Objective To investigate the correlation betw een the short-term blood pressure variability and the recent outcome in patients w ith noncardioembolic ischemic stroke. Methods The patients w ith acute noncardioembolic ischemic stroke admitted to hospital betw een January 1, 2013 to June31, 2015 w ere enrol ed consecutively. The demographic and clinical data w ere col ected, and 24 h ambulatory blood pressure monitoring w as performed and each blood pressure variability parameter w as calculated. The modified Rankin scale (mRS) w as used to evaluate recent neurological outcome at the time of discharge or the fourteenth day in hospital. The mRS score 0-2 w as defined as good outcome, and >2 w as defined as poor outcome. Multivariate logistic regression analysis w as used to determine the correlation betw een the blood pressure and the short-term blood pressure variability indicators and recent neurological outcome. Results A total of 229 patients w ith acute noncardioembolic ischemic stroke w ere enrol ed, and 40.2% of them had recent poor functional outcome. The mean systolic pressure ( 147.8 ±19.6 mmHg vs.137.7 ± 19.1 mmHg; t=3.868, P<0.001; 1 mmHg=0.133 kPa) and the actual variation value of the mean systolic pressure (median, interquartile 11.7 [10.0-14.0] mmHg vs.10.6 [8.2-12.5] mmHg;Z=3.544, P<0.001) of the recent poor outcome group w ere significantly higher than those of the good functional outcome group. Multivariate logistic regression analysis show ed that after adjusting other confounders, the increased mean systolic pressure ( each 10 mmHg increase: odds ratio 1.189, 95% confidence interval 1.013-1.369; P=0.034) and the enlarged actual variation of systolic blood pressure (each 1 mmHg increase:odds ratio 1.182, 95% confidence interval 1.046-1.336; P=0.008) w ere associated w ith the recent poor functional outcome. Conclusions The increased short-term blood pressure variability w as associated w ith the recent poor functional outcome in patients w ith acute noncardioembolic ischemic stroke.

Objective To explore the relationship between 24-hour blood pressure variability after admission and early neurological deterioration in patients with acute non-cardioembolic ischemic stroke.Methods This was a case-control study.Patients with acute non-cardioembolic ischemic stroke within 72 hours after stroke onset were prospectively registered.Clinical and 24 -hour continuous blood pressure monitoring data were recorded, and subsequently compared with regard to whether early neurological deterioration ( END) occurred within 7 days after admission.Factors contributing to END were investigated by logistic regression model.Results Of 221 eligible patients, 59 cases ( 26.7%) exhabited END.Patients with END had higher 24-hour mean systolic blood pressure ( SBP) (145.8 ±18.2 mmHg vs.139.9 ± 20.3 mmHg, P=0.014) and SBP coefficient of deviation (SBP-CV) [9.0(7.3 -11.2) vs.8.4(6.9-10.2), P=0.011].After adjusting for crude variables, multivariate analysis showed that the increase in mean SBP (10 mmHg mean SBP,OR=1.285,95%CI(1.059~1.559) and SBP-CV [1 unit of SBP-CV, OR=1.206,95%CI(1.050~1.384)] was associated with higher risk of END.Conclusions Increased 24-hour blood pressure variability after admission is an independent risk factor for occurrence of END in patients with acute non-cardioembolic ischemic stroke.

From the ethical point of view,this paper explores to carry out AIDS-related training for nursing staff,to enhance their awareness of self protection and occupational protection for better nursing work,and provides reference for training in AIDS prevention and control and reduce occupational risk among nursing staff.

Objective To elucidate whether 24-hour blood pressure (BP) variability in the acute phase of ischemic stroke is associated with functional outcomes.Methods Case-control study was performed in patients with acute ischemic stroke admitted to our hospital from January 2013 to December 2015.Clinical data and 24-hour continuous BP monitoring data right after admission were recorded,and BP variability profiles were subsequently calculated.Functional outcomes were evaluated with modified Rankin scale (mRS) on discharge and at 6 months after discharge respectively (favorable outcome:mRS scores ＜2;poor outcome:mRS scores＞2).BP variability profiles were compared with distinctive functional outcomes.Logistic regression models were established to investigate factors contributing to poor outcome on discharge and at 6 months after discharge.Results Of 188 eligible patients,67 (35.6％) discharged with poor outcome and 95 (50.5％) were reported poor outcome at 6 months follow-up.Patients with poor outcome on discharge had significantly higher 24-hour mean systolic blood pressure (SBP,[149.6±20.0] mmHg vs.[137.6±20.2] mmHg) and SBP standard variation (SBP-SD,[13.4±3.8] mmHg vs.[12.1±3.8] mmHg,P＜0.05).After adjusting for crude variables,the increase of 24-hour mean SBP and SBP-SD was independently associated with poor outcome on discharge (OR=1.284,95％CI=1.067-1.544,P=0.008;OR=1.098,95％CI=1.016-1.188,P=0.019).Patients with poor outcome at 6 month after discharge had significantly higher 24-hour mean SBP ([146.6±20.6] mmHg vs.[137.1 ± 20.2] mmHg,P＜0.05).Conelusion Increased 24-hour BP variability after admission is associated with early functional outcome in patients with acute ischemic stroke,but not with midterm outcome.

