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简介：AIM:TodeterminethevisualoutcomesinadultpatientswhosustainedopenglobeinjuriesandtodeterminewhetherthevisualprognosisfollowinganeyeinjuryinanAfricansettingdiffersfromthepredictedoutcomesaccordingtotheOcularTraumaScore(OTS)study.AsecondaryaimwastoestablishtheeviscerationratefortheseinjuriesandassesshowthisformofinterventionaffectedoutcomesincomparisontotheOTS.·METHODS:Aprospectivecaseseriesofallpatientsadmittedwithopenglobeinjuriesoveratwo-year(July2009toJune2011)period.InjurieswerescoredusingtheOTSandthesurgicalinterventionwasrecorded.Thebestcorrectedvisualacuityatthreemonthswasregardedasvisualoutcome.·RESULTS:Therewere249openglobeinjuries,ofwhich169patients(169eyes)completedthe3-monthfollow-up.Allpatientsunderwentprimarysurgery,175(70.3%)repairs,61(24.5%)eviscerationsand13(5.2%)otherprocedures.GlobeeviscerationsweremainlydoneonOTSCategory1cases,butoutcomesinthiscategorywerenotfoundtobedifferentfromOTSoutcomes.OutcomesweresignificantlyworseinCategory2,butwhentheentiredistributionwastested,thedifferenceswerenotstatisticallysignificant.TheoverallassociationbetweenOTSoutcomesandthefinalvisualoutcomesinthisstudywasfoundtobeastrong(P<0.005).·CONCLUSION:Reliableinformationregardingtheexpectedoutcomesofeyeinjurieswillinfluencemanagementdecisionsandpatientexpectations.TheOTSisavaluabletool,theuseofwhichhasbeenvalidatedinmanypartsoftheworld-itmayalsobeavalidpredictorinanAfricansetting.

简介：AbstractImportance:The diversity of pediatric genitourinary malignancies requires a timely resource detailing tumor characteristics and survival.Objective:To determine the incidence, demographics, and outcomes of all pediatric genitourinary tumors within the United States.Methods:A population-based search for patients diagnosed with genitourinary cancers under age 15 was performed using the National Cancer Institute’s Surveillance, Epidemiology, and End Results 18 registry. Information on primary tumor location, histologic type, patient age, sex, year of diagnosis, race, treatment, cause of death, and survival months was extracted. Descriptive epidemiological and survival statistics were calculated for all variables.Results:A total of 4576 cases from 1973 through 2015 were identified. The most common primary tumor sites were the kidney (80.3%), testis (12.3%), bladder (2.8%), and vagina (1.5%). Nephroblastoma (87.9%) and sarcoma (3.4%) were the most common renal malignancies. Rhabdomyosarcoma was common in the vagina, bladder, and testis at rates of 66.2%, 61.2%, and 24.6%, respectively. Germ cell tumors (71.0%) were the most common primary tumor of the testis. Ten-year overall survival (OS) for renal nephroblastoma and sarcoma was 88% and 82%, respectively. Ten-year OS for RMS of the testis was 91%, the bladder was 79%, the vagina was 79%, and the prostate was 56%. Germ cell tumor 10-year OS were 96% in the testis and 100% in the vagina.Interpretation:A better understanding of the overall distribution and outcomes associated with pediatric genitourinary cancers allows physicians to best understand the patient’s disease in the context of current frequency in a genitourinary setting and reported outcomes.

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简介：AIM:ToinvestigatetheepidemiologiccharacteristicsandoutcomesofopenglobeinjuryinShanghai.METHODS:Aretrospectivestudywasconductedfor148unilateralopenglobeinjurycasespresentingtoatertiaryreferralhospitalofShanghai.Electronicmedicalrecordswerereviewedandphonesurveyswereconductedtocollectandanalyze1)backgroundofpatient;2)settingofinjuryandclinicalsignsatpresentation;3)treatmentprocedureandoutcome;4)qualityoflifeafterinjury.RESULTS:Thereweremoremalepatients(77.03%)thanfemales(22.97%),moretemporaryhabitants(79.05%)thanresidents(20.95%).ThesubjectsinthisstudypresentedasignificantlylowerconstitutionalstatusofeducationthanthatofthewholeShanghaipopulation(P<0.001).Occupationalinjurywasthefirstcauseofinjuries(39.86%),followedbyhomeaccident(20.27%),roadaccident(16.89%),violentbehavior(16.89%)andoutdoorinjury(6.08%).The143subjects(96.62%)werenotwearingspectaclesatthetimeofinjury.Ofallpatients,77subjects(52.03%)hadtheoutcomeofnovision(includingenucleation).Theclassificationandregressiontree(CART)prognosispresents59.58%sensitivitytopredictvisualsurvivalcorrectlyand80.19%specificitytopredictnovisioncorrectly.Thepatientswhoseinjuredeyehadnovisionreportedmorereductionoflifequality.CONCLUSION:Wefoundthatmalesubject,temporaryhabitants,loweducationalstatusandnoeyewearareriskfactorsofopenglobeinjuryinShanghai.Occupationalinjuryistheleadingcause.CARTanalysispresentsacertainagreementtotheactualvisualoutcome.Theinjuryimposesnegativeimpactonqualityoflifeespeciallyinnovisioncases.Theeducationofeyeprotectionmayhelptoavoidtheinjury.

