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Thymic squamous cell carcinoma lurking in a growing large cyst: A case report 潜伏在生长中的大囊肿中的胸腺鳞状细胞癌1例报告
IF 0.5 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-06-01 DOI: 10.1177/20101058221117891
Tomoki Nakagawa, R. Masuda, Hiraiwa Shinichiro, S. Yamada, M. Iwazaki
An 81-year-old man was admitted for resection of an asymptomatic left anterior mediastinal tumor. Chest computed tomography showed that a small, homogeneous lesion had grown to a large, cystic lesion (80 mm) over a 5-year period. The cystic tumor was removed with adherent structures such as the left upper pulmonary parenchyma and lower part of the left innominate vein via median sternotomy with assistance from a left thoracoscopic procedure. Macroscopically, a solid tumor was located within the large multilocular cyst. The pathological diagnosis was cystic squamous cell carcinoma (12 mm), which had not infiltrated any surrounding organs. The patient has remained well without recurrence as of 4 years postoperatively.
一位81岁的男性因切除无症状的左前纵隔肿瘤而入院。胸部计算机断层扫描显示,在5年的时间里,一个小的、均匀的病变已经发展成一个大的、囊性的病变(80毫米)。在左胸腔镜手术的帮助下,通过正中胸骨切开术切除了囊性肿瘤,其具有粘附结构,如左上肺实质和左无名静脉下部。肉眼可见,一个实体瘤位于巨大的多房囊肿内。病理诊断为囊性鳞状细胞癌(12毫米),未浸润任何周围器官。截至术后4年,患者保持良好,无复发。
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引用次数: 0
Anti tumor necrosis factor induced focal myositis 抗肿瘤坏死因子诱导的局灶性肌炎
IF 0.5 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-06-01 DOI: 10.1177/20101058221147755
A. Masnammany, Wendy Lau, P. Wong, N. Manolios
Tumour necrosis factor inhibitors (TNFis) can trigger autoantibody formation and, in a small proportion of patients, result in symptomatic autoimmune diseases, including polymyositis and dermatomyositis. Focal myositis presents with localized muscle pain and is diagnosed based on magnetic resonance imaging (MRI), electromyography (EMG) and muscle histopathology. We report the first case of TNFi-induced focal myositis in the left thigh of a patient with ulcerative colitis on infliximab. A 30-year-old lady presented with left thigh pain with no other systemic manifestation or muscle weakness. The immunology profile showed positivity of antinuclear antibody (ANA), high titre of anti-ds-DNA, and anti-Mi-2 without any features of systemic lupus erythematosus or dermatomyositis. Discontinuation of the TNFi and commencement of glucocorticoids resulted in the resolution of the myositis.
肿瘤坏死因子抑制剂(TNFis)会引发自身抗体的形成,在一小部分患者中,会导致症状性自身免疫性疾病,包括多发性肌炎和皮肌炎。局灶性肌炎表现为局部肌肉疼痛,根据磁共振成像(MRI)、肌电图(EMG)和肌肉组织病理学进行诊断。我们报告了第一例使用英夫利昔单抗治疗的溃疡性结肠炎患者左大腿TNFi诱导的局灶性肌炎。一位30岁的女士出现左大腿疼痛,没有其他全身表现或肌肉无力。免疫学图谱显示抗核抗体(ANA)阳性,抗ds-DNA高滴度,抗Mi-2无任何系统性红斑狼疮或皮肌炎特征。TNFi的终止和糖皮质激素的开始导致肌炎的消退。
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引用次数: 1
Identifying and ranking the attributes of hospitals readiness to apply bring your own device: An explanatory sequential mixed study 识别和排序医院准备申请的属性自带设备:一项解释性的序贯混合研究
IF 0.5 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-06-01 DOI: 10.1177/20101058221144113
M. Jahanbakhsh, M. Amini-Rarani, Shahram Tahmasebian, Masoumeh Shahbazi
Objective The Bring Your Own Device (BYOD) approach has promoted the usage of personal mobile devices for organizational and carrier purposes. Applying a BYOD approach might provide various challenges for healthcare organizations. This study endeavored to identify the attributes of hospitals readiness in applying BYOD and to rank these attributes in order to develop appropriate policies for dealing with challenges. Materials and methods This study is an explanatory sequential mixed method design that was carried out in two qualitative and quantitative phases for identifying the BYOD attributes and ranking them, respectively. Semi-structured interviews with 15 experts in the BYOD field were performed through in the qualitative phase. Purposive and snowball sampling approaches were used to choose experts. Thematic analysis was used to analyze qualitative data. The identified attributes were ranked in a quantitative phase by asking 10 experts using fuzzy hierarchical analysis. Results Six main themes and 23 subthemes were identified. The findings of hierarchical analysis showed that ethical considerations, management principles, human resources, legislation considerations, cost, and technical infrastructure as the six main themes, respectively, have priority in hospitals readiness for BYOD. Conclusion Addressing the highlighted priorities, from ethical considerations to technical infrastructure, in the formulation and implementation of formal programs and policies by health managers and authorities will prepare hospitals for the use of BYOD while decreasing the challenges associated with it.
