100%, compared to 72%-88%in the conventional-LTx group. In the largest study ddL LTx(n = 138) was associated with a lower one-year-survival compared to conventional-LTx(n = 539)(65.1% vs84.1%, P < 0.001). CONCLUSION Further investigations of optimal donor-to-recipient size matching parameters for ddL LTx could improve outcomes of this important surgical option.展开更多
BACKGROUND Vedolizumab(VDZ),a humanised monoclonal antibody that selectively inhibits alpha4-beta7 integrins is approved for use in adult moderate to severe ulcerative colitis(UC)patients.AIM To assess the efficacy an...BACKGROUND Vedolizumab(VDZ),a humanised monoclonal antibody that selectively inhibits alpha4-beta7 integrins is approved for use in adult moderate to severe ulcerative colitis(UC)patients.AIM To assess the efficacy and safety of VDZ in the real-world management of UC in a large multicenter cohort involving two countries and to identify predictors of achieving remission.METHODS A retrospective review of Australian and Oxford,United Kingdom data for UC patients.Clinical response at 3 mo,endoscopic remission at 6 mo and clinical remission at 3,6 and 12 mo were assessed.Cox regression models and Kaplan Meier curves were performed to assess the time to remission,time to failure and the covariates influencing them.Safety outcomes were recorded.RESULTS Three hundred and three UC patients from 14 centres in Australia and United Kingdom,[60%n=182,anti-TNF naïve]were included.The clinical response was 79%at 3 mo with more Australian patients achieving clinical response compared to Oxford(83%vs 70%P=0.01).Clinical remission for all patients was 56%,62%and 60%at 3,6 and 12 mo respectively.Anti-TNF naive patients were more likely to achieve remission than exposed patients at all the time points(3 mo 66%vs 40%P<0.001,6 mo 73%vs 46%P<0.001,12 mo 66%vs 51%P=0.03).More Australian patients achieved endoscopic remission at 6 mo compared to Oxford(69%vs 43%P=0.01).On multi-variate analysis,anti-TNF naïve patients were 1.8(95%CI:1.3-2.3)times more likely to achieve remission than anti-TNF exposed(P<0.001).32 patients(11%)had colectomy by 12 mo.CONCLUSION VDZ was safe and effective with 60%of UC patients achieving clinical remission at 12 mo and prior anti-TNF exposure influenced this outcome.展开更多
In this editorial we comment on the article by Pacheco et al published in a recent issue of the World Journal of Gastroenterology.We focus specifically on the burden of illness associated with perianal fistulizing Cr...In this editorial we comment on the article by Pacheco et al published in a recent issue of the World Journal of Gastroenterology.We focus specifically on the burden of illness associated with perianal fistulizing Crohn’s disease(PFCD)and the diagnostic and therapeutic challenges in the management of this condition.Evol-ving evidence has shifted the diagnostic framework for PFCD from anatomical classification systems,to one that is more nuanced and patient-focused to drive ongoing decision making.This editorial aims to reflect on these aspects to help clinicians face the challenge of PFCD in day-to-day clinical practice.展开更多
BACKGROUND:The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2(CRASH-2)is the largest randomized control trial(RCT)examining circulatory resuscitation for trauma patients to date and conclud...BACKGROUND:The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2(CRASH-2)is the largest randomized control trial(RCT)examining circulatory resuscitation for trauma patients to date and concluded a statistically significant reduction in all-cause mortality in patients administered tranexamic acid(TXA)within 3 hours of injury.Since the publication of CRASH-2,significant geographical variance in the use of TXA for trauma patients exists.This study aims to assess TXA use for major trauma patients with hemorrhagic shock in Ireland after the publication of CRASH-2.METHODS:A retrospective cohort study was conducted using data derived from the Trauma Audit and Research Network(TARN).All injured patients in Ireland between January 2013 and December 2018 who had evidence of hemorrhagic shock on presentation(as defined by systolic blood pressure[SBP]<100 mmHg[1 mmHg=0.133 kPa]and administration of blood products)were eligible for inclusion.Death at hospital discharge was the primary outcome.RESULTS:During the study period,a total of 234 patients met the inclusion criteria.Among injured patients presenting with hemorrhagic shock,133(56.8%;95%confidence interval[CI]50.2%–63.3%)received TXA.Of patients that received TXA,a higher proportion of patients presented with shock index>1(70.68%vs.57.43%)and higher Injury Severity Score(ISS>25;49.62%vs.23.76%).Administration of TXA was not associated with mortality at hospital discharge(odds ratio[OR]0.86,95%CI 0.31–2.38).CONCLUSIONS:Among injured Irish patients presenting with hemorrhagic shock,TXA was administered to 56.8%of patients.Patients administered with TXA were on average more severely injured.However,a mortality benefit could not be demonstrated.展开更多
