Objective: The purpose of this study was to determine the incidence of ultrasonographically detected cerebral white matter lesions (WMLs) in preterm twins at birth in relation to chorionicity, discordant weight and tw...Objective: The purpose of this study was to determine the incidence of ultrasonographically detected cerebral white matter lesions (WMLs) in preterm twins at birth in relation to chorionicity, discordant weight and twin- twin transfusion syndrome (TTTS). Methods: In this retrospective study, perinatal, neonatal, and cranial scan data of 85 monochorionic (MC) and 94 dichorionic (DC) twin pregnancies (341 infants) delivered between 24 and 34 weeks of gestation were collected. Data were analysed according to chorionicity, discordant birth weight (>20% ), single intrauterine death and TTTS. Results: The cerebral WML was seen in 14% of preterm twins. Monochorionic infants had higher risks of WML than DC twin (odds ratio 7.1; 95% CI 3.28- 15.8). In MC group, discordant weight (37% )- , TTTS (38% ), single intrauterine death (67% ) had higher incidence of cerebral WML than concordant weight infants (7% ). Similarly, incidence of WML was higher in DC discordant compared with concordant weight infants (13% versus 2% ; P <.0.05). Conclusion: Monochorionic infants had a seven- fold higher incidence of cerebral WML than DC infants. Discordant birth weight, TTTS and survivor of co- twin demise are an independent risk of cerebral white matter lesion.展开更多
AIM： To establish the efficacy and safety of bimatoprost 0.03% monotherapy in glaucoma and ocular hypertension （OHT） patients with inadequate intraocular pressure （lOP） on current therapy. METHODS： Pre- and pos...AIM： To establish the efficacy and safety of bimatoprost 0.03% monotherapy in glaucoma and ocular hypertension （OHT） patients with inadequate intraocular pressure （lOP） on current therapy. METHODS： Pre- and post-switch lOPs were analyzed for 59 consecutive patients who were switched from current therapy to bimatoprost monotherapy between 2011-2015. Demographic information, diagnosis, and any adverse events were recorded. Change in lOP post-pre switch was analyzed using a 2-sided Student＇s paired t-test at the 5% significance level. RESULTS： There was a statistically significant mean reduction in lOP at the first follow up visit, which was maintained at subsequent follow up visits for patients regardless of diagnosis, or pre-switch treatment （P〈0.001）. Subgroup analysis also demonstrated a statistically significant mean reduction in lOP when looking at OHT patients only, as well as patients with any diagnosis switched from latanoprost monotherapy to bimatoprost monotherapy （P〈0.001）. CONCLUSION： This is the largest independent data set which supports switching glaucoma patients with poor response to current treatment onto bimatoprost monotherapy before considering other adjuvant medical or more invasive therapy.展开更多
BACKGROUND Day case total shoulder arthroplasty(TSA)is a novel approach,not widely practiced in Europe.We conducted a retrospective cohort study of patients comparing elective day case and inpatient TSAs in our United...BACKGROUND Day case total shoulder arthroplasty(TSA)is a novel approach,not widely practiced in Europe.We conducted a retrospective cohort study of patients comparing elective day case and inpatient TSAs in our United Kingdom centre.AIM To evaluate the efficacy and cost-effectiveness of day case TSA compared to standard inpatient total shoulder arthroplasty.METHODS All patients undergoing TSA between January 2017 and July 2018 were included.Outcome measures were:Change in abduction and extension 3 mo postoperatively;30-d postoperative adverse events and re-admissions in day case and inpatient groups.We also conducted an economic evaluation of outpatient arthroplasty.Multivariate linear and logistic regression were used to adjust for demographic and operative covariates.RESULTS Fifty nine patients were included,18 d cases and 41 inpatients.There were no adverse events or re-admissions at 30 d postoperatively in either group.There were no significant differences in adjusted flexion(mean difference 16.4,95%CI:17.6-50.5,P=0.337)or abduction(mean difference:13.2,95%CI:18.4-44.9,P=0.405)postoperatively between groups.Median savings with outpatient arthroplasty were￡529(interquartile range:247.33-789,P<0.0001).CONCLUSION Day case TSA is a safe,effective procedure,with significant cost benefit.Wider use may be warranted in the United Kingdom and beyond,with potential for significant cost savings and improved efficiency.展开更多
Approximately 25%of individuals with colorectal cancer(CRC)present with metastatic disease,and it is estimated that throughout the course of the disease,up to 50%of individuals may develop liver metastases,the majorit...Approximately 25%of individuals with colorectal cancer(CRC)present with metastatic disease,and it is estimated that throughout the course of the disease,up to 50%of individuals may develop liver metastases,the majority of which are unresectable(1).However,thermal ablation is a treatment modality increasingly used to manage individuals with liver metastases.Recently Takahashi et al.published a comprehensive review of the various approaches to thermal ablation and summarised the recent evidence demonstrating an associated survival benefit supporting its use in the management of metastatic CRC(mCRC)(2).It is however critical to analyse the studies evaluated to ensure the strength of the evidence presented.展开更多
