scholarly journals Sterile Gelatin Film Reduces Cortical Injury Associated With Brain Tumor Re-Resection

2020 ◽  
Author(s):  
Colin J Przybylowski ◽  
Veronica So ◽  
Kaylee DeTranaltes ◽  
Corey Walker ◽  
Jacob F Baranoski ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Multivariate Logistic Regression Analysis ◽  
Gelatin Film ◽  
Time Interval ◽  
Cortical Surface ◽  
Tissue Ischemia ◽  
Initial Tumor ◽  
History Of ◽  
Surgically Induced ◽  
Film Group

Abstract BACKGROUND Recurrent intracranial tumors frequently require re-resection. Dural adhesions to the cortex increase the morbidity and duration of these revision craniotomies. OBJECTIVE To describe the use of commercially available sterile gelatin film to prevent meningocerebral adhesions and decrease the rate of surgically induced ischemia from revision craniotomy. METHODS This retrospective cohort study examined patients with recurrent glioma, meningioma, and metastasis who underwent re-resection at least 30 d following their initial tumor resection. Cortical surface tissue ischemia after re-resection on diffusion-weighted magnetic resonance imaging was compared for patients with (gelatin film group) and without (nongelatin film group) a history of gelatin film placement at the conclusion of their initial tumor resection. RESULTS A total of 84 patients in the gelatin film group were compared to 86 patients in the nongelatin film group. Patient age, sex, tumor pathology, tumor volume, tumor eloquence, laterality of surgical approach, history of radiotherapy, and time interval between resections did not differ between groups. Radiographic evidence of cortical ischemia following reoperation was less prevalent in the gelatin film group (13.1% vs 32.6%; P < .01). In multivariate logistic regression analysis, no gelatin film (P < .01) and larger tumor size (P = .02) predicted cortical surface ischemia following revision craniotomy. Postoperative complications in the gelatin film and nongelatin film group otherwise did not differ. CONCLUSION Routine placement of commercially available sterile gelatin film on the cortex prior to dural closure is associated with decreased surgically induced tissue ischemia at the time of revision tumor craniotomy.

High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

2019 ◽  
Vol 16 (3) ◽  
pp. 250-257 ◽  
Author(s):  
Jiann-Der Lee ◽  
Ya-Han Hu ◽  
Meng Lee ◽  
Yen-Chu Huang ◽  
Ya-Wen Kuo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Recurrence ◽  
Prior History ◽  
Multivariate Logistic Regression ◽  
Cart Analysis ◽  
Younger Age ◽  
History Of ◽  
One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

scholarly journals Current understanding on the Cambrian Explosion: questions and answers

PalZ ◽  
2021 ◽  
Author(s):  
Xingliang Zhang ◽  
Degan Shu
Keyword(s):  
Environmental Changes ◽  
Size Variation ◽  
Progressive Increase ◽  
Cambrian Explosion ◽  
Time Interval ◽  
Early Cambrian ◽  
Ecological Processes ◽  
Questions And Answers ◽  
Evolutionary Event ◽  
History Of

AbstractThe Cambrian Explosion by nature is a three-phased explosion of animal body plans alongside episodic biomineralization, pulsed change of generic diversity, body size variation, and progressive increase of ecosystem complexity. The Cambrian was a time of crown groups nested by numbers of stem groups with a high-rank taxonomy of Linnaean system (classes and above). Some stem groups temporarily succeeded while others were ephemeral and underrepresented by few taxa. The high number of stem groups in the early history of animals is a major reason for morphological gaps across phyla that we see today. Most phylum-level clades achieved their maximal disparity (or morphological breadth) during the time interval close to their first appearance in the fossil record during the early Cambrian, whereas others, principally arthropods and chordates, exhibit a progressive exploration of morphospace in subsequent Phanerozoic. The overall envelope of metazoan morphospace occupation was already broad in the early Cambrian though it did not reach maximal disparity nor has diminished significantly as a consequence of extinction since the Cambrian. Intrinsic and extrinsic causes were extensively discussed but they are merely prerequisites for the Cambrian Explosion. Without the molecular evolution, there could be no Cambrian Explosion. However, the developmental system is alone insufficient to explain Cambrian Explosion. Time-equivalent environmental changes were often considered as extrinsic causes, but the time coincidence is also insufficient to establish causality. Like any other evolutionary event, it is the ecology that make the Cambrian Explosion possible though ecological processes failed to cause a burst of new body plans in the subsequent evolutionary radiations. The Cambrian Explosion is a polythetic event in natural history and manifested in many aspects. No simple, single cause can explain the entire phenomenon.

