Cough ; diagnosis ; therapy ; Female ; Humans ; Male

Objectives: Although thrombolytic therapy has been shown to be benefi cial to stroke patients, its safety and effectiveness in stroke patients with cardiac tumor is unknown. This study assessed the safety and effi cacy of intravenous thrombolysis with recombinant-tissue plasminogen activator (rtPa) in stroke patients with cardiac myxoma. Methods: We systematically searched databases for all publications on thrombolysis in patients with cardiac tumor-related strokes. The literature on thrombolysis in ischemic stroke patients with myxoma was systematically analyzed; information on the hemorrhagic transformation and response rates in patients over and under 70 years of age was extracted and compared. Statistical tests were performed to evaluate the odds ratios for these factors. Results: Twelve case reports were identifi ed. Four patients were 70 years of age or older, two (50%) of whom had demonstrated hemorrhagic transformation, which was not found in patients under 60 years of age. The rate of response to treatment was 60% (3/5) in patients under 60 and 25% (1/4) in those ≥70 years of age. The rate of hemorrhagic transformation in the patients ≥70 years of age was higher than that in patients <70 years of age (odds ratio 7). Conclusion: Intravenous thrombolysis in ischemic stroke patients with myxoma who were over 70 years of age was associated with a lower response rate and a higher risk of hemorrhagic transformation.

Background: This study presents an overview of our technique and the perioperative outcomes for the first 100 patients who underwent minimally invasive endoscopic-assisted off-pump multivessel bypass grafting (endoscopic coronary artery bypass [endo-CAB]) at the Catharina Hospital in Eindhoven. Methods: The first 100 patients undergoing multivessel endo-CAB from May 2022 to March 2024 were included in this retrospective, single-center, observational study (N=100).The study encompassed both elective and urgent surgical revascularization. In all cases, endoscopic-assisted harvesting of the internal mammary artery, radial artery, or saphenous vein was performed, followed by beating-heart anastomoses through a mini-thoracotomy. Results: A total of 226 distal anastomoses were performed, utilizing 102 left internal mammary arteries, 80 radial arteries, 30 right internal mammary arteries, and 14 saphenous veins. On average, each patient had 2.3 anastomoses. A Y graft configuration was employed in 78 patients, in-situ bilateral internal mammary artery inflow in 19 patients, and a proximal aortic graft in 3 patients. Four patients underwent concurrent arrhythmia surgery.Eleven patients received hybrid revascularization. There was 1 conversion to sternotomy (1%) and 3 instances where cardiopulmonary bypass was required (3%). The median operation time was 3.3 hours (interquartile range, 3.0–3.7 hours), and the median hospital stay was 4.0 days (interquartile range, 3–4 days). The in-hospital mortality rate was 1%. Conclusion Multivessel off-pump endo-CAB surgery can be safely performed with endoscopic-assisted conduit harvesting. Combining the benefits of a minimally invasive and anaortic approach may improve perioperative outcomes for patients requiring surgical revascularization. Further studies are necessary to establish the role of this technique in routine coronary surgery.

Background: This study presents an overview of our technique and the perioperative outcomes for the first 100 patients who underwent minimally invasive endoscopic-assisted off-pump multivessel bypass grafting (endoscopic coronary artery bypass [endo-CAB]) at the Catharina Hospital in Eindhoven. Methods: The first 100 patients undergoing multivessel endo-CAB from May 2022 to March 2024 were included in this retrospective, single-center, observational study (N=100).The study encompassed both elective and urgent surgical revascularization. In all cases, endoscopic-assisted harvesting of the internal mammary artery, radial artery, or saphenous vein was performed, followed by beating-heart anastomoses through a mini-thoracotomy. Results: A total of 226 distal anastomoses were performed, utilizing 102 left internal mammary arteries, 80 radial arteries, 30 right internal mammary arteries, and 14 saphenous veins. On average, each patient had 2.3 anastomoses. A Y graft configuration was employed in 78 patients, in-situ bilateral internal mammary artery inflow in 19 patients, and a proximal aortic graft in 3 patients. Four patients underwent concurrent arrhythmia surgery.Eleven patients received hybrid revascularization. There was 1 conversion to sternotomy (1%) and 3 instances where cardiopulmonary bypass was required (3%). The median operation time was 3.3 hours (interquartile range, 3.0–3.7 hours), and the median hospital stay was 4.0 days (interquartile range, 3–4 days). The in-hospital mortality rate was 1%. Conclusion Multivessel off-pump endo-CAB surgery can be safely performed with endoscopic-assisted conduit harvesting. Combining the benefits of a minimally invasive and anaortic approach may improve perioperative outcomes for patients requiring surgical revascularization. Further studies are necessary to establish the role of this technique in routine coronary surgery.