Myopia is a highly prevalent refractive error in Asia(1).Although mild myopia does not have serious ocular ramifications,pathological myopia is associated with the development of various ocular pathologies that can le...Myopia is a highly prevalent refractive error in Asia(1).Although mild myopia does not have serious ocular ramifications,pathological myopia is associated with the development of various ocular pathologies that can lead to irreversible visual loss or blindness(2).The prevalence of visual impairment attributable to pathologic myopia is 0.2-1.4% in Asian populations(3).Over the past few generations,the prevalence of myopia has increased significantly(4).In urbanized areas of East展开更多
文摘AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).
文摘Dear editor,Patients with supraventricular tachycardia(SVT)commonly present to the emergency department(ED).Current guidelines[1,2]do not recommend routine pathology testing and a report on the topic has questioned their role.A systematic review concluded that troponin testing is commonly performed with a high proportion of positive fi ndings,but these results were not associated with major adverse cardiac events.[3]The conclusions of this review were limited by paucity of data and heterogeneity among studies.
文摘Application of surgical endoscope, used alone or in combination with the surgical microscope, for the operative management of ear and temporal bone conditions may allow improved access and clearance of disease. Preservation of normal structures may also be improved.As the use of this tool is increasing, the need for better understanding of the anatomy of the ear is becoming evident. This is particularly so for endoscopic surgery aiming at removal of lesions involving the infra-cochlear corridor and/or petrous apex.Human temporal bone-derived labyrinth casts(molds), originally made for endolymphatic duct and sac analysis which genuinely represent the membranous labyrinth and its adjacent soft tissues, were morphometrically analyzed in terms of the anatomic relations between structures in and around the infra-cochlear corridor. The distance between the petrous carotid artery(PCA) and the basal turn of the cochlea, the distance between PCA and infra-cochlear vein(ICV)/cochlear aqueduct(CA), and the distance between the lower surface of basal cochlear turn and the point where the carotid artery and jugular vein(JV) meet close to the jugular foramen, were measured to be around 1.3 mm, 6 mm and 8 mm respectively, thus constituting an approximate 6?8 mm2 infra-cochlear corridor. This analysis and further study with larger samples might be helpful for operation via this corridor led to the petrous apex where cholesterol granuloma, cholesteatoma and other lesions are not uncommon.
文摘In the last 15 years the management of inflammatory bowel disease has evolved greatly,largely through the increased use of immunomodulators and,especially,anti-tumor necrosis factor(anti-TNF) biologic agents. Within this time period,confidence in the use of anti-TNFs has increased,whilst,especially in recent years,the efficacy and safety of thiopurines has been questioned. Yet despite recent concerns regarding the risk: benefit profile of thiopurines,combination therapy with an immunomodulator and an anti-TNF has emerged as the recommended treatment strategy for the majority of patients with moderate-severe disease,especially those who are recently diagnosed. Concurrently,therapeutic drug monitoring has emerged as a means of optimizing the dosage of both immunomodulators and antiTNFs. However the recommended therapeutic target levels for both drug classes were largely derived from studies of monotherapy with either agent,or studies underpowered to analyze outcomes in combination therapy patients. It has been assumed that these target levels are applicable to patients on combination therapy also,however there are few data to support this. Similarly,the timing and duration of treatment with immunomodulators when used in combination therapy remains unknown. Recent attention,including post hoc analyses of the pivotal registration trials,has focused on the optimization of anti-TNF agents,when used as either monotherapy or combination therapy. This review will instead focus on how best to optimize immunomodulators when used in combination therapy,including an evaluation of recent data addressing unanswered questions regarding the optimal timing,dosage and duration of immunomodulator therapy in combination therapy patients.
