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Gallo L, Berton M, Piazza M, Sturaro E, Schiavon S, Bittante G. Environmental impact of Holstein Friesian and 3-breed crossbred dairy cows using a Life Cycle Assessment approach applied to individual animals. J Dairy Sci 2024:S0022-0302(24)00488-0. [PMID: 38369114 DOI: 10.3168/jds.2023-24106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024]
Abstract
This study aimed to set up a Life Cycle Assessment (LCA) approach at level of individual animals to assess the effects of a 3-breed crossbreeding program on the environmental impact of cows. It involved 564 cows, 279 purebred Holstein (HO) and 285 crossbreds (CR), originated from a 3-breed crossbreeding program based on the rotational use of Viking Red, Montebèliarde and HO sires and kept in 2 dairy herds of northern Italy (224 and 340 cows/herd, respectively). The reference unit of the LCA model was the lifetime of cows, from the birth to culling or death. Data were collected at different levels: individual animal-based data referred to the whole life (birth, calving, dry, cull or death dates, and milk production); individual test-date collection of body measures and BCS, used to predict body weight and to estimate energy requirements; common farm-based data concerning herd management (diets composition, and materials used). Data were used to compute: dry matter intake, milk and milk components production, gross income (GI) and income over feed costs (IOFC) pertaining to the lifespan of cows. An individual LCA-derived approach was set up to compute global warming potential (GWP), acidification and eutrophication potential (AP and EP, respectively), and land occupation (LO), which have been associated with different functional units (cow in her whole life or per d of life; kg of milk fat plus protein, and € of GI and of IOFC produced in the herd life). Data were analyzed using a generalized linear model including the fixed effects of genetic group (CR vs HO), farm and their interaction (genetic group x farm). Compared with HO, CR cows completed more lactations (+12%), had earlier first calving (-2 weeks), yielded more fat plus protein in milk both in the lifespan (+8%) and per d of life (+4%). Concerning the environmental impact, when compared with HO herd mates, CR cows had nominal greater emissions per cow in the whole life, similar emissions per d of life and nearly 3% lower GWP, AP and EP per kg of fat plus protein yielded in lifespan. Income over feed costs per unit of emission tended to be nearly 4% greater in CR compared with HO cows. Also the use of land tended to be lower in CR compared with HO in most indicators considered. In conclusion, LCA could be adapted to represent individual animals. Moreover, managing dairy cows according to a 3-breed rotational crossbreeding scheme may be regarded as a strategy that can contribute to mitigate the emissions and to improve the environmental impact of dairy operations.
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Affiliation(s)
- L Gallo
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova, 35020 Legnaro (PD), Italy
| | - M Berton
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova, 35020 Legnaro (PD), Italy.
| | - M Piazza
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova, 35020 Legnaro (PD), Italy
| | - E Sturaro
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova, 35020 Legnaro (PD), Italy
| | - S Schiavon
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova, 35020 Legnaro (PD), Italy
| | - G Bittante
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova, 35020 Legnaro (PD), Italy
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Piazza M, Hanssen NMJ, Scheijen JLJM, Vd Waarenburg M, Caroccia B, Seccia TM, Stehouwer CDA, Rossi GP, Schalkwijk CG. Serum levels of autoantibodies against the angiotensin II type I receptor are not associated with serum dicarbonyl or AGE levels in patients with an aldosterone-producing adenoma. J Hum Hypertens 2023; 37:919-924. [PMID: 36418426 DOI: 10.1038/s41371-022-00773-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 11/25/2022]
Abstract
Patients with an aldosterone-producing adenoma (APA) carry a higher risk of cardiovascular disease and commonly have high levels of autoantibodies (AT1AA) that may activate the angiotensin II type 1 receptor (AT1R). AT1R activation is linked to an increase of the glucose metabolite methylglyoxal (MGO), a potential precursor of advanced glycation endproducts (AGEs) and driver of vascular inflammation. We investigated whether serum AT1AA levels are associated with serum MGO and AGE levels in APA patients. In a case series of 26 patients with APA we measured levels of dicarbonyls MGO, glyoxal (GO) and 3-deoxyglucosone (3-DG), and dicarbonyl-derived AGEs 5-hydro-5-methylimidazolone (MG-H1), Nε-(carboxyethyl)lysine (CEL) and Nε-(carboxymethyl)lysine (CML) with UPLC-MS/MS. We also measured AT1AA by ELISA. These measurements were repeated 1-month after adrenalectomy in a subset of 14 patients. Panels of inflammation and endothelial function were also measured by immunoassays. Although baseline higher AT1AA levels tended to be correlated with higher baseline serum MGO, GO and 3-DG levels (r = 0.18, p = 0.38; r = 0.20, p = 0.33; r = 0.23, p = 0.26; respectively), these correlations were not statistically significant. We observed no obvious correlations between higher AT1AA levels and protein-bound and free MG-H1, CEL and CML levels, and markers of inflammation and endothelial function. No decrease was observed in any of the dicarbonyls, protein-bound AGE levels and markers of inflammation and endothelial function after adrenalectomy. In patients with APA the serum levels of AT1AA were not significantly correlated with serum dicarbonyls, protein-bound and free AGE levels. Increased signalling of the AT1AA receptor may therefore be unlikely to overtly increase systemic dicarbonyl levels.
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Affiliation(s)
- M Piazza
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
- Department of Medicine-DIMED University of Padua, Padua, Italy
| | - N M J Hanssen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
- Department of Vascular and Internal Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - J L J M Scheijen
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - M Vd Waarenburg
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - B Caroccia
- Department of Medicine-DIMED University of Padua, Padua, Italy
| | - T M Seccia
- Department of Medicine-DIMED University of Padua, Padua, Italy
| | - C D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - G P Rossi
- Department of Medicine-DIMED University of Padua, Padua, Italy
| | - C G Schalkwijk
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands.
