Medicine
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Postoperative analgesia for the knee surgery in children can be challenging. Meanwhile acute pain management in pediatric patients is still often undertreated due to inadequate pain assessment or management. We reported the ultrasound-guided single-injection adductor canal block (ACB) with 0.2% ropivacaine and dexmedetomidine (0.5 μg/kg) in addition in a series of 6 children. ⋯ The pain scores were low, and analgesic medication consumption was minimal. Meanwhile, no adverse events were recorded in any of the subject. Single-injection ACB might be an optimal analgesia strategy for patellar dislocation surgery in pediatric patients.
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Review Meta Analysis
Comparison of Direct Anterior and Lateral Approaches in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis (PRISMA).
The direct anterior approach (DAA) to total hip arthroplasty has been promoted as a minimally invasive alternative to the lateral approach, which we sought to verify by systematically reviewing and meta-analyzing the literature comparing clinical, radiographic, and surgical outcomes. Two reviewers independently searched PubMed, OVID, and Web of Science databases for randomized controlled trials (RCTs) and cohort studies comparing the DAA and lateral approach for total hip arthroplasty. Quality of RCTs was assessed using the Jadad scoring system, quality of cohort studies, using the Minors system. ⋯ The 2 approaches were associated with similar rates of perioperative surgical complications and transfusions, as well as similar radiographic analysis results. Although DAA may provide shorter hospitalization and faster recovery during the early postoperative period, the available evidence is still insufficient to conclude whether the DAA or lateral approach is superior for total hip arthroplasty. More high-quality studies and subsequent meta-analyses are needed.
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Observational Study
Trends in Outcomes for Out-of-Hospital Cardiac Arrest by Age in Japan: An Observational Study.
Population aging has rapidly advanced throughout the world and the elderly accounting for out-of-hospital cardiac arrest (OHCA) has increased yearly. We identified all adults who experienced an out-of-hospital cardiac arrest in the All-Japan Utstein Registry of the Fire and Disaster Management Agency, a prospective, population-based clinical registry, between 2005 and 2010. Using multivariable regression, we examined temporal trends in outcomes for OHCA patients by age, as well as the influence of advanced age on outcomes. ⋯ Similar trends were found in the secondary outcomes. Although neurological outcomes from OHCA ware worse as the age group was older, the rates of favorable neurological outcomes have substantially improved since 2005 even in the elderly, including the oldest old. Careful consideration may be necessary in limiting treatment on OHCA solely for the reason of advanced age.
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Review Meta Analysis
Impact of Modifiable Cardiovascular Risk Factors on Mortality After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of 100 Studies.
Modifiable cardiovascular risk factors such as obesity, hypertension, dyslipidemia, smoking, diabetes mellitus, and metabolic syndrome can easily give rise to coronary heart disease (CHD). However, due to the existence of the so-called "obesity paradox" and "smoking paradox," the impact of these modifiable cardiovascular risk factors on mortality after percutaneous coronary intervention (PCI) is still not clear. Therefore, in order to solve this issue, we aim to compare mortality between patients with low and high modifiable cardiovascular risk factors after PCI. ⋯ However, an unexpectedly, significantly lower mortality risk was observed among the smokers and obese patients. Certain modifiable cardiovascular risk subgroups had a significantly higher impact on mortality after PCI. However, mortality among the obese patients and the smokers showed an unexpected paradox after coronary intervention.
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The aim of the study was to investigate the safety and efficacy of using MLT in the treatment of open-angle glaucoma (OAG). This prospective cohort included subjects ≥18 years of age with OAG, defined as the open angle on gonioscopy with glaucomatous optic neuropathy evident from optical coherence tomography. Subjects with IOP < 21 mm Hg were classified as normal tension glaucoma and those with IOP ≥21 mm Hg were classified as primary open-angle glaucoma. ⋯ The MLT success rate was 72.9%. During the first 6 months only 2.1% required a repeated laser trabeculoplasty. MLT was effective in reducing IOP and medications in OAG with minimal postlaser inflammation and low failure rate at 6 months following laser.