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Cancer patients are less likely to undergo percutaneous coronary intervention (PCI) after cardiac arrest, although they demonstrate improved mortality benefit from the procedure. We produced the largest nationally representative analysis of mortality of cardiac arrest and PCI for patients with cancer versus non-cancer.Propensity score adjusted multivariable regression for mortality was performed in this case-control study of the United States' largest all-payer hospitalized dataset, the 2016 National Inpatient Sample. Regression models of mortality and PCI weighted by the complex survey design were fully adjusted for age, race, income, cancer metastases, NIS-calculated mortality risk by Diagnosis Related Group (DRG), acute coronary syndrome, and likelihood of undergoing PCI.Of the 30,195,722 hospitalized adult patients, 15.43% had cancer, and 0.79% of the whole sample presented with cardiac arrest (of whom 20.57% underwent PCI). In fully adjusted regression analysis among patients with cardiac arrest, PCI significantly reduced mortality (OR 0.15, 95 %CI 0.13-0.19; p 0.001) among patients with cancer greater than those without it (OR 0.21, 95 %CI 0.20-0.23; p 0.001).This nationally representative study suggests that post-cardiac arrest PCI is underutilized among patients with cancer despite its significant mortality reduction for such patients (independent of clinical acuity).

Background Arrhythmias are observed to increase during high influenza activity seasons (HIA, December to February) with significant clinical impact among high-risk patients, so their outcomes may be optimized through closer monitoring of these populations. It is unknown if cancer is such a risk factor. Methods This is a retrospective analysis of arrhythmia-related mortality and the effect of health disparities in patients with cancer during HIA and non-HIA seasons in a nationally representative database. Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) was performed using the 2016–2018 National Inpatient Sample (NIS), the United States’ largest all-payer hospitalized dataset. Results 16,795,379 (18.48%) patients presented with arrhythmia of whom 3,214,914 (19.14%) were during HIA. In ML-PSr, HIA did not significantly increase the odds of arrhythmia for cancer patients (OR 1.01, 95%CI 0.99–1.03, p = 0.37), but the odds of arrhythmia-related mortality were higher during HIA seasons (OR 1.19, 95%CI 1.12–1.27, p

Background Mortality disparities in sex, income, and race are unknown among patients with cancer who undergo percutaneous coronary intervention (PCI). Methods Propensity score adjusted multivariable regression for mortality was performed in this case-control study of the 2016 National Inpatient Sample. Regression models by PCI weighted by the complex survey design were adjusted for age, race, income, cancer metastases, NIS-calculated mortality risk by Diagnosis Related Group (DRG), acute coronary syndrome (ACS), and the likelihood of undergoing PCI. Model optimization was conducted with forward and backward stepwise regression, standard regression diagnostics, and performance comparison to backward propagation neural network machine learning (ML) according to root mean squared error (RMSE). Results Of 4,659,200 hospitalized adult cancer patients, females were less likely than males to have ACS (41.52% versus 58.48%), and less likely to undergo PCI during ACS (37.86% versus 62.14%). Multivariable regression in the subgroup of cancer patients who underwent PCI found significant disparities in mortality reduction according to sex, males (OR 0.56; 95%CI 0.50–0.62; p

ObjectivesThe aim of this systematic review is to compare the root coverage outcomes of using a connective tissue graft (CTG) with and without the application of enamel matrix derivative (EMD).MethodologyAn electronic search was performed up to July 2020 in 4 databases, including Ovid MEDLINE, EMBASE, Web of Science and Cochrane Central. Human clinical studies with data on comparing outcomes of root coverage using CTG with and without the application of EMD were included. Meta-analyses for the recorded parameters were performed and the weighted mean difference (WMD) between the 2 groups and 95% confidence interval (CI) were reported.ResultsNine clinical studies were selected for inclusion in this review. The WMD of clinical attachment level gain was 0.78 mm (95% CI of 0.23-1.34 mm, P = .005) and the WMD of recession depth reduction was 0.28 mm (95% CI of 0.06-0.51 mm, P = .01), favoring the CTG + EMD approach. However, the comparisons for the percentage of complete root coverage and mean root coverage between the 2 approaches were not statistically significant.ConclusionAlthough the use of a CTG with and without the application of EMD in root coverage procedures achieved a similar percentage of complete root coverage and mean root coverage, the addition of EMD to CTG may improve the outcome of recession depth reduction and clinical attachment level gain.