Background: This study presents an overview of our technique and the perioperative outcomes for the first 100 patients who underwent minimally invasive endoscopic-assisted off-pump multivessel bypass grafting (endoscopic coronary artery bypass [endo-CAB]) at the Catharina Hospital in Eindhoven. Methods: The first 100 patients undergoing multivessel endo-CAB from May 2022 to March 2024 were included in this retrospective, single-center, observational study (N=100).The study encompassed both elective and urgent surgical revascularization. In all cases, endoscopic-assisted harvesting of the internal mammary artery, radial artery, or saphenous vein was performed, followed by beating-heart anastomoses through a mini-thoracotomy. Results: A total of 226 distal anastomoses were performed, utilizing 102 left internal mammary arteries, 80 radial arteries, 30 right internal mammary arteries, and 14 saphenous veins. On average, each patient had 2.3 anastomoses. A Y graft configuration was employed in 78 patients, in-situ bilateral internal mammary artery inflow in 19 patients, and a proximal aortic graft in 3 patients. Four patients underwent concurrent arrhythmia surgery.Eleven patients received hybrid revascularization. There was 1 conversion to sternotomy (1%) and 3 instances where cardiopulmonary bypass was required (3%). The median operation time was 3.3 hours (interquartile range, 3.0–3.7 hours), and the median hospital stay was 4.0 days (interquartile range, 3–4 days). The in-hospital mortality rate was 1%. Conclusion Multivessel off-pump endo-CAB surgery can be safely performed with endoscopic-assisted conduit harvesting. Combining the benefits of a minimally invasive and anaortic approach may improve perioperative outcomes for patients requiring surgical revascularization. Further studies are necessary to establish the role of this technique in routine coronary surgery.

STUDY DESIGN: A prospective radiological assessment was performed using computerized tomography measurements. OBJECTIVES: The aim of this study was to assess the changes in the dimensions of the neural foramen after anterior interbody fusion with posterior fixation in spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Anterior lumbar interbody fusion distracts the height and width of the neural foramen. MATERIALS AND METHODS: Anterior interboody fusion with posterior fixation was performed in twenty-five patients. The sagittal parameters were the height and area of the neural foramen. The fused lumbar segments was imaged in the direct sagittal projections in a CT (SOMATOM Senstaion; SIMENS, Germany) and 1-mm slice thickness before surgery and after solid fusion. Computer digitation was used for the measurements independently by three different observers. Statistical analysis was performed using a Wilcoxon signed test and a paired T-test to determine the correlation between the measurements, and Pearson correlation to determine the level of interobserver and intraobserver agreement. RESULTS: After anterior interbody fusion and posterior fixation, the height and the area of the neural foramen had increased significantly by 15.5+/-14.0%(p.0.001) and 23.2+/-17.7%(p.0.001). There was a significant confidence in interobserver (0.9466~0.9996) and intraobserver(0.8896~0.9991) agreement. CONCLUSIONS: Anterior interbody fusion significantly increased the changes in the dimensions of the neural foramen. Anterior distraction and decompression with anterior interbody fusion increased the area of the neural foramen This study shows that anterior interbody fusion can be used to decompress the neural foramen in the spondylolisthesis.
Decompression ; Humans ; Prospective Studies ; Spondylolisthesis*