scholarly journals Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Kurniawan Kurniawan ◽  
I Dewa Nyoman Wibawa ◽  
Gde Somayana ◽  
I Ketut Mariadi ◽  
I Made Mulyawan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gastrointestinal Bleeding ◽  
Abdominal Trauma ◽  
Upper Gastrointestinal Bleeding ◽  
Rare Complication ◽  
Gastroduodenal Artery ◽  
Time Interval ◽  
Artery Pseudoaneurysm ◽  
History Of ◽  
Upper Gastrointestinal

Abstract Background Hemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract. It is infrequently considered in diagnosis, especially in the absence of abdominal trauma or history of hepatopancreatobiliary procedure, such as cholecystectomy, which can cause arterial pseudoaneurysm. Prompt diagnosis is crucial because its management strategy is distinct from other types of upper gastrointestinal bleeding. Here, we present a case of massive hemobilia caused by the rupture of a gastroduodenal artery pseudoaneurysm in a patient with a history of laparoscopic cholecystectomy 3 years prior to presentation. Case presentation A 44-year-old Indonesian female presented to the emergency department with complaint of hematemesis and melena accompanied by abdominal pain and icterus. History of an abdominal trauma was denied. However, she reported having undergone a laparoscopic cholecystectomy 3 years prior to presentation. On physical examination, we found anemic conjunctiva and icteric sclera. Nonvariceal bleeding was suspected, but esophagogastroduodenoscopy showed a blood clot at the ampulla of Vater. Angiography showed contrast extravasation from a gastroduodenal artery pseudoaneurysm. The patient underwent pseudoaneurysm ligation and excision surgery to stop the bleeding. After surgery, the patient’s vital signs were stable, and there was no sign of rebleeding. Conclusion Gastroduodenal artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. The prolonged time interval, as compared with other postcholecystectomy hemobilia cases, resulted in hemobilia not being considered as an etiology of the gastrointestinal bleeding at presentation. Hemobilia should be considered as a possible etiology of gastrointestinal bleeding in patients with history of cholecystectomy, regardless of the time interval between the invasive procedure and onset of bleeding.

scholarly journals Predictors for clinical effectiveness of baricitinib in rheumatoid arthritis patients in routine clinical practice: data from a Japanese multicenter registry

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Nobunori Takahashi ◽  
Shuji Asai ◽  
Tomonori Kobayakawa ◽  
Atsushi Kaneko ◽  
Tatsuo Watanabe ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Practice ◽  
Disease Activity ◽  
Retention Rate ◽  
Oral Prednisone ◽  
Multivariate Logistic Regression Analysis ◽  
Jak Inhibitors ◽  
Short Term ◽  
History Of ◽  
Multicenter Registry

AbstractThis study aimed to evaluate the short-term effectiveness and safety profiles of baricitinib and explore factors associated with improved short-term effectiveness in patients with rheumatoid arthritis (RA) in clinical settings. A total of 113 consecutive RA patients who had been treated with baricitinib were registered in a Japanese multicenter registry and followed for at least 24 weeks. Mean age was 66.1 years, mean RA disease duration was 14.0 years, 71.1% had a history of use of biologics or JAK inhibitors (targeted DMARDs), and 48.3% and 40.0% were receiving concomitant methotrexate and oral prednisone, respectively. Mean DAS28-CRP significantly decreased from 3.55 at baseline to 2.32 at 24 weeks. At 24 weeks, 68.2% and 64.1% of patients achieved low disease activity (LDA) and moderate or good response, respectively. Multivariate logistic regression analysis revealed that no previous targeted DMARD use and lower DAS28-CRP score at baseline were independently associated with achievement of LDA at 24 weeks. While the effectiveness of baricitinib was similar regardless of whether patients had a history of only one or multiple targeted DMARDs use, patients with previous use of non-TNF inhibitors or JAK inhibitors showed lower rates of improvement in DAS28-CRP. The overall retention rate for baricitinib was 86.5% at 24 weeks, as estimated by Kaplan–Meier analysis. The discontinuation rate due to adverse events was 6.5% at 24 weeks. Baricitinib significantly improved RA disease activity in clinical practice. Baricitinib was significantly more effective when used as a first-line targeted DMARDs.

scholarly journals A solitary giant neurofibroma of inguinal region: A case report

2021 ◽  
Vol 104 (1) ◽  
pp. 003685042110042
Author(s):  
Haiying Zhou ◽  
Hui Lu
Keyword(s):  
Tumor Resection ◽  
Clinical Manifestations ◽  
Inguinal Region ◽  
Nerve Sheath Tumor ◽  
Neurogenic Tumors ◽  
Long Time ◽  
Giant Neurofibroma ◽  
History Of ◽  
Neuroectodermal Origin ◽  
Recurrence Tendency

