The Role of Patent Foramen Ovale Closure in the Secondary Prevention of Cryptogenic Stroke: a Meta-Analysis Report

Abstract Background: Patent foramen ovale (PFO) closure has been compared to medical therapy for secondary prevention of recurrent cryptogenic stroke. Objectives: To produce an updated meta-analysis including only data from the primary analyses of clinical trials and to evaluate the role of PFO closure in the secondary prevention of recurrent stroke. Methods: Search in Medline (PubMed) and in ISI Web of Knowledge. Parameters under analysis and meta-analyses were: stroke, transient ischemic attack (TIA) and atrial fibrillation (AF). Comprehensive Meta-analysis Software V.2.0 (Biostat) was used. Random-effects analyses were carried out. A level of significance of 5% was used. Results: In this study six, randomized trials enrolling 3,750 patients were included. Unlike other published meta-analyses on the same topic, in this case, only clinical trial data, and not follow-up data, were used. PFO closure, as compared with medical therapy alone, demonstrated superiority in reducing the rate of recurrent stroke (risk ratio with PFO closure vs. medical therapy, 0.37; 95% confidence interval [CI], 0.17 to 0.78; p = 0.01). PFO closure did not offer a significant benefit in prevention of TIA (risk ratio with PFO closure vs. medical therapy, 0.96; 95% CI, 0.64 to 1.44; p = 0.85). Among patients assigned to closure group, an increased risk of atrial fibrillation was seen (risk ratio with PFO closure vs. medical therapy, 4.64; 95% CI, 2.38 to 9.01; p < 0.01). Conclusions: In patients with cryptogenic stroke who had a patent foramen ovale, a protective effect of closure was seen concerning the risk of recurrent stroke, but not regarding the prevention of TIA.

Antiplatelet therapy within 24 hoursof tPA: lessons learned from patientsrequiring combined thrombectomyand stenting for acute ischemic stroke

Objective@#Although stroke guidelines recommend antiplatelets be started 24 hoursafter tissue plasminogen activator (tPA), select mechanical thrombectomy (MT)patients with luminal irregularities or underlying intracranial atherosclerotic diseasemay benefit from earlier antiplatelet administration. @*Methods@#We explore the safety of early (< 24 hours) post-tPA antiplatelet use byretrospectively reviewing patients who underwent MT and stent placement for acuteischemic stroke from June 2015 to April 2018 at our institution. @*Results@#Six patients met inclusion criteria. Median presenting and pre-operativeNational Institutes of Health Stroke Scale scores were 14 (Interquartile Range [IQR]5.5-17.3) and 16 (IQR 13.7-18.7), respectively. Five patients received standard intravenous(IV) tPA and one patient received intra-arterial tPA. Median time from symptomonset to IV tPA was 120 min (IQR 78-204 min). Median time between tPA and antiplateletadministration was 4.9 hours (IQR 3.0-6.7 hours). Clots were successfullyremoved from the internal carotid artery (ICA) or middle cerebral artery (MCA) in 5patients, the anterior cerebral artery (ACA) in one patient, and the vertebrobasilarjunction in one patient. All patients underwent MT before stenting and achievedthrombolysis in cerebral infarction 2B recanalization. Stents were placed in the ICA(n=4), common carotid artery (n=1), and basilar artery (n=1). The median time fromstroke onset to endovascular access was 185 min (IQR 136-417 min). No patientsexperienced symptomatic post-procedure intracranial hemorrhage (ICH). Medianmodified Rankin Scale score on discharge was 3.5. @*Conclusions@#Antiplatelets within 24 hours of tPA did not result in symptomatic ICHin this series. The safety and efficacy of early antiplatelet administration after tPA inselect patients following mechanical thrombectomy warrants further study.

Robotic­assisted pelvic lymph node dissection for prostate cancer: frequency of nodal metastases and oncological outcomes