Objectives: To assess the relationship of variation of blood pressure and neurological deterioration (ND) in ischemic stroke patients. Methods: We recruited patients with the fi rst-ever ischemic stroke at a teaching hospital. The National Institutes of Health Stoke Score (NIHSS) of each patient was monitored for 2 months. ND was defi ned as an increase of ≥ 2 points in NIHSS during the fi rst 7 days after stroke. Blood pressure was measured every 6 hours for fi rst 7 days. We analyzed blood pressure data in the fi rst 36 hours to study the relationship between variation of blood pressure and ND. Successive variation of systolic (svSBP) and diastolic (svDBP) blood pressure was calculated as svSBP= |SBPn+1 – SBPn | and svDBP= |DBPn+1 – DBPn | respectively. The largest svSBP in the fi rst 36 hours of hospitalization or before ND was defi ned as maximum variation of systolic blood pressure (maxvSBP). Then, the mean variation of systolic (mvSBP) and diastolic (mvDBP) blood pressure was calculated as mvSBP= svSBP/N and mvDBP= svDBP/N respectively. Results: A total of 121 patients were included in this study, and 38 of them had ND. The mvSBP was higher in the ND Group (17.9±8.4 mmHg vs. 13.7±4.4 mmHg, p=0.006) but the difference in mvDBP did not reach statistical signifi cance (9.8±3.5mmHg vs. 8.6±3.0 mmHg p=0.06). The ND Group had a larger maxvSBP (35.2±17.2 vs. 27.6±11.6 mmHg, p =0.01), which was more frequently over 30mmHg than that in the stable group (P=0.02). Conclusions: A large svSBP is associated with an increased risk for ND. The study highlights the importance of close monitoring of blood pressure in ischemic stroke patients.

The carpo-metacarpal joint is important for thumb function and for strong pinching and grasping. Inadequately treated fracture of the trapezium can produce long term morbidity. Solitary fracture of the trapezium are uncommon, compose less than 3% of all carpal fractures in adults. However such fractures are very rare in growing patients. Routine anteroposterior (AP) and lateral radiographs of the wrist often fail to show these fractures because of the overlapping trapezoid. Special radiographic views have been described (Robert's view) to detect this fracture. Computer tomography (CT) was found to be essential for the diagnosis and proper treatment of the described injury. We report a case of sagittally split fracture of the trapezium associated with a subluxated carpo-metacarpal joint of the thumb that occurred while playing golf, which was treated by open reduction and percutaneous pinning using two K-wires.
Adult ; Golf ; Hand Strength ; Humans ; Joints ; Thumb ; Wrist

