Medicine
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Multicenter Study Observational Study
Associations of dietary macronutrients and micronutrients with the traditional and nontraditional risk factors for cardiovascular disease among hemodialysis patients: A clinical cross-sectional study.
The current study was to examine the association of adequate intake of macronutrients and micronutrients with traditional and nontraditional cardiovascular risk factors in hemodialysis patients. A clinical cross-sectional study was conducted between September 2013 and April 2017 on 492 hemodialysis patients aged 20 years and above, received thrice-weekly hemodialysis treatment for at least 3 months, adequate dialysis quality (equilibrated Kt/V ≥ 1.2 g/kg/d) from 7 hospital-based hemodialysis centers in Taiwan. The dietary intake was evaluated by the 3-day dietary record, and a 24-hour dietary recall. ⋯ All hemodialysis patients had CVD risks, the lowest proportion of patients with adequate intake of macronutrients and micronutrients were 8.7% and 1.8%, respectively. The adequate dietary intake associated with lower likelihood of having CVD risks in hemodialysis patient by 47% to 84%, including 39% to 58% lower hypertension, 37% to 50% lower dyslipidemia, 42% to 63% diabetes mellitus, 44% to 84% lower obesity, 58% lower low calcium, 38% lower hyperparathyroidism, 47% to 64% lower hyperhomocysteinemia, and 41% to 67% lower inflammation, 63% to 74% lower hypoalbumin, 73% lower inadequate normalized protein nitrogen appearance. Adequate dietary nutrients intake may reduce the cardiovascular risks factors, in turn, to prevent the cardiovascular morbidity and mortality.
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Tracheobronchomalacia (TBM) refers to the weakening trachea or the trachea loss of structural integrity of airway cartilaginous structures. It causes tracheal stenosis, resulting in significantly high rates of mortality. Bronchoplasty by high-pressure balloon dilation under general anesthesia is a simple but effective and safe method to treat tracheobronchial stenosis. However, recurrent postoperative dyspnea after extubation due to tracheal collapse is still a challenge for anesthetists. ⋯ In such an emergency even, the anesthesiologist should take valuable treatments to ensure the patient's effective ventilation. If the anesthesia-related factors can be eliminated, tracheomalacia or airway collapse should be considered whenever dyspnea occurs in the patients who unexpectedly fail to be extubated.
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The corpus callosum, which is the most important fiber pathway linking the bilateral hemispheres, plays a key role in information access, as well as the functional coordination and reorganization between the bilateral hemispheres. However, whether the corpus callosum will undergo structural changes during the recovery of aphasia is still unclear. In the current study, a Chinese aphasic patient with stroke was reported to develop changes in the corpus callosum after speech therapy. ⋯ The fibrous structure between the corpus callosum and cortical language areas may be reconstructed during the recovery of aphasia. In addition, and the corpus callosum may play an important role in the occurrence and recovery of aphasia after stroke.
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As suggested by the 2012 KDIGO guidelines, persistent elevation of serum creatinine > 3.5 mg/dl (> 309 μmol/l) (or an estimated glomerular filtration rate < 30 ml/min per 1.73 m is one of contradictions for the use of immunosuppressive therapy in membranous nephropathy. ⋯ This case strongly suggested that rituximab has promising therapeutic significance, even in patients progressing to CKD4.
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Case Reports
Pulmonary embolism presenting with itinerant chest pain and migratory pleural effusion: A case report.
Pulmonary embolism (PE) presents with complex clinical manifestations ranging from asymptomatic to chest pain, hemoptysis, syncope, shock, or sudden death. To the authors' knowledge, itinerant chest pain has not been reported as sign or symptom of PE. ⋯ The use of CTPA to investigate the possible presence of PE in patients with unexplained migratory pleural effusion complaining of itinerant chest pain is important. Lessons should be learned from the early use of CTPA to investigate the possible presence of PE in patients.