文摘Objective: The purpose of this study was to determine the incidence of ultrasonographically detected cerebral white matter lesions (WMLs) in preterm twins at birth in relation to chorionicity, discordant weight and twin- twin transfusion syndrome (TTTS). Methods: In this retrospective study, perinatal, neonatal, and cranial scan data of 85 monochorionic (MC) and 94 dichorionic (DC) twin pregnancies (341 infants) delivered between 24 and 34 weeks of gestation were collected. Data were analysed according to chorionicity, discordant birth weight (>20% ), single intrauterine death and TTTS. Results: The cerebral WML was seen in 14% of preterm twins. Monochorionic infants had higher risks of WML than DC twin (odds ratio 7.1; 95% CI 3.28- 15.8). In MC group, discordant weight (37% )- , TTTS (38% ), single intrauterine death (67% ) had higher incidence of cerebral WML than concordant weight infants (7% ). Similarly, incidence of WML was higher in DC discordant compared with concordant weight infants (13% versus 2% ; P <.0.05). Conclusion: Monochorionic infants had a seven- fold higher incidence of cerebral WML than DC infants. Discordant birth weight, TTTS and survivor of co- twin demise are an independent risk of cerebral white matter lesion.
文摘AIM： To establish the efficacy and safety of bimatoprost 0.03% monotherapy in glaucoma and ocular hypertension （OHT） patients with inadequate intraocular pressure （lOP） on current therapy. METHODS： Pre- and post-switch lOPs were analyzed for 59 consecutive patients who were switched from current therapy to bimatoprost monotherapy between 2011-2015. Demographic information, diagnosis, and any adverse events were recorded. Change in lOP post-pre switch was analyzed using a 2-sided Student＇s paired t-test at the 5% significance level. RESULTS： There was a statistically significant mean reduction in lOP at the first follow up visit, which was maintained at subsequent follow up visits for patients regardless of diagnosis, or pre-switch treatment （P〈0.001）. Subgroup analysis also demonstrated a statistically significant mean reduction in lOP when looking at OHT patients only, as well as patients with any diagnosis switched from latanoprost monotherapy to bimatoprost monotherapy （P〈0.001）. CONCLUSION： This is the largest independent data set which supports switching glaucoma patients with poor response to current treatment onto bimatoprost monotherapy before considering other adjuvant medical or more invasive therapy.
文摘BACKGROUND Day case total shoulder arthroplasty(TSA)is a novel approach,not widely practiced in Europe.We conducted a retrospective cohort study of patients comparing elective day case and inpatient TSAs in our United Kingdom centre.AIM To evaluate the efficacy and cost-effectiveness of day case TSA compared to standard inpatient total shoulder arthroplasty.METHODS All patients undergoing TSA between January 2017 and July 2018 were included.Outcome measures were:Change in abduction and extension 3 mo postoperatively;30-d postoperative adverse events and re-admissions in day case and inpatient groups.We also conducted an economic evaluation of outpatient arthroplasty.Multivariate linear and logistic regression were used to adjust for demographic and operative covariates.RESULTS Fifty nine patients were included,18 d cases and 41 inpatients.There were no adverse events or re-admissions at 30 d postoperatively in either group.There were no significant differences in adjusted flexion(mean difference 16.4,95%CI:17.6-50.5,P=0.337)or abduction(mean difference:13.2,95%CI:18.4-44.9,P=0.405)postoperatively between groups.Median savings with outpatient arthroplasty were￡529(interquartile range:247.33-789,P<0.0001).CONCLUSION Day case TSA is a safe,effective procedure,with significant cost benefit.Wider use may be warranted in the United Kingdom and beyond,with potential for significant cost savings and improved efficiency.
文摘Approximately 25%of individuals with colorectal cancer(CRC)present with metastatic disease,and it is estimated that throughout the course of the disease,up to 50%of individuals may develop liver metastases,the majority of which are unresectable(1).However,thermal ablation is a treatment modality increasingly used to manage individuals with liver metastases.Recently Takahashi et al.published a comprehensive review of the various approaches to thermal ablation and summarised the recent evidence demonstrating an associated survival benefit supporting its use in the management of metastatic CRC(mCRC)(2).It is however critical to analyse the studies evaluated to ensure the strength of the evidence presented.