文摘Coronary artery disease(CAD)screening and diagnosis are core cardiac specialty services.From symptoms,autopsy correlations supported reductions in coronary blood flow and dynamic epicardial and microcirculatory coronaries artery disease as etiologies.While angina remains a clinical diagnosis,most cases require correlation with a diagnostic modality.At the onset of the evidence building process much research,now factored into guidelines were conducted among population and demographics that were homogenous and often prior to newer technologies being available.Today we see a more diverse multi-ethnic population whose characteristics and risks may not consistently match the populations from which guideline evidence is derived.While it would seem veryunlikely that for the majority,scientific arguments against guidelines would differ,however from a translational perspective,there will be populations who differ and importantly there are cost-efficacy questions,e.g.,the most suitable first-line tests or what parameters equate to an adequate test.This article reviews non-invasive diagnosis of CAD within the context of multi-ethnic patient populations.
文摘Patients presenting with abdominal pain and diarrhea are often labelled as suffering from irritable bowel syndrome,and medications may be used often without success. Advances in the understanding of the causes of the symptoms(including pelvic floor weakness and incontinence,bile salt malabsorption and food intolerance) mean that effective,safe and well tolerated treatments are now available.
文摘Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie’s disease.Currently,there is a variety of options for the correction of residual curvature,including penile modeling,plication techniques,as well as tunical incision/excision with or without grafting.A literature search of PubMed and Medline databases was conducted from 1964 until 2020,using search terms for all articles in the English language.In this article,we provide a review of the techniques and the outcomes,according to the published literature.
基金funded by the National Health and Medical Research Council of Australia(Grant No.APP1130353)supported by a Royal Australian College of Physicians Research Entry Scholarship(Grant No.2023RES00039)+4 种基金The National Health and Medical Research Council Postgraduate Scholarship(Grant No.2031119)a Heart Foundation PhD Scholarship(Grant No.107659)supported through an Australian Government Research Training Program Scholarshipsupported as a postdoctoral clinical researcher by the Fund for Scientific Research Flanderssupported by a National Health and Medical Research Council of Australia Investigator Grant(Grant No.APP 2027105)。
文摘Background:A greater prevalence of arrhythmias has been described in endurance athletes,but it remains unclear whether this risk persists after detraining.We aimed to evaluate the prevalence of arrhythmias and their relationship with cardiac remodeling in lifelong and retired master endurance athletes compared to non-athletic controls.Methods:We performed a cross-sectional analysis of observational studies that used echocardiography and cardiac magnetic resonance to detail cardiac structure and function,and Holter monitors to identify atrial and ventricular arrhythmias in 185 endurance athletes and 81 non-athletic controls aged≥40 years.Athletes were categorized as active lifelong(n=144)or retired(n=41)based on hours per week of high-intensity endurance exercise within 5 years of enrollment and validated by percentage of predicted maximal oxygen consumption(VO_(2max)).Athletes with overt cardiomyopathies,channelopathies,pre-excitation,and/or myocardial infarction were excluded.Results:Lifelong athletes(median age=55 years(interquartile range(IQR):46-62),79%male)were significantly fitter than retired athletes(median age=66 years(IQR:58-71),95%male)and controls(median age=53 years(IQR:48-60),96%male),respectively(predicted VO_(2max):131%±18%vs.99%±14%vs.98%±15%,p<0.001).Compared to controls,athletes in our cohort had a higher prevalence of atrial fibrillation((AF):32%vs.0%,p<0.001)and non-sustained ventricular tachycardia((NSVT):9%vs.1%,p=0.007).There was no difference in prevalence of any arrhythmia between lifelong and retired athletes.Lifelong athletes had larger ventricular volumes than retired athletes,who had ventricular volumes similar to controls(left ventricular end-diastolic volume indexed to body surface area(LVEDVi):101±20 m L/m^(2)vs.86±16 mL/m^(2)vs.94±18 mL/m^(2),p<0.001;right ventricular end-diastolic volume indexed to body surface area(RVEDVi):117±23 mL/m^(2)vs.101±19 mL/m^(2)vs.100±19 mL/m^(2),p<0.001).Athletes had more scar(40%vs.18%,p=0.002)and larger left atria(median volume=45m L/m^(2)(IQR:38-52)vs.31 mL/m^(2)(IQR:25-38),p<0.001)than controls,with no difference in atrial volumes and non-ischaemic scar between the athlete groups.Conclusion:Master endurance athletes have a higher prevalence of AF and NSVT than non-athletic controls.Whereas ventricular remodeling tends to reverse with detraining,the propensity to arrhythmias persists regardless of whether they are actively exercising or retired.
