简介：AbstractPreeclampsia is a progressive, multi-system disorder of pregnancy associated with morbidity and mortality on both the mother and the fetus. Currently, research is directed at identifying early biomarkers of preeclampsia in order to predict its occurrence. This is important because it helps understand the pathophysiology of the disease, and thus, promises new treatment modalities. Although a clear understanding of the pathogenesis of PE remains elusive, the currently most accepted theory suggests a two-stage process. The first stage results in inadequate remodeling of the spiral arteries and leads to the second stage, whereby the clinical features of the syndrome are featured. In this review, we summarize the modalities that have been studies so far to predict preeclampsia. The use of uterine artery Doppler and several other biomarkers such as vitamin D, soluble fms-like tyrosine kinase 1/placental growth factor (sFLT1/PlGF) ratio, soluble endoglin, and a subset of T-lymphocytes has shown promising results. We are still at early stages in this advance, and no clear recommendations have been made about their clinical use to date. Further studies are still needed to improve screening strategies and evaluate the cost-effectiveness of any intervention.

简介：Objective:Thepredictiveandprognosticroleofprognosticnutritionalindex(PNI)ingastriccancerpatientswithperitonealdisseminationremainsunclear.ThisstudyaimstoexploretheroleofthePNIinpredictingoutcomesofgastriccancerpatientswithperitonealdissemination.Methods:Atotalof660patientsdiagnosedwithgastricadenocarcinomawithperitonealmetastasisbetweenJanuary2000andApril2014atSunYat-senUniversityCancerCenterandtheSixthAffiliatedHospitalofSunYatsenUniversitywereretrospectivelyanalyzed.Theclinicopathologiccharacteristicsandclinicaloutcomesofpatientswithperitonealdisseminationwereanalyzed.Results:ComparedwithPNI-highgroup,PNI-lowgroupwascorrelatedwithadvancedage(P=0.036),worseperformancestatus(P<0.001),higherfrequencyofascites(P<0.001)andhigherfrequencyofmultisitedistantmetastasis(P<0.001).Kaplan-MeiersurvivalcurvesshowedthatPNI-highgrouphadasignificantlylongermedianoverallsurvivalthanPNI-lowgroup(13.13vs.9.03months,P<0.001).MultivariatesurvivalanalysisrevealedthatBorrmanntypeIV(P=0.014),presenceofascites(P=0.017)andlowerPNI(P=0.041)wereindependentpoorprognosticfactors,andpalliativesurgery(P<0.001)andfirst-linechemotherapy(P<0.001)weregoodprognosticfactors.Forpatientsreceivingpalliativesurgery,thepostoperativemorbidityratesinthePNI-lowgroupandPNIhighgroupwere9.1%and9.9%,respectively(P=0.797).ThepostoperativemortalityratewasnotsignificantlydifferentbetweenPNI-lowandPNI-highgroups(2.3%vs.0.9%,P=0.362).Conclusions:PNIisausefulandpracticaltoolforevaluatingthenutritionalstatusofgastriccancerpatientswithperitonealdissemination,andisanindependentprognosticfactorforthesepatients.

简介：AbstractPurpose:The present study examined the joint impact of coping and rumination after trauma on posttraumatic growth (PTG) and posttraumatic depreciation (PTD) based on the PTG model.Methods:A cross-sectional study was conducted between October 2017 and May 2018. A sample of 253 individuals who had experienced a traumatic event in the last two years, was included. Participants completed an online self-reported survey, including demographic variables, trauma characteristics, the German Posttraumatic Growth and Depreciation Inventory — Expanded, the Brief COPE Inventory, and the Event Related Rumination Inventory. An analysis of correlation, a principal component analysis and hierarchical regression analyses were conducted. Statistical analyses were undertaken on SPSS (version 25.0; IBM, New York, USA).Results:After controlling for the effects of personal and trauma characteristics, self-sufficient coping and socially supported coping were found to favor the emergence of PTG. Event-related and recent deliberate rumination were positively related to PTG. Avoidant-focused coping and recent intrusive rumination were positively associated with PTD. Overall, the final models accounted for 46% and 58% of the variance in PTG and PTD.Conclusion:Our findings confirm the PTG model and support the central role of deliberate rumination, self-sufficient coping and socially supported coping in the development of PTG. Our results indicate that a similar model of PTD with comparable influencing factors can be assumed: if the individual is stuck in ongoing intrusive rumination and uses more avoidance-focused coping, it might lead to more reports of PTD.

