Medicine
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Observational Study
Prolonged B cell depletion with rituximab is effective in treating refractory pulmonary granulomatous inflammation in granulomatosis with polyangiitis (GPA).
Pulmonary nodule formation is a frequent feature of granulomatosis with polyangiitis (GPA). Traditional induction therapy includes methotrexate or cyclophosphamide, however, pulmonary nodules generally respond slower than vasculitic components of disease. Efficacy of rituximab (RTX) solely for the treatment of pulmonary nodules has not been assessed. ⋯ Repeated RTX treatment in these 3 and persistent B cell depletion in the whole cohort was associated with further significant radiological improvement. Radiographic scoring at each time interval showed reduction in both number of nodules (P = <0.0001) and largest nodule diameter (P = <0.0001) in all patients for at least 18 months following B cell depletion. In summary, RTX therapy induces resolution of pulmonary granulomatous inflammation in GPA following prolonged B cell depletion.
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To investigate the incidence and risk factors of retinopathy of prematurity (ROP) and Type 1 ROP in extremely preterm Chinese infants. A retrospective review of medical records was performed of all extremely preterm neonates (gestational age, GA≤28 weeks) screened for ROP from 2007 to 2012 at an ophthalmology centre in Hong Kong. Thirty-three maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP. ⋯ On multivariate analysis, neonatal congenital heart disease and greater GA were protective factors for ROP development (P≤0.04). On the other hand, 4 risk factors were associated with Type 1 ROP development in univariate analysis, including: lower GA, lighter BW, multiple pregnancies, and invasive mechanical ventilation (all P≤0.02); while there was no significant risk factors on multivariate analysis. A lighter BW and lower GA were the only common independent risk factors for both ROP and Type 1 ROP while neonatal congenital heart disease and greater GA were the protective factors against ROP.
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Review Meta Analysis
Obstructive sleep apnea and serious adverse outcomes in patients with cardiovascular or cerebrovascular disease: a PRISMA-compliant systematic review and meta-analysis.
Obstructive sleep apnea (OSA) is seen in approximately 60% to 70% of patients with stroke or ischemic heart disease (IHD). The relationship between OSA and recurrent vascular events and all-cause mortality remains inconclusive. We aimed to systematically evaluate the associations between OSA and serious adverse outcomes following stroke or IHD by a meta-analysis of prospective cohort studies. ⋯ The results did not materially change in the sensitivity analyses for the outcomes of stroke and all-cause mortality. OSA may be a significant predictor of serious adverse outcomes following stroke or IHD. More high-quality studies are needed to determine if better treatment of OSA leads to fewer recurrent vascular events, especially a large-scale, multicenter randomized-controlled trial.
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Review Meta Analysis
Coracoclavicular ligament reconstruction: a systematic review and a biomechanical study of a triple endobutton technique.
Operative intervention is recommended for complete acromioclavicular (AC) joint dislocation to restore AC stability, but the best operative technique is still controversial. Twelve fresh-frozen male cadaveric shoulders (average age, 62.8±7.8 years) were equally divided into endobutton versus the modified Weaver-Dunn groups. Each potted scapula and clavicle was fixed in a custom made jig to allow translation and load to failure testing using a Zwick BZ2.5/TS1S material testing machine (Zwick/Roell Co, Germany). ⋯ From our systematic review of 21 studies, which involved comparison of the modified Weaver-Dunn technique with other methods, the majority showed that the modified Weaver-Dunn procedure had significantly (P<.05) greater laxity than other methods including the endobutton technique. The triple endobutton reconstruction proved superior to the modified Weaver-Dunn technique in restoration of AC joint stability and strength. Triple endobutton reconstruction of the coracoclavicular ligament is superior to the modified Weaver-Dunn reconstruction in controlling both superior and anteroposterior displacements with a failure load that approximates the intact ligament.
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Review Meta Analysis
Predictive accuracy of amyloid imaging for progression from mild cognitive impairment to Alzheimer disease with different lengths of follow-up: a meta-analysis. [Corrected].
In the past decade, amyloid deposition has been shown to begin many years before the clinical symptoms of dementia in mild cognitive impairment (MCI) due to Alzheimer disease (AD). Longitudinal studies with different follow-up durations have suggested that C-Pittsburgh compound B positron emission tomography (C-PIB-PET) may play a role in stratifying patients with MCI into risk levels for developing AD. However, the predictive accuracy of amyloid imaging for the progression from MCI to AD with different follow-up durations has not yet been systematically evaluated. ⋯ Not all of the methodological quality scores of studies included in this systematic review were high. Current evidence suggests that prolongation of the follow-up duration tended to yield greater accuracy of C-PIB-PET for predicting the progression from MCI to AD. In particular, the specificity, which reflects the exploratory nature of the use of amyloid imaging to identify the process of MCI to AD, was improved with a longer follow-up period.