“Poor Effort” Does Not Account for Reduced Forced Vital Capacity in Asthmatic Children

Purpose: Poor forced vital capacity (FVC) effort has been considered to be the main reason for FVC reduction by the ATS/ERS guideline; however, this has rarely been mentioned in previous studies. The present study aims to determine whether reduced FVC in asthmatic children is correlated to poor FVC effort.Methods: A total of 209 asthmatic children within 5–13 years old were included and divided into reduced FVC (“restricted,” n = 66) and typical obstruction group (“obstructed,” n = 143). Forced expiratory flows before and after bronchodilation were recorded in asthmatic children. The differences in clinical characteristics, spirometric results, FVC effort, and bronchodilator response were compared between two groups. Exhalation time (ET) was divided into effective ET (ETe) and plateau ET (ETp) by the start point of exhalation plateau on the time-volume curve. FVC effort was assessed by ET, ETp, and back extrapolated volume (EV)/FVC (%).Results: Asthmatic children in the restricted group had significantly higher slow vital capacity (SVC)/FVC (%), higher EV/FVC (%), shorter ET, shorter ETe, and longer ETp, when compared with those with obstructed. In the obstructed group, ET (r = 0.201, P = 0.016) and ETe (r = 0.496, P < 0.001) positively correlated with FVC, and ETp (r = −0.224, P = 0.007) negatively correlated with FVC. In the restricted group, FVC positively correlated with ETe (r = 0.350, P = 0.004) but not ET and ETp. FVC z-score significantly correlated with total IgE (n = 51, r = −0.349, P = 0.012) and with FEF25−75% z-score (n = 66, r = 0.531, P < 0.001) in the restricted group. The further logistic regression revealed that the risk of restricted increased by 1.12 (95% CI, 1.04–1.22, P = 0.005) with every 1% increase in %ΔFVC. In subjects with restricted and bronchodilation tests, %ΔFVC was significantly associated with FeNO (n = 29, r = 0.386, P = 0.039), FEF25−75% z-score (n = 29, r = −0.472, P = 0.010), and SVC/FVC (%) (n = 19, r = 0.477, P = 0.039) but not with EV/FVC (%), ET, ETe, or ETp (P > 0.05).Conclusion: These findings suggested that “poor FVC effort” does not account for the FVC reduction in asthmatic children. Short ET and high SVC/FVC (%) are characteristics of reduced FVC.

Outcomes of bicanalicular nasal stent inserted by sheath-guided dacryoendoscope in patients with lacrimal passage obstruction: a retrospective observational study

Background The dacryoendoscope is the only instrument that can observe the luminal side of the lacrimal passage with minimal invasiveness. It was developed to treat lacrimal passage obstructions by inserting a bicanalicular nasal stent with sheath-guided bicanalicular intubation (SG-BCI). The purpose of this study was to determine the outcomes of SG-BCI to treat lacrimal passage obstructions. In addition, to determine the effects of SG-BCI treatment on the quality of life. Methods This was a retrospective observational study of 128 patients (mean age 70.9 ± 11.0 years, range 28–93 years) diagnosed with a unilateral lacrimal passage obstruction. There were 73 patients with a nasolacrimal duct obstruction, 37 with a lacrimal canaliculus obstruction, 7 with a lacrimal punctum obstruction, and 11 with common lacrimal canaliculus and nasolacrimal duct obstructions. They were all treated with SG-BCI. The postoperative subjective outcomes were assessed by the answers to the Glasgow Benefit Inventory (GBI) questionnaire and to an ocular specific questionnaire on 6 symptoms including tearing, ocular discharges, swelling, pain, irritation, and blurred vision. The objective assessments were the surgical success rates and the patency at 6 months after the bicanalicular nasal stent was removed. The patients were divided into those with a pre-saccal obstruction, Group 1, and with a post-saccal obstruction, Group 2. The subjective and objective outcomes were compared between the two groups. Results One hundred twenty-four sides (96.9%) had a successful probing and intubation of the lacrimal passage obstruction by SG-BCI. Of the 124 sides, 110 sides (88.7%) retained the patency after the stent was removed for at least 6 months. The GBI total, general subscale, social support, and physical health scores were + 37.1 ± 29.0, + 41.5 ± 30.0, + 28.0 ± 39.4, and + 24.1 ± 37.7, respectively, postoperatively. All of the 6 ocular specific symptom scores improved significantly postoperatively. The postoperative score of tearing improved in Group 1 (P < 0.0001), while the postoperative scores of all symptoms improved significantly in Group 2. Conclusions The relatively high surgical success rates and positive GBI scores, and improved ocular symptom scores indicate that SG-BCI is a good minimally invasive method to treat lacrimal passage obstructions.