This study aimed to investigate the effect of whole-body vibration therapy on lower extremity function in subacute stroke patients. Subacute stroke patients who were able to undergo gait training were randomly divided into a vibration therapy group and a control group. All patients attended 20-min training sessions twice daily, 5 times a week for 2 weeks. Each session included 45 squats. The vibration group trained on a vibration platform and the control group trained on the ground. The degree of maximal isokinetic voluntary contraction torque was evaluated, and manual muscle tests of hip and knee flexion and extension were performed. The Berg Balance Scale, 10-m walk test, Timed Up and Go Test, and Functional Ambulation Category were used. A total of 38 patients, 20 in the vibration group and 18 in the control group, were included in the analysis. After the 2-week therapy, the vibration group showed significant improvements in lower extremity strength, balance, and gait performance. The vibration group showed significantly better performance on the Berg Balance Scale, 10-m walk test, and Functional Ambulation Category than the control group. There were no significant differences in maximal isokinetic voluntary contraction torque or manual muscle tests between the groups. Our results suggest that additional training with whole-body vibration may effectively improve the balance and gait performance of subacute stroke patients. Further studies on large populations are required to determine the therapy's clinical efficacy.

Author's summary Cardiovascular adverse events (CVAEs) are rare, but potentially serious complications of immune checkpoint inhibitor (ICI) therapy. The most severe manifestation is myocarditis which can lead to heart failure, arrhythmias, and sudden cardiac death. Clinicians must recognize the common symptoms and diagnostic studies as well as their limitations to initiate early intervention. The optimal management of cardiotoxicity generally involves cessation of the ICI, early initiation of steroids, and secondary immunomodulatory treatments in refractory cases. As the use of ICIs continues to grow, our understanding of CVAEs will continue to evolve to effectively monitor and treat patients., Immune checkpoint inhibitor (ICI) associated cardiovascular adverse events (CVAE) have become more frequent with the growing use of cancer immunotherapy. CVAEs include a wide spectrum of diseases such as myocarditis, pericarditis, heart failure, arrhythmias, coronary artery disease, and hypertension. The induction of cardiovascular side effects by ICI use is hypothesized to occur due to inflammation and immune dysregulation of normal tissue in response to immunotherapy. Management of ICI-associated CVAEs mitigates an overactive immune response by utilizing steroids, immunomodulatory drugs and hemodynamic stabilization. However, few controlled studies on the cardiovascular safety of ICIs exist and treatment of their side effects are mostly from limited case series. Our review seeks to provide the most recent understanding of ICI-associated CVAEs and their management.

Taking a conventional implant abutment-level impression with the gingival retraction technique can cause side effects such as gingival recession and bleeding. In order to overcome these problems, an impression technique using digital superimposition of the customized abutment is newly introduced. In this technique, digital impression data and pre-scanned abutment data are superimposed to reproduce the abutment's location and shape on computer-aided design software. The present investigation was conducted to evaluate the clinical accuracy of the newly adapted digital superimposition impression technique by assessing the fit of fabricated prostheses. The results showed clinical efficacy of this technique, satisfying both convenience and clinically acceptable marginal and internal fit.

Background The current study evaluated the hemodynamic effects of different types of pneumatic compressions of the lower extremities during anesthesia induction. In addition, the hemodynamic effects were compared between patients older than 65 age years and those aged 65 years or younger. Methods One hundred and eighty patients (90: > 65 years and 90: ≤ 65 years) were enrolled. Each age group of patients was randomly assigned to one of three groups; Group 1 (no compression), Group 2 (sequential pneumatic compression), and Group 3 (sustained pneumatic compression without decompression). Invasive blood pressure, cardiac index (CI), and stroke volume variation (SVV) were measured. Results In patients aged ≤ 65 years, mean arterial pressure (MAP) and CI were significantly higher and SVV was lower in Group 3 compared to Group 1 before tracheal intubation, but there were no differences between Groups 1 and 2. However, there were no differences in MAP, CI, and SVV among the three groups in patients aged > 65 years. The number of patients who showed a MAP < 60 mmHg was less in Group 3 than Group 1 in patients aged ≤ 65 years, but not in patients aged > 65 years. Conclusions Sustained pneumatic compression of the lower extremities has more hemodynamic stabilizing effects compared to sequential compression during anesthesia induction in patients aged 65 years or younger. However, no difference between methods of compression was observed in patients older than 65 years.