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简介：Varicocelectomy是为有痛苦的精索静脉曲张的病人的一种管理选择。在这研究，我们为痛苦的精索静脉曲张估计了varicocelectomy的有效性并且检验了可能结果预兆的因素。为在2007年2月和2009年7月之间的疼痛经历了varicocelectomy的所有病人被包括。耐心的医药记录的评论被进行；疼痛的耐心的年龄，身体团索引(BMI)，等级，精索静脉曲张的地点，阴囊的卷，持续时间和质量(迟钝，拖，跳动或锋利)并且外科的技术(腹股沟对subinguinal)被记录。所有参数与疼痛的决定相比(完全，部分或失败)。我们列在后面在上面在104个病人中的53个上(51.0%；)。疼痛的完全的手术后的分辨率被28个病人报导(52.8%；)，而22(41.5%；)报导部分分辨率。仅仅三个病人(5.7%；)报导失败。没有关系在手术后的疼痛分辨率和年龄之间被观察，BMI，精索静脉曲张的等级，精索静脉曲张的地点，ipsilateral阴囊的hypotrophy，疼痛的质量或外科的技术。在外科前的疼痛的持续时间是与手术后的疼痛分辨率相关的唯一的因素(univariate，P=0.004；multivariate，P=0.002)。我们的结果显示varicocelectomy是为在适当地选择的病人的痛苦的精索静脉曲张的有效治疗，并且在外科前的疼痛的那持续时间可能结果是预兆的。

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简介：<正>Background:Muscularstrengthcanbeconceptuallydeterminedbytwocomponents:muscleactivationandsize.Muscleactivationbythecentralnervoussystemcanbemeasuredbysurfaceelectromyography(sEMG).Muscularsizereflectstheamountofcontractileproteinwithinaskeletalmuscleandcanbeestimatedbyanthropometricmeasurements.Thepurposeofthisstudywastodeterminetherelativecontributionsofsizeparametersandmuscleactivationtothepredictionofmaximalvoluntaryisometricelbowflexionstrength.Methods:Aseriesofanthropometricmeasurementsweretakenfrom96participants.Torqueandroot-mean-square(RMS)ofthesEMGfromthebicepsbrachiiwereaveragedacrossthreemaximalvoluntaryisometriccontractions.AmultiplelinearregressionanalysiswasperformedbasedonaPearson’scorrelationmatrix.Results:Bodyweight(BW)accountedfor39.1%and27.3%inmalesandfemales,respectively,andwasthestrongestpredictorofstrengthformales.Forearmlength(L3)wasthestrongestpredictorofstrengthinfemales(partialR~2=0.391).Elbowcircumference(ELB)accountedforasignificant(p<0.05)amountofvarianceinmalesbutnotfemales.TheadditionofsEMGRMSasathirdvariableaccountedforanaverageof10.1%ofthevarianceexcludingtheequationofBWandL3infemales.ThestrongestpredictionequationincludedBW,L3,andELBaccountingfor55.6%and58.5%ofthevarianceinmalesandfemales,respectively.Conclusion:Anthropometricsprovideastrongpredictionequationfortheestimationofisometricelbowflexionstrength.Muscleactivation,asmeasuredbysEMGactivity,accountedforasignificant(p<0.05)amountofvarianceinmostpredictionequations,however,itscontributionwascomparabletoanadditionalanthropometricvariable.

简介：AbstractPurpose:Spinal injuries resulting in neurological damage cause significant morbidity. Swift neurosurgical intervention can mitigate negative outcomes. However, variable mechanisms of injury may be associated with inappropriate transport (IAT), which may delay necessary surgical interventions. Patients with near shore spinal injuries (NSSI) presented with unique mechanisms, so we investigated factors associated with IAT in patients with NSSI.Methods:We performed a multicenter retrospective study of all adult patients transported from a beach resort to 3 hospitals for suspected NSSI between 2006 - 2017. We excluded patients transferred to other facilities, and those not injured in the water. Primary outcome was IAT, defined as patients with NSSI requiring transfer to another trauma center. To avoid heterogeneity in our analysis, we further excluded patients without NSSI who were inappropriately transported to a level I trauma center. We used multivariable logistic regression to assess association of independent variables (such as demographic, environmental, and clinical factors) with outcome.Results:We analyzed 278 patients with suspected NSSI, and found 14 (5.0%) had IAT. Compared to appropriately transported patients, diving was associated with higher percentages of IAT (28.6% vs. 3.9%, p = 0.014) and more were transported by air (50.0% vs. 20.6%, p = 0.01). In multivariable regression, patients’ oxygenation saturation (odds ratio [OR] = 0.8, 95% confidence intervals [CI]: 077-0.98) and diving (OR= 7.5, 95% CI: 1.2-46) were significantly associated with IAT.Conclusion:Rate of IAT for patients with NSSI was low. However, first responders and emergency medicine providers should be aware that diving is associated with a higher likelihood of IAT.

