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   2022| January-March  | Volume 34 | Issue 1  
    Online since January 3, 2022

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Nevi, dysplastic nevi, and melanoma: Molecular and immune mechanisms involving the progression
Wei-Wen Sung, Chung-Hsing Chang
January-March 2022, 34(1):1-7
Melanocytic nevi, dysplastic nevi, and melanoma are all derived from the pigment-producing cells, namely melanocytes. Concerning the clinical spectrum, cutaneous melanoma is the most aggressive skin cancer with a low survival rate, while nevi are the most common benign lesions in the general population, and dysplastic nevi place in between nevi and melanoma. Ultraviolet (UV) radiation is a well-recognized extrinsic risk factor for all three. BRAFV600E is a well-recognized driver mutation that activates the RAS-BRAF-mitogen-activated protein kinase (MAPK) signaling pathway among 40%–60% of melanoma cases. Interestingly, BRAFV600E mutation is detected even more in acquired nevi, approximately 80%. However, in nevi, several tumor suppressors such as p53 and phosphatase and tensin homolog (PTEN) are intact, and senescence factors, including p15INK4b, p16INK4a, p19, and senescence-associated acidic β-galactosidase, are expressed, leading to cell senescence and cell cycle arrest. Although loss of p53 function is rarely found in melanoma, decreased or loss of PTEN with an activated PI3k/Akt signaling pathway is common in nevi, which may abolish senescence status and allow further progression into dysplastic nevi or melanoma. At present, mouse models closely resembling human nevi are used for investigating these phenomena. Melanocortin 1 receptor deficiency, an intrinsic risk factor for melanomagenesis, is related to the production of procarcinogenic pheomelanin and the inhibition of PTEN function. Immune response escape via programmed cell death-1/programmed cell death ligand-1 interaction plays further roles in monitoring the spectrum. Here, we review the current literature on the molecular and immune mechanisms involving the transition from benign nevi to malignant melanoma.
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The role of Type III secretion system in the pathogenesis of Pseudomonas aeruginosa microbial keratitis
Justin J Yang, Kai-Si Claire Tsuei, Elizabeth P Shen
January-March 2022, 34(1):8-14
Pseudomonas aeruginosa is the most commonly isolated Gram-negative pathogen causing sight-threatening microbial keratitis (MK). Contact lens wear is the most significant risk factor associated with pseudomonal MK. Understanding the pathogenesis of MK due to P. aeruginosa and its interactions with contact lenses is crucial in preventing these often rapidly progressive and highly antibiotic-resistant infections. Bacterial virulence factor Type III secretion system (T3SS) has significant interplays between contact lens material, antibiotic sensitivity, disinfectant selectivity, and bacterial cell invasion. Depending on the T3SS exotoxins produced, P. aeruginosa strains are divided into cytotoxic or invasive strains. Cytotoxic strains are relatively resistant to commercial disinfectants, while invasive strains are more antibiotic resistant. Therefore, contact lens wearers are more predisposed to cytotoxic P. aeruginosa infections, and patients with trauma or previous surgery are more prone to infection by invasive strains. Previous studies with mutant P. aeruginosa strains unable to produce T3SS exotoxins were more susceptible to disinfectants and less able to adhere to soft contact lenses, indicating an essential role of T3SS in bacterial virulence. Invasion of P. aeruginosa intracellularly was found to be associated with control of scaffold protein IQ-domain GTPase-activating protein 1 (IQGAP1) and human corneal epithelial cell tight junctions. Knockdown of IQGAP1 strengthened tight junctions that prevented intracellular survival of invasive P. aeruginosa strains and enhanced corneal epithelial cell survival. These novel findings of the vital role of T3SS in the pathogenesis of pseudomonal MKs will provide new guidelines in both prevention and treatment of this common eye-blinding infection.