文摘Acute cardiomyocyte necrosis in the infarcted heart generates damage-associated molecular patterns, activating complement and toll-like receptor/interleukin-1 signaling, and triggering an intense inflammatory response. Iuflammasomes also recognize danger signals and mediate sterile inflammatory response following acute myocardial infarction （AMI）, Inflammatory response serves to repair the heart, but excessive inflammation leads to adverse left ventricular remodeling and heart failure. In addition to local inflammation, profound systemic inflammation response has been documented in patients with AMI, which includes elevation of circulating inflammatory cytokines, chemokines and cell adhesion molecules, and activation of peripheral leukocytes and platelets. The excessive inflammatory response could be caused by a deregulated immune system. AMI is also associated with bone marrow activation and spleen monocytopoiesis, which sustains a continuous supply of monocytes at the site of inflammation. Accumulating evidence has shown that systemic inflammation aggravates atherosclerosis and markers for systemic inflammation are predictors of adverse clinical outcomes （such as death, recurrent myocardial in- farction, and heart failure） in patients with AMI.
文摘Immune and inflammatory responses have been known to play an important role in the initiation, progression and destabilization of atherosclerosis. Chronic inflammatory diseases such as rheumatoid arthritis and probably inflammatory bowel diseases such as Crohn＇s disease which are associated with systemic inflammation also appear to increase the likelihood of clinically manifest atherosclerotic vascular disease. Acute myocardial infarction （AMI） triggers an intense acute inflammatory response both locally and systemically. However, the differences in systemic immune and inflammatory response between AMI and chronic phase of atherosclerosis are not fully understood.
文摘Gastrointestinal ultrasound is a practical,safe,cheap and reproducible diagnostic tool in inflammatorybowel disease gaining global prominence amongst clinicians.Understanding the embryological processes of the intestinal tract assists in the interpretation of abnormal sonographic findings.In general terms,the examination principally comprises interrogation of the colon,mesentery and small intestine using both lowfrequency and high-frequency probes.Interpretation of findings on GIUS includes assessment of bowel wall thickness,symmetry of this thickness,evidence of transmural changes,assessment of vascularity using Doppler imaging and assessment of other specific features including lymph nodes,mesentery and luminal motility.In addition to B-mode imaging,transperineal ultrasonography,elastography and contrast-enhanced ultrasonography are useful adjuncts.This supplement expands upon these features in more depth.
文摘Severe traumatic brain injury remains a major health-care problem worldwide. Although major progress has been made in understanding of the pathophysiology of this injury,this has not yet led to substantial improvements in outcome. In this report,we address present knowledge and its limitations,research innovations,and clinical implications. Improved outcomes for patients with severe traumat- ic brain injury could result from progress in pharmacological and other treatments,neural repair and regeneration,optimisation of surgical indications and techniques,and combination and individually targeted treatments. Expanded classification of traumatic brain injury and in- novations in research design will underpin these advances. We are optimistic that further gains in outcome for patients with severe traumat- ic brain injury will be achieved in the next decade.