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Piazza M, Berton M, Amalfitano N, Bittante G, Gallo L. Cull cow carcass traits and risk of culling of Holstein cows and 3-breed rotational crossbred cows from Viking Red, Montbéliarde, and Holstein bulls. J Dairy Sci 2022; 106:312-322. [DOI: 10.3168/jds.2022-22328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/10/2022] [Indexed: 11/09/2022]
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Piazza M, Giannuzzi D, Tessari R, Fiore E, Gianesella M, Pegolo S, Schiavon S, Trevisi E, Piccioli-Cappelli F, Cecchinato A, Gallo L. Associations between ultrasound hepatic measurements, body measures, and milk production traits in Holstein cows. J Dairy Sci 2022; 105:7111-7124. [DOI: 10.3168/jds.2021-21582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/27/2022] [Indexed: 12/17/2022]
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Piazza M, Daniel R. 395 Abnormal Blood Glucose Testing in Febrile Children Has No Association With Serious Bacterial Infection: A Retrospective Chart Review. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Piazza M, Hanssen NMJ, Persson F, Scheijen JL, van de Waarenburg MPH, van Greevenbroek MMJ, Rossing P, Hovind P, Stehouwer CDA, Parving H, Schalkwijk CG. Irbesartan treatment does not influence plasma levels of the dicarbonyls methylglyoxal, glyoxal and 3-deoxyglucosone in participants with type 2 diabetes and microalbuminuria: An IRMA2 sub-study. Diabet Med 2021; 38:e14405. [PMID: 32961617 PMCID: PMC8451908 DOI: 10.1111/dme.14405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/18/2020] [Accepted: 09/11/2020] [Indexed: 12/13/2022]
Abstract
AIM Angiotensin receptor blockers (ARBs) reduce vascular complications in diabetes independently of blood pressure. Experimental studies suggested that ARBs may restore the detoxifying enzyme glyoxalase 1, thereby lowering dicarbonyls such as methylglyoxal. Human data on the effects of ARBs on plasma dicarbonyl levels are lacking. We investigated, in individuals with type 2 diabetes, whether irbesartan lowered plasma levels of the dicarbonyls methylglyoxal, glyoxal, 3-deoxyglucosone and their derived advanced glycation end products (AGEs), and increased d-lactate, reflecting greater methylglyoxal flux. METHODS We analysed a subset of the Irbesartan in Patients with T2D and Microalbuminuria (IRMA2) study. We measured plasma dicarbonyls methylglyoxal, glyoxal and 3-deoxyglucosone, free AGEs and d-lactate using ultra-performance liquid chromatography tandem mass-spectrometry (UPLC-MS/MS) in the treatment arm receiving 300 mg irbesartan (n = 121) and a placebo group (n = 101) at baseline and after 1 and 2 years. Effect of treatment was analysed with repeated measurements ANOVA. RESULTS There was a slight, but significant difference in baseline median methylglyoxal levels [placebo 1119 (907-1509) nmol/l vs. irbesartan 300 mg 1053 (820-1427) nmol/l], but no significant changes were observed in any of the plasma dicarbonyls over time in either group and there was no effect of irbesartan treatment on plasma free AGEs or d-lactate levels at either 1 or 2 years. CONCLUSION Irbesartan treatment does not change plasma levels of the dicarbonyls methylglyoxal, glyoxal and 3-deoxyglucosone, free AGEs or d-lactate in type 2 diabetes. This indicates that increased dicarbonyls in type 2 diabetes are not targetable by ARBs, and other approaches to lower systemic dicarbonyls are needed in type 2 diabetes. (Clinical Trial Registry No: #NCT00317915).
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Affiliation(s)
- M. Piazza
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
- Department of Medicine‐DIMED University of PaduaItaly
| | - N. M. J. Hanssen
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
| | - F. Persson
- Steno Diabetes Center CopenhagenCopenhagenDenmark
| | - J. L. Scheijen
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
| | - M. P. H. van de Waarenburg
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
| | - M. M. J. van Greevenbroek
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
| | - P. Rossing
- Steno Diabetes Center CopenhagenCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - P. Hovind
- Steno Diabetes Center CopenhagenCopenhagenDenmark
- Clinical Physiology and Nuclear MedicineBispebjerg HospitalCopenhagenDenmark
| | - C. D. A. Stehouwer
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
| | - H‐H. Parving
- Medical EndocrinologyUniversity Hospital of CopenhagenCopenhagenDenmark
| | - C. G. Schalkwijk
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
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Piazza M. CN60 Why speaking about continuity of care among cancer patients? How to ensure it? A literary review about organizational strategies. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hitti FL, Piazza M, Sinha S, Kvint S, Hudgins E, Baltuch G, Diaz-Arrastia R, Davis KA, Litt B, Lucas T, Chen HI. Surgical Outcomes in Post-Traumatic Epilepsy: A Single Institutional Experience. Oper Neurosurg (Hagerstown) 2021; 18:12-18. [PMID: 30924499 DOI: 10.1093/ons/opz043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 02/14/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Post-traumatic epilepsy (PTE) is a debilitating sequela of traumatic brain injury (TBI), occurring in up to 20% of severe cases. This entity is generally thought to be more difficult to treat with surgical intervention. OBJECTIVE To detail our experience with the surgical treatment of PTE. METHODS Patients with a history of head injury undergoing surgical treatment for epilepsy were retrospectively enrolled. Engel classification at the last follow-up was used to assess outcome of patients that underwent surgical resection of an epileptic focus. Reduction in seizure frequency was assessed for patients who underwent vagal nerve stimulator (VNS) or responsive neurostimulator (RNS) implantation. RESULTS A total of 23 patients met inclusion criteria. Nineteen (82.6%) had mesial temporal sclerosis, 3 had lesional neocortical epilepsy (13.0%), and 1 had nonlesional neocortical epilepsy (4.3%). Fourteen patients (60.9%) underwent temporal lobectomy (TL), 2 underwent resection of a cortical focus (8.7%), and 7 underwent VNS implantation (30.4%). Three patients underwent RNS implantation after VNS failed to reduce seizure frequency more than 50%. In the patients treated with resection, 11 (68.8%) were Engel I, 3 (18.8%) were Engel II, and 2 (12.5%) were Engel III at follow-up. Average seizure frequency reduction in the VNS group was 30.6% ± 25.6%. RNS patients had reduction of seizure severity but seizure frequency was only reduced 9.6% ± 13.6%. CONCLUSION Surgical outcomes of PTE patients treated with TL were similar to reported surgical outcomes of patients with nontraumatic epilepsy treated with TL. Patients who were not candidates for resection demonstrated variable response rates to VNS or RNS implantation.