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How to choose appropriate medication for overactive bladder: Findings from the largest integrated clinical trial database analysis of mirabegron studies
Hann-Chorng Kuo
January-March 2022, 34(1):23-28
Medical treatment of overactive bladder (OAB) includes antimuscarinic agents, beta-3 adrenoceptor agonist (mirabegron), or combination with both drugs. Recently, a meta-analysis reported the integrated clinical trial data from 10 phase 2–4, double-blind, 12-week mirabegron monotherapy studies. The results confirmed that mirabegron is as effective as the previously used antimuscarinic agent to treat OAB. The treatment-emergent adverse events were similar across subgroups. This article comments on this largest integrated clinical trial data analysis, and reviews the recently published literature and tries to reveal how to choose the appropriate medication for OAB. For OAB patients, starting from antimuscarinic agent is feasible. However, if the patients have risk of cognitive dysfunction, a history of constipation, dry mouth, and urinary retention, starting with mirabegron 50 mg might be more safe and appropriate. In the elderly patients with low detrusor contractility, with central nervous system lesion, and men with benign prostatic hyperplasia, starting from 25 mg mirabegron is recommended. If the treatment result is not satisfactory to the 25 mg mirabegron, increase dose to 50 mg mirabegron is appropriate. In patients who have failed from the first OAB medication either with antimuscarinics or mirabegron 50 mg, the exchange of the OAB medication to each other should be tried first. If the treatment result is still not satisfactory, a combination of antimuscarinics and mirabegron is recommended.
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Diagnosis and treatment for normal pressure hydrocephalus: From biomarkers identification to outcome improvement with combination therapy
Pao-Hui Tseng, Li-Kung Wu, Yi-Cheng Wang, Tsung-Jung Ho, Shinn-Zong Lin, Sheng-Tzung Tsai
January-March 2022, 34(1):35-43
Idiopathic normal pressure hydrocephalus (iNPH), albeit characterized by gait impairment, cognitive decline, and urinary incontinence, in clinical diagnosis is poorly defined and is usually coexistent with other neurodegenerative diseases. Surgical operation with shunt implantation is the primary treatment but leads to variable outcomes. Recent studies demonstrated that the pathophysiology of iNPH may include both preceding cerebrovascular events and concomitant Alzheimer's dementia or dopaminergic degenerative neuropathology in patients' brain. These factors not only help differentiate iNPH from its mimics but also associated with the extent of symptomatic improvement after surgery. In this review, we examined these mechanisms underlying the development of iNPH and the beneficial effects of shunt surgery. Furthermore, the increasing identification and importance of biomarkers from cerebrospinal fluid and neural imaging could also predict the responsiveness of treatment. Finally, these progresses suggest that combination therapy would be necessary for iNPH treatment in the future.
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Acute kidney injury in COVID-19: Considerations in pregnancy
Seema Chopra, Arshi Syal, Yajur Arya
January-March 2022, 34(1):29-34
The clinical manifestations of COVID-19 are diverse with the involvement of different organ systems. Renal involvement is particularly noteworthy with acute kidney injury (AKI) being an important disease manifestation, particularly in pregnancy. Pregnancy itself serves as a high-risk condition for COVID-19 disease and a risk factor for deterioration, developing a more severe illness than nonpregnant women, and subsequent higher intensive care unit admission, oxygen therapy, and ventilatory support. There are reports in the literature highlighting the involvement of vital organs in pregnancy; however, data pertaining to AKI in pregnancy during COVID-19 are lacking in terms of risk factors, disease management, and outcomes. The entire spectrum of hormonal changes and adaptive mechanisms in pregnancy can be adversely affected by this viral infection. A literature search regarding AKI in COVID-19 in pregnancy was performed on PubMed, Scopus, Google Scholar, and ScienceDirect, and the relevant articles were selected. Our review highlights key issues pertaining to AKI in COVID-19 in pregnancy in an attempt to overcome, albeit partly, the scarcity of corroborative literature regarding the same.
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Calmodulin: The switch button of calcium signaling
Chiu-Fen Yang, Wen-Chin Tsai
January-March 2022, 34(1):15-22
Calmodulin (CaM), a calcium sensor, decodes the critical calcium-dependent signals and converts them into the driving force to control various important cellular functions, such as ion transport. This small protein has a short central linker to connect two globular lobes and each unit is composed of a pair of homologous domains (HD) which are responsible for calcium binding. The conformation of each HD is sensitive to the levels of the intracellular Ca2+ concentrations while the flexible structure of the central domain enables its interactions with hundreds of cellular proteins. Apart from calcium binding, posttranslational modifications (PTMs) also contribute to the modulations of CaM functions by affecting its protein-protein interaction networks and hence drawing out the various downstream signaling cascades. In this mini-review, we first aim to elucidate the structural features of CaM and then overview the recent studies on the engagements of calcium binding and PTMs in Ca2+/CaM-mediated conformational alterations and signaling events. The mechanistic understanding of CaM working models is expected to be a key to decipher the precise role of CaM in cardiac physiology and disease pathology.