Trends in the Surgical Management and Outcomes of Complicated Peptic Ulcer Disease

Background Older data indicate that less patients undergo surgery for complicated peptic ulcer disease (PUD). We evaluated contemporary trends in the surgical management and outcomes of patients with complicated PUD. Methods The National Inpatient Sample (2005-2014) was queried for patients with complicated PUD (hemorrhage, perforation, or obstruction). Trend analyses were used to evaluate changes in management and outcomes. Results There were 1 570 696 admissions for complicated PUD during the study period. Majority (87.0%) presented with hemorrhage, 10.6% presented with perforation, and 2.4% had an obstruction. The average age was 67 years. Overall, admissions with complicated PUD decreased from 180 054 in 2005 to 150 335 in 2014. The proportion of patients managed operatively decreased from 2.5% to 1.9% in the hemorrhage group, 75.0% to 67.4% in the perforation group, and 26.0% to 20.2% in the obstruction group (all P-trend < .05). Overall, among patients managed operatively, the use of acid-reducing procedures decreased from 25.9% to 13.9%, mortality decreased from 11.9% to 9.4% (both P-trend < .001), while complications remained stable (10.4% to 10.3%, P-trend = .830). Conclusions There are fewer admissions with complicated PUD and more patients are treated nonoperatively. Despite subtle improvements, significant proportions of patients still die from complicated PUD indicating the need for improved preoperative optimization and postoperative care among these patients.

Evaluation of Matrix Metalloproteinase-7 and Matrix Metalloproteinase-9 as Biomarkers in Ureteropelvic Junction Obstruction in Children- a preliminary report

Background In children with congenital ureteropelvic junction obstruction (UPJO), Urinary biomarker may provide understanding of the health of the kidney, the need to intervene surgically, and the expected response and recoverability of the kidney following successful surgery. We evaluate whether the urinary matrix metalloproteinase-7(MMP-7) and matrix metalloproteinase-9(MMP-9) might be served as biomarkers in UPJO patients. Methods In this study, 24 unilateral UPJO patients and 16 healthy childrens were enrolled. Of which, 20 patients underwent 99mTc-DTPA (Diethylenetriaminepentaacetic Acid) renal dynamic imaging. And 16 patients underwent pyeloplasty and 8 others were followed. Postoperative follow-ups included ultrasonography, as well as MMP-7 and MMP-9 levels in urine, six months and one year after pyeloplasty. Study population was divided in 4 categories according to Society of Fetal Urology classification. For DTPA we subdivided the UPJO patients in 2 groups, obstructive (T 1/2 more than 20 min) and partial obstructive (T 1/2 less than 20 min). Quantitative urine protein analysis was performed and urinary creatinine levels were used to normalize protein levels for the markers analyzed. Results The results showed Creatinine-normalized urinary levels of MMP-7 and MMP-9 proteins were higher in patients with UPJO compared to healthy control subjects(P༜0.05). Moreover, urinary levels of MMP-7 and MMP-9 proteins in operation group were higher than non-operation group. Studies revealed that normalized urinary levels of MMP-7 and MMP-9 proteins in obstruction group were higher than partial obstruction group, although this differences were not statistically significant(P༞0.05). No significant differences in the Creatinine-normalized urinary levels of MMP-7 and MMP-9 in different degrees of hydronephrosis (P༞0.05). And normalized MMP-7 and MMP-9 levels were not correlated with the glomerular filtration rate of affected side(r = -0.128, P = 0.592; r = -0.157, P = 0.507). Conclusions Compared to control group, the levels of MMP-7 and MMP-9 in urine of unilateral UPJO patients are significantly elevated, and they can potentially be used as determining indices for surgical plan. Although preliminary results indicate no significant correlation between them and clinical parameters, they would be potential biomarkers for UPJO.

Is there an association between congenital nasolacrimal duct obstruction and cesarean delivery?