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Affiliation(s)
- Frederick L Hitti
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Piazza
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saurabh Sinha
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Svetlana Kvint
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric Hudgins
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gordon Baltuch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramon Diaz-Arrastia
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathryn A Davis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian Litt
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy Lucas
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - H Isaac Chen
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Piazza M, Xodo A, Squizzato F, Conti GD, Boemo D, Carretta G, Grego F, Antonello M. The challenge of maintaining necessary vascular and endovascular services at a referral center in Northern Italy during the COVID-19 outbreak. Vascular 2020; 29:477-485. [PMID: 33054679 DOI: 10.1177/1708538120962964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The Padova Hospital Vascular Surgery Division is located in Veneto, one of the area of the Northern Italy most hit by the Coronavirus disease 2019 outbreak. The aim of this paper is to describe the protocols adopted and to evaluate their impact during the acute phase of Coronavirus spread, focusing on the management of elective and urgent/emergent surgery, outpatients activity, and also health staff preservation from intra-hospital Coronavirus disease 2019 infection. METHODS Several measures were progressively adopted in the Padova University Hospital to front the Coronavirus disease 2019 outbreak, with a clear strong asset established by 9 March 2020, after the Northern Italy lockdown. Since this date, the Vascular Surgery Unit started a "scaled-down" activity, both for elective surgical procedures and for the outpatient Clinical activities; different protocols were developed for health preservation of staff and patients. We compared a two months period, 30 days before and 30 days after this time point. In particular, emergent vascular surgery was regularly guaranteed as well as urgent surgery (to be performed within 24 h). Elective cases were scheduled for "non-deferrable" pathology. A swab test protocol for COVID-19 was applied to health-care professionals and hospitalized patients. RESULTS The number of urgent or emergent aortic cases remained stable during the two months period, while the number of Hospital admissions via Emergency Room related to critical limb ischemia decreased after national lockdown by about 20%. Elective vascular surgery was scaled down by 50% starting from 9 March; 35% of scheduled elective cases refused hospitalization during the lockdown period and 20% of those contacted for hospitalization where postponed due to fever, respiratory symptoms, or close contacts with Coronavirus disease 2019 suspected cases. Elective surgery reduction did not negatively influence overall carotid or aortic outcomes, while we reported a higher major limb amputation rate for critical limb ischemia (about 10%, compared to 4% for the standard practice period). We found that 4 out of 98 (4%) health-care providers on the floor had an asymptomatic positive swab test. Among 22 vascular doctors, 3 had a confirmed Coronavirus disease 2019 infection (asymptomatic); a total of 72 swab were performed (mean = 3.4 swab/person/month) during this period; no cases of severe Coronavirus disease 2019 (deaths or requiring intensive care treatment) infection were reported within this period for the staff or hospitalized patients. CONCLUSIONS Elective vascular surgery needs to be guaranteed as possible during Coronavirus disease 2019 outbreak. The number of truly emergent cases did not reduce, on the other side, Emergency Room accesses for non-emergent cases decreased. Our preliminary results seem to describe a scenario where, if the curve of the outbreak in the regional population is flattened, in association with appropriate hospitals containment rules, it may be possible to continue the activity of the Vascular Surgery Units and guarantee the minimal standard of care.
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Affiliation(s)
- M Piazza
- Vascular and Endovascular Surgery Division, Padua University, Padua, Italy
| | - A Xodo
- Vascular and Endovascular Surgery Division, Padua University, Padua, Italy
| | - F Squizzato
- Vascular and Endovascular Surgery Division, Padua University, Padua, Italy
| | - G De Conti
- Department of Radiology, Padua Hospital, Padua, Italy
| | - D Boemo
- Department of Directional Hospital Management, Padua Hospital, Padua, Italy
| | - G Carretta
- Department of Directional Hospital Management, Padua Hospital, Padua, Italy
| | - F Grego
- Vascular and Endovascular Surgery Division, Padua University, Padua, Italy
| | - M Antonello
- Vascular and Endovascular Surgery Division, Padua University, Padua, Italy
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Piazza M, Baldeo R, Daniel R. Vomiting of unclear etiology in an autistic child-multiple possible diagnoses: A case report. J Am Coll Emerg Physicians Open 2020; 1:1009-1012. [PMID: 33145552 PMCID: PMC7593463 DOI: 10.1002/emp2.12097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 12/04/2022] Open
Abstract
Appendicitis is a common complaint in the emergency department (ED) presenting with abdominal pain or vomiting and is often the foremost etiology the provider must rule out using history and physical examination. However, history and physical examination is limited in children and the developmentally delayed who are often non-cooperative. Less commonly, choledochal cysts are found that also require management, or rarer still, multiple possible radiologic or surgical diagnoses. This case report follows a delayed child presenting with vomiting found to have a large type 1 choledochal cyst, cholecystitis, and appendicitis on advanced imaging prompting surgical management of these etiologies. This report reviews the evaluation of children with vomiting and the need for thorough evaluation with advanced imaging when appropriate.
