Medicine
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Meta Analysis
Efficacy and safety of riociguat in the treatment of chronic thromboembolic pulmonary arterial hypertension: A meta-analysis.
Riociguat is a novel soluble guanylate cyclase stimulator, and has been widely used for the treatment of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (CTEPH). Some studies found that riociguat had better effects on CTEPH and proved to be safe, but the results were not utterly consistent. Therefore, the purpose of this study was to comprehensively evaluate the efficacy and safety of riociguat in the treatment of CTEPH. ⋯ We confirmed that riociguat had better therapeutic effects in improving the hemodynamic parameters and exercise capacity in patients with CTEPH without inducing serious adverse events. This will provide a reasonable medication regimen for the treatment of CTEPH.
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Measurement of cortisol in hair is a reliable method for determining long-term cortisol exposure reflecting chronic stress. Research using hair cortisol concentration has been limited to mainly cardiometabolic diseases. The association between hair cortisol concentration and aneurysmal rupture has not yet been studied. ⋯ High hair cortisol concentration was found to be an independent risk factor for aneurysmal rupture (odds ratio [OR]: 2.245, 95% confidence interval [CI]: 1.825-2.753; P = .013). Additionally, a history of cerebrovascular disease was significantly associated with an increased risk of aneurysmal rupture (OR: 1.577, 95% CI: 1.099-2.262; P = .040). Based on our results, we suggest that chronic stress as measured by hair cortisol concentration could be an independent risk factor for intracranial aneurysmal rupture.
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Case-control studies by examining the lumbar spine computed tomography (CT) findings focusing on the spinous processes."Passing spine" was defined as a lumbar degenerative change observed on CT images. In contrast, kissing spine, which is also an image finding, has been acknowledged as an established clinical condition. ⋯ Compared with patients with kissing spine, patients with passing spine had an increased incidence of lower extremity pain, lower intervertebral disc height at the level of passing spine, relatively static LL, and VP commonly observed in the intervertebral discs at the level of passing spine. Because the clinical and imaging characteristics of patients with passing spine are different from those of patients with kissing spine, passing spine might be a pathological condition distinct from kissing spine.
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Comparative Study
A comparative study of propofol alone and propofol combined with midazolam for dental treatments in special needs patients.
Although dental treatment with sedation is performed increasingly in special needs patients, data on adding midazolam to intravenous propofol sedation are very limited for this group. The purpose of this study was to identify the factors and procedure time associated with the use of intravenous sedation with propofol alone or propofol combined with midazolam in dental patients with special needs. This was a retrospective data analysis. ⋯ Sedation time was associated with body mass index (BMI) < 25 (adjusted odds ratio [aOR] = 1.45, 95% confidence interval [CI]: 1.04-2.04) and the performance of multiple dental procedures (aOR = 1.44, 95% CI: 1.06-1.97) but not associated with the sedation types. A significant odds ratio for the combined use of propofol and midazolam was shown for adolescents (aOR = 2.22, 95% CI: 1.28-3.86), men (aOR = 2.05, 95% CI: 1.41-2.98), patients with cognitive impairment (aOR = 1.99, 95% CI: 1.21-3.29), and patients undergoing scaling procedures (aOR = 1.64, 95% CI: 1.13-2.39). With the acceptable side effects of the use of propofol alone and propofol combined with midazolam, multiple dental procedures increase the sedation time and the factors associated with the combined use of propofol and midazolam are younger age, male sex, recognition problems, and the type dental procedure in the dental treatment of patients with special needs.
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Multiple endocrine neoplasia 2A (MEN2A) is a rare autosomal-dominant genetic syndrome, frequently misdiagnosed or neglected clinically, resulting in delayed therapy to patients. ⋯ Patients with MEN2A should be screened regularly and managed by a multidisciplinary team.