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Three-dimensional ultrasound for carotid vessel wall volume measurement
Ying-An Chen, Pei-Ya Chen, Shinn-Kuang Lin
January-March 2022, 34(1):88-94
Objectives: The intima–media thickness (IMT) of the carotid artery can now be detected on a three-dimensional (3D) plane. The 3D vessel wall volume (VWV) more accurately represents vascular conditions. Through 3D ultrasound, we established a standardized method for carotid VWV measurement. Materials and Methods: A total of thirty patients without stroke or cardiovascular disease who received carotid duplex sonography were retrospectively reviewed. Gray-scale 3D images from the distal common carotid artery (CCA) to internal carotid artery on both sides were acquired using a single-sweep 3D transducer and analyzed offline by using the vascular plaque quantification function of the Philips QLAB software. Then, the 3D IMT(QLAB intima–media thickness [QIMT]), total plaque volume (TPV), and VWV were measured by a neurologist and a technician, and the interobserver variability was assessed. Results: The mean two-dimensional (2D) carotid IMT was 0.65 ± 0.12 mm. The mean QIMT, TPV, and VWV measured by observer 1 were 0.68 ± 0.18 mm, 26 ± 12 mm3, and 94 ± 10 mm3, respectively. The Bland–Altman plot of the mean differences between the QIMT, TPV, and VWV values measured by observers 1 and 2 showed that those of observer 2 were within two standard deviations of those of observer 1. Intraclass correlation coefficients (ICCs) indicated strong correlations in QIMT (ICC = 0.76), TPV (ICC = 0.85), and VWV (ICC = 0.90; P < 0.001) between observers 1 and 2. Both 2D IMT and 3D QIMT exhibited a positive linear correlation with age. Conclusion: This study established a standardized VWV measurement through 3D ultrasound. Reasonable interobserver differences were obtained within a 95% limit of agreement and high reliability (ICC = 0.90). The VWV 1 cm from the CCA bifurcation was quantified with a mean value of 94.2 mm3. Further studies on the 3D ultrasound quantification of carotid arteries are warranted.
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An update of medical care in Marfan syndrome
Hsin-Hui Chiu
January-March 2022, 34(1):44-48
Marfan syndrome (MFS), a multisystemic connective disorder, caused by fibrillin 1 gene mutations with autosomal dominant inheritance. The disease spectrum is wide and the major causes of death are related to aortic root aneurysm or dissection. The purposes of medical treatment are to reduce structural changes in the aortic wall and slow aortic root dilatation. Advance in medical researches have provided new insights into the pathogenesis of disease and opened up new horizons for treatments. Several medications such as angiotensin II type I receptor blockers, β-blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, tetracyclines, and statins have been studied for the purpose. Currently, the life expectancy of Marfan patients improves significantly and is closes to the general population with proper treatment. In this article, we review and update the medical treatments for patients with MFS.
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Taoism, bioethics, and the COVID-19 pandemic
Liam C Butchart
January-March 2022, 34(1):107-112
The stress that the COVID-19 pandemic has placed on health systems internationally has forced difficult decisions concerning the rationing of medical care and has put the bioethical structures that inform those choices under scrutiny. Often, ethical approaches to pandemic circumstances center around utilitarianism, dehumanizing the treatment process and ignoring the plurality of other philosophical doctrines that inform non-Western bioethics, which could be of use in addressing the pandemic. This paper focuses on philosophical Taoism, as developed in the Tao Te Ching and Zhuangzi, in order to suggest an alternative approach to medical care when medical capacity is limited, grounded in the concept of wu-wei, or inaction.