简介：AbstractAlthough considerable advances have been made in the field of assisted reproductive technology (ART), millions of couples still suffer from infertility and miscarriage. In a large number of cases, the etiology of these common reproductive failures remains unknown. However, the significance of autoantibodies in infertility and miscarriage has sparked extensive interest because of their pleiotropic roles in disrupting normal pregnancy. This review discusses the pleiotropic roles of a series of autoantibodies in infertility and miscarriage. A brief recapitulation of how the autoantibodies interfere with ART outcomes and treatments for this type of idiopathic infertility or miscarriage is also provided. While several disputes remain to be resolved, further studies employing better designs and larger sample sizes are required in view of the therapeutic potential of autoantibody inhibitors and the future of contraceptive vaccines.

简介：AbstractAssisted reproductive technology (ART) has evolved rapidly over the last 40 years, offering hope to individuals and couples struggling with infertility. As technology continues to evolve, simulating a realistic female reproductive system environment has become a common goal for all types of ARTs, thereby reducing the impact of the artificial microenvironment on perinatal and offspring health. In this review, we provide a brief history of the development of each major ART and discuss the impact of ART on perinatal and offspring health. We also explore how the negative consequences of ART may be overcome and how its benefits can be maximized.

简介：Globaldemographicchangesrelatedtolongevityareleadingtoincreasingnumbersoftheelderly,forwhomhearinglossisasignificantcauseofmorbidityanddisability.Oncemetwithreticence,severelyhearingimpairedolderadultsareincreasinglybeingconsideredforcochlearimplantation(CI).SignificantdataindicatethatCIintheelderlypopulationissafe,well-tolerated,andeffective.RisksfromCIsurgeryandanesthesiaarelowandgenerallycomparabletoratesinotheragegroups.OutcomesstudiesregardingCIinolderadultshaveshownexcellentimprovementstospeechperception,qualityoflife,andevencognition.Overall,currentlyavailabledatasuggeststhatadvancedageshouldnot,initself,beconsideredabarriertoimplantation.ThisreviewpaperwillhighlightselectedarticlesfromrecentmedicalliteratureregardingthesafetyandefficacyofCIintheelderlypopulation.

简介：BackgroundManypatientshavesymptomssuggestiveofcoronaryarterydisease(CAD)andareoftenevaluatedwiththeuseofdiagnostictesting,althoughtherearelimiteddatafromrandomizedtrialstoguidecare.MethodsWerandomlyassigned10,003symptomaticpatientstoastrategyofinitialanatomicaltestingwiththeuseofcoronarycomputedtomographicangiography(CTA)ortofunctionaltesting(exerciseelectrocardiography,nuclearstresstesting,orstressechocardiography).Thecompositeprimaryendpointwasdeath,myocardialinfarction,hospitalizationforunstableangina,ormajorproceduralcomplication.SecondaryendpointsincludedinvasivecardiaccatheterizationthatdidnotshowobstructiveCADandradiationexposure.ResultsThemeanageofthepatientswas60.8±8.3years,52.7%werewomen,and87.7%hadchestpainordyspneaonexertion.ThemeanpretestlikelihoodofobstructiveCADwas53.3±21.4%.Overamedianfollow-upperiodof25months,aprimaryend-pointeventoccurredin164of4996patientsintheCTAgroup(3.3%)andin151of5007(3.0%)inthefunctional-testinggroup(adjustedhazardratio,1.04;95%confidenceinterval,0.83to1.29;P=0.75).CTAwasassociatedwithfewercatheterizationsshowingnoobstructiveCADthanwasfunctionaltesting(3.4%vs.4.3%,P=0.02),althoughmorepatientsintheCTAgroupunderwentcatheterizationwithin90daysafterrandomization(12.2%vs.8.1%).ThemediancumulativeradiationexposureperpatientwaslowerintheCTAgroupthaninthefunctional-testinggroup(10.0mSvvs.11.3mSv),but32.6%ofthepatientsinthefunctional-testinggrouphadnoexposure,sotheoverallexposurewashigherintheCTAgroup(mean,12.0mSvvs.10.1mSv;P<0.001).ConclusionsInsymptomaticpatientswithsuspectedCADwhorequirednoninvasivetesting,astrategyofinitialCTA,ascomparedwithfunctionaltesting,didnotimproveclinicaloutcomesoveramedianfollow-upof2years.

