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Mortality After Procedural or Spontaneous Myocardial Infarction.
No full textBACKGROUND
It remains unclear whether procedural myocardial infarction (pMI) and spontaneous myocardial infarction (spMI) have a similar impact on prognosis.
OBJECTIVES
The aim of this study was to assess mortality after pMI and spMI.
METHODS
Patients with chronic coronary syndrome (CCS) and baseline troponin ≤1× the upper reference level (URL) or with acute spMI who underwent percutaneous coronary intervention (PCI) were included. PMI was defined as post-PCI troponin increase >1× URL in patients with CCS. SpMI comprised any acute coronary syndrome with elevated troponin. The 1-year risk of all-cause death was assessed after pMI and spMI across 3 strata of troponin elevation (>1-5×, >5-35×, and >35× URL), with CCS patients having post-PCI troponin ≤1× URL as a reference group. Conventional troponin I was measured using the Architect methodology (Abbott).
RESULTS
Among 10,707 patients undergoing PCI from 2012 to 2020, 8,515 patients presented with CCS and 2,192 with spMI. Among CCS patients, 913 (10.7%) had pMI. Troponin peaks >1-5×, >5-35×, and >35× URL were observed in 53%, 41%, and 6% of patients with pMI, and in 24%, 38%, and 37% of patients with spMI, respectively. Mortality at 1 year was higher after pMI (7.7%; adjusted HR: 4.40; 95% CI: 1.59-12.2), and spMI (8.5%; adjusted HR: 7.57; 95% CI: 5.44-10.5) with troponin peak >35× URL compared with no-MI (1.4%). Mortality was also increased after spMI with troponin peak >1-5× or >5-35× URL.
CONCLUSIONS
Mortality at 1 year was significantly increased after pMI and spMI with troponin peak >35× URL, whereas for troponin levels ≤35× only spMI had a relevant impact on mortality
Analysis of the fastest backstroke age group swimmers competing in the World Masters Championships 1986-2024.
Get PDFBackstroke has been thoroughly investigated in the context of sports science. However, we have no knowledge about the nationalities of the fastest age group backstroke swimmers. Therefore, the present study intended to investigate the nationalities of the fastest backstroke swimmers. For all World Masters Championships held between 1986 and 2024, the year of competition, the first and last name, the age, and the age group, and both the stroke and the distance were recorded for each swimmer. Descriptive data were presented using mean, standard deviation, maximum and minimum values, and confidence intervals. The top ten race times for each swimming distance and sex were identified for descriptive purposes. Nationalities were then grouped into six categories: the top five nationalities with the most appearances in the backstroke swimming top ten times by distance each year and one group consisting of all other nationalities. The Kruskal-Wallis test compared nationality differences, followed by Bonferroni-adjusted pairwise comparisons to identify specific distinctions. Between 1986 and 2024, most age group backstroke swimmers (39.6%) competed in the 50 m event (11,964, 6206 women, and 5,758 men), followed by the 100 m event (32.3%, n = 9764, 5157 women, and 4607 men), and the 200 m event (28.1%, n = 8483, 4511 women, and 3,972 men). Germany had the highest number of top ten female swimmers in the 50 m backstroke distance. Brazil had the highest number of top ten male swimmers in the same distance. The USA had the highest number of female and male swimmers among the top ten in the 100 m and 200 m backstroke distances. Germany and Great Britain were the only countries with swimmers in the top ten for all female backstroke distances. Brazil, the USA, Italy, and Germany were the countries that had swimmers in the top ten for all male backstroke distances. In summary, the fastest backstroke age group swimmers originated from Germany, Brazil, USA, Great Britain, and Italy, where differences between the sexes and race distances exist
Rarity and life-history strategies shape inbreeding and outbreeding effects on early plant fitness
Get PDFLocal abundance and regional distribution are two aspects of a species’ rarity. They are suggested to differentially alter genetic processes in plants: Locally rare species are hypothesized to suffer less from inbreeding and outbreeding than locally common species, thanks to genetic purging through long inbreeding histories and weaker local adaptations, respectively. Regionally rare species are hypothesized to be more susceptible to outbreeding, but less to inbreeding, compared to regionally common ones, due to small and declining range size. While this has major implications for plant conservation practices, we lack evidences and general understanding on how breeding effects on a plant’s early life fitness are related to its local and regional rarity. To investigate effects of inbreeding and outbreeding on plants’ early fitness, we performed self-, within- and between-population pollinations in eight pairs of closely related species differing in regional and local rarity. To avoid biases due to context dependency, we took species competitive ability, habitat resource-richness and resource-allocation strategy into account in the analyses. We then tested how inbreeding and outbreeding affected five fruit-, seed- and seedling-related traits. Inbreeding did not generally have more negative effects on early fitness of regionally rare and non-competitive species than on regionally common and competitive ones. Outbreeding was generally beneficial to early fitness of plant species across the gradients of regional rarity, competitive ability and habitat resource-richness. Our results show that outbreeding may be beneficial to the early fitness of plant species, including rare and non-competitive ones and may be considered for conservation strategies
Spontaneous suprachoroidal haemorrhage: clinical features, visual outcomes and prognosis factors.