简介：Background：Thesteady-stateincreaseinmuscleforcegeneratingpotentialfollowingalengtheningcontractioniscalledresidualforceenhancement（RFE）.Inthisstudy,weaimedtotestfordifferencesintorque,electromyographicactivity（EMG）,andtheassociatedneuromuscularefficiency（NME）betweenisometricvoluntarycontractionsofelbowflexorsprecededandnotprecededbyalengtheningcontraction.Thedependenceofsuchdifferenceson（i）stretchamplitude,（ii）theregionoftheforce-length（FxL）relationshipwherecontractionoccurs,and（iii）theindividual＇sabilitytoproduce（negative）workduringthestretchwasinvestigated.Methods：Sixteenhealthyadultsparticipatedinthestudy.Elbowflexortorque,angle,andbicepsbrachiiEMGforpurelyisometriccontractions（referencecontractions）andforisometriccontractionsprecededbyactivestretchesof20°and40°weremeasuredattheascending,plateau,anddescendingregionsofsubject-specificFxLcurves.Allcontractionswereperformedinanisokineticdynamometer.Two-factor（stretch×FxLregion）repeatedmeasuresanalysisofvarianceANOVAswasusedtoanalyzetheeffectofactivestretchonEMG,torque,andNMEacrossconditions.Therelationshipsbetweenmechanicalworkduringstretch-calculatedasthetorque-angulardisplacementintegral-andthechangesinEMG,torque,andNMEwereanalyzedusingPearsoncorrelation.Results：Ingeneral,torque,EMG,andNMEfollowingactivestretchesdifferedfromthevaluesobservedforthepurelyisometricreferencecontractions.WhilealthoughthedetailedeffectsofactivestretchontorqueandEMGdifferedbetweenregionsoftheFxLrelationship,NMEincreasedbyabout19%forallmusclelengths.Upto30%oftheinterindividualvariabilityintorquegeneratingpotentialchangeinresponsetoactivestretchingwasaccountedforbydifferencesin（negative）workcapacitybetweensubjects.Conclusion：Ourresultssuggestthat（i）RFEcontributesto＂flatten＂theelbowflexortorque-anglerela

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简介：AbstractBackground:The detrimental outcomes of right ventricular pacing on left ventricular electromechanical function ultimately result in heart failure, a phenomenon termed pacing-induced cardiomyopathy (PICM) in clinical research. This study aimed to validate prognostic factors that can be used to identify patients with higher susceptibility to progress to the stage of cardiomyopathy before pacemaker implantation.Methods:This observational analysis enrolled 256 patients between January 2013 and June 2016, 23 (8.98%) of whom progressed to PICM after 1 year of follow-up. A Cox proportional hazard model was used to analyze the prognostic factors associated with PICM. Dose-response analysis was used to evaluate the relationship between significant indicators in multifactor analysis and PICM.Results:The mean values of left ventricular ejection fraction before and after pacemaker implantation in 23 patients diagnosed with PICM were 62.3% and 42.7%, respectively. Univariate analysis showed that sex, atrio-ventricular block, paced QRS duration, and ventricular pacing percentage were significantly associated with PICM. In the multivariate analysis, male sex (hazard ratio: 1.20, 95% confidence interval [CI]: 1.09-1.33, P < 0.005), paced QRS duration (hazard ratio: 1.95 per 1 ms increase, 95% CI: 1.80-2.12, P < 0.001), and ventricular pacing percentage (hazard ratio: 1.65 per 1% increase, 95% CI: 1.51-1.79, P < 0.001) were independent prognostic factors associated with the development of PICM. The ventricular pacing percentage and paced QRS duration level defined by the dose-response analysis were positively associated with PICM (P < 0.05).Conclusions:Our findings indicated that paced QRS duration and ventricular pacing percentage were the most sensitive prognostic factors for PICM.