简介：胆囊疾病在发达国家是很普通的。复杂胆石疾病代表外科定期为被倡导的胆汁的混乱最经常。关于，胆囊炎代表普通腹的外科的干预；它能作为选任的干预或紧急情况外科被执行，在坏疽，穿孔，腹膜炎或败血的情况中。现在，laparoscopic途径被喜欢甚于开的剖腹术。全球性，众多的胆囊炎每天被执行；然而，小证据都不关于对跟随这些干预的生活(QOL)的surgical以后质量的评价存在。为了估计胆囊炎以后的QOL，事实上，高质量的照顾的文档服从于报导病人的结果满足的扩大讨论，和使用因为优秀改进被倡导几年了。然而，几乎没有很少研究，关于跟随胆囊炎的QOL结果出版；另外，许多当前的文学在以病人为中心的结果上缺乏系统的数据。然后，尽管几个工具被用来在胆囊炎以后测量QOL，困难留在选择有意义的参数以便获得可再现的数据反映手术后的QOL。这研究的目的是在QOL上为胆囊疾病考察外科的影响。这评论在QOL后面的胆囊炎上包括当前的文学的Medline搜索。大多数研究证明征兆的病人比收到选任的干预的病人从外科更获利。因此，在没有症状的外科，和病人少些获利或可以甚至在QOL有减小以前，在QOL的获得取决于一般条件。

简介：AbstractThis review summarizes recent evidences regarding the potential influences of epidural labor analgesia (ELA) on the outcomes of neonates and children. Terms and relevant words including "ELA," "ELA and neonatal outcomes," "ELA and children’s development," and "ELA and children’s neurocognitive development" were used to search articles published in PubMed database up to October 2019. Original articles and reviews regarding potential influences of ELA on neonates and children were identified. Relevant references of the selected articles were also screened. The anesthetics used during ELA can be absorbed, enter the fetus, and produce neonatal depression; however, these effects are less severe than those during systematic opioid analgesia. The impact of anesthetic exposure during ELA on children’s neurodevelopment has not been fully studied, but would be mild if any. ELA increases the risk of intrapartum maternal fever; the latter may be harmful to neonatal outcomes. The use of ELA may increase birth injury by increasing instrumental delivery, although long-term adverse events are rare. On the other hand, ELA may reduce maternal depression and, thus, produce favorable effects on neurocognitive development in childhood; but evidences are still lacking in this aspect. ELA may produce both favorable and unfavorable effects on neonates and children. These effects should be discussed with parturient women before making decisions. The potential harmful effects should be carefully managed. The overall impacts of ELA on neonatal and children’s outcomes need to be studied further.

简介：AbstractObjective:This study aims to describe presenting characteristics of patients diagnosed with non-invasive chronic rhinosinusitis (CRS) following liver or kidney transplant and determine factors associated with disease-related complications, selection of endoscopic sinus surgery (ESS), and disease resolution in this population.Study design:Retrospective chart review.Setting:An academic tertiary care center (Mayo Clinic, Rochester, Minnesota).Subjects and methods:Liver and kidney transplant recipients evaluated by Mayo Clinic otolaryngologists for CRS between 1998 and 2018 were identified. Univariate and multivariate logistic regression analyses were used to determine patient factors and treatment modalities associated with developing complications, selection of ESS, and disease resolution.Results:Fifty-seven patients met inclusion criteria. No patients developed intraorbital or intracranial complications of their CRS. Multivariate modeling demonstrated that the presence of polyps (P = 0.036) was associated with undergoing ESS within one year of presentation. A higher Lund-Mackay (LM) computed tomography score (P = 0.023) and older age (P = 0.018) were significantly associated with decreased disease resolution. No other factors were significantly associated with the use of endoscopic sinus surgery within one year of otolaryngology presentation or resolution of CRS in this cohort.Conclusion:The risk of developing CRS-related intraorbital or intracranial complications in this immunecompromised patient cohort may be lower than originally thought. For liver- and kidney-recipients stable on immunosuppressive medication for many years, prognostic factors for CRS may mirror those for immunocompetent patients.