目的携带自己的设备(BYOD)方法促进了个人移动设备用于组织和运营目的。应用BYOD方法可能会给医疗保健组织带来各种挑战。本研究试图确定医院在应用BYOD时准备就绪的属性,并对这些属性进行排序,以制定应对挑战的适当政策。材料和方法本研究是一种解释性的顺序混合方法设计,分定性和定量两个阶段进行,分别用于识别BYOD属性并对其进行排名。在定性阶段,对BYOD领域的15名专家进行了半结构化访谈。采用有目的和滚雪球抽样的方法来选择专家。专题分析用于分析定性数据。通过使用模糊层次分析询问10名专家,在定量阶段对识别出的属性进行排名。结果确定了6个主题和23个子主题。层次分析结果表明,伦理考虑、管理原则、人力资源、立法考虑、成本和技术基础设施分别是医院应对BYOD的六个主要主题。结论在卫生管理人员和当局制定和实施正式计划和政策时,解决从伦理考虑到技术基础设施等突出的优先事项,将使医院为使用BYOD做好准备,同时减少与之相关的挑战。
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引用次数: 0
The association between pre-operative malnutrition and post-amputation clinical outcomes: A systematic review 术前营养不良与截肢后临床结果的关系:一项系统综述
IF 0.5 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-06-01 DOI: 10.1177/20101058221094864
Xiaomei Zheng, Mei En Joy Yeo, Charles Chin Han Lew
Background: In patients who underwent lower limb amputation (LLA), the prevalence of malnutrition and its association with clinical outcomes are unclear. Objectives: This systematic review aims to identify literature and summarise existing information on (1) the prevalence of malnutrition in the patients with LLA and (2) the association between pre-operative nutritional status and post-surgery clinical outcomes in patients who require amputation. Methods: A search was conducted in four electronic databases (Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, CINAHL and Scopus) to identify eligible studies. The search strategy was based on keywords – amputation, malnutrition and undernutrition. Article were included regardless of the study design; and if they were written in English; included adult patients with lower limb or foot amputation; and performed pre-amputation nutrition assessments. Results: Seven articles met the eligibility criteria. Malnutrition was assessed by biochemistry and/or anthropometry – none of which are validated nutrition assessment tools. Nevertheless, abnormal biochemistry and/or anthropometry results were associated with delayed wound healing, complications and failed amputation compared to normal ranges. The association between abnormal biochemistry and/or anthropometry parameters and mortality was less consistent. Only one study used a validated nutrition screen tool and found half of the population with LLA were at risk of malnutrition, but no association was reported. Conclusions: The association between malnutrition and clinical outcomes in patients who underwent LLA remains unclear as all the eligible studies that investigated association used unvalidated nutrition assessment tools. There is an urgent need to address this knowledge gap in future research.
