Objective To investigate maternal and neonatal outcomes after different intrapartum interventions for vaginal birth after cesarean section (VBAC) in mainland China. Methods A retrospective study was performed on 143 VBAC cases from Beijing Obstetrics and Gynecology Hospital between January 2015 and November 2016. These cases were divided into two groups on the basis of different intrapartum interventions. Maternal and neonatal outcomes were compared. Results The durations of the first stage and total labor after oxytocin were significantly longer than those before oxytocin use. The proportion of operative vaginal delivery with oxytocin was significantly higher than that without oxytocin (43.9% vs. 11.8%). The times of the first stage, second stage, and total labor with analgesia were significantly longer than those without analgesia (548.4 +/- 198.1 vs. 341.8 +/- 233.0 minutes, 52.0 +/- 38.9 vs. 36.0 +/- 29.1 minutes, and 606.3 +/- 212.1 vs. 387.3 +/- 233.0 minutes, respectively). Postpartum hemorrhage and operative vaginal delivery occurred significantly more frequently in women with epidural analgesia than in those without epidural analgesia (29.7% vs. 12.3 and 35.1% vs. 16.0%, respectively). Conclusions Induction can increase the rate of operative vaginal delivery in VBAC. Oxytocin and epidural analgesia may increase the risk of operative vaginal delivery, and may be associated with a prolonged duration of labor.
Agenesis of the dorsal pancreas is a rare congenital pancreatic malformation. We herein describe a 67-year-old woman with a 5-day history of lower back pain who was eventually diagnosed with agenesis of the dorsal pancreas. Abdominal computed tomography showed an enlarged pancreatic head, but the pancreatic body and tail were invisible. The magnetic resonance imaging findings were similar to the computed tomography findings. Magnetic resonance cholangiopancreatography showed that the major pancreatic duct was mildly dilated but otherwise normal. Endoscopic ultrasound revealed absence of the pancreatic body and tail, an enlarged head of the pancreas, and mild pancreatic duct dilation. The final diagnosis was dorsal pancreatic agenesis.
Eperythrozoonosis is a zoonosis transmitted from animals to humans. It is caused by bacteria in the genus Eperythrozoon. These bacteria have a high infection rate and can cause varying degrees of damage. This is the first case report of infective endocarditis caused by Eperythrozoon. The patient had a 30-day history of remittent fever accompanied by chills and progressive weakness and gradually recovered after 6 weeks of minocycline treatment.
A 61-year-old woman was referred to our institution for evaluation of severe nonischemic dilated cardiomyopathy and left bundle branch block (LBBB). After permanent His bundle pacing, the LBBB was immediately corrected; however, the right bundle branch was injured during the procedure. Subsequent recovery of the right bundle branch block and normalization of heart function were observed during follow-up. This case indicates that LBBB might result in the development of nonischemic cardiomyopathy and emphasizes the necessity of a temporary pacemaker during His bundle pacing for patients with LBBB.
Background The induction of general anesthesia may cause hemodynamic instability. Remifentanil is often administered to suppress the hemodynamic response. We aimed to evaluate the effect of remifentanil infusion on the hemodynamic response to induction of anesthesia in hypertensive and normotensive patients. Methods Patients were divided into two groups: Group H (n = 102) were hypertensive patients and Group C (n = 107) were normotensive patients. During induction, all patients received 1 mu g/kg of remifentanil as a loading dose over 2 minutes, followed by a continuous infusion at 0.05 mu g/kg/minute. We analyzed the systolic, diastolic, and mean pressures and heart rate pre-induction, pre-intubation, immediately post-intubation, and at 2, 4, 6, 8, and 10 minutes after intubation. Results The systolic, diastolic, and mean pressures before induction were significantly higher in group H compared with group C, but there was no significant difference between the two groups immediately after intubation. Blood pressures immediately after intubation were similar to the pre-induction blood pressure. There was no significant difference in heart rate between the two groups at any time point. Conclusions Remifentanil infusion effectively attenuates the hemodynamic response to induction of general anesthesia in hypertensive and normotensive patients.
Objective Capacitive and resistive electric transfer therapy (CARE) reduces pain and improves quality of life for many orthopaedic degenerative and inflammatory disorders. The research aim was to determine the effects of CARE on painful shoulder. The outcomes were pain reduction and recovery of shoulder function. Methods A retrospective, observational case-control study was conducted. Participants were 46 patients (22 in the CARE group and 24 in the SHAM group). Clinical data, pain (visual analogic scale, VAS) and functional scale scores (Disabilities of the Arm, Shoulder and Hand scale, and Constant-Murley Scale) were measured at baseline T0 (before treatment), T1 (after treatment) and follow-up T2 (2 months after the end of the treatment). Results VAS scores in the CARE group improved from 7.23 +/- 1.11 at baseline to 2.68 +/- 0.99 at follow-up. The SHAM group did not experience any improvement. Similarly, functional scale scores improved in the CARE group compared with the SHAM group. Conclusion Considering the small number of sessions needed, low cost and long-term benefits, CARE could be a useful therapeutic option for the conservative management of shoulder pain to restore pain-free and powerful movement to the shoulder joint.
