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Sleep quality in Patient with Heart failure: A cross-sectional study

Background: Patients with Heart failure (HF) and sleep disordered breathing influence health-related quality of life (HRQOL). However, the objective characteristics of sleep in HF patients which related to HRQOL remain unclear. Objectives: This study is to identify and correlates quality of sleep and related factors in patients with HF in Taiwan. Methods: Adult patients (aged ≥20 years) with a current diagnosis of Heart failure, who voluntarily elected (n=200), were evaluated within single medical center. This study was a cross-sectional study based on consecutive hospitalized HF patients in Cathay General Hospital, Taiwan. HRQOL was assessed by using the Pittsburgh sleep Quality Index (PSQI). The cut-off point for PSQI score ≤ 5 were defined as good sleep quality. Results: Seventy-two percent of patients (n = 144) reported poor sleep quality (PSQI ＞ 5) at baseline with a mean global PSQI score of 8.48. Also, a significant relationship was found between PSQI scores and patients’ age (p＜0.05), Comorbidity (p＜ 0.01), NHYA class (p＜ 0.01), Marital status (p＜ 0.03). When covariates of age, gender, BMI, left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) functional class were entered, Multivariate logistic regression for sleep quality showed that New York Heart Association (NYHA) class IV heart disease was still a significant risk factor (odds ratio=2.31, 95% confidence interval, 1.38-3.88). Moreover, the score of each component of PSQI might increase as NYHA class worsens. Conclusions: The NHYA class IV was the most significant factor for sleep quality in HF patient.

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Ergonomic study of power grasp task in short opponens thumb splint users using different wrist positions with utensils having different handle sizes

Background and purpose: The short opponens splint is a common device that limits the motion of the thumb and may interfere with daily activities. The objectives were to investigate 1) the effect on grasp strength; 2) the relationship between anthropometric data and grasp strength; and 3) the interaction of handle diameter and wrist posture during a power grasp. Methods: Twenty healthy adults were recruited in this study. A 3x4 (handle diameter x wrist position) repeated measures design was applied. Results: Positive correlations were found for anthropometric data such as hand length and grasp strength in the splint condition. The electromyography activity results indicated that the exertion of the abductor pollicis longus muscle (APL) was significantly lower in the wrist radial deviation posture. When the handle diameter was greater than 68.90 mm and the wrist was flexed, exertion of the APL significantly increased. Conclusion: It is recommended that handles be held with wrist radial deviation. If wrist flexion is inevitable, the handle diameters should not exceed 54.64mm.

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Symptomatic Schmorl's Nodes Inducing Severe Lower Back Pain in the Lumbar Spine: Two Case Reports

Background and purpose: Schmorl's nodes (SNs) represent a thoracolumbar lesion, which are defined histologically as a loss of the nuclear material of intervertebral discs through the cartilage plate, growth plate, and endplate into the vertebral body. We report two cases of symptomatic SNs and assess the effect of two different surgical procedures to treat severe lower back pain caused by traumatic SNs. Case presentation: Two cases of symptomatic SNs with a history of trauma are presented. One involved a 15-year-old male patient and the other involved a 66-year-old female patient. The results of magnetic resonance imaging and X-ray confirmed the diagnosis of SNs. The male patient underwent laminotomy, discectomy, and insertion of a Rocker interspinous spacer under general anesthesia. The female patient underwent percutaneous vertebroplasty under local anesthesia. The visual analog scale was used to measure lower back pain before and after surgery. Both patients were asymptomatic at a 3-month follow-up; however, the male patient was readmitted due to new SN lesions 6 months after surgery. Conclusion: Both procedures were effective in relieving lower back pain from SNs, had a relatively short recovery time, and resulted in no postoperative complications. However, the male patient required further follow-up due to new lesions.

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Cortical bone trajectory with bone cement: An alternative fixation option for treating patients with previously augmented osteoporotic vertebrae

Fusion in the lumbosacral spine is a common surgical procedure for management of a variety of spinal pathologies. Transpedicular screw fixation is the most commonly used technique for posterior lumbar fusion surgery. However, the traditional transpedicular path can become blocked by bone cement, which is frequently used to treat osteoporotic compression fractures. Therefore, we introduced the cortical bone trajectory (CBT) with bone cement as an alternative fixation option for treating patients with previously augmented vertebrae. An 87-year-old woman presented with lower back pain with radiation to the left leg after a fall 2 months prior to presentation. She had undergone vertebroplasty at the L3 osteoporotic vertebra and discectomies in the L3-4 and L4-5 vertebrae 2 years before admission. Progressive spondylolisthesis and recurrent discs with nerve root compression in previous surgical levels were diagnosed based on magnetic resonance images. The patient underwent transforaminal lumbar interbody fusion in L3-4 and L4-5 and screw fixation from L3 to L5 using CBT with bone cement. During surgery, CBT was approached under fluoroscopy. Because of the osteoporotic vertebrae, 0.5 ml of polymethylmethacrylate cement was injected before insertion of each screw. No immediate cement leakage was observed. Postoperatively, the patient's previous neurological deficits gradually recovered, and no displacement or loosening of instruments was observed 6 months after surgery. Our case demonstrated that CBT with bone cement is an alternative fixation option for osteoporotic patients with previously augmented vertebrae.

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Uterine Perforation as Initial Presentation of Cervical Cancer: a Case Report

Uterine perforation with acute abdomen as initial presentation of cervical cancer is an extremely rare condition. In this paper, we report a 76-year-old female patient who presented with acute abdomen with intra-abdominal free air. Hollow organ perforation was the initial diagnosis but a FIGO stage IIIb cervical cancer with pyometra and uterine perforation was later discovered after laparoscopic operation. She received concurrent chemo-radiation after operation and recovered well after therapy.

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Incidental Detection of Bilateral Submandibular Gland Agenesis in Diffuse Large B-Cell Lymphoma Patient -A Case Report

Major salivary gland agenesis, a rare condition, may be asymptomatic or exhibit symptoms, such as dry mouth, dysphagia, and dental caries. Although uncommon, various ectodermal developmental syndromes associated with major salivary gland agenesis have been reported. Here, we report a patient who presented with a left submandibular triangle neck mass mimicking a salivary gland tumor, and received the final diagnosis of diffuse large B-cell lymphoma after excisional biopsy. Moreover, bilateral submandibular gland agenesis was incidentally detected during physical examination and image study. Though submandibular gland is the major structure in the submandibular triangle, its agenesis may occur even in nonsyndromic and nonxerostomic patients.