文摘BACKGROUND:The use of staged liver resections for colorectal metastases has been increasing in recent times.The aim of this study was to determine the practices and outcomes of those surgeons attending the Australia and New Zealand Hepatic, Pancreatic and Biliary Association(ANZHPBA)meeting in 2008 who perform staged resections. METHODS:A questionnaire was sent to all members of the ANZHPBA and the international faculty who were invited to attend the annual meeting held in Coolum,Queensland, Australia in October 2008. RESULTS:There were 30 responses from 7 centres across the UK,Germany and Australia.Twenty-eight patients completed treatment.The study population was predominantly male (n=20,67%),with an average age of 59.4 years.All patients had bilobar disease.A right-sided first resection was planned in 39%of cases.Seventeen percent of patients underwent portal vein embolization prior to first resection.A second operation was performed at an average of 2.8 months from the first resection.Overall,50%(n=14)of patients eventually achieved a complete(R0)staged procedure.Twelve complications after the first resection were seen in 32%patients(n=9).Twenty- three patients underwent a second liver resection.Twenty-five complications after the second resection were present in 57% (n=13). CONCLUSIONS:Two-stage liver resections are beneficial if both stages are completed and an R0 resection is achieved. While there is increased morbidity and mortality,we believe that staged liver resection for colorectal metastases is a valuable strategy in selected cases.
基金This study was funded by Sina Trauma and Surgery Research Center under the project of National Trauma Registry of Iran(NTRI).The contract number was 97-03-38-40539.
文摘Purpose:Injuries are one of the leading causes of death and lead to a high social and financial burden.Injury patterns can vary significantly among different age groups and body regions.This study aimed to evaluate the relationship between mechanism of injury,patient comorbidities and severity of injuries.Methods:The study included trauma patients from July 2016 to June 2018,who were admitted to Sina Hospital,Tehran,Iran.The inclusion criteria were all injured patients who had at least one of the following:hospital length of stay more than 24 h,death in hospital,and transfer from the intensive care unit of another hospital.Data collection was performed using the National Trauma Registry of Iran minimum dataset.Results:The most common injury mechanism was road traffic injuries(49.0%),followed by falls(25.5%).The mean age of those who fell was significantly higher in comparison with other mechanisms(p<0.001).Severe extremity injuries occurred more often in the fall group than in the vehicle collision group(69.0%vs.43.5%,p<0.001).Moreover,cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls(27.8%vs.12.9%,p=0.003).Conclusion:Comparing falls with motor vehicle collisions,patients who fell were older and sustained more extremity injuries.Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls.Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.
基金the Flight Attendant Medical Research Institute (FAMRI)
文摘AIM To systematically review reports on deceased-donor-lobar lung transplantation(dd LLTx) and uniformly describe sizematching using the donor-to-recipient predicted-total lung-capacity(pT LC) ratio. METHODS We set out to systematically review reports on ddL LTx and uniformly describe size matching using the donorto-recipient pT LC ratio and to summarize reported oneyear survival data of ddL LTx and conventional-LTx. We searched in Pub Med, CINAHL via EBSCO, Cochrane Database of Systematic Reviews via Wiley(CDSR),Database of Abstracts of Reviews of Effects via Wiley(DARE), Cochrane Central Register of Controlled Trials via Wiley(CENTRAL), Scopus(which includes EMBASE abstracts), and Web of Science for original reports on ddL LTx. RESULTS Nine observational cohort studies reporting on 301 ddL LTx met our inclusion criteria for systematic review of size matching, and eight for describing one-year-survival. The dd LLTx-group was often characterized by high acuity;however there was heterogeneity in transplant indications and pre-operative characteristics between studies. Data to calculate the pT LC ratio was available for 242 ddL LTx(80%). The mean pT LCratio before lobar resection was1.25 ± 0.3 and the transplanted pT LCratio after lobar resection was 0.76 ± 0.2. One-year survival in the ddL LTxgroup ranged from 50%-100%, compared to 72%-88%in the conventional-LTx group. In the largest study ddL LTx(n = 138) was associated with a lower one-year-survival compared to conventional-LTx(n = 539)(65.1% vs84.1%, P < 0.001). CONCLUSION Further investigations of optimal donor-to-recipient size matching parameters for ddL LTx could improve outcomes of this important surgical option.