Objective Based on theoretical and methodological research and the results of a literature review, we evaluated and comparatively analyzed the quality of long-term care for older populations in China and in Western countries. Methods We performed a literature review, using the search terms long-term care and care services for older adults, in the databases ProQuest, CNKI, and Wanfang Data. Results Our comparative analysis demonstrated that the overall quantity of articles related to long-term care for older populations was relatively large. The literature comprises advanced accumulated experiences in terms of theoretical and methodological perspectives in developed countries. The field of long-term care is relatively young in China and we could retrieve only a few related studies. Conclusions The system of long-term care for older populations in China has much room for improvement. In addition, the evaluation criteria for long-term care quality remain controversial. Relevant research focusing on the quality of long-term care services in the country lacks comprehensive, systematic, and scientific validation, comparison, and evaluation. This topic warrants further evidence-based investigation in China.
Objective To assess the impact of repetitive movements of the thumb caused by playing a smartphone game continuously for 30 min. Methods This study recruited healthy volunteers. They were instructed to play a game called Subway Surfers, which ran continuously. Subjects played the game for 30 min. The function of the abductor pollicis brevis and extensor pollicis brevis muscles was assessed by surface electromyography and the signals were obtained at 10 min, 20 min and 30 min. The median frequency (MDF) was used as an indicator of muscle fatigue. A visual analogue scale (VAS) was used to assess the subjective discomfort of the volunteers. Results Twelve subjects participated in this study. The MDF of the abductor pollicis brevis and extensor pollicis brevis muscles decreased significantly over the test period. The MDF of the extensor pollicis brevis had decreased significantly by 10 min after the start of the gaming session, while the abductor pollicis brevis had decreased significantly by 20 min. The VAS scores significantly increased after 30 min of continuous gaming. Conclusions This study suggests that playing continuous games on a smartphone might result in chronic muscle injury. Continuous gaming time should be kept below 20 minutes.
Objective In this meta-analysis, we aimed to compare efficacy and clinical outcomes of tolvaptan in treating acute heart failure (AHF). Methods Using MEDLINE, we searched relevant clinical studies using tolvaptan that investigated clinical effects in treating AHF. We performed meta-analysis for potentially extractable clinical outcomes such as body weight reduction, change in serum sodium levels, and clinical or safety events including worsening heart failure, worsening renal function (WRF), all-cause mortality, rehospitalization, and dyspnea improvement. Results The results showed that tolvaptan significantly reduced body weight (mean change: -1.28 kg, 95% credible interval (CI): -1.58-0.98), increased serum sodium levels (mean change: 3.48 mmol/L; 95% Cl: 3.22-3.74), and improved dyspnea function (odds ratio (OR): 1.43; 95% CI: 1.26-1.62) versus conventional therapy. The event risk of WRF was also significantly reduced (OR: 0.35; 95% CI: 0.15-0.80). Low, intermediate, and high tolvaptan doses did not reduce mortality and rehospitalization risks. No significant publication bias was observed regarding effects on mortality and rehospitalization. Conclusion Current evidence indicates that using tolvaptan as add-on therapy can decrease body weight, increase sodium levels, improve dyspnea function, and reverse WRF, which may circumvent loop diuretics overdose and improve outcomes in patients with AHF.
We present a rare case of a woman with a mass containing soft tissue, fat, and calcified components attached to the fimbrial end of the left fallopian tube. A 38-year-old nulligravida woman who visited our clinic for infertility counseling had mild abdominal discomfort and a palpable mass in the lower abdomen. Multiple examinations were performed. Preoperatively, we considered that the patient had teratoma or teratocarcinoma of the left ovary. On exploratory laparotomy, we found that she had a mass with protuberances and a bulbous projection at one surface that was attached to the fimbrial end of the left fallopian tube. A histopathological examination showed a mature cystic teratoma that arose from the fimbrial end of the fallopian tube. Obstetricians should be aware of this abnormality. Early detection of this abnormality is advantageous for infertility counseling and planning of less invasive surgery in the hospital.
Objectives The relationship between the A240T polymorphism in the angiotensin-converting enzyme (ACE) gene and cancer risk remains controversial. Therefore, we conducted a meta-analysis of relevant studies from the published literature. Methods We comprehensively searched available databases to identify eligible studies on the relationship of ACE A240T polymorphism with cancer risk. We calculated pooled odds ratios (OR) with 95% confidence intervals (CI) and then evaluated heterogeneity and publication bias. Results Eight case-control studies were identified from five articles. Results showed that the ACE A240T polymorphism was related to cancer risk (AT vs AA: OR 2.14, 95% CI: 1.51-3.04; TT vs AA: OR 1.07, 95% CI: 0.90-1.27; recessive model: OR 0.48, 95% CI: 0.31-0.77; dominant model: OR 2.13, 95% CI: 1.54-2.97). The same conclusion was made for subgroup analysis by race or cancer type. In the subgroup analysis by quality score assessment, the ACE A240T polymorphism contributed to cancer risk in high-quality studies but not in low-quality studies. Conclusion The A240T polymorphism in the ACE gene might be related to the risk of cancer. Nevertheless, large-scale studies should be performed to obtain convincing evidence on the roles of ACE A240T polymorphism on cancer risk.
