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Conversation skills predict social-emotional skills.
ient after acute coronary syndrome.
This study aimed to assess the prevalence of lipohypertrophy (LH) in diabetes mellitus (DM) patients on insulin therapy and identify factors influencing the prevalence rates through a meta-analysis and meta-regression.

Databases of PubMed, Embase, Scopus, and Google Scholar were screened from inception to 20th Aug 2020. Data on prevalence was transformed using the logit transformation for pooling the proportions using the DerSimonian-Laird meta-analysis model. Random-effects meta-regression analysis was performed to assess the influence of the following moderators on the pooled prevalence male gender, mean age, type of DM, DM duration, duration of insulin therapy, needle re-users, rotation of injection site, HbA
, insulin dose, ≥8mm needle users and mean number of injections/day.

Forty-five studies were included. LH was diagnosed by observation and palpation by all studies. On meta-analysis of data from 26,865 participants, the overall prevalence of LH was found to be 41.8% (95% CI 35.9% to 47.6%). On region-wise analysis, pooled prevalence of LH in Europe was 44.6% (95% CI 37.5% to 51.8%) in Africa was 34.8% (95% CI 16.9% to 52.8%) and in Asia was 41.3% (95% CI 27.2% to 55.3%). The pooled prevalence of LH in studies only on type 1 and type 2 DM patients was 39.9% (95% CI 28.3% to 51.6%) and 45.9% (95% CI 29.5% to 62.4%) respectively. Only insulin duration was found to significantly influence the prevalence of LH on meta-regression.

Our study indicates that the prevalence of LH in DM patients on insulin therapy is estimated to be 41.8%. The longer the duration of insulin therapy, the higher is the prevalence of LH.
Our study indicates that the prevalence of LH in DM patients on insulin therapy is estimated to be 41.8%. The longer the duration of insulin therapy, the higher is the prevalence of LH.Pyridoxine is an important co-factor for many biochemical reactions in cellular metabolism related to the synthesis and catabolism of amino acids, fatty acids, neurotransmitters. Deficiency of pyridoxine results in impaired transcellular signaling between neurons and presents with muscular convulsions, hyperirritability, and peripheral neuropathy. Deficiency of pyridoxine is usually found in association with other vitamin B deficiencies such as folate (vitamin B9) and cobalamin (vitamin B12). Isolated pyridoxine deficiency is extremely rare. We present the case of a 59-year old female with type 2 diabetes who complained of painful muscle spasms. Her muscle spasms involved in both feet, which have spread proximally to her legs. She also experienced intermittent muscle spasms in her left arm, which is not alleviated by baclofen, cyclobenzaprine. Her plasma pyridoxal 5-phosphate confirmed pyridoxine deficiency. Vitamins B1, B3, B12, and folate were within normal limits. The patient received standard-dose intramuscular pyridoxine injections for three weeks followed by oral supplements for 3 months and her symptoms resolved. This case illustrates the rare instance of isolated pyridoxine deficiency in type 2 diabetes patient manifesting as myoclonic muscle spasms involving the legs and arms in the absence of objective polyneuropathy. Pyridoxine level should, therefore, be assessed in patients with type 2 diabetes, including newly diagnosed patients.For online early fault detection of rolling bearings in non-stop scenarios, one of the main concerns is the model bias caused by the distribution shift between offline and online working conditions. Under such concern, how to improve the feature sensitivity to early faults and the robustness of detection model has become a key challenge of improving the effectiveness of online detection. To solve this problem, a new online early fault detection method is proposed in this paper based on a strategy of deep transfer learning. First, a new robust state assessment method is presented. By introducing priori degradation information in the anomaly detection process of the isolated forest algorithm, this method can accurately assess the normal state and early fault state under noise interference. Second, a new deep domain adaptation algorithm is proposed. The algorithm uses the results of state assessment as output labels, and designs a deep domain adaptation neural network for joint adversarial training at feature level and model level simultaneously. Then a domain-invariant feature representation can be extracted from the data of different working conditions, and an online detection model can then be constructed. Comparative experiments are run on two bearing datasets IEEE PHM Challenge 2012 and XJTU-SY, and the results verifies the effectiveness of the proposed method in false alarm number and detection location.Hydrostatic pulmonary edema is a well-known complication of veinoarterial extracorporeal membrane oxygenation (VA-ECMO) caused by increased left ventricle afterload due to reverse blood flow in the aorta. Several techniques are commonly used for left ventricle venting such as intra-aortic balloon pump, Impella® (Abiomed, Danvers, MA), central surgical cannulation or Rahskind atrial septostomy. We reported two cases of hydrostatic pulmonary edema in patients under VA-ECMO for whom it was decided to perform Rashkind technique. The first is a late anterior myocardial infarction complicated with cardiac arrest and cardiogenic shock. Refractory hypoxemia due to hydrostatic pulmonary edema conducted us to perform atrial septostomy. The second case is a refractory cardiogenic shock due to left main stent thrombosis myocardial infarction. Procedural transesophageal echocardiography revealed a large left atrial thrombus extended to pulmonary veins preventing the procedure. These two cases illustrate the importance and gravity of pulmonary edema induced by VA-ECMO. The first shows that this technique is feasible, allows great left ventricle unloading and improves hypoxemia. The second underlines the interest of performing transesophageal echocardiography to look for pulmonary veins thrombosis that can take part in the elevation of hydrostatic pressure and forbid Rashkind manoeuver.
Spontaneous coronary artery dissection (SCAD) may occur in middle age population without any cardiovascular risk factor. We retrospectively evaluated anatomic features of 11 patients with SCAD using a coronary arteries computed tomography (CCT), compared to age and sex balanced patients who underwent CCT.