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Affiliation(s)
- Matthew Piazza
- Emergency Medicine, Good Samaritan Hospital Medical CenterWest IslipNew YorkUSA
| | - Rudolph Baldeo
- Emergency Medicine, Good Samaritan Hospital Medical CenterWest IslipNew YorkUSA
| | - Reethamma Daniel
- Emergency Medicine, Good Samaritan Hospital Medical CenterWest IslipNew YorkUSA
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Sinha S, Caplan I, Schuster J, Piazza M, Glauser G, Sharma N, Welch WC, Osiemo B, Mcclintock S, Ozturk AK, Malhotra NR. Evaluation of Lumbar Spine Bracing as a Postoperative Adjunct to Single-level Posterior Lumbar Spine Surgery. Asian J Neurosurg 2020; 15:333-337. [PMID: 32656128 PMCID: PMC7335149 DOI: 10.4103/ajns.ajns_35_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background Clinical practice in postoperative bracing after posterior single-level lumbar spine fusion (PLF) is inconsistent between providers. This study seeks to assess the effect of bracing on short-term outcomes related to safety, quality of care, and direct costs. Methods Retrospective cohort analyses of consecutive patients undergoing single-level PLF with or without bracing at a three-hospital urban academic medical center (2013-2017) were undertaken (n = 906). Patient demographics and comorbidities were analyzed. Test of independence, Mann-Whitney-Wilcoxon test, and logistic regression were used to assess differences in length of stay (LOS), discharge disposition/need for postacute care, quality-adjusted life year (QALY), surgical site infection (SSI), hospital cost, total cost, readmission within 30 days, and emergency room (ER) visits within 30 days. Results Among the study population, 863 patients were braced and 43 were not braced. No difference was seen between the two groups in short-term outcomes from surgery including LOS (P = 0.836), discharge disposition (P = 0.226), readmission (P = 1.000), ER visits (P = 0.281), SSI (P = 1.000), and QALY gain (P = 0.319). However, the braced group incurred a significantly higher direct hospital cost (median increase of 41.43%, P < 0.001) compared to the unbraced cohort (bracing cost excluded). There was no difference in graft type (P = 0.145) or comorbidities (P = 0.20-1.00) such as obesity (P = 1.000), smoking (P = 1.000), chronic obstructive pulmonary disease (P = 1.000), hypertension (P = 0.805), coronary artery disease (P = 1.000), congestive heart failure (P = 1.000), and total number of comorbidities (P = 0.228). Conclusion Short-term data suggest that removal of bracing from the postoperative regimen for PLF will not result in increased adverse outcomes but will reduce cost.
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Affiliation(s)
- Saurabh Sinha
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ian Caplan
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - James Schuster
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Matthew Piazza
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Departments of Neurosurgery and Orthopedic Surgery, Translational Spine Research Lab of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Glauser
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nikhil Sharma
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - William Charles Welch
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Benjamin Osiemo
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.,Department of Mathematics, West Chester Statistical Institute, West Chester University, Philadelphia, PA, USA
| | - Scott Mcclintock
- Department of Mathematics, West Chester Statistical Institute, West Chester University, Philadelphia, PA, USA
| | - Ali Kemal Ozturk
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Neil Rainer Malhotra
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Departments of Neurosurgery and Orthopedic Surgery, Translational Spine Research Lab of the University of Pennsylvania, Philadelphia, PA, USA
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Lucca F, Tenero L, Volpi S, Piazza M, Borruso A, Menin L, Sandri M, Cipolli M, Piacentini G. WS04.2 Electronic nose (E-nose) analysis of systemic volatile organic compounds (VOCs) pattern distinguishes paediatric patients with cystic fibrosis (CF) from healthy controls (HC) and depicts disease status. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Piazza M, Sullivan PZ, Madsen P, Branche M, McShane B, Saylany A, Sharma N, Arlet V, Ozturk A. Proximal junctional kyphosis following T10-pelvis fusion presenting with neurologic compromise: case presentations and review of the literature. Br J Neurosurg 2020; 34:715-720. [PMID: 32186198 DOI: 10.1080/02688697.2020.1742293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Proximal Junctional Kyphosis (PJK) is a well-documented phenomenon following spinal instrumented fusion. Myelopathy associated with proximal junctional failure (PJF) is poorly described in the literature. Adjacent segment disease, fracture above the upper instrumented vertebrae and subluxation may all cause cord compression, ambulatory dysfunction, and/or lower extremity weakness in the postoperative period.Materials and methods: We review the literature on PJK and PJF, and discusses the postoperative management of three patients who experienced myelopathy associated with PJF following T9/10 to pelvis fusion at a single institution.Results and conclusions: PJF with myelopathy must be diagnosed and surgically corrected early on so as to minimize permanent neurologic injury. Patients requiring significant sagittal deformity correction are at greater risk for PJF, and may benefit from constructs terminating in the upper thoracic spine.