No full textBACKGROUND
To describe clinical features, risk factors and outcomes of patients with diagnosis of rare spontaneous suprachoroidal haemorrhage (SSCH) over a 20-year period from a tertiary eye unit.
METHODS
Retrospective, observational case-series of patients with SSCH, defined as SCH without a known cause at diagnosis. Variables analysed included age, gender, ethnicity, systemic and ocular comorbidities, systemic medication, initial and final best corrected visual acuity (BCVA), clinical features, management and follow-up.
RESULTS
Total of 11 eyes of 11 patients were identified. Median age was 70 years (SD 25.9). Most patients were female (82%) and white British. Median follow-up period was 2.2 years. Hypertension was the most frequently associated underlying systemic disease (45%) and 36% were on anti-coagulant or anti-platelet therapy. High myopia was observed in 36% of cases. Presenting BCVA of 1.00 logMAR or better was a positive predictor of final BCVA. No significant improvement in the initial versus final BCVA was found in patients who underwent surgery versus those who remained under observation.
CONCLUSION
Patients over 60 years-old with hypertension, anticoagulant treatment, high myopia, and pseudophakia were common. Visual outcomes were poor, surgical intervention had limited impact. Good initial BCVA predicted better final acuity while extensive SSCH correlated with poorer visual results. Despite the study's limitations, this series offers valuable insights into visual prognosis and prognostic factors
Rotational femoral osteotomies and cam resection improve hip function and internal rotation for patients with anterior hip impingement and decreased femoral version.
Get PDFFemoroacetabular impingement (FAI) patients with reduced femoral version (FV) are poorly understood. The aim of this study is to assess (i) hip pain and range of motion, (ii) subjective satisfaction and (iii) subsequent surgeries of symptomatic patients who underwent rotational femoral osteotomies. A retrospective case series involving 18 patients (23 hips, 2014-2018) with anterior hip pain that underwent rotational femoral osteotomies for treatment of decreased FV was performed. The mean preoperative age was 25 ± 6 years (57% male), and all patients had decreased FV < 10° and minimum 1-year follow-up (mean follow-up 2 ± 1 years). Surgical indication was the positive anterior impingement test, limited internal rotation (IR) in 90° of flexion (mean 10 ± 8°) and IR in extension (mean 24 ± 11°), anterosuperior chondrolabral damage in Magnet resonance (MR) arthrography, CT-based measurement of decreased FV (mean 5 ± 3°, Murphy method) and no osteoarthritis (Tönnis Grade 0). Most patients had intra- and extra-articular subspine FAI (patient-specific 3D impingement simulation). Subtrochanteric rotational femoral osteotomies to increase FV (correction 20 ± 4°) were combined with cam resection (78%) and surgical hip dislocation (91%). (i) The positive anterior impingement test decreased significantly (P < 0.001) from pre- to postoperatively (100% to 9%). IR in 90° of flexion increased significantly (P < 0.001, 10 ± 8° to 31 ± 10°). (ii) Subjective satisfaction increased significantly (P < 0.001) from pre- to postoperatively (33% 77%). The mean Merle d'Aubigné and Postel score increased significantly (P < 0.001) from 14 ± 2 (8-15) points to 17 ± 1 (13-18, P < 0.001) points. Most patients (85%) reported at follow-up that they would undergo surgery again. (iii) At follow-up, all 23 hips were preserved (no conversion to total hip arthroplasty). One hip (4%) underwent revision osteosynthesis. Proximal rotational femoral osteotomies combined with cam resection improve hip pain and IR in most FAI patients with decreased FV at short-term follow-up. Rotational femoral osteotomies to increase FV are safe and effective
Student Ultrasound Education, Current Views and Controversies; Who Should be Teaching?