Purpose: The aim of this study was to research the relationship between types of birth and congenital nasolacrimal duct obstruction. Method: The study enrolled 665 infantile patients with prediagnosis of congenital nasolacrimal duct obstruction due to associated ophthalmic symptoms. Age, gender, family history, delivery type, and patient medical records were investigated. Patients were grouped and compared according to their birth type and whether it was the first birth. Results: The number of the infants with and without congenital nasolacrimal duct obstruction was 227 (34.1%) and 438 (65.9%), respectively. Comparison of the congenital nasolacrimal duct obstruction and non-congenital nasolacrimal duct obstruction groups according to the first births showed that ratio of cesarean section was significantly higher in the congenital nasolacrimal duct obstruction group than the non- congenital nasolacrimal duct obstruction group (58.7% and 20.7%, respectively). Number with positive family history also was significantly higher in the congenital nasolacrimal duct obstruction group. Conclusion: Cesarean section in first birth and positive family history of congenital nasolacrimal duct obstruction appear to be important risk factors in the etiopathogenesis of congenital nasolacrimal duct obstruction.

Bishop Koop conversion of temporary stoma can be an option to establish gut continuity early when primary anastomosis is not safe

BackgroundIntestinal perforation and sometimes obstruction in neonates demand diverting stomas which are associated with fluid, electrolytes and nutrient loss. Early establishment of gut continuity is the key to the best outcome, though primary anastomosis is not always safe. The aim of this study was to evaluate the effectiveness of Bishop Koop stoma in establishing early continuity of gut and confirming the function of distal gut.MethodsData of patients who underwent Bishop Koop conversion of diverting stoma from July 2016 to June 2018 were reviewed retrospectively. Demographic and outcome data were recorded and analyzed using Statistical Package for the Social Science (SPSS) V.22 software. Ethical permission was taken from hospital ethical committee.Results29 patients were included (16 male and 13 female). Mean age of conversion was 5.8±2.5 months and mean weight was 4.9±1.6. Normal bowel movement was established in 26 patients. One patient died of sepsis on sixth postoperative day and one had anastomotic leakage. There was no significant difference with respect to outcome between perforation and obstruction group. Bishop Koop stomas were closed after 6 weeks of formation.ConclusionsBishop Koop conversion of temporary stoma was turned out as a good choice for these patients.

Long-Term Consequences of Nonclosure of Mesenteric Defects after Traditional Right Colectomy

Background. There are still discrepancies among general/colorectal surgeons regarding closure of mesenteric defect in scientific literature. This study aimed to assess the long-term consequences of nonclosure of the mesenteric defect after open right colectomy.Methods. A 7-year retrospectively collected and continuous database revealed 212 consecutive patients who had undergone traditional right colectomy without closing the mesenteric defects at Kaohsiung Chung-Gung Memorial Hospital; all patients were operated by a single surgeon. Among these patients, 17 were excluded (those who died within 30 days after surgery or those who received an end ileostomy). The mean age of the 195 patients (58% men and 42% women) was 61.6 ± 12.6 years, and the follow-up period was 4.1 ± 2.8 years (interquartile range 0.09 ~ 10.4).Results. Forty-four patients (22.5%) encountered intestinal obstruction. Nine (20.4%) required surgical intervention. The cause of intestinal obstruction was adhesion (n=1), ventral hernia (n=1), and cancer recurrence (n=7). Conservative treatment was successful in 35 patients. The intestinal obstruction group (n = 44) were similar to the no-intestinal obstruction group (n = 151) in terms of the following parameters: age, sex, previous abdominal surgery, indication for colectomy, and procedure related complications. Carcinomatosis was found to increase the incidence of intestinal obstruction. No patient developed intestinal obstruction because of the nonclosure of mesenteric defects after right colectomy.Conclusion. This study suggested that routine procedure of closing the mesenteric defect after open right colectomy might not be beneficial. Additional studies with extended long-term follow-up periods are needed to confirm the benefits of the nonclosure.

Does Nasal Obstruction Increase Heart Rate?

Introduction Nasal obstruction is implicated in the etiopathogenesis of Obstructive Sleep Apnea (OSA). OSA is associated with mean heart rate (HR) variations in wakefulness and in sleep. Early intervention has proven to reduce cardiovascular morbidity in OSA patients. In spite of various confounding factors HR measurement has been utilised as an independent predictor of mortality. The influence of severity of nasal obstruction on HR has not been studied in the literature. This study aims to clarify the influence of severity of nasal obstruction on HR. Materials and Methods We examined 55 patients aged less than 50 years with no previous cardiac complaints, who underwent overnight oxygen saturation and HR monitoring. The patients were divided into Mild, Moderate and Severe Nasal Obstruction group depending on NOSE scale grading. Results There was no statistically significant difference in the Mean HR, Min HR, Max HR, and Max-Min HR in mild, moderate or severe nasal obstruction groups. Discussion The role of nasal obstruction in Obstructive Sleep Apnoea and the importance of HR as predictor of cardiovascular morbidity have been discussed. The studies on the heart rate in nasal obstruction and OSA were reviewed. Conclusion Nasal obstruction does not influence the heart rate.

