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Pritchard Pagh posted an update a month ago
A 67-year old woman with a history of long-term Chinese herb use was admitted to our institution complaining of abdominal pain. Barium enema disclosed rigidity of throughout the proximal colon and a slightly elevated lesion in the transverse colon. Colonoscopy showed diffuse and bronze mucosa in the proximal colon, which was compatible with mesenteric phlebosclerosis. There was also a reddish, elevated lesion in the transverse colon. Magnifying colonoscopy revealed irregular microsurface and microvessels on the surface of the lesion. Under a diagnosis of intramucosal cancer, the elevated lesion was treated by endoscopic submucosal dissection. Histological examination of the resected specimen showed intramucosal well-differentiated adenocarcinoma, and fibrous thickening of the vascular wall together with collagen deposition in the submucosa. The final diagnosis was an intramucosal cancer occurring in mesenteric phlebosclerosis.
Central sleep apnea occurs in up to 50% of heart failure patients and worsens outcomes. Established therapies are limited by minimal supporting evidence, poor patient adherence, and potentially adverse cardiovascular effects. However, transvenous phrenic nerve stimulation, by contracting the diaphragm, restores normal breathing throughout sleep and has been shown to be safe and effective. This review discusses the mechanisms, screening, diagnosis, and therapeutic approaches to CSA in patients with HF.
In a prospective, multicenter randomized Pivotal Trial (NCT01816776) of transvenous phrenic nerve stimulation with the remedē System, significantly more treated patients had a ≥ 50% reduction in apnea-hypopnea index compared with controls, with a 41 percentage point difference between group difference at 6months (p < 0.0001). All hierarchically tested sleep, quality of life, and daytime sleepiness endpoints were significantly improved in treated patients. Freedom from serious related adverse events at 12ml sleep apnea. Controlled trials evaluating the impact of this therapy on mortality/heart failure hospitalizations and “real world” experience are needed to confirm safety and effectiveness.Functional capacity represents an important predictor for cardiovascular and all-cause mortality in patients with diabetes mellitus (DM). Impaired cardiopulmonary fitness is frequently seen in DM patients, and it might partly explain morbidity and mortality in these patients. There are several potential reasons that could explain impaired functional capacity in DM patients hyperglycemia, insulin resistance, endothelial dysfunction, inflammation, microvascular impairment, myocardial dysfunction, and skeletal muscle changes. These changes are partly reversible, and improvement of any of these components might increase functional capacity in DM patients and improve their outcome. Physical activity is related with decreased cardiovascular disease and all-cause mortality in patients with type 2 DM. Diabetic cardiomyopathy is the most important clinical entity in DM patients that involves left ventricular diastolic dysfunction and cardiac autonomic neuropathy, which potentially induce heart failure with preserved ejection fraction. Development of diabetic cardiomyopathy may slow oxygen uptake kinetics and affect the cardiorespiratory fitness in DM patients, but it can also induce development of heart failure. Improvement of functional capacity in DM patients represents an important therapeutic task, and it can be achieved mainly with exercise training and significantly less with pharmacological treatment. Exercise training reduces body weight and improves glycemic control, as well as left ventricular structure and function. The aim of this review was to summarize current knowledge about importance of functional capacity in DM patients, as well as possible mechanisms that could explain the relationship between DM and oxygen kinetics.
Initial studies have reported excellent safety and efficacy for stereotactic body radiation therapy (SBRT) in patients with refractory ventricular tachycardia (VT).
This is a single-center retrospective analysis of eight consecutive patients who underwent SBRT for refractory, scar-related VT. The anatomic target for radioablation was defined based on surface 12-lead ECG VT morphology, cardiac magnetic resonance imaging, and electroanatomic mapping data when available. The target volume treated and the prescribed radiation dose (15-25Gy) was based on the combined clinical assessment of the cardiac electrophysiologist and radiation oncologist. Ventricular arrhythmias, radiation-related outcomes, and adverse events were monitored at follow-up.
Eight patients underwent nine SBRT sessions. All patients were male with an average age of 75 ± 7.3years and mean ejection fraction of 21 ± 7%. SBRT was performed with delivery of an average of 22.2 ± 3.6Gy in a single session with a procedure time of 18.2 ± 6.0min. All but one session was performed on an inpatient basis. No acute complications occurred. During a median follow-up of 7.8months (IQR 4.8, 9.9), ICD therapies decreased from median 69.5 (43.5, 115.8) pre-SBRT to 13.3 (IQR 7.7, 35.8) post-SBRT (p = 0.036). There were three patient deaths in the follow-up period, unrelated to SBRT. Apparent clinical benefit occurred 33% of the time after SBRT.
The patients experienced overall reduction in VT burden following SBRT, though not with the immediate effect seen in other patient series. Further studies (basic, translational, and clinical) are essential to determine the benefit of SBRT and if so, the optimal protocols and patient selection.
The patients experienced overall reduction in VT burden following SBRT, though not with the immediate effect seen in other patient series. Further studies (basic, translational, and clinical) are essential to determine the benefit of SBRT and if so, the optimal protocols and patient selection.
The use of two operating microsurgeons has been shown to improve the efficiency and reduce the operative duration of microsurgical breast reconstruction (MSBR). However, the impact of this practice on healthcare cost has not been previously assessed. The goal of this study is to query a national claims database to assess complication rates and overall cost in patients undergoing MSBR using co-surgeon (CS) vs. single-surgeon (SS) approach.
The study cohort, extracted from the MarketScan database, included all female patients who underwent MSBR between 2010 and 2017. this website Our primary outcome measure was the difference in total healthcare cost between the two operative groups while differences in complication rates were secondary outcome measures.
We identified a total of 8680 patients, out of whom 7531 (87%) underwent MSBR with a SS and 1149 (13%) had a CS. Over the study period, the annual incidence rate of MSBR cases using CS increased from 7.2% in 2010 to 23.3% in 2017 (p < 0.001). Following propensity score matching, complications, emergency room visits, readmissions, and reoperations were all similar between the CS and SS groups.
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Start with a huge, uncovered box, or even a kiddie pool, and fill with a thick layer (about 6 inches) of unscented clay or fine sand-like particulate clumping/scoopable litter. For Ollie, you may need to play around with the substrate types to make it more natural. Try using soil or peat.