Flexion contracture deformities, as well as severe varus and valgus deformities of the knee joint, accompany osteoarthritis or rheumatoid arthritis (RA). In particular, severe flexion contracture deformity of the knee joint is often found in patients with RA, which renders them nonambulatory. This report describes a 26-year-old female patient diagnosed with RA 10 years ago. She had chronic joint pain, severe flexion contracture, valgus deformity in both knees, and limited range of motion in both knees and became nonambulatory. She underwent a total knee arthroplasty (TKA) and serial casting and physical therapy to restore stable joint movement and correct knee joint deformity. Her pain was successfully relieved, and she was able to walk after surgery. Here, we report the excellent results of TKA in this RA patient with severe flexion contracture of both knees.

The AAA+ adenosine triphosphatase (ATPase) Thorase plays a critical role in controlling synaptic plasticity by regulating the expression of surface α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs). Bidirectional sequencing of exons of ATAD1, the gene encoding Thorase, in a cohort of patients with schizophrenia and healthy controls revealed rare Thorase variants. These variants caused defects in glutamatergic signaling by impairing AMPAR internalization and recycling in mouse primary cortical neurons. This contributed to increased surface expression of the AMPAR subunit GluA2 and enhanced synaptic transmission. Heterozygous Thorase-deficient mice engineered to express these Thorase variants showed altered synaptic transmission and several behavioral deficits compared to heterozygous Thorase-deficient mice expressing wild-type Thorase. These behavioral impairments were rescued by the competitive AMPAR antagonist Perampanel, a U.S. Food and Drug Administration-approved drug. These findings suggest that Perampanel may be useful for treating disorders involving compromised AMPAR-mediated glutamatergic neurotransmission.

The authors present 2 cases of late mobile-bearing dislocation after unicompartmental knee arthroplasty with long-term follow-up. Patients had anterior bearing dislocation more than 10 years after primary unicompartmental knee arthroplasty. Retrieved mobile bearings showed severe erosion on the posterior lip, suggesting frequent deep knee flexion as the cause of wear. Bearing dislocation is known to occur in the early postoperative phase. However, for Asians with a lifestyle that requires high knee flexion, dislocation might occur in the late postoperative phase. Such late bearing dislocation has a mechanism different from those reported in previous studies. Loss of bump in the posterior lip was found to be the cause. After late bearing dislocation, conversion to total knee arthroplasty is unnecessary because a simple bearing exchange will suffice. [ Orthopedics . 2019; 42(1):e124–e127.]

Background Caudal epidural injections have been commonly performed in patients with low back pain and radiculopathy. Although caudal injection has generally been accepted as a safe procedure, serious complications such as inadvertent intravascular injection and dural puncture can occur. The present prospective study was designed to investigate the influence of the depth of the inserted needle on the success rate of caudal epidural blocks. Methods A total of 49 adults scheduled to receive caudal epidural injections were randomly divided into 2 groups: Group 1 to receive the caudal injection through a conventional method, i.e., caudal injection after advancement of the needle 1 cm into the sacral canal (n = 25), and Group 2 to receive the injection through a new method, i.e., injection right after penetrating the sacrococcygeal ligament (n = 24). Ultrasound was used to identify the sacral hiatus and to achieve accurate needle placement according to the allocated groups. Contrast dyed fluoroscopy was obtained to evaluate the epidural spread of injected materials and to monitor the possible complications. Results The success rates of the caudal injections were 68.0% in Group 1 and 95.8% in Group 2 (P = 0.023). The incidences of intravascular injections were 24.0% in Group 1 and 0% in Group 2 (P = 0.022). No intrathecal injection was found in either of the two groups. Conclusions The new caudal epidural injection technique tested in this study is a reliable alternative, with a higher success rate and lower risk of accidental intravascular injection than the conventional technique.

The demand and the supply are increasing sharply in accordance with the growth of the Memory Semiconductor Industry. The Flash Memory above all is being utilized substantially in the Industry of smart phone, the tablet PC and the System on Chip (SoC). The Flash Memory is divided into the NOR-type Flash Memory and the NAND-type Flash Memory. A lot of study such as the Built-In Self Test (BIST), the Built-In Self Repair (BISR) and the Built-In Redundancy Analysis (BIRA), etc. has been progressed in the NOR-type fash Memory, the study for the Built-In Self Test of the NAND-type Flash Memory has not been progressed. At present, the pattern test of the NAND-type Flash Memory is being carried out using the outside test equipment of high price. The NAND-type Flash Memory is being depended on the outside equipment as there is no Built-In Self Test since the erasure of block unit, the reading and writing of page unit are possible in the NAND-type Flash Memory. The Built-In Self Test equipped with 2 kinds of finite state machine based structure is proposed, so as to carry out the pattern test without the outside pattern test equipment from the NAND-type Flash Memory which carried out the test dependant on the outside pattern test equipment of high price.