背景:在接受下肢截肢(LLA)的患者中,营养不良的患病率及其与临床结果的关系尚不清楚。目的:本系统综述旨在确定文献并总结现有信息:(1)LLA患者营养不良的患病率;(2)需要截肢的患者术前营养状况与术后临床结果之间的关系。方法:在四个电子数据库(Cochrane Central Register of Controlled Trials(Central)、PubMed、CINAHL和Scopus)中进行搜索,以确定符合条件的研究。搜索策略基于关键词——截肢、营养不良和营养不良。无论研究设计如何,均包括文章;如果它们是用英语写的;包括下肢或足部截肢的成年患者;并进行截肢前营养评估。结果:7篇文章符合资格标准。营养不良通过生物化学和/或人体测量法进行评估——这些都不是经过验证的营养评估工具。然而,与正常范围相比,异常的生物化学和/或人体测量结果与伤口愈合延迟、并发症和截肢失败有关。异常生物化学和/或人体测量参数与死亡率之间的相关性不太一致。只有一项研究使用了经过验证的营养筛查工具,发现半数LLA患者有营养不良的风险,但没有相关报告。结论:LLA患者的营养不良与临床结果之间的相关性尚不清楚,因为所有调查相关性的合格研究都使用了未经验证的营养评估工具。在未来的研究中,迫切需要解决这一知识差距。
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引用次数: 1
Lung mass in patient with congestive heart failure – Now you see it, now you don’t ! 充血性心力衰竭患者的肺肿块-现在你看到了,现在你看不见了!
IF 0.5 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-06-01 DOI: 10.1177/20101058221144111
Kuan Yau Yeh, Asyif Fairus Ahmad, A. Alaga
Phantom tumour, vanishing tumour, and pseudotumour of the lung are terms used to describe the tumour appearance on a chest radiograph of a decompensated heart failure patient, which typically disappears after appropriate treatment of their underlying condition. It is a loculated pleural effusion in the fissures that gives rise to the tumour appearance on the chest radiograph of a patient with heart failure. Its existence might mislead the diagnosis, resulting in unnecessary invasive diagnostic investigations done on the patient. We present a case of a 64 year-old male with multiple co-morbidities presenting with dyspnea, loss of weight, and loss of appetite. A chest radiograph showed homogenous opacity over the right lower zone with cardiomegaly, raising the suspicion of a lung mass apart from heart failure. It disappeared after appropriate diuretic treatment. The computed tomography (CT) thorax, which was planned by the primary team, subsequently showed no lung mass. Hence, a high index of suspicion of phantom tumour is important when a lung mass is noted on a chest radiograph of a patient clinically presented with heart failure. This is because exposure to ionising radiation from CT is completely avoidable with just appropriate treatment of fluid overload. However, CT is still the best modality for assisting physicians in a doubtful case.
幻象肿瘤、消失肿瘤和肺假肿瘤是用来描述失代偿心力衰竭患者胸片上肿瘤外观的术语,通常在对其基础条件进行适当治疗后消失。心衰患者胸片上可见裂隙内的胸腔积液引起肿瘤。它的存在可能会误导诊断,导致对患者进行不必要的侵入性诊断检查。我们提出一个病例64岁男性多重合并症表现为呼吸困难,体重减轻,食欲不振。胸片示右下区均匀浑浊伴心脏增大,除心力衰竭外,怀疑肺肿块。经适当利尿剂治疗后消失。原计划的胸部计算机断层扫描(CT)随后未发现肺肿块。因此,当临床表现为心力衰竭的患者胸片上发现肺肿块时,高度怀疑幽灵瘤是很重要的。这是因为只要适当处理液体超载,就完全可以避免CT产生的电离辐射。然而,CT仍然是协助医生在可疑病例的最佳方式。
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引用次数: 0
Contemporary review of heart transplant immunology and immunosuppressive therapy 心脏移植免疫学与免疫抑制治疗的现代综述
IF 0.5 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-06-01 DOI: 10.1177/20101058221138840
Kamalesh Anbalakan, K. Chew, J. Loh, D. Sim, S. Lai, Louis Teo Loon Yee
Background Survival after heart transplantation (HT) has improved considerably since the first HT was performed in 1967 in Cape Town, South Africa. Understanding immunology behind organ rejection has paved way for advances in the assessment of pre-transplant compatibility, development of newer and more specific immunosuppressive drugs, and management of rejection. Objectives Unlike medical therapy for heart failure, transplant protocols vary considerably between different centers. These variations in protocols generally reflect unique population characteristics and the availability of resources. This review article aims to provide a consolidated update on contemporary cardiac transplant medicine. We also aim to highlight local practice and its difference from our international counterparts. Methods A literature search was performed on Pubmed and Cochrane Central Register of Controlled Trials to identify trials and review articles that discussed heart transplant immunology and protocols. The International Society for Heart and Lung Transplant (ISHLT) guidelines were also reviewed. We focused on risk factors, prevention strategies, and treatment of cardiac rejection. Results A total of 48 articles were selected to provide a comprehensive overview of the contemporary practice of cardiac transplant immunosuppressive therapy. Comparisons were made with local data and practice protocols to highlight key differences. Conclusion Heart transplant covers a small subset of cardiac patients and much of the evidence is derived from empirical observations and retrospective analysis. This accounts for the heterogeneity in care and treatment protocols. More studies are needed to select best practices from around the world to further improve outcomes.
