Medicine
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The adding-on phenomenon is a common complication in adolescent idiopathic scoliosis (AIS) patients after correction surgery. However, the risk factors of previous studies and the optimal treatment strategies remain controversial. The aim of this study was to identify new risk factors for the adding-on phenomenon after posterior correction surgery in AIS patients and compare different treatment strategies to guide the selection of the lowest instrumented vertebra (LIV). ⋯ Among the 4 methods, only choosing touch type A as LIV shows satisfactory outcome. The Touch classification is an important risk factor that is highly correlated with the incidence of the adding-on phenomenon. The best LIV choice to preserve the lumbar activity segment as much as possible is Touch type C, and no significant difference was observed in the SRS-22 scores between the Touch type C group and the control group in the short-term follow-up.
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Observational Study
Postmastectomy intensity modulation radiated therapy of chest wall and regional nodes: Retrospective analysis of the performance and complications up for 5 years.
To retrospectively evaluate the performance and complications of postmastectomy intensity modulation radiated therapy (IMRT) technique. From January 2010 to December 2014, IMRT technique was applied to 200 patients after modified radical mastectomy. The acute and late radiation toxicities have been followed up for 5 years. ⋯ The 2-year local-regional recurrence (LRR), distant metastasis (DM), and disease free survival (DFS) were 1.6%, 6.4%, and 92.80%, respectively. Postmastectomy treatment with the IMRT technique can reduce the incidence rate of radiation toxicity by decreasing organs at risk (OARs) irradiation. Patients with risk factors for radiation toxicity should be strictly surveyed throughout radiotherapy.
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Chart reviews have been used to assess the incidence and impact of adverse events, but most of them are not a nationally representative sample. In addition, the definition of adverse events is generally broad and covers unintended events; the relationship to outcome is often unclear, and official estimates have not matched those of medical practitioner's recognition. The number of patient deaths from adverse events remains unknown. ⋯ The mortality rate was high at acute care hospitals with ≥500 beds and at psychiatric hospitals. The nationwide number of patient deaths recognized by medical practitioners as caused by adverse events and its mortality rate were estimated. In comparison with a chart review, a mail survey was a faster and a cheaper way, and was able to cover a wide range of hospitals for estimating mortality rate of adverse events.
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Observational Study
Usefulness of end-tidal carbon dioxide as an indicator of dehydration in pediatric emergency departments: A retrospective observational study.
Physician assessment of hydration status is one of the most important factors in the management of dehydration in the pediatric emergency department (ED). Overestimating dehydration may lead to overtreatment with intravenous fluids or unnecessary hospitalization, whereas underestimation may lead to delayed therapy and aggravation of symptoms. Various methods to estimate hydration status have been proposed, including use of physical findings, body weight, and laboratory results. ⋯ ETCO2 can be considered a simple, noninvasive parameter for identifying dehydration among patients in the pediatric ED. Though weak, ETCO2 showed a correlation with HCO3 level as well as CDS. In the future, a prospective study with a large number of pediatric patients is warranted.
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Genetic and environmental (behavior, clinical, and demographic) factors are associated with increased risks of both myocardial infarction (MI) and high cholesterol (HC). It is known that HC is major risk factor that may cause MI. However, whether there are common single nucleotide polymorphism (SNPs) associated with both MI and HC is not firmly established, and whether there are modulate and modified effects (interactions of genetic and known environmental factors) on either HC or MI, and whether these joint effects improve the predictions of MI, is understudied. ⋯ Overall, the prediction power in successfully classifying MI status is increased to 80% with inclusions of all significant tagSNPs and environmental factors and their interactions compared with environmental factors only (72%). Having a history of either HC or MI has significant effects on each other in both directions, in addition to HTN and gender. Genes/SNPs identified from this analysis that are associated with HC may be potentially linked to MI, which could be further examined and validated through haplotype-pairs analysis with appropriate population stratification corrections, and function/pathway regulation analysis to eliminate the limitations of the current analysis.