Low-dose rescue tirofiban in mechanical thrombectomy for acute cerebral large-artery occlusion.

BACKGROUND AND PURPOSE: Tirofiban administration during mechanical thrombectomy (MT) remains controversial. The aim was to evaluate the safety and efficacy of a low-dose rescue tirofiban regimen during MT for Chinese acute ischaemic stroke (AIS) patients. METHODS: Patients from the ANGEL study, a multicentric, prospective registry study that included AIS patients who underwent MT owing to proximal large-artery occlusion from June 2015 to December 2017, were collected. The patients were dichotomized into tirofiban and non-tirofiban groups according to whether rescue tirofiban was performed during MT. Safety outcomes [symptomatic intracerebral haemorrhage (sICH), total intracerebral haemorrhage (ICH) and distal embolization] and efficacy outcomes (artery recanalization and functional outcomes at 3-month follow-up) were compared between groups using logistic regression analysis. RESULTS: A total of 662 patients were included in this study, and 230 (34.7%) were in the tirofiban group. No significant differences in safety outcomes on sICH, total ICH and distal embolization and efficacy outcomes on artery recanalization and 3-month functional independence were observed between the tirofiban and non-tirofiban group in the entire cohort or the anterior circulation stroke or posterior circulation stroke patients (P > 0.05 for all groups). However, low-dose rescue tirofiban was significantly correlated with 3-month mortality reduction for posterior circulation stroke patients [adjusted hazard ratio 0.35 (0.14-0.92), P = 0.03]. CONCLUSIONS: Low-dose rescue tirofiban during MT was not associated with increased risk of sICH, ICH and distal embolization for AIS patients, and may be correlated with 3-month mortality reduction for posterior circulation stroke.

[Clinical results of Mei mini maze procedure for atrial fibrillation patients with previously failed catheter ablation].

Objective: To evaluate the efficacy of Mei mini maze procedure for treating atrial fibrillation (AF) patients with previously failed catheter ablation. Methods: Between August 2010 and May 2016, 48 AF (8 proximal AF, 15 persistent AF and 25 long-standing persistent AF) patients (29 males, 19 females, mean age: (62.5±7.3) years old) with previously 1-3 failed catheter ablation results were treated with Mei mini maze procedure in our department. Under thoracoscopic assistance, the procedure was performed through three ports on left chest wall, pulmonary vein isolation and ablations of the roof and posterior wall of left atrium was made by bipolar radiofrequency ablation. Ganglionic plexus ablation was made by the ablation pen. Left atrial appendage was excluded. Patients were followed at outpatient clinic and per telephone. Electrocardiogram, CT and echocardiography examinations were performed at 1, 3, 6 and 12 months post operation. The success rate of the procedure was analyzed by Kaplan-Meier curves and evaluated by the log-rank test. Results: Mean AF history was (8.1±6.3) years and left atria dimension was (44.1±6.2) mm in this patient cohort. All procedures were performed successfully in these 48 patients. Pericardial adhesions were dissected in 21 patients. Durations of the procedures were (142.3±35.6) minutes.There were no serious complications. The hospital stay was (9.3±1.8) days. Sinus rhythm was documented in 44 patients (91.7%) at discharge. The mean follow-up duration was (28.0±17.2) months. Thirty-eight patients (82.6%) were in sinus rhythm. There was no stroke, thrombus in the left atrium and stenosis of pulmonary vein during the follow-up. Sinus rhythm was achieved in 7 out of 8 paroxysmal AF patients, in 31 out of 38 non-paroxysmal AF patients, and in 13 out of 15 persistent AF patients. Kaplan-Meier curve showed that the success rate in the long-standing persistent AF group was lower than in the other two groups, but there was no statistical difference. Conclusions: Mei mini maze procedure has a high success rate for AF patients with previously failed catheter ablation history, which could completely isolate the bilateral pulmonary vein and left atrial posterior wall with good quality and integrity of ablation line, and left atrial appendage is also resected during the procedure.

Oral Cavity Cancers: Ethnic Differences in Radiotherapy Outcomes in a Majority South Asian Leicester Community.

AIMS: Squamous cell carcinoma oral cavity cancers (SCCOCCs) have a higher reported incidence in South Asian countries. We sought to compare presenting stage and outcome by ethnicity in patients with SCCOCC treated with radical radiotherapy in a single centre in the UK. MATERIALS AND METHODS: All patients with SCCOCC treated with radical radiotherapy at an oncology department in Leicester (UK) between 2011 and 2017 were identified. Baseline demographic, clinical data and 2-year treatment outcomes were reported. RESULTS: Of the 109 patients included, 40 were South Asian and 59 were non-South Asian. South Asians had significantly poorer 2-year disease-free survival compared with non-South Asians (54.6% versus 73%, P = 0.01). CONCLUSION: Our analysis suggests that South Asians with SCCOCC have poorer outcomes despite a younger age and similar disease characteristics. Environmental, social factors and differing biology of disease may be responsible and further research is required to inform targeted interventions.

[Application of autologous cartilage in rhinoplasty for patients with traumatic nasal contraction and nasal dysfunction].