背景:自1967年在南非开普敦首次进行心脏移植手术以来,心脏移植术后的生存率有了很大的提高。了解器官排斥反应背后的免疫学为评估移植前相容性、开发更新、更特异性的免疫抑制药物和处理排斥反应铺平了道路。与内科治疗心力衰竭不同,不同中心的移植方案差异很大。这些协议的变化通常反映了独特的人口特征和资源的可用性。这篇综述文章旨在提供当代心脏移植医学的综合更新。我们还旨在突出本地实践及其与国际同行的不同之处。方法在Pubmed和Cochrane中央对照试验注册库进行文献检索,以确定讨论心脏移植免疫学和方案的试验和综述文章。国际心肺移植学会(ISHLT)指南也进行了审查。我们关注心脏排斥反应的危险因素、预防策略和治疗。结果共选择48篇文章,对心脏移植免疫抑制治疗的当代实践进行了全面概述。与当地数据和实践方案进行了比较,以突出关键差异。结论心脏移植只覆盖一小部分心脏患者,大部分证据来自经验观察和回顾性分析。这解释了护理和治疗方案的异质性。需要进行更多的研究,从世界各地选择最佳做法,以进一步改善结果。
{"title":"Contemporary review of heart transplant immunology and immunosuppressive therapy","authors":"Kamalesh Anbalakan, K. Chew, J. Loh, D. Sim, S. Lai, Louis Teo Loon Yee","doi":"10.1177/20101058221138840","DOIUrl":"https://doi.org/10.1177/20101058221138840","url":null,"abstract":"Background Survival after heart transplantation (HT) has improved considerably since the first HT was performed in 1967 in Cape Town, South Africa. Understanding immunology behind organ rejection has paved way for advances in the assessment of pre-transplant compatibility, development of newer and more specific immunosuppressive drugs, and management of rejection. Objectives Unlike medical therapy for heart failure, transplant protocols vary considerably between different centers. These variations in protocols generally reflect unique population characteristics and the availability of resources. This review article aims to provide a consolidated update on contemporary cardiac transplant medicine. We also aim to highlight local practice and its difference from our international counterparts. Methods A literature search was performed on Pubmed and Cochrane Central Register of Controlled Trials to identify trials and review articles that discussed heart transplant immunology and protocols. The International Society for Heart and Lung Transplant (ISHLT) guidelines were also reviewed. We focused on risk factors, prevention strategies, and treatment of cardiac rejection. Results A total of 48 articles were selected to provide a comprehensive overview of the contemporary practice of cardiac transplant immunosuppressive therapy. Comparisons were made with local data and practice protocols to highlight key differences. Conclusion Heart transplant covers a small subset of cardiac patients and much of the evidence is derived from empirical observations and retrospective analysis. This accounts for the heterogeneity in care and treatment protocols. More studies are needed to select best practices from around the world to further improve outcomes.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45383361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Methaemoglobinaemia in pregnancy: Real world experience in a single centre in Malaysia 妊娠期甲基血红蛋白血症:马来西亚单一中心的真实世界经验
IF 0.5 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-06-01 DOI: 10.1177/20101058221111575
Andy Sing Ong Tang, Kok Choon Cheah, T. S. Leong, L. Chew
The literature on methaemoglobinaemia in pregnancy is scarce, imposing clinical challenges to both obstetricians and haematologists. We report a total of nine pregnancies with methaemoglobinaemia treated in our centre. Their methaemoglobin levels, mode of delivery, pregnancy management and outcome were summarized.