简介：Normalregionalleftventricular(LV)mechanicalcontractionissynchronous,resultinginefficientejection.Abnormalitiesinelectricalactivationormyocardialdiseasesmayaffectthetimingofregionalcontraction,resultingindiscoordinatedordyssynchronouscontraction,whichisinefficient.Thisarticlereviewsvariousapproachestoquantifydyssynchrony,focusingonLVdyssynchrony,thathavebeenprincipallyrelatedtocardiacresynchronizationtherapy(CRT).SeveralattemptshavebeenmadetoimprovepatientselectionforCRTbyuseofechocardiographicdyssynchrony;however,nonehavegainedclinicalacceptance.ThisreviewfocusesonthedifferentreasonsfortheexistenceLVdyssynchrony,thedyssynchronousstrainpatternsindicativeofCRTresponse,andtheprognosticimplicationsofdyssynchrony.Interestinechocardiographicdyssynchronyremainshighbecauseofitsmechanisticandprognosticimportance.Dyssynchronymayoccurfromelectricalornonelectricalcauses.PatientswithawideQRScomplexwhohavebaselinedyssynchronyfromelectricaldelayingeneralhaveafavorableresponsetoCRT,whereaspatientswithnonelectricaldyssynchrony(fromcontractileheterogeneityorscar)atthebaselinehaveaworseprognosis.Newinsightsintothemeaningofmechanicaldyssynchronycontinuetoemerge,andthisarticle

简介：AbstractObjective:Current guidelines for hypoglossal nerve stimulator (HGNS) implantation eligibility include drug-induced sleep endoscopy (DISE) findings and other patient characteristics but lead to highly variable rates of surgical success across institutions. Our objective was to determine whether additional factors seen on preoperative evaluation could be used as predictors of surgical success.Study design:Retrospective chart review.Setting:Single-institution academic tertiary care medical center.Subjects:and Methods:This study included patients with obstructive sleep apnea (OSA) who underwent HGNS implantation between 2015 and 2018. Surgical success was defined as a post-operative apnea-hypopnea index (AHI) of less than 20 events per hour and an AHI reduction of at least 50%. Preoperative polysomnogram (PSG) results, DISE findings, and physical parameters were compared between surgical successes and failures.Results:A total of 68 patients were included in the analysis. The overall surgical success rate was 79.4% (54/68). Elevated preoperative AHI was associated with an increased likelihood of treatment failure, with an AHI of (36.9 ± 16.8) events/hour in the success group compared to (49.4 ± 19.6) events/hour in the failure group (P = 0.05). Patients observed to have partial lateral oropharyngeal collapse on DISE was more frequently associated with the treatment failure group than in the success group (P = 0.04).Conclusion:Patients who underwent HGNS implantation overall had a very high treatment response rate at our institution. Factors that may predispose patients to surgical failure included the presence of lateral oropharyngeal collapse and a significantly elevated preoperative AHI. These should be considered when determining surgical candidacy for HGNS implantation.

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简介：AbstractBackground:The association between free triiodothyronine (FT3) and long-term prognosis in dilated cardiomyopathy (DCM) patients has not been evaluated. The purpose of this study was to determine whether the level of FT3 could provide prognostic value in patients with DCM.Methods:Data of consecutive patients diagnosed with DCM were collected from October 2009 to December 2014. FT3 was measured by fluoroimmunoassay. Other biochemical markers, such as free thyroxin (FT4), thyroid-stimulating hormone, red blood cell, hemoglobin, blood urea nitrogen, and serum creatinine, were tested at the same time. Follow-up was performed every 3 months. The primary endpoint was all-cause mortality. Pearson analysis was used to evaluate the correlation of FT3 and other lab metrics with DCM patients’ prognosis. The association of long-term mortality in DCM and FT3 was compared using Cox hazards model.Results:Data of 176 patients diagnosed with DCM were collected. Of them, 24 patients missed FT3 values and six patients were lost to follow-up. Altogether, data of 146 patients were analyzed. During the median follow-up time of 79.9 (53.5-159.6) months, nine patients lost, 61 patients died (non-survival group), and 85 patients survived (survival group). FT3 was significantly lower in non-survival group than that in survival group (3.65 ± 0.83 pmol/L vs. 4.36 ± 1.91 pmol/L; P = 0.003). FT3 also showed a significantly positive correlation with red blood cell and hemoglobin, negatively correlated with age, blood urea nitrogen and serum creatinine (P < 0.05), respectively. Patients in the group of lower FT3 levels (FT3 ≤ 3.49 pmol/L) suffered from a higher risk of all-cause mortality (P for log-rank = 0.001). In multivariate Cox regression analysis, FT3 level was significantly associated with all-cause mortality (hazard ratio: 0.70, 95% confidence interval 0.52-0.95, P for trend = 0.021).Conclusion:Low levels of FT3 were associated with increased all-cause mortality in patients with DCM.

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