Neurofibroma is a rare nerve sheath tumor of neuroectodermal origin, especially the huge and isolated neurofibroma located in the inguinal region. To our knowledge, no such case has previously been reported. We report a case of 34-year-old male patient with a 4-year history of progressive enlargement of the medial root mass in his left thigh with sitting and standing disorders along with pain. The tumor was completely removed by operation, and pathological diagnosis showed neurofibroma. There was no obvious neurologic defect after surgery, and no recurrence tendency was found in the follow-up of 2 years. For a large solitary mass with slow growth and no malignant clinical manifestations for a long time, clinicians cannot rule out the hypothetical diagnosis of neurofibroma, even though its growth site is very rare, such as this case of a huge tumor located in the groin. For neurogenic tumors, early operation should be performed, and the prognosis of patients after tumor resection is excellent.

Abstract 090: Armenian Ethnicity: An Independent Risk Factor for Positive Exercise Treadmill Tests

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Ara H Rostomian ◽  
Daniel Sanchez ◽  
Jonathan Soverow
Keyword(s):  
Risk Factors ◽  
Los Angeles ◽  
Multivariate Logistic Regression Analysis ◽  
Safety Net ◽  
The United States ◽  
World Health ◽  
Limited Information ◽  
Safety Net Hospital ◽  
Exercise Treadmill ◽  
History Of

Background: Several studies have examined the risk of cardiovascular disease (CVD) among larger racial and ethnic groups such as Hispanics and African-Americans in the United States, but limited information is available on smaller subgroups such as Armenians. According to the World Health Organization, Armenia ranks eighth in CVD rates among all countries however it is unclear if Armenian immigrants living in the US have the same high rates of disease. This study examined whether being of Armenian descent increased the risk of having a positive exercise treadmill test (ETT) among patients treated at a safety net hospital in Los Angeles County. Methods: Data on patients who received an ETT from 2008-2011 were used to conduct a retrospective analysis of the relationship between Armenian ethnicity and ETT result as a surrogate measure for CVD. A multivariate logistic regression analysis was used to estimate the odds ratios (OR) for having a positive ETT among Armenians relative to non-Armenians, adjusting for the following pre-specified covariates: gender, age, diabetes, hypertension, hyperlipidemia, smoking, family history of coronary artery disease (CAD), and patient history of CAD. Results: A total of 5,297 patients, ages 18 to 89, were included. Of these, 13% were Armenian and 46% were male, with an average age of 53 years. Armenians had higher odds of having a positive ETT than non-Armenians (Crude OR=1.30, p=0.037, CI:1.02,1.66). After adjusting for CV risk factors, Armenians were still significantly more likely to have a positive ETT than non-Armenians (OR=1.33, p=0.029, CI:1.03,1.71). CAD (OR 2.02, p<0.001, CI:1.38,2.96), and hyperlipidemia (OR=1.31, p=0.008, CI:1.07,1.60) were also significantly associated with a positive ETT. Conclusion: Armenians have a higher likelihood of having a positive ETT than non-Armenians. This relationship appears to be independent of traditional CV risk factors and suggests a role for cultural and/or genetic influences.

Abstract 16725: Family History of Cardiovascular Disease is an Independent Predictor of Gestational Hypertensive Disease and Diabetes: The Korean Nurses’ Survey

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Heesun Lee ◽  
Chang-Hwan Yoon ◽  
Hyun-Young Park ◽  
Hea Young Lee ◽  
Dong-Ju Choi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Family History ◽  
Gestational Diabetes ◽  
Medical Knowledge ◽  
Multivariate Logistic Regression Analysis ◽  
Computer Assisted ◽  
Hypertensive Disease ◽  
Medical Disorders ◽  
Hypertensive Disorders ◽  
History Of