关于妊娠期甲基血红蛋白血症的文献很少,这给产科医生和血液科医生都带来了临床挑战。我们报告了在我们中心治疗的共有9例妊娠血红蛋白贫血。总结她们的血红蛋白水平、分娩方式、妊娠管理和结局。
{"title":"Methaemoglobinaemia in pregnancy: Real world experience in a single centre in Malaysia","authors":"Andy Sing Ong Tang, Kok Choon Cheah, T. S. Leong, L. Chew","doi":"10.1177/20101058221111575","DOIUrl":"https://doi.org/10.1177/20101058221111575","url":null,"abstract":"The literature on methaemoglobinaemia in pregnancy is scarce, imposing clinical challenges to both obstetricians and haematologists. We report a total of nine pregnancies with methaemoglobinaemia treated in our centre. Their methaemoglobin levels, mode of delivery, pregnancy management and outcome were summarized.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48178751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Subjective sleep quality among hospitalised adult patients: An observational, cross-sectional study 成年住院患者的主观睡眠质量:一项观察性横断面研究
IF 0.5 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-06-01 DOI: 10.1177/20101058221111664
Siti Nadiah Binte Arman, YingHui Lee, Violeta Lopez, Siew Hoon Lim
Background Inpatient sleep quality is influenced by multiple factors including medical conditions, use of medication and the ward environment. Without adequate rest, detrimental effects on patients’ physical and psychological performances may persist, inhibiting recovery and increasing length of stay. Objective This study examined the sleep quality of adult inpatients and its’ associations with sociodemographic, clinical and environmental factors. Methods An observational study was conducted in the medical wards of an acute care hospital in Singapore from July to December 2018. Patients completed the Pittsburgh Sleep Quality Index (PSQI) to establish baseline sleeping habits and the Richards-Campbell Sleep Questionnaire (RCSQ) to assess perception of sleep quality during hospitalisation. Noise levels were measured using the SL-4023SD sound level meter. Environmental factors affecting sleep were also recorded. Results 52 patients were recruited reported a mean RCSQ score of 5.83 (SD = 2.31) and mean Global PSQI score was 6.06 (SD = 3.33), indicative of poor baseline sleep. The highest mean noise level presented with an average reading of 80 dB, surpassing the WHO recommended noise levels by two times. Subjective sleep quality was not affected by demographic, clinical factors and bed locations. Patients exposed to night lamps reported a reduction in sleep quality (p = .04). Conclusions Recognising the importance of overall sleep quality and the identification of external factors influencing patients’ sleep quality during hospitalisation is a vital step towards developing successful interventions to promote good sleep hygiene in the general wards of the Asian context.
背景住院患者的睡眠质量受多种因素的影响,包括医疗条件、药物使用和病房环境。如果没有充分的休息,对患者的身体和心理表现的不利影响可能会持续存在,抑制恢复并增加住院时间。目的探讨成人住院患者的睡眠质量及其与社会人口学、临床和环境因素的关系。方法2018年7月至12月在新加坡某急症医院病房进行观察性研究。患者完成匹兹堡睡眠质量指数(PSQI)以建立基线睡眠习惯,并完成理查兹-坎贝尔睡眠问卷(RCSQ)以评估住院期间的睡眠质量感知。使用SL-4023SD声级计测量噪声级。影响睡眠的环境因素也被记录下来。结果入选的52例患者RCSQ平均评分为5.83 (SD = 2.31), Global PSQI平均评分为6.06 (SD = 3.33),表明基线睡眠较差。最高平均噪音水平为80分贝,比世界卫生组织建议的噪音水平高出两倍。主观睡眠质量不受人口统计学、临床因素和床位的影响。暴露在夜灯下的患者报告睡眠质量下降(p = .04)。认识到整体睡眠质量的重要性和确定住院期间影响患者睡眠质量的外部因素是开发成功干预措施以促进亚洲普通病房良好睡眠卫生的重要一步。
{"title":"Subjective sleep quality among hospitalised adult patients: An observational, cross-sectional study","authors":"Siti Nadiah Binte Arman, YingHui Lee, Violeta Lopez, Siew Hoon Lim","doi":"10.1177/20101058221111664","DOIUrl":"https://doi.org/10.1177/20101058221111664","url":null,"abstract":"Background Inpatient sleep quality is influenced by multiple factors including medical conditions, use of medication and the ward environment. Without adequate rest, detrimental effects on patients’ physical and psychological performances may persist, inhibiting recovery and increasing length of stay. Objective This study examined the sleep quality of adult inpatients and its’ associations with sociodemographic, clinical and environmental factors. Methods An observational study was conducted in the medical wards of an acute care hospital in Singapore from July to December 2018. Patients completed the Pittsburgh Sleep Quality Index (PSQI) to establish baseline sleeping habits and the Richards-Campbell Sleep Questionnaire (RCSQ) to assess perception of sleep quality during