Pre-Operative Left Ventricular Torsion, QRS Width/CRT, and Post-Mitral Surgery Outcomes in Patients With Nonischemic, Chronic, Severe Secondary Mitral Regurgitation

SummaryThe selection of appropriate candidates for mitral surgery among symptomatic patients with nonischemic, chronic, secondary severe mitral regurgitation (NICSMR) remains a clinical challenge. We studied 50 consecutive symptomatic NICSMR patients for a median follow-up of 2.5 years after mitral surgery and concluded that the pre-operative 2-dimensional speckle tracking echocardiography-derived left ventricular torsional profile and QRS width/cardiac resynchronization therapy are potentially important prognostic indicators for post-surgery survival and reverse remodeling

Association between statistical significance and time to publication among systematic reviews: a study protocol for a meta-epidemiological investigation

INTRODUCTION: Many studies have indicated the impact of bias in dissemination and publication in medical research. Existence of such bias among clinical trials has been repeatedly pointed out, but it has not been well studied in the field of systematic reviews (SRs). We therefore aim to investigate whether or not time lag bias and publication bias in SRs based on statistical significance in results exist. In addition, we will examine at what stage of paper publication process such bias, if any, creeps in. METHOD AND ANALYSIS: The present study is a meta-epidemiological study. We will include all SRs of interventions registered in the international prospective register of SRs (PROSPERO) before December 2014 if the SR has completed its analysis irrespective of its publication status. All contact authors of eligible SRs will be asked to participate in a survey administered through the Internet. Our primary outcome is time from protocol registration to full publication of SR as a journal article, defined as time from the registration date to the acceptance date among all the relevant SRs. We will examine the impact of statistically significant findings on the primary outcomes through time to event analyses. ETHICS AND DISSEMINATION: Ethics approval will be obtained from the Ethical Committee of the Kyoto University Graduate School of Medicine. This protocol has been registered in the University Hospital Medical Information Network Clinical Trials Registry. We will publish our findings in a peer-reviewed journal and also may present them at conferences. TRIAL REGISTRATION NUMBER: UMIN000028325

高フェリチン血症を契機に成人Still 病と診断した不明熱症例

　成人Still 病は弛張熱，関節炎，発熱時に増強する発疹（サーモンピンク疹）を３徴とする疾患で，白血球増加，血清CRP やフェリチン値の上昇などの強い炎症所見を認め，しばしば不明熱の原因となる．高フェリチン血症を契機に成人Still 病と診断した症例を経験したので報告する．患者は57歳女性，入院３週間前から発熱とともに咽頭痛，関節痛が出現し，近医にて抗菌薬治療が行われた．抗菌薬不応の発熱で当院を紹介受診し，不明熱精査目的に入院した．入院時より前胸部や背部に淡い紅斑が出現し，採血で，白血球増加（11,480/μL），CRP 高値（12.98 mg/dL），フェリチン著明高値（5,511 ng/mL）を認めた．胸腹部CT 検査では腋窩・鼠径リンパ節の腫脹と脾腫大を認めた．血液培養検査は陰性で，骨髄生検や皮膚生検にて造血器腫瘍を示唆する所見を認めなかった．感染症や悪性腫瘍を除外し，Yamaguchi らの分類基準を満たし，成人Still 病と診断した．プレドニゾロンとメトトレキサートの併用療法を開始したところ，速やかに全身状態は改善した．不明熱の原因検索を行う際に，フェリチン値の測定は有用であると考えられる．　Adult-onset Still\u27s disease (AOSD) is a systemic inflammatory disorder which is responsible for a significant proportion of cases of fever of unknown origin. This disease is characterized by high spiking fevers, musculoskeletal disorders and salmon-colored rash. Here we report the case of a 57-year-old woman with fever of unknown origin who was diagnosed with AOSD. Hyperferritinemia contributed to her diagnosis. The patient was referred to our clinic with persistent spike fevers and arthralgia for 3 weeks despite antibiotic treatment. The patient also had a sore throat, and developed a skin rush on her trunk upon admission. Laboratory data indicated leukocytosis (11,480 /μL), elevated levels of CRP (12.98 mg/dL), and hyperferritinemia (5,511 ng/mL). To exclude infections and malignant diseases, systemic computed tomography scans and biopsy from bone marrow and skin were performed. From these examinations, and based on the criteria set by Yamaguchi et al. , the patient was given a diagnosis of AOSD. She was started on prednisone and methotrexate, and these treatments were effective. Serum ferritin levels should be checked for the evaluation of fever of unknown origin