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Affiliation(s)
- Matthew Piazza
- Department of Neurosurgery, Penn Medicine, Philadelphia, PA, USA
| | | | - Peter Madsen
- Department of Neurosurgery, Penn Medicine, Philadelphia, PA, USA
| | - Marc Branche
- Department of Neurosurgery, Penn Medicine, Philadelphia, PA, USA
| | - Brendan McShane
- Department of Neurosurgery, Penn Medicine, Philadelphia, PA, USA
| | - Anissa Saylany
- Department of Neurosurgery, Penn Medicine, Philadelphia, PA, USA
| | - Nikhil Sharma
- Department of Neurosurgery, Penn Medicine, Philadelphia, PA, USA
| | - Vincent Arlet
- Department of Orthopaedic Surgery, Penn Medicine, Philadelphia, PA, USA
| | - Ali Ozturk
- Department of Neurosurgery, Penn Medicine, Philadelphia, PA, USA
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Glauser G, Piazza M, Dimentberg R, Choudhri O. Clipping of a partially thrombosed giant PICA aneurysm associated with the anterior spinal artery. BMJ Case Rep 2019; 12:12/10/e232491. [PMID: 31611229 DOI: 10.1136/bcr-2019-232491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gregory Glauser
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Piazza
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Dimentberg
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Omar Choudhri
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Glauser G, Piazza M, Berger I, Osiemo B, McClintock SD, Winter E, Chen HI, Ali ZS, Malhotra NR. The Risk Assessment and Prediction Tool (RAPT) for Discharge Planning in a Posterior Lumbar Fusion Population. Neurosurgery 2019; 86:E140-E146. [DOI: 10.1093/neuros/nyz419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/10/2019] [Indexed: 12/20/2022] Open
Abstract
Abstract
BACKGROUND
As the use of bundled care payment models has become widespread in neurosurgery, there is a distinct need for improved preoperative predictive tools to identify patients who will not benefit from prolonged hospitalization, thus facilitating earlier discharge to rehabilitation or nursing facilities.
OBJECTIVE
To validate the use of Risk Assessment and Prediction Tool (RAPT) in patients undergoing posterior lumbar fusion for predicting discharge disposition.
METHODS
Patients undergoing elective posterior lumbar fusion from June 2016 to February 2017 were prospectively enrolled. RAPT scores and discharge outcomes were recorded for patients aged 50 yr or more (n = 432). Logistic regression analysis was used to assess the ability of RAPT score to predict discharge disposition. Multivariate regression was performed in a backwards stepwise logistic fashion to create a binomial model.
RESULTS
Escalating RAPT score predicts disposition to home (P < .0001). Every unit increase in RAPT score increases the chance of home disposition by 55.8% and 38.6% than rehab and skilled nursing facility, respectively. Further, RAPT score was significant in predicting length of stay (P = .0239), total surgical cost (P = .0007), and 30-d readmission (P < .0001). Amongst RAPT score subcomponents, walk, gait, and postoperative care availability were all predictive of disposition location (P < .0001) for both models. In a generalized multiple logistic regression model, the 3 top predictive factors for disposition were the RAPT score, length of stay, and age (P < .0001, P < .0001 and P = .0001, respectively).
CONCLUSION
Preoperative RAPT score is a highly predictive tool in lumbar fusion patients for discharge disposition.
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Affiliation(s)
- Gregory Glauser
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Piazza
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ian Berger
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin Osiemo
- McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania
- The West Chester Statistical Institute, Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Scott D McClintock
- The West Chester Statistical Institute, Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Eric Winter
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - H Isaac Chen
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zarina S Ali
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil R Malhotra
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Glauser G, Pisapia JM, Piazza M, Choudhri O. Occult AVM nidus in symptomatic left temporal arteriovenous malformations: operative management strategies in two sister cases. BMJ Case Rep 2019; 12:12/7/e231452. [PMID: 31352403 DOI: 10.1136/bcr-2019-231452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Gregory Glauser
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jared M Pisapia
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Piazza
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Omar Choudhri
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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17
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Caplan I, Sinha S, Schuster J, Piazza M, Glauser G, Osiemo B, McClintock S, Welch WC, Sharma N, Ozturk A, Malhotra NR. The Utility of Cervical Spine Bracing as a Postoperative Adjunct to Single-level Anterior Cervical Spine Surgery. Asian J Neurosurg 2019; 14:461-466. [PMID: 31143262 PMCID: PMC6516037 DOI: 10.4103/ajns.ajns_236_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Context: Use of cervical bracing/collar subsequent to anterior cervical spine discectomy and fusion (ACDF) is variable. Outcomes data regarding bracing after ACDF are limited. Purpose: The purpose of the study is to study the impact of bracing on short-term outcomes related to safety, quality of care, and direct costs in single-level ACDF. Study Design/Setting: This retrospective cohort analysis of all consecutive patients (n = 578) undergoing single-level ACDF with or without bracing from 2013 to 2017 was undertaken. Methods: Patient demographics and comorbidities were analyzed. Tests of independence (Chi-square, Fisher's exact, and Cochran–Mantel–Haenszel test), Mann–Whitney–Wilcoxon tests, and logistic regressions were used to assess differences in length of stay (LOS), discharge disposition (home, assisted rehabilitation facility-assisted rehabilitation facility, or skilled nursing facility), quality-adjusted life year (QALY), surgical site infection (SSI), direct cost, readmission within 30 days, and emergency room (ER) visits within 30 days. Results: Among the study population, 511 were braced and 67 were not braced. There was no difference in graft type (P = 1.00) or comorbidities (P = 0.06–0.73) such as obesity (P = 0.504), smoking (0.103), chronic obstructive pulmonary disease hypertension (P = 0.543), coronary artery disease (P = 0.442), congestive heart failure (P = 0.207), and problem list number (P = 0.661). LOS was extended for the unbraced group (median 34.00 + 112.15 vs. 77.00 + 209.31 h, P < 0.001). There was no difference in readmission (P = 1.000), ER visits (P = 1.000), SSI (P = 1.000), QALY gain (P = 0.437), and direct costs (P = 0.732). Conclusions: Bracing following single-level cervical fixation does not alter short-term postoperative course or reduce the risk for early adverse outcomes in a significant manner. The absence of bracing is associated with increased LOS, but cost analyses show no difference in direct costs between the two treatment approaches. Further evaluation of long-term outcomes and fusion rates will be necessary before definitive recommendations regarding bracing utility following single-level ACDF.