Objective To investigate the correlation betw een visit-to-visit blood pressure variability and long-term stroke recurrence in patients w ith ischemic stroke. Methods Consecutive patients w ith first-ever acute ischemic stroke w ere registered. The demographic and clinical data w ere documented. The patients w ere follow ed up every month after discharge. Visit-to-visit blood pressure w as measured, and its mean value and blood pressure variability parameters w ere calculated.A 12-month follow-up period w as completed and the recurrent stroke events w ere documented.Univariate analysis w as used to compare the demographic and clinical data in the recurrent and non-recurrent groups.Multivariate logistic regression analysis w as used to identify the correlation betw een visit-to-visit blood pressure variability and stroke recurrence. Results A total of 556 patients completed the follow-up, including 62 (11.2%) w ith recurrent stroke. The standard deviation (16.5 ±4.7 mmHg vs.13.4 ±4.2 mmHg, 1 mmHg=0.133 kPa; t=1.953, P=0.042) and coefficient of variation (11.9 ±3.1 vs.9.8 ±2.4; t=2.287, P=0.001) of visit-to-visit systolic blood pressure in the recurrent group w ere significantly higher than those in the non-recurrent group.Multivariable logistic regression analysis show ed that visit-to-visit coefficient of variation of systolic pressure w as independently associated w ith stroke recurrence (odds ratio 1.305,95% confidence interval 1.004-7.491;P=0.017). Conclusion The visit-to-visit blood pressure variability w as independently associated w ith long-term stroke recurrence in patients w ith acute ischemic stroke.

INTRODUCTION: To date, there have only been 2 systematic reviews, and 1 systematic review and meta-analysis on high-intensity focused ultrasound (HIFU) for benign thyroid nodules. The present systematic review and meta-analysis seeks to evaluate the efficacy and safety of HIFU in the treatment of benign thyroid nodules. METHODS: Pubmed, Embase and Cochrane databases were searched for relevant studies from 1990 to 2021. Nine studies were included in the systematic review and 6 in the meta-analysis. Pooled volume reduction rates (VRRs) at 3, 6 and 24 months after HIFU were assessed. RESULTS: This systematic review and meta-analysis showed that pooled VRRs at 3, 6, and 24 months after HIFU were 42.14 (95% confidence interval [CI] 28.66-55.62, I2=91%), 53.51 (95% CI 36.78-70.25, I2=97%) and 46.89 (95% CI 18.87-74.92, I2=99%), respectively. There was significant heterogeneity in the pooled VRRs at 3, 6 and 24 months after HIFU. No studies recorded complete disappearance of the nodules. Common side effects included pain, skin changes and oedema. There were no major complications except for transient vocal cord paralysis and voice hoarseness (0.014%) and transient Horner syndrome (0.5%). CONCLUSION HIFU may be an effective and safe alternative treatment modality for benign thyroid nodules. Larger clinical trials with longer follow-up are needed to evaluate the effectiveness of HIFU in treating benign thyroid nodules.
High-Intensity Focused Ultrasound Ablation/adverse effects* ; Humans ; Pain ; Reconstructive Surgical Procedures ; Thyroid Nodule/surgery* ; Treatment Outcome

BACKGROUNDNasopharyngeal carcinoma (NPC) patients have a 19%-56% locoregional recurrence rate after primary therapy. For those recurrent NPC (rNPC) patients, re-irradiation may cause some complications. In recent years, endoscopic endonasal nasopharyngectomy (EEN) has become a surgical option for rNPC patients. Here we introduce the concept of en bloc excision (EBE) technique for EEN, including the surgical technique and clinical outcomes.

METHODSA retrospective study was conducted covering September 2009 to May 2013, involving the collection of locoregional rNPC cases from two institutions (Kuang-Tien General Hospital (KTGH) in Taiwan and National University Health System (NUHS) in Singapore). These patients failed prior therapy and then underwent EEN. We reported the 2-year overall survival rate, the 2-year disease-free survival rate, and related complications.

RESULTSNine patients (five from KTGH and four from NUHS) completed this study, with five, two, and two patients of recurrence tumors (rT1), rT2, and rT3, respectively. The mean age was 46.4 years (range 32-63); the mean follow-up period was 24.9 months (range 10-45). The 2-year survival rate and the 2-year disease-free rate were 100% and 80%, respectively, in five patients. No significant complications or cases of mortality occurred.

CONCLUSIONSThe EBE concept of EEN is suitable for early rT1 and has relatively encouraging short-term outcomes. In selected rT2, careful EBE can be performed by expanding the surgical field. A clear view of the internal carotid artery-related anatomy is indispensable. In the future, more series may be needed to determine the role of EEN in rNPC patients.

Adult ; Carcinoma ; Endoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome

The number of patients requiring intensive care has surged since the outbreak of the SARS-CoV-2 virus. This had rendered the intensive care unit (ICU) a huge challenge not only to provide care for the existing patients but also to support the COVID-19 patients. The ICU was restructured to ensure strict adherence to the infection control guidelines. The aspects of change in the ICU had been ranging from the clinical operation, medication equipment and facilities, medications supply, and staffing. Strategies required upon implementation of change include having contingency plans, being innovative, getting the collaboration from other ICUs, exchanging information, getting support from the health policymakers, and ensuring the safety of the healthcare workers. This article aimed to share the experience of challenges and strategies in managing an ICU for the COVID-19 pandemic in Malaysia.