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Serum myostatin level is a positive predictor of endothelial function measured by digital thermal monitoring of vascular reactivity in kidney transplantation patients
Hsiu-Hsien Lin, Ching-Chun Ho, Yen-Cheng Chen, Guan-Jin Ho, Bang-Gee Hsu, Ming-Che Lee
January-March 2022, 34(1):62-68
Objectives: Myostatin is a myokine predominantly expressed and secreted in skeletal muscle in response to stimulations, including oxidative stress or inflammation. We investigated a potential association between myostatin levels and endothelial function among kidney transplantation (KT) patients. Materials and Methods: Fasting blood samples were collected from 64 KT patients. The endothelial function that indicated by vascular reactivity index (VRI) was measured by digital thermal monitoring test. Serum myostatin levels were measured using a commercial enzyme-linked immunosorbent assay kit. All patients were categorized into three groups according to their VRI values: poor vascular reactivity was considered if VRI <1.0; 1.0 ≤VRI <2.0 indicated intermediate vascular reactivity, and VRI ≥2.0 was grouped as good vascular reactivity. Results: Seven KT patients (10.9%) were categorized as poor vascular reactivity, 24 KT patients (37.5%) were grouped as intermediate vascular reactivity, and 33 KT patients had good vascular reactivity. Advanced age (r = −0.372, P = 0.002) and serum alkaline phosphate (ALP) level (r = −0.341, P = 0.006) were negatively correlated with VRI. However, serum myostatin level (r = 0.430, P < 0.001) was positively correlated with VRI. In multivariable forward stepwise linear regression analysis, high serum level of myostatin (β = 0.441, adjusted R2 change = 0.171; P < 0.001), advanced age (β = −0.317, adjusted R2 change = 0.138; P = 0.003), and serum ALP level (β = −0.270, adjusted R2 change = 0.060; P = 0.011) were significantly associated with VRI in KT patients. Conclusion: Our study showed that fasting myostatin level was positively associated with VRI and endothelial function among KT patients.
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Early prediction of survival at different time intervals in sepsis patients: A visualized prediction model with nomogram and observation study
Shih-Hong Chen, Yi-Chia Wang, Anne Chao, Chih-Min Liu, Ching-Tang Chiu, Ming-Jiuh Wang, Yu-Chang Yeh
January-March 2022, 34(1):55-61
Objectives: Sepsis is a major cause of death around the world. Complicated scoring systems require time to have data to predict short-term survival. Intensivists need a tool to predict survival in sepsis patients easily and quickly. Materials and Methods: This retrospective study reviewed the medical records of adult patients admitted to the surgical intensive care units between January 2009 and December 2011 in National Taiwan University Hospital. For this study, 739 patients were enrolled. We recorded the demographic and clinical variables of patients diagnosed with sepsis. A Cox proportional hazard model was used to analyze the survival data and determine significant risk factors to develop a prediction model. This model was used to create a nomogram for predicting the survival rate of sepsis patients up to 3 months. Results: The observed 28-day, 60-day, and 90-day survival rates were 71.43%, 52.53%, and 46.88%, respectively. The principal risk factors for survival prediction included age; history of dementia; Glasgow Coma Scale score; and lactate, creatinine, and platelet levels. Our model showed more favorable prediction than did Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment at sepsis onset (concordance index: 0.65 vs. 0.54 and 0.59). This model was used to create the nomogram for predicting the mortality at the onset of sepsis. Conclusion: We suggest that developing a nomogram with several principal risk factors can provide a quick and easy tool to early predict the survival rate at different intervals in sepsis patients.
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Movement-based mind-body interventions for cardiac rehabilitation: An updated systematic review of randomized controlled trials
Chun-Hou Huang, Shen-Feng Chao, Yi-Tso Cheng, Pei-Chun Lai, I-Hsin Lin, Tai-Chu Peng
January-March 2022, 34(1):49-54
This study aimed to assess evidence for the effect of movement-based mind-body interventions (MMBIs) for cardiac rehabilitation (CR). Six databases were searched from January 1995 to September 2020. All randomized controlled trials (RCTs) evaluated the effect of MMBIs on heart disease (HD) patients' physical and psychological outcomes. Two reviewers independently assessed the quality of all the included studies using the revised Cochrane risk-of-bias tool for RCTs. Sixteen RCTs (5160 participants) published between 1996 and 2020 met all inclusion criteria. In total, these studies investigated the effect of MMBIs for CR. Outcome measures that emerged in these studies included physical and psychological, and/or biochemical parameters to comprehensively evaluate the effects of MMBIs on HD patients. Overall, these studies suggest that MMBIs seem to be an alternative with the optimal CR option.