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简介：Cochlearimplantationisoneofthebestamongstthevariousmanagementoptionsavailableforchildrenandadultswithseveretoprofoundsensorineuralhearingloss.Innerearandinternalauditorycanal(IAC)malformationsaccountstoapproximately25%ofcongenitalsensorineuralhearinglossinchildren.Theprimarygoalofthisreportwastoevaluatethecommunicationoutcomesaftercochlearimplantationinachildwithcysticcochleovestibularanomaly(CCVA).Thechildwasevaluatedthroughvariousstandardizedoutcomemeasuresatregularintervalstotracktheprogressintermsofauditoryandspokenlanguageskills.ThescoresonCategoriesofAuditoryPerception(CAP),MeaningfulAuditoryIntegrationScale(MAIS),SpeechIntelligibilityRating(SIR),MeaningfulUseofSpeechScale(MUSS),andlisteningandspokenlanguageskillsshowedasignificantleapin12monthsdurationpostimplantation.Thereportthushighlightsandcorrelatesthesignificantprogressinauditoryandspokenlanguageskillsofthechildwithcongenitalmalformationstoappropriateauditoryrehabilitationandintensiveparentaltraining.

简介：AIM:ToevaluatetheoutcomesofAhmedglaucomavalve(AGV)implantationsurgeryforrefractoryglaucoma.METHODS:Thisone-armedhistoricalcohortstudywasconductedin2011.Refractoryglaucomawasdefinedaseyeswithanintraocularpressure(IOP)greaterthan21mmHgwithmaximallytoleratedglaucomamedications,failedsurgeries,orboth.ForalleyeswithrefractoryglaucomathatunderwentAGVimplantation,datawerecollectedonIOP,thebestcorrectedvisualacuity(BCVA)andglaucomamedicationspreoperativelyand4,6,12,24and56wkpostoperatively.LogarithmvaluesofIOPwerecalculatedandcompared.RESULTS:Thestudygroupwascomprisedof30patients(30eyes,16malesand14females)withrefractoryglaucoma.MeanpreoperativeIOPwas39.3±13.8mmHg.PostoperativemeanIOPwas15.7±7.1mmHg,19.6±12.8mmHgand13.9±14.2mmHgat12,24and56wkrespectively.BCVAwas≥6/60in11eyespreoperatively,andfiveeyeshadBCVA≥6/60at56wkpostoperatively.Preoperatively,morethanfourmedicationswereusedtotreatglaucomain21eyes.At12wkpostoperatively,nomedicationswererequiredtocontrolIOPin20eyes.At56wkpostoperatively,atleastonemedicationwasrequiredtocontrolIOPin10eyes.Overtheentirefollowupperiod,foureyesweretreatedwithyttriumaluminiumgarnet(YAG)laserand14eyesrequiredasecondsurgery.TheAGVwasremovedinfoureyes.CONCLUSION:AGVimplantationreducedIOPandthenumberofmedicationsrequiredtocontrolrefractoryglaucoma.However,therewasahigherriskofdecreasedvision.Long-termfollowupandpromptinterventionarerecommended.

简介：BackgroundArrhythmogenicrightventricularcardiomyopathy(ARVC)isamajorcauseforsuddencardiacdeathduetoventriculartachycardia.Litterisknownaboutitslong-termoutcomesinChineseARVCpatients.Thepurposeofthisstudywastoevaluatethelong-termclinicaloutcomesinpatientswithARVCandtoclarifytheriskfactorsofcardiacevents.MethodsFortysubjectsfulfillingmodifiedTaskForcecriteriawereincludedinthisstudy.Informationonclinicalpresentation,electrocardiographicandcardiacimagingfindings,andlong-termoutcomeofcaseswereinvestigated.ResultsAveragefollow-upperiodfromonsetwas57.5±42.6months.Themeanageatonsetofsymptoms(32.2±12.7years)andmalepredominance(85.0%)weresimilartothatreportedinotherstudies.Palpitationswerethemostfrequentsymptom(82.5%).T-waveinversionwasthemostcommonpresentingabnormalityonresting12-leadECG(75%).Ventriculartachycardiawithleftbundlebranchblockmorphologywassubsequentlydocumentedinatotalof28(70%)subjectsduringastudyperiod.Thecumulativemortalityratewas7.5%.ConclusionClinicalpresentationinChineseARVCpatientswassimilartothatreportedinotherstudies.ARVCisassociatedwithearlymortalitythatisdifferenttoothercountrypopulation.