Cerebral amyloid deposition predicts long-term cognitive decline in hemorrhagic small vessel disease.

BACKGROUND: To investigate the association between cerebral amyloid deposition and long-term cognitive outcomes in patients with hemorrhagic small vessel disease (SVD) and survivors of intracerebral hemorrhage (ICH). METHODS: Patients experiencing an ICH without overt dementia were prospectively recruited (n = 68) for brain MRI and Pittsburgh compound B (PiB) positron emission tomography scans at baseline. Cognitive function was assessed using the mini-mental status examination (MMSE) and clinical dementia rating after an overall median follow-up of 3.8 years. A positive amyloid scan was defined as a global PiB standardized uptake value ratio >1.2. Associations between follow-up cognitive outcomes and neuroimaging markers were explored using multivariable Cox regression models. RESULTS: PiB(+) patients were older (72.1 ± 7.8 vs. 59.9 ± 11.7, p = .002) and more frequently had cerebral amyloid angiopathy (CAA) (63.6% vs. 15.8%, p = .002) than PiB(-) patients. PiB(+) was associated with a higher risk of dementia conversion (32.9 vs. 4.0 per 100-person-years, hazard ratio [HR] = 15.7 [3.0-80.7], p = .001) and MMSE score decline (58.8 vs. 9.9 per 100-person-years, HR = 6.2 [1.9-20.0], p = .002). In the non-CAA subgroup (n = 52), PiB(+) remained an independent predictor of dementia conversion, p = .04). In the Cox models, PiB(+) was an independent predictor of dementia conversion (HR = 15.8 [2.6-95.4], p = .003) and MMSE score decline (HR = 5.7 [1.6-20.3], p = .008) after adjusting for confounders. CONCLUSIONS: Cerebral amyloid deposition potentially contributes to long-term cognitive decline in SVD-related ICH.

Efficacy and Safety of High-Dose Intracoronary Adenosine Injection in Fractional Flow Reserve Assessment.

Background: The recommended dosage of intracoronary adenosine in fractional flow reserve (FFR) assessment is controversial. High-dose adenosine may overcome the biological variability of adenosine response in hyperemia. Objectives: We aimed to test the efficacy and safety of a high-dose escalation protocol at our institute. Methods: Using the adenosine dose escalation protocol, the percentages of FFR ≤ 0.75 and 0.80 after high-dose escalation were compared with those at conventional doses. The chi-squared test was used to evaluate the accuracy of FFR values with the tested doses by comparing them with the results of a non-invasive pretest. Results: A total of 87 patients (130 vessels) were included, and protocol adherence was 93.1%. High-dose intracoronary adenosine was injected in 78.5% of the vessels. The dose escalation strategy was well-tolerated without serious complications. The positive rate increased significantly after conducting the protocol compared to that with a conventional dose (28.2% vs. 23.6% with an FFR threshold of 0.75, and 48.7% vs. 42.5% with a threshold of 0.80, both p < 0.05). In the validation cohort, only FFR ≤ 0.75 was associated with the binary result of the non-invasive pretest (p < 0.01 vs. p = 0.37). The high-dose adenosine escalation strategy did not increase the accuracy of FFR (77.8% vs. 75.6% in conventional dose and high-dose adenosine, respectively). Conclusions: The use of a high-dose escalation strategy increased the positive rate in FFR assessments.

Fostering revision of argumentative writing through structured peer assessment.

This quasi-experimental study investigated the effect of structured peer assessment on revision of an argumentative writing. Two intact classes (N = 22, 26) were randomly assigned to be the trained and control groups. The latter received no facilitative resources, while the former participated in structured peer assessment based on Calibrated Peer Review, a web-based program purposefully designed for students to receive peer-assessment training, assess their peers' writing, and make written commentary online. At the end of the treatment, both groups revised their writing. The trained group revised their writing more extensively, outperforming the control group on frequency and type of revision, as well as the holistic quality of argumentative writing. After structured peer assessment, participants of the trained group became critical of their own work and invested more effort in spontaneous revision to produce higher-quality argumentative writing.

Primary small cell neuroendocrine carcinoma of the nasal cavity after successful curative therapy of nasopharyngeal carcinoma: a case report.

Patients with head and neck cancer have a greater risk of developing second primary malignant neoplasms than patients with any other type of malignancy. Small cell neuroendocrine carcinoma (SNEC) mainly occurs in the lung, and is rarely found in the head and neck region. Only a few cases of sinonasal SNEC have been reported in the English literature. A woman aged 53 years, who had undergone successful curative radiotherapy for nasopharyngeal carcinoma 10 years earlier, presented with a history of bleeding from the left nostril for several weeks. A computed tomography scan of the head and neck showed a mass in the left nasal cavity with extension into the maxillary sinus. A biopsy specimen was taken and pathology revealed SNEC. The patient underwent a full course of concurrent chemoradiotherapy. No local recurrence or distant metastasis was noted during the 12 months of follow-up.

Clinical analysis of chronic peritoneal dialysis related peritonitis in children.

In most countries, chronic peritoneal dialysis (PD) is the preferred dialysis mode for children and adolescents below the age of 15 years with end-stage renal disease. PD-related peritonitis is a serious complication that has a great impact on uremic patients'outcome. We retrospectively reviewed the charts of a total of 22 uremic children who underwent chronic peritoneal dialysis. The total peritonitis rate in our study was one episode every 23.7 patient-months, and there was no significant difference in the incidence of peritonitis between children with automated peritoneal dialysis and those with continuous ambulatory peritoneal dialysis (p=0.219). Staphylococcus aureus was the most common causative organism, accounting for 13.3% of the episodes of peritonitis. The combination therapy of vancomycin plus ceftazidime is effective for common pathogens in peritonitis. Rare microorganisms, e. g., fungus and mycobacterium, should be taken into consideration when the response to initial treatment is poor. Early diagnosis and treatment is important to prevent sequelae and mortality.