CCT was performed in 11 patients (7 females and 4 males) as follow-up in patients with SCAD (left anterior descending - LAD or circumflex artery - Cx) and compared, using the propensity score matching analysis, with 11 healthy patients. Several anatomic features were evaluated Left main (LM) length, angle between descending coronary artery (LAD) and its first branch, angle between LAD and LM, distance from the annulus to RCA (a-RCA distance) and LM (a-LM distance) ostia and their ratio; ratio between LM length and length a-LM and tortuosity score of the vessel with SCAD. A fluid dynamic analysis has been performed to evaluate the effects on shear stress of vessels wall.

LM length was significantly shorter in patients with SCAD versus healthy subjects (P=0.01) as well as LM length/a-LM (P=0.03) and the angle between LAD and the first adjacent branch was sharper (P<0.01). Tortuosity score showed a statistically significant difference between groups (P<0.001). Fluid dynamic analysis demonstrates that, in SCAD group, an angle<90 degree is present at the first bifurcation and it can be a cause of increased strain on vessel wall in patients with high tortuosity of coronary artery.

Tortuosity and angle between the LAD and the adjacent arterial branch combined may determine increased shear stress on the vessel wall that increases the risk of SCAD.
Tortuosity and angle between the LAD and the adjacent arterial branch combined may determine increased shear stress on the vessel wall that increases the risk of SCAD.
Identify the predective echocardiographic parameters of major cardiovascular events (death, ischemic recurrence, heart failure and rehospitalization) in-hospital and after six months of follow-up and to establish an echocardiographic prognostic score and to evaluate its prognostic value alone or in association with clinical risk scores.

We recruited 302 patients in intensive care unit of cardiology for ACS consecutively on admission, patients were assessed by clinical risk scores (GRACE, TIMI, CRUSADE) and resting doppler echocardiography, a follow-up of six months.

The echocardiographic risk score has four variables LV-EF (RR=0.931; 95%CI=0.885-0.979, P<0.01), RV-AF (RR=0.951; 95%CI=0.903-0.999, P<0.05), iMAE-M-strain (RR=1.226; 95%CI=1.081-1.390, P<0.01) and ULCs (RR=1.151; 95%CI=1.081-1.224, P<0.01). Its discrimination capacity (AUC=0.85), greater than that of the clinical risk scores, (GRACE AUC=0.72, TIMI AUC=0.71 and CRUSADE AUC=0.76).

The risk stratification can be achieved using ecple because it contains only four simple echocardiographic variables as predictors.
QRS fragmentation (fQRS) represents a marker of local myocardial fibrosis, especially in patients with CAD (coronary artery disease). However, little is known about the association between fQRS and the severity of coronary atherosclerosis as defined by the Gensini score.

To identify the angiographic and echocardiographic characteristics of patients with suspected CAD depending on the location and extent of fQRS.

A total of 178 patients who underwent coronary angiography were included in the study. fQRS was defined as the presence of RSR' and/or notching of the R/S wave (if QRS<120ms) or≥2 notches of the R/S wave (if QRS≥120ms). All patients were divided into three groups non-fQRS; fQRS in 1-2 and≥3 leads.

Statistically significant differences in the LVEF (left ventricular ejection fraction, P=0.009) and the degree of coronary atherosclerosis severity (P=0.008) were found among 3 groups. The median Gensini score was 7 in non-fQRS group (minimal CAD) and >20 in other groups (severe CAD). Both the anterior and lateral fQRS groups had a lower LVEF compared to no fQRS (P=0.039 and P=0.01, respectively). The median Gensini score was significantly higher in case of the lateral fQRS (P=0.037). fQRS in≥1 lead was associated with coronary occlusion (OR 2.1, 95% CI 1.1-4.1, P=0.038).

The presence of fQRS, particularly in lateral leads, can be a useful noninvasive marker of severe coronary atherosclerosis. Patients with≥1 fragmented lead have a lower LVEF, a higher Gensini score and a two-fold increased risk of occlusion.
The presence of fQRS, particularly in lateral leads, can be a useful noninvasive marker of severe coronary atherosclerosis. this website Patients with≥1 fragmented lead have a lower LVEF, a higher Gensini score and a two-fold increased risk of occlusion.
In hypertensive patients, the autoregulation curve shifts rightward, making these patients more sensitive than normotensive individuals to hypotension. Hypotension following the induction of anesthesia has been studied in normotensive patients to determine its effects on brain tissue oxygenation, but not enough studies have examined the effect of hypotension on brain oxygenation in hypertensive patients. The current study aimed to use near-infrared spectroscopy to evaluate brain tissue oxygen saturation after the induction of anesthesia in hypertensive patients, who may have impaired brain tissue oxygen saturation.

The study included a total of 200 patients aged > 18 years old with ASA I-III. Measurements were taken while the patient was breathing room air, after the induction of anesthesia, when the lash reflex had disappeared following the induction of anesthesia, after intubation, and in the 5th, 10th, and 15th minutes of surgery. The patients were divided into nonhypertensive and hypertensive groups.
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