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Affiliation(s)
- Ian Caplan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Saurabh Sinha
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - James Schuster
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Matthew Piazza
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Department of Neurosurgery and Orthopedic Surgery, Translational Spine Research Laboratory, University of Pennsylvania, Philadelphia, USA
| | - Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Benjamin Osiemo
- Department of Neurosurgery, McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, USA.,Department of Mathematics, West Chester Statistical Institute, West Chester University, West Chester, PA, USA
| | - Scott McClintock
- Department of Mathematics, West Chester Statistical Institute, West Chester University, West Chester, PA, USA
| | - William C Welch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Nikhil Sharma
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ali Ozturk
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Neil Rainer Malhotra
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Department of Neurosurgery and Orthopedic Surgery, Translational Spine Research Laboratory, University of Pennsylvania, Philadelphia, USA
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Ramayya AG, Chen HI, Marcotte PJ, Brem S, Zager EL, Osiemo B, Piazza M, Sharma N, McClintock SD, Schuster JM, Ali ZS, Connolly P, Heuer GG, Grady MS, Kung DK, Ozturk AK, O'Rourke DM, Malhotra NR. Assessing variability in surgical decision making among attending neurosurgeons at an academic center. J Neurosurg 2019; 132:1970-1976. [PMID: 31151100 DOI: 10.3171/2019.2.jns182658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although it is known that intersurgeon variability in offering elective surgery can have major consequences for patient morbidity and healthcare spending, data addressing variability within neurosurgery are scarce. The authors performed a prospective peer review study of randomly selected neurosurgery cases in order to assess the extent of consensus regarding the decision to offer elective surgery among attending neurosurgeons across one large academic institution. METHODS All consecutive patients who had undergone standard inpatient surgical interventions of 1 of 4 types (craniotomy for tumor [CFT], nonacute redo CFT, first-time spine surgery with/without instrumentation, and nonacute redo spine surgery with/without instrumentation) during the period 2015-2017 were retrospectively enrolled (n = 9156 patient surgeries, n = 80 randomly selected individual cases, n = 20 index cases of each type randomly selected for review). The selected cases were scored by attending neurosurgeons using a need for surgery (NFS) score based on clinical data (patient demographics, preoperative notes, radiology reports, and operative notes; n = 616 independent case reviews). Attending neurosurgeon reviewers were blinded as to performing provider and surgical outcome. Aggregate NFS scores across various categories were measured. The authors employed a repeated-measures mixed ANOVA model with autoregressive variance structure to compute omnibus statistical tests across the various surgery types. Interrater reliability (IRR) was measured using Cohen's kappa based on binary NFS scores. RESULTS Overall, the authors found that most of the neurosurgical procedures studied were rated as "indicated" by blinded attending neurosurgeons (mean NFS = 88.3, all p values < 0.001) with greater agreement among neurosurgeon raters than expected by chance (IRR = 81.78%, p = 0.016). Redo surgery had lower NFS scores and IRR scores than first-time surgery, both for craniotomy and spine surgery (ANOVA, all p values < 0.01). Spine surgeries with fusion had lower NFS scores than spine surgeries without fusion procedures (p < 0.01). CONCLUSIONS There was general agreement among neurosurgeons in terms of indication for surgery; however, revision surgery of all types and spine surgery with fusion procedures had the lowest amount of decision consensus. These results should guide efforts aimed at reducing unnecessary variability in surgical practice with the goal of effective allocation of healthcare resources to advance the value paradigm in neurosurgery.
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Affiliation(s)
| | | | | | | | | | - Benjamin Osiemo
- 1Department of Neurosurgery and.,2McKenna EpiLog Fellowship in Population Health, Department of Neurosurgery, University of Pennsylvania, Philadelphia; and
| | | | | | - Scott D McClintock
- 3West Chester University, Department of Mathematics and West Chester Statistical Institute, West Chester, Pennsylvania
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Berger I, Piazza M, Sharma N, Glauser G, Osiemo B, McClintock SD, Lee JYK, Schuster JM, Ali Z, Malhotra NR. Evaluation of the Risk Assessment and Prediction Tool for Postoperative Disposition Needs After Cervical Spine Surgery. Neurosurgery 2019; 85:E902-E909. [DOI: 10.1093/neuros/nyz161] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/21/2019] [Indexed: 12/26/2022] Open
Abstract
AbstractBACKGROUNDBundled care payment models are becoming more prevalent in neurosurgery. Such systems place the cost of postsurgical facilities in the hands of the discharging health system. Opportunity exists to leverage prediction tools for discharge disposition by identifying patients who will not benefit from prolonged hospitalization and facilitating discharge to post-acute care facilities.OBJECTIVETo validate the use of the Risk Assessment and Predictive Tool (RAPT) along with other clinical variables to predict discharge disposition in a cervical spine surgery population.METHODSPatients undergoing cervical spine surgery at our institution from June 2016 to February 2017 and over 50 yr old had demographic, surgical, and RAPT variables collected. Multivariable regression analyzed each variable's ability to predict discharge disposition. Backward selection was used to create a binomial model to predict discharge disposition.RESULTSA total of 263 patients were included in the study. Lower RAPT score, RAPT walk subcomponent, older age, and a posterior approach predicted discharge to a post-acute care facility compared to home. Lower RAPT also predicted an increased risk of readmission. RAPT score combined with age increased the predictive capability of discharge disposition to home vs skilled nursing facility or acute rehabilitation compared to RAPT alone (P < .001).CONCLUSIONRAPT score combined with age is a useful tool in the cervical spine surgery population to predict postdischarge needs. This tool may be used to start early discharge planning in patients who are predicted to require post-acute care facilities. Such strategies may reduce postoperative utilization of inpatient resources.