Purpose Limited data are available regarding the oncologic efficacy of pelvic lymph node dissection (PLND) performed during robotic-assisted laparoscopic prostatectomy (RALP) for prostate cancer. We aimed to determine the frequency of pelvic lymph node metastasis and oncological outcomes following RALP with PLND in patients who did not receive adjuvant androgen deprivation therapy (ADT). Methods We retrospectively reviewed the records of 1740 consecutive patients who underwent RALP and extended PLND. The primary endpoint was biochemical recurrence (BCR). The estimated BCR probability was obtained using the Kaplan­Meier method. Cox proportional hazard regression models were used to assess for predictors of BCR. Results One hundred and eight patients (6 pertcent) with positive LNs were identified. The median number of LNs removed was 17 (IQR 11­24), and median follow-up was 26 months (IQR 14­43). Ninety-one (84 pertcent) patients did not receive adjuvant ADT of whom 60 pertcent had BCR with a median time to recurrence of 8 months. The 1- and 3-year BCR-free probability was 42 and 28 pertcent, respectively. Patients with ≤2 LN+ had significantly better biochemicalfree estimated probability compared to those with >2 LN+ (p = 0.002). The total number of LN+ (HR = 1.1; 95 pertcent CI 1.01­1.2, p = 0.04) and Gleason 8­10 (HR = 1.96; 95 perrtcent CI 1.1­3.4, p = 0.02) were predictors of BCR on multivariate analysis. Conclusion Among men with positive lymph nodes at time of robotic prostatectomy, those with two or fewer positive nodes and Gleason <8 exhibited favorable biochemical-free survival without adjuvant therapy.(AU) Cerrar

Clinically localized type 1 and 2 papillary renal cell carcinomas have similar survival outcomes following surgery / Los carcinomas papilares de células renales tipo 1 y 2 localizados clínicamente tienen resultados de supervivencia similares después de la cirugía

Propósito Se intentó determinar la incidencia, hallazgos patológicos, factores pronósticos y resultados clínicos para pacientes con CCR papilar clínicamente localizado. Métodos Demográfico, Se recopilaron hallazgos clínicos y patológicos en todos los pacientes con CCRP sometidos a cirugía en cuatro centros médicos académicos. El punto final primario fue la supervivencia específica del cáncer (CSS). La supervivencia sin recaída (RFS) y la supervivencia general (OS) fueron puntos finales secundarios. Kaplan- Se obtuvieron estimaciones de Meier y se usaron modelos de regresión de riesgos proporcionales de Cox para evaluar predictores de mortalidad y recaída. Resultados Identificamos 626 CCPR, de los cuales 373 (60por ciento) fueron del tipo 1 y 253 (40 por ciento) fueron del tipo 2, con tres cuartas partes de todos los tumores siendo pT1. En comparación con los pacientes con tipo 1, aquellos con tipo 2 eran mayores (edad media: 63 frente a 61; (AU)

Purpose We aimed to determine incidence, pathologic fndings, prognostic factors and clinical outcomes for patients with clinically localized papillary RCC. Methods Demographic, clinical and pathologic fndings were collected on all patients with PRCC undergoing sur-gery at four academic medical centers. The primary end-point was cancer-specifc survival (CSS). Relapse-free survival (RFS) and overall survival (OS) were secondary endpoints. Kaplan­ Meier estimates were obtained, and Cox proportional hazard regression models were used to assess predictors of mortality and relapse. Results We identifed 626 PRCC, of which 373 (60 pertcent) were type 1 and 253 (40 pertcent) were type 2, with three-quar-ters of all tumors being pT1. Compared to patients with type 1, those with type 2 were older (mean age: 63 vs 61; (AU)

Implementation of a peer-mediated health education model in the United Arab Emirates: addressing risky behaviours among expatriate adolescents

Tobacco use among young people is increasing in the United Arab Emirates, and the country is ranked 15th in the world for prevalence of type II diabetes. Expatriates comprise a majority of the population, making them an important subset to study. We aimed to test whether an educational intervention would be effective in this cultural setting. We designed 2 peer-to-peer health workshops: tobacco use and nutrition/physical activity. One workshop was randomly assigned to 18 classrooms in private schools in Abu Dhabi. Surveys were administered before and after the workshops to assess intervention effectiveness. The tobacco workshop significantly improved responses [P < 0.05]. The nutrition and physical activity workshop resulted in decreased satisfaction with personal activity levels. This study provides evidence to support the national adoption of a peer-to-peer health education model as an intervention for tobacco use but not for nutrition and physical activity choices

Ecologia e sustentabilidade / Ecology and sustainability

Ecologia e sustentabilidade aborda princípios e conceitos da evolução biológica e da ecologia em suas diferentes escalas: populações, comunidades e ecossistemas. O diferencial desta obra é abordar as temáticas do campo da ecologia com o enfoque da sustentabilidade. Tema principal do século XXI e desta obra, a sustentabilidade propõe a integração dos interesses econômicos, sociais e culturais da sociedade à preservação da biodiversidade e dos ecossistemas.E para o leitor ter profundo conhecimento da temática, este livro oferece diversos estudos de caso que expõem uma visão detalhada dos problemas ambientais e sociais acompanhados de suas possíveis soluções. Oferece também exercícios interativos em todos os capítulos reforçando os conceitos científicos abordados.Trata-se de uma obra fundamental para o conhecimento da biodiversidade e dos ecossistemas e para se ampliar as discussões relacionadas à existência de um planeta socialmente justo e sustentável...