文摘BACKGROUND Vedolizumab(VDZ),a humanised monoclonal antibody that selectively inhibits alpha4-beta7 integrins is approved for use in adult moderate to severe ulcerative colitis(UC)patients.AIM To assess the efficacy and safety of VDZ in the real-world management of UC in a large multicenter cohort involving two countries and to identify predictors of achieving remission.METHODS A retrospective review of Australian and Oxford,United Kingdom data for UC patients.Clinical response at 3 mo,endoscopic remission at 6 mo and clinical remission at 3,6 and 12 mo were assessed.Cox regression models and Kaplan Meier curves were performed to assess the time to remission,time to failure and the covariates influencing them.Safety outcomes were recorded.RESULTS Three hundred and three UC patients from 14 centres in Australia and United Kingdom,[60%n=182,anti-TNF naïve]were included.The clinical response was 79%at 3 mo with more Australian patients achieving clinical response compared to Oxford(83%vs 70%P=0.01).Clinical remission for all patients was 56%,62%and 60%at 3,6 and 12 mo respectively.Anti-TNF naive patients were more likely to achieve remission than exposed patients at all the time points(3 mo 66%vs 40%P<0.001,6 mo 73%vs 46%P<0.001,12 mo 66%vs 51%P=0.03).More Australian patients achieved endoscopic remission at 6 mo compared to Oxford(69%vs 43%P=0.01).On multi-variate analysis,anti-TNF naïve patients were 1.8(95%CI:1.3-2.3)times more likely to achieve remission than anti-TNF exposed(P<0.001).32 patients(11%)had colectomy by 12 mo.CONCLUSION VDZ was safe and effective with 60%of UC patients achieving clinical remission at 12 mo and prior anti-TNF exposure influenced this outcome.
文摘In this editorial we comment on the article by Pacheco et al published in a recent issue of the World Journal of Gastroenterology.We focus specifically on the burden of illness associated with perianal fistulizing Crohn’s disease(PFCD)and the diagnostic and therapeutic challenges in the management of this condition.Evol-ving evidence has shifted the diagnostic framework for PFCD from anatomical classification systems,to one that is more nuanced and patient-focused to drive ongoing decision making.This editorial aims to reflect on these aspects to help clinicians face the challenge of PFCD in day-to-day clinical practice.
文摘BACKGROUND:The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2(CRASH-2)is the largest randomized control trial(RCT)examining circulatory resuscitation for trauma patients to date and concluded a statistically significant reduction in all-cause mortality in patients administered tranexamic acid(TXA)within 3 hours of injury.Since the publication of CRASH-2,significant geographical variance in the use of TXA for trauma patients exists.This study aims to assess TXA use for major trauma patients with hemorrhagic shock in Ireland after the publication of CRASH-2.METHODS:A retrospective cohort study was conducted using data derived from the Trauma Audit and Research Network(TARN).All injured patients in Ireland between January 2013 and December 2018 who had evidence of hemorrhagic shock on presentation(as defined by systolic blood pressure[SBP]<100 mmHg[1 mmHg=0.133 kPa]and administration of blood products)were eligible for inclusion.Death at hospital discharge was the primary outcome.RESULTS:During the study period,a total of 234 patients met the inclusion criteria.Among injured patients presenting with hemorrhagic shock,133(56.8%;95%confidence interval[CI]50.2%–63.3%)received TXA.Of patients that received TXA,a higher proportion of patients presented with shock index>1(70.68%vs.57.43%)and higher Injury Severity Score(ISS>25;49.62%vs.23.76%).Administration of TXA was not associated with mortality at hospital discharge(odds ratio[OR]0.86,95%CI 0.31–2.38).CONCLUSIONS:Among injured Irish patients presenting with hemorrhagic shock,TXA was administered to 56.8%of patients.Patients administered with TXA were on average more severely injured.However,a mortality benefit could not be demonstrated.
文摘Myopia is a highly prevalent refractive error in Asia(1).Although mild myopia does not have serious ocular ramifications,pathological myopia is associated with the development of various ocular pathologies that can lead to irreversible visual loss or blindness(2).The prevalence of visual impairment attributable to pathologic myopia is 0.2-1.4% in Asian populations(3).Over the past few generations,the prevalence of myopia has increased significantly(4).In urbanized areas of East
