Journal of investigative medicine : the official publication of the American Federation for Clinical Research
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Although Multiple Sclerosis is the most common central nervous system (CNS) inflammatory demyelinating disorder, other CNS inflammatory disorders should be included as diagnostic considerations. Neuromyelitis Optica Spectrum Disorder (NMOSD) and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease are less common but share some clinical characteristics, such as optic neuritis and myelitis, which can make a specific diagnosis challenging. However, these disorders have distinctive and generally different clinical phenotypes, prognosis and management. ⋯ Clinical indicators are important to guide diagnostic work-up. Careful review of the history, neurological exam, imaging, and/or spinal fluid results are essential to making an accurate diagnosis. In this review, we will examine the clinical presentation, diagnosis, and natural history of these inflammatory CNS disorders.
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The nasopharyngeal tract traps mainly coarse particles in inhaled air. Soluble carcinogenic compounds, endotoxins, and trace metals contained in these particles are potential causes of inflammation and oxidative stress which could enhance carcinogenesis. The aim of this study was to determine the association between coarse particulate matter (PM10-2.5) and nasopharyngeal cancer (NPC). ⋯ With PM10-2.520.44 μg/m3 as the reference, the ORs and 95% CIs were 1.47; 1.03-2.11, 1.34; 0.94-1.91, and 1.68; 1.16-2.44 for 20.44≤PM10-2.524.08, 24.08≤PM10-2.529.27, and PM10-2.5≥29.27 μg/m3, respectively. PM10-2.5 remained significantly associated with a higher risk of NPC after further adjustments were made for the aforementioned covariates and PM2.5 The ORs; 95% CIs were 1.42; 0.96 to 2.12, 1.41; 0.94 to 2.10, and 1.71; 1.10 to 2.66 for 20.44≤PM10-2.524.08, 24.08≤PM10-2.529.27, and PM10-2.5≥29.27 μg/m3, respectively. In conclusion, PM10-2.5 was significantly associated with a higher risk of NPC in Taiwanese men.
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While low-risk patients who undergo elective surgery can tolerate low hematocrit levels, the benefits of higher hematocrit levels might outweigh the risk of transfusion in high-risk patients. Therefore, this study aimed to evaluate the effects of perioperative hematocrit levels on mortality in patients requiring prolonged mechanical ventilation (PMV) after a cardiovascular surgery. This single-center retrospective cohort study was conducted on 172 patients who underwent cardiovascular surgery with cardiopulmonary bypass or off-pump coronary artery bypass grafting and required PMV for ≥72 hours in the intensive care unit (ICU) from 2008 to 2012 at the Yokohama City University Medical Center in Yokohama, Japan. ⋯ The difference in survival rates was significant between the two groups using the log-rank test (HR 0.55, 95% CI 0.32 to 0.95, p=0.033). Cox regression analysis revealed that ≥30% increase in hematocrit levels on ICU admission was significantly associated with decreased long-term mortality (HR 0.40, 95% CI 0.20 to 0.80, p=0.0095). Lower hematocrit levels on ICU admission was a risk factor for increased long-term mortality, and higher hematocrit levels might outweigh the risk of transfusion in patients requiring PMV after a cardiovascular surgery.
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Comparative Study
Area under the expiratory flow-volume curve (AEX): actual versus approximated values.
Previous work has shown that area under the expiratory flow-volume curve (AEX) performs well in diagnosing and stratifying respiratory physiologic impairment, thereby lessening the need to measure lung volumes. Extending this prior work, the current study assesses the accuracy and utility of several geometric approximations of AEX based on standard instantaneous flows. These approximations can be used in spirometry interpretation when actual AEX measurements are not available. ⋯ All four approximations had strong correlations with AEX, that is, 0.95-0.99. Differences were the smallest for AEX-AEX4, with a mean of 0.52 (95% CI 0.51 to 0.54) and a SD of 0.75 (95% CI 0.74 to 0.76) L2/s. In the absence of AEX and in addition to the usual spirometric variables used for assessing functional impairments, parameters such as AEX4 can provide reasonable approximations of AEX and become useful new tools in future interpretative strategies.
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Heart rate variability (HRV) is an accepted clinical tool for evaluating autonomic nervous system function and a marker of adverse cardiac outcome. Although 5 min long HRV recordings are considered methodologically acceptable, it remains impractical in most clinical settings. Also, while some ultrashort HRV (usHRV) parameters were found useful in healthy individuals, their applicability to patients with cardiovascular risk factors is largely unknown. ⋯ In conclusion, evaluation of SDNN, RMSSD or Ln(RMSSD) from 10 s ECG recordings can be used to estimate autonomic nervous system function in patients with hypertension. These appealing markers can be readily calculated from any standard ECG tracing. The prognostic significance of ultrashort SDNN and ultrashort RMSSD in patients with cardiovascular risk factors needs to be determined in future prospective cohort studies.