hospitalisation. Noise levels were measured using the SL-4023SD sound level meter. Environmental factors affecting sleep were also recorded. Results 52 patients were recruited reported a mean RCSQ score of 5.83 (SD = 2.31) and mean Global PSQI score was 6.06 (SD = 3.33), indicative of poor baseline sleep. The highest mean noise level presented with an average reading of 80 dB, surpassing the WHO recommended noise levels by two times. Subjective sleep quality was not affected by demographic, clinical factors and bed locations. Patients exposed to night lamps reported a reduction in sleep quality (p = .04). Conclusions Recognising the importance of overall sleep quality and the identification of external factors influencing patients’ sleep quality during hospitalisation is a vital step towards developing successful interventions to promote good sleep hygiene in the general wards of the Asian context.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48239493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Thoracoscopic lobectomy for an aberrant pulmonary artery of mediastinal inferior lobar branch: A case report 胸腔镜肺叶切除术治疗纵隔下肺叶分支异常肺动脉1例
IF 0.5 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-06-01 DOI: 10.1177/20101058221111576
Hajime Watanabe, A. Wada, Tomoki Nakagawa, R. Masuda, S. Yamada, M. Iwazaki
We report on a rare case of thoracoscopic surgery for a patient with an aberrant pulmonary artery of the inferior lobar branch (A7) in the right lower lobe. A 69-year-old woman presented with a chief complaint of an abnormal shadow on chest radiography. Computed tomography (CT) revealed a 14-mm solid nodule in the right lower lobe. The patient was diagnosed with lung cancer by bronchoscopic biopsy, and a surgery was planned. Preoperative thin-slice CT and three-dimensional CT showed an aberrant A7 branching from the right main pulmonary artery. The right lower lobe and lymph node dissection was performed safely under a video view. Preoperative evaluation of this anomaly is important for a safe surgery.
我们报告一个罕见的病例胸腔镜手术的病人有一个异常的肺动脉下叶分支(A7)在右下叶。一位69岁的女性以胸片上的异常阴影主诉。计算机断层扫描(CT)显示右下肺叶一14毫米实性结节。患者经支气管镜活检诊断为肺癌,并计划进行手术。术前薄层CT及三维CT显示右侧肺动脉主干有异常的A7分支。右下叶和淋巴结清扫在视频下安全进行。术前对该异常的评估对手术安全至关重要。
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引用次数: 0
Safety, adherence and efficacy of PCSK9 inhibitors: a retrospective real-world study PCSK9抑制剂的安全性、依从性和有效性:一项回顾性现实世界研究
IF 0.5 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-06-01 DOI: 10.1177/20101058221144115
Bee Ling Kelly Chng, Wei Heng, Yu Ming Soon, J. S. Hon, Y. Lau, R. Tan, J. Tan
Introduction PCSK9 inhibitors demonstrated their effectiveness in reducing low-density lipoprotein cholesterol (LDL-C) and cardiovascular events in landmark trials. It remains unclear whether the results can be translated to Asian populations. This study was designed to assess the real-world safety, adherence and efficacy of PCSK9 inhibitors. Methods A retrospective review for patients newly initiated on PCSK9 inhibitors between 1st June 2017 and 31st July 2021 was conducted in a tertiary cardiology centre. Patients aged ≥ 21 years with a minimum one-month follow-up were included. Adverse drug reactions (ADRs), drug discontinuation, adherence patterns and efficacy between evolocumab and alirocumab groups were compared. Multivariable and propensity score adjusted Cox regression analyses were applied to analyse the outcomes. Results Of 87 patients screened, 80 (51 evolocumab; 29 alirocumab) were included. There were no significant differences between evolocumab and alirocumab groups in ADRs (11.8% vs 3.4%, adjusted HR, 2.97; 95% CI, 0.34 – 25.89 in multivariable analysis; adjusted HR, 3.24; 95% CI, 0.38–27.69 after propensity score adjustment) and discontinuation rates (27.5% vs 34.5%, adjusted HR, 0.89; 95% CI, 0.40–2.02 in multivariable analysis; adjusted HR, 0.88; 95% CI, 0.39–1.99 after propensity score adjustment). High medication cost was the main reason for discontinuation. One-third of patients had inadequate adherence to PCSK9 inhibitors. Both groups showed significant reductions of LDL-C compared to baseline. Conclusions PCSK9 inhibitors are efficacious, safe and well tolerated. Further studies are warranted to examine the cost-effectiveness of PCSK9 inhibitors to rationalise their sustainable use for cardiovascular prevention.