Objective: To explore the application and effect of autologous cartilage in rhinoplasty for patients with traumatic hernia and nasal dysfunction. Methods: From January 2017 to April 2019,30 patients with nasal trauma admitted to Department of Otorhinolaryngology Head and Neck Surgery, Daping Hospital, Army Medical University were treated for 6 days to 14 years. All patients were accompanied by different degrees of nasal deformity and nasal ventilatory disorders. They were classified into three categories: light, medium and heavy. All of them were open at the same time. Rhinoplasty and nasal septum deviation correction. For mild to moderate nasal deformity and nasal ventilatory disorders, ear cartilage was used to modify the tip of the nose and strengthen the nasal septal cartilage support to modify the deformity of the nasal back. For severe nasal deformity and nasal ventilatory disorders, we engraved the costal cartilage into a "Y" shaped monolithic stent or flank costal cartilage to form a 2+1 or 4+1 stent, and the costal cartilage stent and the septal cartilage tail end were sutured. Reshape the nasal septum frame support and the nasal column to avoid collapse of the nose. Results: Three patients had a septal hematoma after operation and recovered normally after cleansing. All patients were followed up for 2 months to 2 years, and no complications such as nasal septum perforation and nasal bridge collapse occurred. The postoperative cure rate was 60.0% (18/30). All patients had a grade I nasal drop after surgery, and the effective rate was 100% (30/30). The patient's preoperative measurement deviation was (6.85±2.43) mm, the postoperative measurement deviation was (2.4±1.58) mm, the preoperative nasal appearance VAS score was (1.93±1.31), and the postoperative nasal appearance VAS score was (6.60±1.16), the difference in facial appearance deviation and VAS score before and after surgery was statistically significant (P<0.05). All patients had improved nasal ventilation after operation. The preoperative nasal ventilation VAS score was (1.97±1.07), the postoperative nasal ventilation VAS score was (6.53±1.04), and the difference between preoperative and postoperative nasal ventilation VAS scores was statistically significant (P<0.05). Conclusions: Autologous cartilage is effective in rhinoplasty in patients with traumatic nasal contraction and nasal dysfunction. One stage open rhinoplasty and nasal septum deviation surgery are performed to shorten the treatment time and improve the nasal appearance and nasal ventilation function. The patients got satisfaction.

[Effect of skin soft tissue expansion on repair of large area of scars on extremities].

Objective: To investigate the effect of skin soft tissue expansion on repair of large area of scars on extremities. Methods: Twenty-five patients with large area of scars on extremities were admitted to our department from June 2007 to October 2014. There were 14 males and 11 females, aged 4 to 36 years. Operations were performed under local infiltration anesthesia or general anesthesia. In the first stage, 1 to 5 cylindrical expanders with capacities of 250 to 600 mL were placed at left or right sides or at upper or lower parts of the scars. In the second stage, scars of 21 patients were repaired with expanded transverse propulsive and lateral flaps, and scars of 4 patients were repaired with expanded perforator flaps whose pedicles were perforators of brachial artery, superior ulnar collateral artery, or posterior interosseous artery according to areas and shapes of the scars. The secondary wound areas ranged from 13 cm×7 cm to 34 cm×18 cm after dissolution or excision of scars. The areas of flaps ranged from 13 cm×7 cm to 20 cm×12 cm. The donor sites were sutured directly. The flaps after operation and follow-up of patients were observed and recorded. Results: All expanded flaps survived after operation. And the superficial distal part of flap whose pedicle was perforator of posterior interosseous artery in one patient was with necrosis, and other flaps survived well. During follow-up of 3 to 15 months after operation of the second stage, color and texture of flaps were similar to surrounding skin, while extremities of donor sites were thinner and auxiliary incisional scars formed after expansion. Conclusions: Expanded flap is a good way to repair large area of scar on extremities. Bilateral skin of scar is the first choice of donor site of expanded flap. If there isn't enough skin for expanding on bilateral sides, expanded perforator flap designed at upper or lower part of the scar is another choice to repair the scar.

How to Integrate Personalized Medicine into Prevention? Recommendations from the Personalized Prevention of Chronic Diseases (PRECeDI) Consortium.

Medical practitioners are increasingly adopting a personalized medicine (PM) approach involving individually tailored patient care. The Personalized Prevention of Chronic Diseases (PRECeDI) consortium project, funded within the Marie Sklodowska Curie Action (MSCA) Research and Innovation Staff Exchange (RISE) scheme, had fostered collaboration on PM research and training with special emphasis on the prevention of chronic diseases. From 2014 to 2018, the PRECeDI consortium trained 50 staff members on personalized prevention of chronic diseases through training and research. The acquisition of skills from researchers came from dedicated secondments from academic and nonacademic institutions aimed at training on several research topics related to personalized prevention of cancer and cardiovascular and neurodegenerative diseases. In detail, 5 research domains were addressed: (1) identification and validation of biomarkers for the primary prevention of cardiovascular diseases, secondary prevention of Alzheimer disease, and tertiary prevention of head and neck cancer; (2) economic evaluation of genomic applications; (3) ethical-legal and policy issues surrounding PM; (4) sociotechnical analysis of the pros and cons of informing healthy individuals on their genome; and (5) identification of organizational models for the provision of predictive genetic testing. Based on the results of the research carried out by the PRECeDI consortium, in November 2018, a set of recommendations for policy makers, scientists, and industry has been issued, with the main goal to foster the integration of PM approaches in the field of chronic disease prevention.