OBJECTIVE：To investigate the effects of Periplaneta americana extract on the proliferation and apoptosis of human non-small cell lung cancer A 549 cells as well as its possible mechanism. METHODS ：The dry bodies of P. americana were soaked with 90％ ethanol and eluted with gradient water-methanol by polyamide column chromatography. The 20％，30％，40％， 50％，60％，70％，80％，90％ methanol elution sites （YS-A-H）were obtained. MTT method was used to screen the active site ， and the inhibition rate of different doses of active site was detected. Flow cytometry was adopted to detect cell apoptosis ，cell cycle and mitochondrial membrane potential of cells after treated with different doses of active site. RESULTS ：Half inhibition concentrations of YS-A-H were （95.25±8.42），（129.93±7.24），（221.28±12.68），（275.39±14.87），（276.76±16.32），（31.90± 5.34），（163.15±6.97），（122.81±8.36）μg/mL，respectively. YS-F had the strongest activity. After treated with 3，9，27，81 μg/mL YS-F for 24，48，72 h，cell proliferation inhibitory rate was increased significantly at different time points ；after treated for 48，72 h，that was significantly higher than same group after treated for 24 h；after 72 h treatment ，that was significantly higher than same group after 48 h treatment （P＜0.01）. There was no significant effect of 24 h treatment of 3 μg/mL YS-F and 72 h treatment of 9 μg/mL YS-F on the percentage of cells in the late stage of necrosis，24 h treatment of 3 μg/mL YS-F on the percentage of cells in G2/M phase and 48 h treatment of 3 μg/mL YS-F on the reduction rate of mitochondrial membrane potential（P＞0.05）. The percentage of cells in the early stage of apoptosis ，the late stage of apoptosis and the early stage of necrosis ，the late stage of necrosis，as well as the percentage of cells in the Sub-G 0/G1 and S phase at each time point were significantly increased in other different doses groups ，while the percentage of cells in G 0/G1 and G 2/M phase was decreased significantly （P＜0.01）. In each dose group，the percentage of cells in the early stage of apoptosis ，the late stage of apoptosis and the early stage of necrosis ，the late stage of necrosis （except for the percentage of cells in the late stage of necrosis treated with YS-F 9 μg/mL for 72 h）and the percentage of cells in Sub-G 0/G1 phase，G2/M phase （except for YS-F 27，81 μg/mL for 48 h）after treated for 48，72 h were significantly higher than same group after 24 h of treatment ；the percentage of cells in G 0/G1 phase，S phase and G 2/M phase （except for YS-F 9 μg/mL for 48 h）after treated for 48，72 h were significantly lower than same group after 24 h of treatment （P＜0.01）；the percentage of cells in the early stage of apoptosis ，the late stage of apoptosis and the early stage of necrosis ，the late stage of necrosis （except for the percentage of cells in the late stage of apoptosis and early stage of necrosis when treated with YS-F 27 μg/mL for 72 h，the percentage of cells in the late stage of necrosis when treated with YS-F 3，9 μg/mL for 72 h were decreased significantly ）and the percentage of cells in S phase （except for YS-F 3 μg/mL for 72 h）and Sub-G 0/G1 phase after treated for 72 h were significantly higher than same group after 48 h of treatment ，while the percentage of cells in G 0/G1 and G 2/M phase were significantly lower than same group after 48 h of treatment （P＜0.01）. After treated with YS-F 9，27，81 μg/mL for 48 h，the reduction rate of cell mitochondrial membrane potential was increased significantly ；YS-F 27，81 μg/mL groups were significantly higher than YS-F 9 μg/mL group，and YS-F 81 μg/mL group was significantly higher than YS-F 27 μg/mL group. CONCLUSIONS：YS-F can inhibit the proliferation and promote the apoptosis of A 549 cells by preventing cell transformation from S phase to G 2/M phase ，and reducing mitochondrial membrane potential ，in time-dependent or dose-dependent manner.

OBJECTIVE：To evaluate the econo mics of pembrolizumab in the second-line treatment of advanced hepatocellular carcinoma in China. METHODS ：From the perspective of Chinese healthcare system ，a three-state PartSA model and Markov model were established ；the cost and utility for the second-line treatment of advanced hepatocellular carcinoma in China were compared between pembrolizumab and placebo. The circulation cycle of the model was 3 weeks and the study time limit was lifetime；one-way sensitivity analysis ，probability sensitivity analysis and scenario analysis were used to verify the robustness of the base-case analysis results. RESULTS ：PartSA results showed that the ICER for the second-line treatment of advanced hepato- cellular carcinoma with pembrolizumab was 1 266 846.18 yuan/QALY，which is far more than 1-3 times of China ’s per capita GDP in 2020. The results of one-way sensitivity analysis showed that the three parameters that had the greatest impact on ICER were the PFS status utility of the placebo group ，the PFS status utility of the pembrolizumab group ，and the cost of pembrolizumab. The results of probability sensitivity analysis verified the robustness of the base-case analysis. The scenario analysis showed that the treatment cost of pembrolizumab had dropped significantly when the charity donation of pembrolizumab was considered. Although it was still not economical ，ICER was close to 3 times of per capita GDP of China in 2020. When WTP threshold was 1 and 3 times of China ’s per capita GDP ，the economic prices of pabolizumab （100 mg）were 4 157.67 and 5 829.24 yuan，respectively. The results of Markov model were similar to those of PartSA model. CONCLUSIONS ：Under the WTP threshold of 1-3 times China ’s per capita GDP in 2020，pembrolizumab is not economical for second-line treatment of advanced hepatocellular carcinoma.