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Affiliation(s)
- Ian Berger
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Piazza
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nikhil Sharma
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory Glauser
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin Osiemo
- Department of Mathematics, West Chester Statistical Institute, West Chester University, West Chester, Pennsylvania
| | - Scott D McClintock
- Department of Mathematics, West Chester Statistical Institute, West Chester University, West Chester, Pennsylvania
| | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James M Schuster
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zarina Ali
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil R Malhotra
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
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20
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Glauser G, Piazza M, Choudhri OA. Aneurysm Dome Excision and Picket Fence Clip Reconstruction of a Previously Coiled Recurrent Giant Middle Cerebral Artery Aneurysm: Technical Nuances. World Neurosurg 2019; 127:24. [PMID: 30947002 DOI: 10.1016/j.wneu.2019.03.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
This video case illustrates key surgical steps required in safe management of a giant recurrent previously coiled middle cerebral artery (MCA) aneurysm (Video 1). The patient described in this case was a 68-year-old man who presented with sudden-onset severe headache and dizziness. The patient had a history of a prior coil embolization of a 12-mm left middle cerebral artery aneurysm at an outside hospital. Imaging demonstrated recurrence now of a giant left middle cerebral artery aneurysm with coil compaction and left temporal lobe edema. Magnetic resonance imaging further demonstrated thrombus in the aneurysm and aneurysm wall enhancement concerning for impending rupture. Given the aneurysm size, imaging features, and mass effect, the aneurysm was treated with microsurgical clipping. This case is valuable to the literature with a clear video case illustration of aneurysm dome excision, aneurysm endarterectomy, and picket fence aneurysm neck reconstruction. Aneurysm dome excision is critical for treatment of giant aneurysms causing mass effect and was only used in this case because thrombus and coil mass did not allow for direct clipping across the neck without compromise of the MCA M2 branch. Hence, this video highlights key technical tenets, such as safe thrombus removal and adequate cleaning of the endoluminal surface and preparedness for bypass in challenging cases.
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Affiliation(s)
- Gregory Glauser
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Piazza
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Omar A Choudhri
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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21
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Giovannini M, Comberiati P, Piazza M, Chiesa E, Piacentini G, Boner A, Zanoni G, Peroni D. Retrospective definition of reaction risk in Italian children with peanut, hazelnut and walnut allergy through component-resolved diagnosis. Allergol Immunopathol (Madr) 2019; 47:73-78. [PMID: 30017213 DOI: 10.1016/j.aller.2018.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Serum IgE evaluation of peanut, hazelnut and walnut allergens through the use of component-resolved diagnosis (CRD) can be more accurate than IgE against whole food to associate with severe or mild reactions. OBJECTIVES The aim of the study was to retrospectively define the level of reaction risk in children with peanut, hazelnut and walnut sensitization through the use of CRD. METHODS 34 patients [n=22 males, 65%; median age eight years, interquartile range (IQR) 5.0-11.0 years] with a reported history of reactions to peanut and/or hazelnut and/or walnut had their serum analyzed for specific IgE (s-IgE) by ImmunoCAP® and ISAC® microarray technique. RESULTS In children with previous reactions to peanut, the positivity of Arah1 and Arah2 s-IgE was associated with a history of anaphylaxis to such food, while the positivity of Arah8 s-IgE were associated with mild reactions. Regarding hazelnut, the presence of positive Cora9 and, particularly, Cora14 s-IgE was associated with a history of anaphylaxis, while positive Cora1.0401 s-IgE were associated with mild reactions. Concerning walnut, the presence of positive Jug r 1, Jug r 2, Jug r 3 s-IgE was associated with a history of anaphylaxis to such food. ImmmunoCAP® proved to be more useful in retrospectively defining the risk of hazelnut anaphylaxis, because of the possibility of measuring Cor a14 s-IgE. CONCLUSIONS Our data show that the use of CRD in patients with allergy to peanut, hazelnut and walnut could allow for greater accuracy in retrospectively defining the risk of anaphylactic reaction to such foods.
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22
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Janjua MB, Ozturk A, Piazza M, Passias P, Arlet V, Welch WC. Technical nuances of percutaneous sacroiliac joint fixation: A cadaveric study. J Clin Neurosci 2018; 61:315-321. [PMID: 30424968 DOI: 10.1016/j.jocn.2018.10.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
Abstract
Sacroiliac (SI) joint can produce debilitating lower back pain with radiation to groin, buttocks, and lower extremities. SI joint dysfunction poses a clinical challenge to the spine surgeons. Studies entailing surgical arthrodesis utilizing Titanium implants have been reported with reputedly high level of patient satisfaction. Authors have described technical aspects of surgical technique with use of titanium screw implants. The transarticular technique is used to places SI joint screw implants across the articular portion of SI joint. Cadaveric SI joint instrumentation is performed under fluoroscopic guidance. Moreover, Medline literature search is conducted to study surgical outcome, and patient satisfaction. 4 cadavers are prepped prone for the percutaneous approach. Bilaterally 6 screws are placed using transarticular placement technique under fluoroscopic guidance. The posterior technique utilizes alignment guide to place the screws inline on the inlet view, parallel in the outlet view, and parallel to the dorsal aspect of the sacral body in the lateral view. One C-arm is used in the entire technique. The technical aspects of surgical technique have been described in a stepwise fashion for easy reproducibility in the operating room. Each screw track is checked with tactile feel of a blunt K-wire before final deployment. All bilateral screws were checked on a set of fluoroscopic views. A detail clinical examination, diagnostic joint injection, with the radiological imaging must be considered before surgical consideration. SI Joint fusion utilizing 3 transarticular sacral screws is equally effective and safe procedure to treat chronic lower back pain ensuing from SI joint dysfunction.
