Obstructive sleep apnea and its malajemente in patients with atrial fibrillation: An International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) global survey of practicing cardiologists

Background: Among international cardiologists it is unclear whether equipoise exists regarding the benefit of diagnosing and managing obstructive sleep apnea (OSA) to improve atrial fibrillation (AF) outcomes and whether clinical practice and equipoise are linked. Methods: Between January 2019 and June 2020 we distributed a web-based 12-question survey regarding OSA and AF management to practicing cardiologists in 16 countries. Results: The United States, Japan, Sweden, and Turkey accounted for two-thirds of responses. 863 cardiologists responded; half were general cardiologists, a quarter electrophysiologists. Responses regarding treating OSA with CPAP to improve AF endpoints were mixed. 33% of respondents referred AF patients for OSA screening. OSA was diagnosed in 48% of referred patients and continuous positive airway pressure (CPAP) was prescribed for 59% of them. Nearly 70% of respondents believed randomized controlled trials (RCTs) of OSA treatment in AF patients were necessary and indicated willingness to contribute to such trials. Conclusions: There was no clinical equipoise among surveyed cardiologists; a majority expressed certainty that combined OSA and AF treatment is superior to AF treatment alone for improving AF outcomes. However, a minority of surveyed cardiologists referred AF patients for OSA testing, and while half of screened AF patients had OSA, CPAP was prescribed in little more than half of them, reflecting the view that better clinical trial evidence is needed to support this practice. Our results underscore the need for larger, multi-national prospective studies of OSA treatment and AF outcomes to inform more uniform society guideline recommendations

Preparing to be unprepared: ground force commander decision making in a volatile, uncertain, complex, and ambiguous world

What are the characteristics of effective ground force commander (GFC) decision making? What commonalities do we see? What are best practices for pre-mission preparation and mission execution? This thesis focuses on GFC decision making in order to investigate how to better prepare leaders for the current operating environment. It examines tactical-level decision making under conditions of uncertainty. It does so by drawing on interviews with combat-experienced commanders. An examination of their thought processes while leading tactical combat elements reveals that mental preparation, vicarious experience, and complex, repetitive training are key components of effective GFC decision making. The thesis concludes with recommendations about how to enhance GFC decision making for future volatile, uncertain, complex, and ambiguous (VUCA) environments.http://archive.org/details/preparingtobeunp1094549503Lieutenant, United States NavyApproved for public release; distribution is unlimited

Exercise induced compartment syndrome in a professional footballer

PubMedID: 15039267Recurrent pain in the lower leg caused by exercise is a common problem in athletes. The main causes are exercise induced compartment syndrome, periostitis of the tibia, stress fracture, venous diseases, obliterative arterial diseases, and shin splints. Exercise induced compartment syndrome is the least common. A recurrent tightening or tense sensation and aching in anatomically defined compartments is pathognomonic. The symptoms are caused by abnormally high pressure in compartments of the leg during and after exercise, in this report, a case of exercise induced compartment syndrome in a professional footballer is described

An early prenatal diagnosis of a 69,XXY case using quantitative fluorescent PCR (QF-PCR) in uncultured amniocytes

Quantitative fluorescent polymerase chain reaction (QF-PCR) has been largely employed for rapid detection of common aneuploidies in prenatal and postnatal diagnosis and consists in DNA amplification by PCR using fluorescent labelled primers and the analysis of chromosome specific small tandem repeats (STR). QF-PCR can rapidly and accurately diagnose sex chromosome status and imbalances, reducing maternal anxiety and aiding in efficient pregnancy management. In this study, an early diagnosis of a 69,XXY case was performed with QF-PCR technique from the uncultured amniocytes. Although, long-term cultures are more common techniques performed in prenatal cytogenetic diagnostic centers, QF-PCR is also an additional molecular reliable technique that enables early prenatal diagnosis. We conclude that, cytogenetic results are important for identifying structural chromosomal abnormalities

Comparison of ultrasonography and radiography in assessment of the heel pad compressibility index of patients with plantar heel pain syndrome. Measurement of the fat pad in plantar heel pain syndrome.

Conclusion. - Measuring unloaded and loaded heel pad thickness by ultrasonography is reliable in the adult feet with heel pain. The preference of ultrasonography is reasonable in the studies involving the heel fat pad. (c) 2006 Elsevier SAS. All rights reserved

Which One is The Better Radiotherapy Technique for Patients with Thoracic Esophageal Tumors, IMRT or VMAT?

Comparison of IMRT and VMAT techniques in thoracic esophageal tumors. IMRT and VMAT plans were created for a total of 10 thorax-located esophagus patients. All plans were compared in terms of HI and CI for PTV; V-5, V-10, V-20 and mean lung dose parameters for total lung; V-30, V-40 and mean heart dose for the heart; and the Dmax for the medulla spinalis. IMRT and VMAT techniques yielded similar results with respect to HI and CI values (p> 0.05). Median mean lung dose was found to be lower in VMAT (11.77 Gy) technique compared to IMRT (12.05 Gy). While the lowest lung median V-5 (67.17%) and V-10 (41.95%) values belonged to IMRT, the V-20 value was achieved with VMAT (17.85%) planning. Median mean heart dose was found the lowest in VMAT (28.81 Gy) and the highest IMRT (29.31 Gy) planning. The lowest heart median V30 value was obtained with IMRT (43.00%) and median V-40 value was obtained with VMAT (18.95%) planning. The median mean medulla spinalis maximum dose was found to be lower with VMAT (41.54 Gy), with no statistically significant difference between them (p= 0.074). VMAT technique was better for reducing cardiovascular and medulla spinalis doses with reduced duration of treatment time and dosimetric uncertainties, while YART technique provides higher PTV control with less low-dose lung volume. Both threatment options have advantages and disadvantages over normal tissue and tumor volume compared to each other, and should be evaluated according to the other clinical conditions of the patient

Hand grip strength in patients with type 2 diabetes mellitus

Conclusion: Hand grip strength and key pinch power values were found to be lower in patients with T2DM than in age-matched control subjects. Hands, as well as feet, are also affected by diabetes and physicians should be aware of this. (c) 2005 Elsevier Ireland Ltd. All rights reserved

Diagnostic value of ferritin in the differential diagnosis of malignant effusions

PubMedID: 10072208The diagnostic value of ferritin in pleural effusions or ascites was studied in 151 samples from 147 patients (four patients had both kind of effusions). Samples (99 pleural effusions, 52 ascites) were evaluated in 4 groups: benign transudate (27 cases), benign nontuberculous exudate (26 cases), tuberculous exudate (47 cases) and malignant exudate (51 cases). Median ferritin levels in effusions were 67 ng/ml, 805 ng/ml, 889 ng/ml, 998 ng/ml and median effusion/serum (E/S) ratios were 0.7, 2.0, 4.9, 3.2 respectively. There was a significant difference between the concentrations of ferritin in malignant (51 cases) and nonmalignant effusions (100 cases) (p 0.05). When compared the all inflammatory effusions (malignant, tuberculous, nontuberculous inflammatory exudates) with noninflammatory effusions (transudate and exudate), we determined a significant difference (p < 0.001). Conclusions: 1) Elevated ferritin concentration in effusions is significant indicators of exudates; 2) It is not good a parameter to discriminate the malignant effusions from the benign ones; 3) They can be useful in the differential diagnosis of the inflammatory exudations from the noninflammatory ones