Medicine
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Observational Study
PIVKA-II is a useful tool for diagnostic characterization of ultrasound-detected liver nodules in cirrhotic patients.
Protein induced by vitamin K absence-II (PIVKA-II) is a potential screening marker for hepatocellular carcinoma (HCC). Limited data are available about its utility in discriminating neoplastic from regenerative nodules at ultrasonography (US) evaluation in cirrhotic patients. Aim of this study was to investigate the diagnostic utility of PIVKA-II in cases showing liver nodules of uncertain diagnosis at US. ⋯ ROC curves showed that PIVKA-II had 60% sensitivity, 88% specificity, 80% positive predictive value (PPV), and 73% negative predictive value (NPV), whereas AFP had 67% sensitivity, 68% specificity, 63% PPV, and 72% NPV. AUROC curves showed that the combination of both biomarkers increased the diagnostic accuracy for HCC (AUC 0.76; sensitivity 70%, specificity 94%, PPV 91%, and NPV 79%). In conclusion, PIVKA-II is a useful tool for the diagnostic definition of US-detected liver nodules in cirrhotic patients, and it provides high diagnostic accuracy for HCC when combined with AFP.
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Observational Study
Incidence and risk factors of deep venous thrombosis following arthroscopic posterior cruciate ligament reconstruction.
The objective of this study was to identify the incidence and associated risk factors for deep venous thrombosis (DVT) after arthroscopic posterior cruciate ligament (PCL) reconstruction. This study included 128 patients who underwent arthroscopic PCL reconstruction. Venography was performed on the operated leg 3 days postoperatively. ⋯ The rate of asymptomatic clots in the calf region was rather high after PCL reconstruction, and the rate of proximal clots was 4%. Older age, longer durations of tourniquet application, higher VAS scores and D-dimer levels, and complex surgical procedures were all substantial risk factors for DVT after PCL reconstruction. The treatment of DVT with batroxobin and anticoagulants was effective and safe.
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Randomized Controlled Trial
Antihypertensive treatments for spontaneous intracerebral hemorrhage in patients with cerebrovascular stenosis: A randomized clinical trial (ATICHST).
Antihypertensive treatment is associated with clinical outcomes in patients with spontaneous intracerebral hemorrhage (sICH). ADAPT showed that intensive blood pressure lowering (<140 mm Hg) does not reduce peri-hematoma regional cerebral blood flow (rCBF) in patients with sICH. However, the stenosis of main cerebral arteries that has a high presence in patients with sICH is well-known related to the brain ischemia. The effect of intensive BP lowering for sICH in patients with cerebrovascular stenosis is still unknown. ⋯ The protocol will determine the safety and effectiveness of intensive BP lowering for sICH with cerebrovascular stenosis.
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Observational Study
Different surgical approaches for the treatment of adjacent segment diseases after anterior cervical fusion: A retrospective study of 49 patients.
Studies in the literature have not delineated the surgical approaches of symptomatic adjacent segment diseases (ASDs) in patients undergoing reoperation after an initial anterior cervical fusion (ACF). The purpose of this study was to determine the optimal surgical approaches of ASD and the incidence of the dysphagia after reoperation. This was a retrospective study of 49 patients with ASD after an initial ACF surgery, which had undergone a reoperation at our medical center between January 2010 and December 2014. ⋯ There were no cases of major neurological or vascular complications, and wound complications. The clinical situation, initial operation, and secondary preoperative imaging findings were analyzed comprehensively, anterior or posterior approach were chosen, which can effectively relieve spinal cord compression and improve spinal cord function. In ACDF with the Zero-profile device surgery, there was no need to remove the previous internal fixation, shorten the operation time, and reduce the incidence of postoperative dysphagia.
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Case Reports
Discordant lumbar epidural hematoma after caudal steroid injection: A case report (CARE-compliant).
Caudal epidural injection is one of the conventional treatments of chronic back pain. Even though spinal epidural hematoma after caudal epidural injection is rare but it can cause serious neurologic complication. ⋯ Continuous vigilance after caudal epidural injection is important to prevent catastrophic neurologic deterioration with early detection and early treatment.