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Positive correlation of serum angiopoietin-like protein 3 levels with metabolic syndrome in patients with coronary artery disease
Sy-Harn Lian, Bang-Gee Hsu, Ji-Hung Wang, Ming-Chun Chen
January-March 2022, 34(1):75-81
Objectives: Angiopoietin-like protein 3 (ANGPTL3) regulates triglyceride metabolism by reversibly inhibiting the lipoprotein lipase activity. Metabolic syndrome (MetS) is an independent risk factor for further cardiovascular disease. This study evaluated the relationship between the fasting serum ANGPTL3 levels and MetS in patients with coronary artery disease (CAD). Materials and Methods: Fasting blood samples were obtained from 90 patients with CAD. Serum ANGPTL3 levels were measured using a commercial enzyme-linked immunosorbent assay kit. MetS and its components were defined using the diagnostic criteria of the International Diabetes Federation. Results: Fifty-three patients (58.9%) had MetS. The hypertension (P = 0.001), diabetes (P < 0.001), body weight (P = 0.027), body mass index (P = 0.001), waist circumference (P < 0.001), systolic blood pressure (P = 0.001), fasting glucose (P < 0.001), triglycerides (P < 0.001), blood urea nitrogen (P = 0.044), C-reactive protein (P = 0.010), insulin (P = 0.040), homeostasis model assessment of insulin resistance (P = 0.002), and ANGPTL3 level (P = 0.001) of CAD patients who had MetS were higher, and the high-density lipoprotein cholesterol (P = 0.001) and estimated glomerular filtration rate (P = 0.016) were lower. A binary logistic regression analysis of the significant variables also revealed that the ANGPTL3 level (odds ratio: 1.023, 95% confidence interval: 1.008–1.038, P = 0.002) was an independent predictor of MetS in patients with CAD. Conclusion: The results of our study indicated that the fasting ANGPTL3 level was positively associated with MetS among patients with CAD.
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Risk of urinary tract infection symptoms recurrence in women: A prospective observational study
Yi-Sheng Chen, Stephen Shei-Dei Yang, Chun-Chun Yang, Shang-Jen Chang
January-March 2022, 34(1):69-74
Objectives: Urinary tract infection (UTI) symptoms recurrence is common with estimated rate of 30%–50% within 1 year. The study aimed to evaluate the potential risk factors for symptoms UTI recurrence in women at outpatient clinic in a prospective fashion. Materials and Methods: This study was conducted from July 1, 2016, to June 30, 2019. Women who visited urological clinics with symptoms suggestive of UTI were invited to fill the questionnaire including baseline characteristics and Urinary Tract Infection Symptom Assessment questionnaire. Mid-stream urine samples of the participants were collected for urine analysis and urine culture. Phone interviews were done at 12 months' postclinic visit to inquire if the participants have any episode of UTI symptoms recurrence during the period of time. Results: Among the 188 eligible patients, 183 patients (age = 50.0 ± 15.3 years old) were included in the analysis. There were 44 (24%) participants had UTI symptoms recurrent episodes during the 12-month follow-up. Further multivariate analysis revealed that menopause (odds ratio [OR] = 4.89, 95% confidence interval [CI] = 1.63–14.68, P = 0.005), history of UTI-related symptoms within 1 year before the episode OR = 3.79, 95% CI = 1.29–11.15, P = 0.016) and Escherichia coli infection (OR = 4.81, 95% CI = 1.51-15.28, P = 0.008) were significant risk factors for UTI symptoms recurrence during the 12 months' follow-up. Conclusion: Menopause, history of UTI-related symptoms within 1 year before this episode of UTI and E. coli infection in 12 months were potential risk factors for UTIs symptoms recurrence in women.
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A cone-beam computed tomography evaluation of bone density for insertion of pterygoid implants in dentulous and edentulous patients
Pradyumna Kumar Sahoo, Vaibhav Awinashe, Yashika Bali, Nitika Gupta, Anuj Singh Parihar, Kyatsandra Narasimhaiah Jagadeesh, Prashant Babaji
January-March 2022, 34(1):82-87
Objectives: The bone quantity and quality determine the prosthetic success outcome. This research was performed to evaluate the bone density for insertion of pterygoid implants in edentulous and dentulous participants with cone-beam computed tomography (CBCT). Materials and Methods: CBCT evaluation was done for 66 dentate and edentulous patients for pterygoid implants at the pterygomaxillary region. The calculation of joint width, height, and volume of bone was done. Density of the bone was evaluated at the superior and inferior aspects of the pterygomaxillary column. Results: It was observed that average pterygomaxillary joint height for dentulous (dentate) was −12.7 ± 7.2 mm, edentulous −12.4 ± 7.1 mm, the average pterygomaxillary joint width for dentulous was 8.15 ± 7.3 mm, and 8.13 ± 6.2 mm for edentulous. The average pterygomaxillary joint volume in dentulous participants was 279.4 ± 189.2 mm3 and for edentulous was 254.5 ± 176.4 mm3. There was expressively greater density of the bone in dentulous participants over edentulous participants (P < 0.05). Conclusion: There was better bone density found in dentate participants in comparison to edentulous participants. CBCT is a recent investigative device which measures pterygoid area efficiently. Pterygoid implants may be deliberated as an alternative method for resorbed (atrophic) maxilla.