Background: Gestational hypertensive disorders and diabetes are well-known to increase the risk of cardiovascular disease (CVD) and diabetes later in life. However, there were few researches to evaluate the association between family history of cardiovascular disease and the occurrence of pregnancy-related medical disorders. We aimed to investigate whether family history of CVD could predict gestational hypertensive disorders and diabetes. Methods: The Korean Nurses’ Survey was conducted through web-based computer-assisted self-administered questionnaires, which were compiled by consultation to cardiologists, gynecologists, and statisticians, from October to December 2011. We enrolled a total of 9,989 female registered nurses who could answer reliably the questionnaires based on their medical knowledge. Multivariate logistic regression analysis was used to clarify the effect of family history of CVD on pregnancy-related medical disorders. Result: In this survey, 3900 subjects had more than 1 pregnancy. Among them, 247 interviewees (6.3%) had experienced hypertensive disorders during pregnancy, which included preeclampsia (n = 160, 4.1%) and transient hypertension (n = 144, 3.7%), and 120 (3.1%) had experienced gestational diabetes. And, 2872 subjects (73.6%) answered that they had at least 1 family history of CVD. Having family history of CVD increased the risk of gestational hypertensive disorders (adjusted RR 1.51, 95% CI 1.08-2.11, p = 0.015) and diabetes (adjusted RR 2.40, 95% CI 1.38-4.17, p = 0.002). In particular, family history of hypertension was significantly associated with gestational hypertensive disorders (adjusted RR 2.00, 95% CI 1.47-2.50, p <0.001), and diabetes was highly related with gestational diabetes (adjusted RR 3.37, 95% CI 2.35-4.83, p <0.001), respectively. Furthermore, this relationship was observed regardless of maternal parity. Conclusion: Family history of CVD was a significant predictor of pregnancy-related medical disorders in this survey. Meticulous history taking for family history of CVD can provide the risk of gestational hypertensive disease and diabetes. Thus, special attention should be paid to women with family history of CVD during pregnancy.

scholarly journals Intraperitoneal hemorrhage after cupping therapy

2018 ◽  
Vol 27 (2) ◽  
pp. 107-109
Author(s):  
Meng-Chuan Lu ◽  
Chih-Jen Yang ◽  
Shih-Hung Tsai ◽  
Chih-Chieh Hung ◽  
Sy-Jou Chen
Keyword(s):  
Rare Complication ◽  
Hypovolemic Shock ◽  
Cupping Therapy ◽  
Tissue Ischemia ◽  
Intraperitoneal Hemorrhage ◽  
Relieve Pain ◽  
History Of ◽  
Enhanced Computed Tomography ◽  
Clinical Conditions ◽  
High Degree

Introduction: Cupping therapy has been widely performed in oriental countries and considered a safety alternative to relieve pain. Here, we report a rare complication from abdominal cupping. Case presentation: A 49-year-old man presented with a 2-day history of left upper quadrant abdominal pain after cupping therapy 3 days earlier. His abdomen was soft but appeared a localized rebounding tenderness. Contrast-enhanced computed tomography of the abdomen showed intraperitoneal hemorrhage originated from the left upper quadrant of the omentum. Discussion: Several mechanisms are proposed for the development of intraperitoneal hemorrhage after cupping therapy, including the tensile stress generated by cupping that facilitates the disruption of omentum vessels, strong negative pressure generated by cupping that suppresses blood supply to the cup-applied sites causing adjacent tissue ischemia, and subsequent vascular extravasation. Treatment for intraperitoneal hemorrhage depends on clinical conditions. Stable patients can be managed conservatively, whereas surgery is reserved for those with continuous bleeding and hypovolemic shock. Conclusion: Cupping therapy complicated with omentum bleeding can present insidiously until peritoneal irritation developed by intraperitoneal hemorrhage. A comprehensive history taking and a high degree of vigilance are crucial to diagnose early patients with this rare complication.

Suicide attempts preceding completed suicide

1998 ◽  
Vol 173 (6) ◽  
pp. 531-535 ◽  
Author(s):  
Erkki T. Isometsä ◽  
Jouko K. Lönnqvist
Keyword(s):  
Suicide Attempt ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Suicide Attempts ◽  
Early Recognition ◽  
Preventive Measure ◽  
Time Interval ◽  
Psychological Autopsy ◽  
Autopsy Study ◽  
History Of

BackgroundThis study investigated three questions with major implications for suicide prevention: the sensitivity of the history of previous suicide attempt(s) as an indicator of suicide risk, the time interval from a preceding suicide attempt to the fatal one, and switching of suicide methods by those eventually completing suicide.MethodThe lifetime history of suicide attempts and the methods the victims (n=1397) used were examined in a nationwide psychological autopsy study comprising all suicides in Finland within a 12-month research period in 1987–1988.ResultsOverall, 56% of suicide victims were found to have died at their first suicide attempt, more males (62%) than females (38%). In 19% of males and 39% of females the victim had made a non-fatal attempt during the final year. Of the victims with previous attempts, 82% had used at least two different methods in their suicide attempts (the fatal included).ConclusionsMost male and a substantial proportion of female suicides die in their first suicide attempt, a fact that necessitates early recognition of suicide risk, particularly among males. Recognition of periods of high suicide risk on the grounds of recent non-fatal suicide attempts is likely to be important for suicide prevention among females. Subjects completing suicide commonly switch from one suicide method to another, a finding that weakens but does not negate the credibility of restrictions on the availability of lethal methods as a preventive measure.

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