ABSTRACT
OBJECTIVE: The study objective was to evaluate the association between surgical left atrial appendage ligation and in-hospital stroke incidence after coronary artery bypass grafting among patients with atrial fibrillation. METHODS: A retrospective cohort study was performed by using the Nationwide Inpatient Sample between 2008 and 2014. All atrial fibrillation patients who underwent coronary artery bypass graft were included and categorized as left atrial appendage ligation or control group. Propensity score-weighted regression analyses were performed to assess the impact of left atrial appendage ligation on stroke incidence. RESULTS: A total of 234,642 patients were identified, among whom 20,664 (8.81%) received concomitant left atrial appendage ligation. The national postoperative stroke incidence was 0.92%. Results of the propensity-weighted regression analysis showed no significant association between LAA ligation and control with regard to postoperative stroke (odds ratio [OR], 0.83; confidence interval [CI], 0.57-1.22; P = .35), pericardial complications (OR, 1.15; CI, 0.88-1.49; P = .31), hemorrhage and/or hematoma (OR, 1.08; CI, 0.99-1.17; P = .07), mortality (OR, 1.29; CI, 0.99-1.68; P = .06), and length of stay (coefficient -0.21; CI, -0.44-0.02; P = .08). There was no specific CHA2DS2VASC score cutoff above which left atrial appendage ligation was demonstrated to have lower postoperative stroke incidence. CONCLUSIONS: The postoperative stroke risk after coronary artery bypass grafting was low at approximately 1% among patients with atrial fibrillation in the United States. Concomitant left atrial appendage ligation was not associated with lower postoperative stroke risk.
Subject(s)
Atrial Appendage/surgery , Coronary Artery Bypass , Ligation , Postoperative Complications/epidemiology , Stroke , Aged , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/statistics & numerical data , Female , Humans , Incidence , Ligation/adverse effects , Ligation/statistics & numerical data , Male , Retrospective Studies , Risk Factors , Stroke/epidemiology , Stroke/etiologyABSTRACT
Carcinosarcomas are malignant neoplasms with biphasic carcinomatous and sarcomatous or sarcoma-like components. In general, the sarcomatous component is accepted to be the result of divergent mesenchymal differentiation of the epithelial component. Although well characterized in some anatomic locations (e.g. uterus, upper aerodigestive tract and lung), carcinosarcomas of the skin are rare. Reported epithelial components include squamous, adnexal, neuroendocrine and basaloid. Including this case, only 47 cases of primary cutaneous basal cell carcinosarcoma have been reported in the literature to date. We performed an extensive immunophenotypic evaluation in our case, which confirmed the previously reported coexpression of p53 in both components, and revealed a hitherto unreported coexpression of p16 and p63. Additionally, this report reviews the clinical, pathologic, immunophenotypic characteristics and outcomes of the basal cell carcinosarcomas reported in the literature, in order to emphasize the overall uniform characteristics and clinical behavior of this neoplasm.
Subject(s)
Carcinoma, Basal Cell/pathology , Carcinosarcoma/pathology , Skin Neoplasms/pathology , Aged , Biomarkers, Tumor/metabolism , Carcinoma, Basal Cell/metabolism , Carcinosarcoma/metabolism , Humans , Immunophenotyping , Male , Skin Neoplasms/metabolismABSTRACT
Allergy to lanolin has been recognized by dermatologists for decades. This review summarizes the history, epidemiology, and allergenicity of lanolin and its derivatives. "The lanolin paradox" and the safety of pharmaceutical-grade lanolin products are also discussed.
Subject(s)
Allergens/adverse effects , Dermatitis, Allergic Contact/etiology , Lanolin/adverse effects , Allergens/chemistry , Allergens/history , Animals , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/epidemiology , Dermatologic Agents/adverse effects , Dermatologic Agents/chemistry , History, 19th Century , History, 20th Century , History, Ancient , Humans , Lanolin/chemistry , Lanolin/history , Patch Tests/methods , Reproducibility of Results , Risk Factors , Wool/adverse effects , Wool/chemistryABSTRACT
The effect of acclimation salinity and salinity changes on the concentration of high-energy phosphate metabolites and arginine kinase (AK) flux was examined in vivo in juvenile blue crabs using 31P-nuclear magnetic resonance (NMR). Crabs were acclimated for 7 days to a salinity of 5 or 35 per thousand and then placed in a flow apparatus that could sustain the animals while NMR spectra were acquired. Crabs were subjected to either hyperosmotic salinity changes, where an animal acclimated to 5 per thousand was exposed to a salinity of 35 per thousand, or hyposmotic changes, which involved the reciprocal exchange. Neither acclimation salinity nor salinity change had a significant effect on the concentrations of arginine phosphate, inorganic phosphate or ATP. 31P-NMR saturation transfer experiments were used to determine the effect of salinity on the forward and reverse flux of the AK reaction. There was no significant effect of acclimation salinity or salinity change on the flux rate through this reaction. This is in contrast to previous results, which showed that AK flux in isolated muscle was sensitive to prevailing osmotic conditions (Holt and Kinsey, J. Exp. Biol. 205 (2002) 1775-1785). The present study indicates that the integrated osmoregulatory capacity of the intact animal is sufficient to preserve cellular energy status and enzyme function during acute salinity changes.