具有里程碑意义的试验表明PCSK9抑制剂在降低低密度脂蛋白胆固醇(LDL-C)和心血管事件方面具有有效性。目前尚不清楚该结果是否适用于亚洲人群。本研究旨在评估PCSK9抑制剂在现实世界中的安全性、依从性和有效性。方法回顾性分析2017年6月1日至2021年7月31日在三级心脏病中心新开始使用PCSK9抑制剂的患者。患者年龄≥21岁,随访至少1个月。比较evolocumab组和alirocumab组之间的药物不良反应(adr)、停药、依从模式和疗效。采用多变量和倾向评分校正Cox回归分析对结果进行分析。结果在87例患者中,80例(51例evolocumab;纳入29例alirocumab)。evolocumab组和alirocumab组在adr方面无显著差异(11.8% vs 3.4%,调整HR, 2.97;多变量分析95% CI为0.34 ~ 25.89;调整后的HR为3.24;倾向评分调整后95% CI, 0.38-27.69)和停药率(27.5% vs 34.5%,调整后HR, 0.89;多变量分析95% CI为0.40-2.02;调整后的HR为0.88;95% CI, 0.39-1.99后倾向评分调整)。药物费用高是导致停药的主要原因。三分之一的患者对PCSK9抑制剂的依从性不足。与基线相比,两组的LDL-C均显著降低。结论PCSK9抑制剂有效、安全、耐受性好。有必要进一步研究PCSK9抑制剂的成本效益,以使其用于心血管预防的可持续使用合理化。
{"title":"Safety, adherence and efficacy of PCSK9 inhibitors: a retrospective real-world study","authors":"Bee Ling Kelly Chng, Wei Heng, Yu Ming Soon, J. S. Hon, Y. Lau, R. Tan, J. Tan","doi":"10.1177/20101058221144115","DOIUrl":"https://doi.org/10.1177/20101058221144115","url":null,"abstract":"Introduction PCSK9 inhibitors demonstrated their effectiveness in reducing low-density lipoprotein cholesterol (LDL-C) and cardiovascular events in landmark trials. It remains unclear whether the results can be translated to Asian populations. This study was designed to assess the real-world safety, adherence and efficacy of PCSK9 inhibitors. Methods A retrospective review for patients newly initiated on PCSK9 inhibitors between 1st June 2017 and 31st July 2021 was conducted in a tertiary cardiology centre. Patients aged ≥ 21 years with a minimum one-month follow-up were included. Adverse drug reactions (ADRs), drug discontinuation, adherence patterns and efficacy between evolocumab and alirocumab groups were compared. Multivariable and propensity score adjusted Cox regression analyses were applied to analyse the outcomes. Results Of 87 patients screened, 80 (51 evolocumab; 29 alirocumab) were included. There were no significant differences between evolocumab and alirocumab groups in ADRs (11.8% vs 3.4%, adjusted HR, 2.97; 95% CI, 0.34 – 25.89 in multivariable analysis; adjusted HR, 3.24; 95% CI, 0.38–27.69 after propensity score adjustment) and discontinuation rates (27.5% vs 34.5%, adjusted HR, 0.89; 95% CI, 0.40–2.02 in multivariable analysis; adjusted HR, 0.88; 95% CI, 0.39–1.99 after propensity score adjustment). High medication cost was the main reason for discontinuation. One-third of patients had inadequate adherence to PCSK9 inhibitors. Both groups showed significant reductions of LDL-C compared to baseline. Conclusions PCSK9 inhibitors are efficacious, safe and well tolerated. Further studies are warranted to examine the cost-effectiveness of PCSK9 inhibitors to rationalise their sustainable use for cardiovascular prevention.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45584284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
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Proceedings of Singapore Healthcare
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