Utility of Diffusion-Weighted MRI to Detect Changes in Liver Diffusion in Benign and Malignant Distal Bile Duct Obstruction: The Influence of Choice of b-Values

Purpose The study sought to evaluate the potential of diffusion-weighted magnetic resonance imaging to detect changes in liver diffusion in benign and malignant distal bile duct obstruction and to investigate the effect of the choice of b-values on apparent diffusion coefficient (ADC). Methods Diffusion-weighted imaging was acquired with b-values of 200, 600, 800, and 1000 s/mm2. ADC values were obtained in 4 segments of the liver. The mean ADC values of 16 patients with malignant distal bile duct obstruction, 14 patients with benign distal bile duct obstruction, and a control group of 16 healthy patients were compared. Results Mean ADC values for 4 liver segments were lower in the malignant obstruction group than in the benign obstruction and control groups using b = 200 s/mm2 ( P < .05). Mean ADC values of the left lobe medial and lateral segments were lower in the malignant obstruction group than in the benign obstructive and control groups using b = 600 s/mm2 ( P < .05). Mean ADC values of the right lobe posterior segment were lower in the malignant and benign obstruction groups than in the control group using b = 1000 s/mm2 ( P < .05). Using b = 800 s/mm2, ADC values of all 4 liver segments in each group were not significantly different ( P > .05). There were no correlations between the ADC values of liver segments and liver function tests. Conclusion Measurement of ADC shows good potential for detecting changes in liver diffusion in patients with distal bile duct obstruction. Calculated ADC values were affected by the choice of b-values.

Abstract 17083: Assessment of Both Coronary Microvascular Damage and Left Ventricular Chamber Stiffness after Successful Percutaneous Coronary Intervention Predicts In-Hospital Cardiac Complications and Left Ventricular Remodeling in ST-Segment Elevation Myocardial Infarction

Background: In ST-segment elevation myocardial infarction (STEMI), the short deceleration time of left ventricular (LV) early filling by Doppler is a powerful independent predictor of clinical cardiac events. It has also been reported that the coronary flow velocity pattern in patients with microvascular obstruction is characterized by the presence of early systolic retrograde flow and a rapid diastolic deceleration time (DDT). The purpose of this study was to examine the effects of both microvascular damage and LV chamber stiffness on cardiac complications and LV remodeling after successful percutaneous coronary intervention (PCI) in STEMI patients. Methods: Two hundred and one consecutive patients with first anterior STEMI were studied following successful PCI. Microvascular damage was evaluated on the basis of coronary flow velocity patterns using Doppler guidewires. We defined the presence of microvascular obstruction as DDT ≤600 ms and the presence of systolic flow reversal. LV filling patterns were determined by LV inflow pulsed-wave Doppler examination on day 3 after STEMI. Deceleration time ≤130 ms was defined as restrictive. We classified patients into three categories: without restrictive and microvascular obstruction (group 1, n=116), with restrictive or microvascular obstruction (group 2, n= 38), and with restrictive and microvascular obstruction (group 3, n=47). Left ventriculograms were obtained immediately and 6 months after PCI. LV remodeling was defined as an increase in end-diastolic volume index ≥20%. The clinical event rate was compared among the 3 groups. Results: The in-hospital event rates for LV thrombus (2/116 [2%], 5/38 [13%] and 14/47 [30%], respectively; P < 0.01) and congestive heart failure (5/116 [4%], 10/38 [26%], and 22/47 [47%]; P < 0.01) were highest in group 3 and lowest in group 1. Group 3 was at the highest risk of LV remodeling, while group 1 was at the lowest (7/116 [6%], 14/38 [37%], and 39/47 [83%]; P < 0.01). Conclusions: Assessment of both microvascular damage and LV chamber stiffness can accurately predict in-hospital complications and LV remodeling in STEMI patients who underwent successful reperfusion of the infarct-related coronary artery, identifying a subset of high risk patients.