No full textAcquiring diagnostic ultrasound competencies and skills is crucial in modern health care, and achieving the practical experience is vital in developing the necessary anatomy interpretation and scan acquisition skills. However, traditional teaching methods may not be sufficient to provide hands-on practice, which is essential for this skill acquisition. This paper explores various modalities and instructors involved in ultrasound education to identify the most effective approaches. The field of ultrasound instruction is enriched by the diverse roles of physicians, anatomists, peer tutors, and sonographers. All these healthcare professionals can inspire and empower the next generation of ultrasound practitioners with continuous training and support. Physicians bring their clinical expertise to the table, while anatomists enhance the understanding of anatomical knowledge through ultrasound integration. Peer tutors, often medical students, provide a layer of social congruence and motivation to the learning process. Sonographers provide intensive practical experience and structured learning plans to students. By combining different instructors and teaching methods, success can be achieved in ultrasound education. An ultrasound curriculum organized by experts in the field can lead to more efficient use of resources and better learning outcomes. Empowering students through peer-assisted learning can also ease the burden on faculty. Every instructor must receive comprehensive didactic training to ensure high-quality education in diagnostic ultrasound
An ontology-based tool for modeling and documenting events in neurosurgery.
Get PDFBACKGROUND
Intraoperative neurophysiological monitoring (IOM) plays a pivotal role in enhancing patient safety during neurosurgical procedures. This vital technique involves the continuous measurement of evoked potentials to provide early warnings and ensure the preservation of critical neural structures. One of the primary challenges has been the effective documentation of IOM events with semantically enriched characterizations. This study aimed to address this challenge by developing an ontology-based tool.
METHODS
We structured the development of the IOM Documentation Ontology (IOMDO) and the associated tool into three distinct phases. The initial phase focused on the ontology's creation, drawing from the OBO (Open Biological and Biomedical Ontology) principles. The subsequent phase involved agile software development, a flexible approach to encapsulate the diverse requirements and swiftly produce a prototype. The last phase entailed practical evaluation within real-world documentation settings. This crucial stage enabled us to gather firsthand insights, assessing the tool's functionality and efficacy. The observations made during this phase formed the basis for essential adjustments to ensure the tool's productive utilization.
RESULTS
The core entities of the ontology revolve around central aspects of IOM, including measurements characterized by timestamp, type, values, and location. Concepts and terms of several ontologies were integrated into IOMDO, e.g., the Foundation Model of Anatomy (FMA), the Human Phenotype Ontology (HPO) and the ontology for surgical process models (OntoSPM) related to general surgical terms. The software tool developed for extending the ontology and the associated knowledge base was built with JavaFX for the user-friendly frontend and Apache Jena for the robust backend. The tool's evaluation involved test users who unanimously found the interface accessible and usable, even for those without extensive technical expertise.
CONCLUSIONS
Through the establishment of a structured and standardized framework for characterizing IOM events, our ontology-based tool holds the potential to enhance the quality of documentation, benefiting patient care by improving the foundation for informed decision-making. Furthermore, researchers can leverage the semantically enriched data to identify trends, patterns, and areas for surgical practice enhancement. To optimize documentation through ontology-based approaches, it's crucial to address potential modeling issues that are associated with the Ontology of Adverse Events
Electrophysiological differences of randomized deep sedation with dexmedetomidine versus propofol.