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Clinico-hematological profile of pancytopenic adult patients in a tertiary care teaching hospital
Anil Jain, Ravinder Garg, Rupinderjeet Kaur, Sarita Nibhoria, Sumit Pal Singh Chawla, Sarabjot Kaur
January-March 2022, 34(1):95-101
Objective: The causes of pancytopenia vary in different populations depending on age, gender, nutrition, geographic location, standard of living, and exposure to certain infections and drugs. As the severity of pancytopenia and its underlying etiology determine the management and prognosis, identifying the correct etiology in a given case is crucial and helps in implementing timely and appropriate treatment. The objectives of this study were to study the clinical profile and hematological parameters of pancytopenic adults and to identify different etiologies of pancytopenia. This observational study was conducted in the Medicine department of a tertiary care teaching hospital. Materials and Methods: The study was conducted on 100 adult patients aged 18–65 years presenting with pancytopenia. All the participants were subjected to detailed clinical examination and relevant investigations including bone marrow (BM) examination. Categorical variables were presented in number and percentage (%). Qualitative variables were correlated using the Chi-square test. A P <0.05 was considered statistically significant. Results: A female preponderance was observed, and the majority of patients were aged between 18 and 40 years. The most common clinical features were generalized weakness, fever, and pallor. Seventy-four percent of patients were vegetarians; 58% had vitamin B12 deficiency, 25% had folic acid deficiency and 19% had a deficiency of both. The most common cause of pancytopenia was megaloblastic anemia (MA) (37%), followed by dimorphic anemia (DA) (26%), aplastic anemia (AA) (20%), and hematological malignancies (11%). Conclusion: MA, DA, and AA are the most prevalent etiologies of pancytopenia. BM examination is of utmost importance in the definitive diagnosis of pancytopenia and is useful in initiating timely treatment as a significant number of causes of pancytopenia are potentially curable.
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The feasibility of Kimny guiding catheter for ST-segment elevation myocardial infarction
Sou-Chan Tsai, Michael Yu-Chih Chen, Sing-Kai Chuo, Ji-Hung Wang
January-March 2022, 34(1):102-106
Objectives: The Kimny guiding catheter is a single universal guiding catheter used for performing percutaneous coronary intervention (PCI) in both the right coronary artery (RCA) and the left coronary artery (LCA). Although this guiding catheter has been shown to yield high procedural success rates in nonemergent conditions, its feasibility for patients with ST-segment elevation myocardial infarction (STEMI) remains unknown and therefore needs to be further investigated. Materials and Methods: We retrospectively enrolled 62 consecutive STEMI patients who underwent primary PCI using the Kimny guiding catheter from January 2016 through December 2017. We then evaluated the rates of engagement and procedural success for PCI of the LCA and RCA with the Kimny guiding catheter. Results: Primary PCI of the infarct-related artery (IRA) by means of the Kimny guiding catheter proved to be successful in 61 of the STEMI patients (98.3%). Besides, the procedural success rate was found to be 100% (44/44) for the LCA and 94.4% (17/18) for the RCA (P = 0.293). With regard to contralateral (non-IRA) angiography, engagement rates of 97.4% (38/39) and 100% (18/18) were obtained for the RCA and LCA, respectively, (P = 1.0). No coronary artery ostial dissection was observed during the procedures. The mean number of total catheters used for each patient turned out to be only 1.035. Conclusion: Using the Kimny guiding catheter for primary PCI is feasible and results in high procedural success rates, particularly for the treatment of the LCA, with fewer catheters, and at a lower cost.
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