Objective To compare the test-retest reliability and validity of three simple maximal isometric back extensor strength (BES) assessment protocols with different test postures, and to recommend an optimal clinical protocol to quantify BES. Methods Asymptomatic adults, aged over 45 years, were assessed for maximal isometric BES using external fixation of dynamometers, with the subject in standing, prone and sitting positions, respectively. Measurements were repeated at a one-week interval to examine test-retest reliability. Validation was performed by comparing with results obtained from isokinetic dynamometer assessments. Results Out of a total of 60 included participants, intra-class correlation coefficients (ICC) were 0.92, 0.93 and 0.90 in standing, prone and sitting positions, respectively. Correlation analyses revealed acceptable convergent validity in the standing and prone position (r = 0.50 and 0.54, respectively), whereas tests conducted in the sitting position showed a relatively low validity (r = 0.32). Among the three protocols, measurement error was lowest in the prone position. Conclusions Maximal isometric BES assessment in the prone position was shown to be the most reliable and valid protocol, and may be considered the preferred option for assessing BES in clinical practice.
Hepatic artery aneurysm rupture is a rare cause of massive hemobilia, which is potentially life-threatening, cause of upper gastrointestinal hemorrhage. Cases of mycotic hepatic artery aneurysm associated with streptococcal endocarditis have rarely been reported. In the present study, we report a case of massive hemobilia that was caused by ruptured mycotic hepatic artery aneurysm in a patient who was infected with streptococcal endocarditis 3 months previously. Transarterial embolization in the patient failed, possibly due to vascular variations. However, surgical treatment was successfully performed, and the patient completely recovered. In conclusion, surgical treatment may be useful in treating massive hemobilia under life-threatening conditions, even in cases of vascular variations and failure of transarterial embolization.
Objective Pulmonary vein stenosis (PVS) is a serious complication in patients with atrial fibrillation (AF) receiving radiofrequency catheter ablation (RFCA). We therefore examined these patients' clinical characteristics in relation to PVS occurrence. Method We retrospectively analyzed the clinical symptoms, diagnostic procedures, and treatment strategies in patients with AF who developed PVS after RFCA. Results Among 205 patients with AF who underwent RFCA, five (2.44%) developed PVS (all men; age 44-64 years; AF history 12-60 months; 2 paroxysmal AF, 3 persistent AF). One patient underwent two RFCA sessions and the others received one. The time to PVS diagnosed by pulmonary vein computed tomography angiography (CTA) was 3 to 21 months. PVS symptoms included dyspnea and hemoptysis. Nine pulmonary veins developed PVS. Single mild PVS occurred in two asymptomatic patients and multiple PVS or single severe PVS in three symptomatic patients who underwent pulmonary vein angiography and stent placement. Symptoms in the three patients significantly improved after stent implantation; however, stent restenosis occurred 1 year later in one case. Conclusion PVS is a rare complication of RFCA for AF that can be diagnosed by CTA. Pulmonary vein stent implantation can remarkably improve the symptoms, but stent restenosis may occur.
Miller Fisher syndrome (MFS), a variant of Guillain-Barre syndrome, is characterized by ataxia, areflexia and ophthalmoplegia. This case report describes a 40-year old male that presented with a 3-day history of unsteady walking and numbness on both hands, and a 2-day history of seeing double images and unclear articulation. Lumbar puncture revealed an opening pressure of 260 mm H2O. Plasma serology was positive for anti-ganglioside M1-immunoglobulin M (anti-GM1-IgM) antibodies and negative for anti-ganglioside Q1b (anti-GQ1b) antibodies. The patient was diagnosed with MFS based on the clinical course and neurophysiological findings. On the 4th day of treatment with intravenous immunoglobulin (IVIG), his ataxia and unsteady walking improved, but his bilateral eyeballs were fixed, and over the next few days he developed bilateral peripheral facial paralysis. After 5 days of IVIG treatment, methylprednisolone treatment was offered and the patient's symptoms gradually improved. Early intracranial hypertension and delayed facial nerve palsy may be atypical presentations of MFS. Anti-GM1-IgM antibodies may be the causative antibodies for MFS. If the IVIG therapy does not stop the progression of the disease, the addition of corticosteroid therapy may be effective. However, the relationship between IgM type, anti-GM1 antibody and MFS remains unclear and requires further research.