Get PDFBACKGROUND
Dexmedetomidine and propofol are common sedatives in intensive care units and for interventional procedures. Both may compromise sinus node function and atrioventricular conduction. The objective of this prospective, randomized study is to compare the effect of dexmedetomidine with propofol on sinus node function and atrioventricular conduction.
METHODS
In a tertiary care center in Switzerland we included from September 2019 to October 2020 160 patients (65 ± 11 years old; 32% female) undergoing first ablation for atrial fibrillation by cryoballoon ablation or by radiofrequency ablation. Patients were randomly assigned to deep sedation with dexmedetomidine (DEX group) versus propofol (PRO group). A standard electrophysiological study was performed after pulmonary vein isolation with the patients still deeply sedated and hemodynamically stable.
RESULTS
Eighty patients each were randomized to the DEX and PRO group. DEX group patients had higher baseline sinus cycle length (1022 vs. 1138 ms; p = 0.003) and longer sinus node recovery time (SNRT400; 1597 vs. 1412 ms; p = 0.042). However, both corrected SNRT and normalized SNRT did not differ. DEX group patients had longer PR interval (207 vs. 186 ms; p = 0.002) and AH interval (111 vs. 95 ms, p = 0.008), longer Wenckebach cycle length of the atrioventricular node (512 vs. 456 ms; p = 0.005), and longer atrioventricular node effective refractory period (390 vs. 344 ms; p = 0.009). QRS width and HV interval were not different. An arrhythmia, mainly atrial fibrillation, was induced in 33 patients during the electrophysiological study, without differences among groups (20% vs. 15%, p = 0.533).
CONCLUSIONS
Dexmedetomidine has a more pronounced slowing effect on sinus rate and suprahissian AV conduction than propofol, but not on infrahissian AV conduction and ventricular repolarization. These differences need to be taken into account when using these sedatives.
TRIAL REGISTRATION
ClinicalTrials.gov number NCT03844841, 19/02/2019
Late diagnosis of partial 3β-hydroxysteroid dehydrogenase type 2 deficiency - characterization of a new genetic variant.
Get PDFSUMMARY
Congenital adrenal hyperplasia (CAH) is one of the most common inherited rare endocrine disorders. This case report presents two female siblings with delayed diagnosis of non-classical CAH 3β-hydroxysteroid dehydrogenase type 2 (3βHSD2D/HSD3B2) despite early hospital admission and apparent CAH manifestations such as infections, hirsutism, menstrual disturbances, and PCOS phenotype. Initially, sister 1 was misdiagnosed with PCOS and then 11-hydroxylase deficiency (CYP11B1), based on ultrasound, biochemical findings, and negative genetic testing for 21-hydroxylase deficiency (CYP21A2). Additional diagnostic workup was performed when sister 2also presented with symptoms of androgen excess. Genetic testing for CAH/steroid disorders finally revealed that both siblings were compound heterozygous for two variants in the HSD3B2 gene: a frameshift variant, c.558dup, p.(Thr187Hisfs*17) and a novel missense variant, c.65T>C, p.(Leu22Ser). A Synacthen test showed an insufficient cortisol increase. In vitro studies of the variants in a cell model revealed loss of function for the p.(Thr187Hisfs*17) and partial activity for p.(Leu22Ser) confirming non-classic CAH. Overlapping symptomatology and lack of specialized knowledge on steroid biosynthesis and associated rarest forms of CAH may explain the delayed diagnosis. However, with newer diagnostic methods comprising a less biased approach, very rare forms of non-classical CAH may no longer be overlooked in the future.
LEARNING POINTS
Non-classic 3βHSD2 is likely underdiagnosed. Late diagnosis of mild non-classic 3βHSD2 does occur and one should be aware of this diagnosis. Early diagnosis of NCCAH may prevent many consequences such as severe hirsutism, prolonged menstrual irregularities, infertility, or even adrenal crisis with severe infections. Comprehensive steroid profiling and genetic testing should be used earlier, especially when in doubt about a diagnosis
Verletzungen im Sport und bei Freizeitpferden - Management und Prognose
No full textManagement von Hufgelenksproblemen
Management von Spat
Management von Sehnenproblemen
Management von Fesselträgerprobleme
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