Spontaneously resolving periocular erythema and ciliary madarosis following intra-arterial chemotherapy for retinoblastoma

To describe an unusual clinical finding seen in children undergoing intra-arterial chemotherapy for retinoblastoma. A retrospective review of 69 eyes of 63 patients receiving intra-arterial chemotherapy over a 3-year period. Charts and photographs of 69 consecutive cases were reviewed, and data were collected on patients with clinical evidence of a hyperemic cutaneous periocular abnormality following the procedure. A blanching erythematous and edematous patch was noted in the periocular region in 16% [11 of 69] of the children who received intra-arterial chemotherapy. The plaque extended into the region of the supertrochlear and medial marginal artery distribution on the ipsilateral side of the intra-arterial chemotherapy. All patches of erythema spontaneously resolved within 3 months following completion of the intra-arterial chemotherapy. Periocular erythema and swelling is a self-limited clinical finding associated with intra-arterial chemotherapy in a small number of patients

Estimating the cost of hospital services in a small island state: a case study of the Milton Cato Memorial Hospital in St Vincent and the Grenadines / Estimación del Costo de los Servicios Hospitalarios en un Pequeño Estado Insular Estudio de Caso del Milton Cato Memorial Hospital en San Vicente y las Granadinas

Cost estimates are derived for services provided at the Milton Cato Memorial Hospital (previously known as the Kingstown General Hospital) using the step-down accounting method Both total and average unit cost estimates are provided Among the findings of note is that the cost per patient per day spent on the Maternity Ward is 57.4 higher than for the Surgical Ward. Even with the 1995 increase in user fees, the levels of subsidization for inpatient services remains relatively high at 78-96 for public patients and 43-72 for private patients. Ancillary services werefoundto have lower levels of subsidization and in most cases the full costs were recovered from private patients. Laboratory services are not subsidized

Se deducen los costos estimados para los servicios que se brindan en el Milton Cato Memorial Hospital (previamente conocido como Kingstown General Hospital) usando el método de etapas en contabilidad. Se ofrecen los estimados del costo total y el costo promedio por unidad. Entre los resultados a resaltar se halla que el costo por paciente por día en la sala de maternidad es 57.4% más alto que en la sala de cirugía. Incluso con el aumento llevado a cabo en 1995 en relación con el pago de honorarios por parte del usuario, los niveles de subvención de los servicios a pacientes hospitalizados permanecen relativamente altos, llegando a ser de un 78%-96% para los pacientes públicos y 43% - 72% para los pacientes privados. Se halló que los servicios suplementarios presentaban niveles de subsidio más bajos, y que en la mayor parte de los casos se recuperaba la totalidad de los costos de los pacientes privados. Los servicios de laboratorio no se subvencionan.

Preliminary Report of Clinical Experience of Iodine-125 Seed Implant for Early Prostatic Cancer: The First Case in Korea / 대한비뇨기과학회지

Radical prostatectomy, external irradiation, and brachytherapy are currently available for the cure of early localized prostatic cancer. This report documents the first successful Iodine-125 seeds implant treatment of early prostatic cancer in Korea. Patient was 70-year-old man with mild urinary urgency and nocturia. Serum PSA (prostate specific antigen) was 6.51ng/ml. Transrectal ultrasonography showed a small, roundish, low echogenic lesion measuring 8mm in diameter in the left lower peripheral zone of the prostate. The volume of prostate was 27cc and biopsy revealed adenocarcinoma (Gleason score 7). MRI confirmed the presence of a small nodular lesion in the left peripheral zone without evidence of local invasion, and bone scintigraphy was unremarkable. The tumor was staged as T2a. We performed permanent implantation of Iodine-125 seeds using Mick procedure. The patient experienced immediate post-implant irritation of the bladder and urethra with hematuria. Follow up CT and radiography showed all seeds were remained in the same prostate as implanted. Follow up serum PSA was 1.85ng/ml at 3 months and 0.62ng/ml at 9 months after the procedure.