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Affiliation(s)
- M Burhan Janjua
- Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, PA, United States; Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, PA, United States.
| | - Ali Ozturk
- Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, PA, United States
| | - Matthew Piazza
- Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, PA, United States
| | - Peter Passias
- Department of Orthopedic Surgery, NYU Langone Medical Center, and Hospital for Joint Diseases, New York, NY, United States
| | - Vincent Arlet
- Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, PA, United States
| | - William C Welch
- Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, PA, United States
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23
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Sharma N, Piazza M, Marcotte PJ, Welch W, Ozturk AK, Chen HI, Ali ZS, Schuster J, Malhotra NR. Implications of anesthetic approach, spinal versus general, for the treatment of spinal disc herniation. J Neurosurg Spine 2018; 30:78-82. [PMID: 30497221 DOI: 10.3171/2018.7.spine18460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEHealthcare costs continue to escalate. Approaches to care that have comparable outcomes and complications are increasingly assessed for quality improvement and, when possible, cost containment. Efforts to identify components of care to reduce length of stay (LOS) have been ongoing. Spinal anesthesia (SA), for select lumbar spine procedures, has garnered interest as an alternative to general anesthesia (GA) that might reduce cost and in-hospital LOS and accelerate recovery. While clinical outcomes with SA or GA have been studied extensively, few authors have looked at the cost-analysis in relation to clinical outcomes. The authors' objectives were to compare the clinical perioperative outcomes of patients who received SA and GA, as well as the direct costs associated with each modality of care, and to determine which, in a retrospective analysis, can serve as a dominant procedural approach.METHODSThe authors retrospectively analyzed a homogeneous surgical population of 550 patients who underwent hemilaminotomy for disc herniation and who received either SA (n = 91) or GA (n = 459). All clinical and billing data were obtained via each patient's chart and the hospital's billing database, respectively. Additionally, the authors prospectively assessed patient-reported outcome measures for a subgroup of consecutively treated patients (n = 75) and compared quality-adjusted life year (QALY) gains between the two cohorts. Furthermore, the authors performed a propensity score-matching analysis to compare the two cohorts (n = 180).RESULTSDirect hospital costs for patients receiving SA were 40% higher, in the hundreds of dollars, than for patients who received GA (p < 0.0001). Furthermore, there was a significant difference with regard to LOS (p < 0.0001), where patients receiving SA had a considerably longer hospital LOS (27.6% increase in hours). Patients undergoing SA had more comorbidities (p = 0.0053), specifically diabetes and hypertension. However, metrics of complications, including readmission (p = 0.3038) and emergency department (ED) visits at 30 days (p = 1.0), were no different. Furthermore, in a small pilot group, QALY gains were statistically no different (n = 75, p = 0.6708). Propensity score-matching analysis demonstrated similar results as the univariate analysis: there was no difference between the cohorts regarding 30-day readmission (p = 1.0000); ED within 30 days could not be analyzed as there were no patients in the SA group; and total direct costs and LOS were significantly different between the two cohorts (p < 0.0001 and p = 0.0126, respectively).CONCLUSIONSBoth SA and GA exhibit the qualities of a good anesthetic, and the utilization of these modalities for lumbar spine surgery is safe and effective. However, this work suggests that SA is associated with increased LOS and higher direct costs, although these differences may not be clinically or fiscally meaningful.
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Affiliation(s)
- Nikhil Sharma
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Matthew Piazza
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Paul J Marcotte
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and.,2The Penn Spinal Research Group, Philadelphia, Pennsylvania
| | - William Welch
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and.,2The Penn Spinal Research Group, Philadelphia, Pennsylvania
| | - Ali K Ozturk
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and.,2The Penn Spinal Research Group, Philadelphia, Pennsylvania
| | - H Isaac Chen
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Zarina S Ali
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - James Schuster
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and.,2The Penn Spinal Research Group, Philadelphia, Pennsylvania
| | - Neil R Malhotra
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and.,2The Penn Spinal Research Group, Philadelphia, Pennsylvania
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24
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Piazza M, Peck SH, Gullbrand SE, Bendigo JR, Arginteanu T, Zhang Y, Smith HE, Malhotra NR, Smith LJ. Quantitative MRI correlates with histological grade in a percutaneous needle injury mouse model of disc degeneration. J Orthop Res 2018; 36:2771-2779. [PMID: 29687490 PMCID: PMC6200662 DOI: 10.1002/jor.24028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 04/19/2018] [Indexed: 02/04/2023]
Abstract
Low back pain due to disc degeneration is a major cause of morbidity and health care expenditures worldwide. While stem cell-based therapies hold promise for disc regeneration, there is an urgent need to develop improved in vivo animal models to further develop and validate these potential treatments. The objectives of this study were to characterize a percutaneous needle injury model of intervertebral disc degeneration in the mouse caudal spine, and compare two non-invasive quantitative imaging techniques, microcomputed tomography and magnetic resonance imaging (MRI), as effective measures of disc degeneration in this model. Percutaneous needle injury of mouse caudal discs was undertaken using different needle sizes and injury types (unilateral or bilateral annulus fibrosus (AF) puncture). Mice were euthanized 4 weeks post-injury, and MRI and microcomputed tomography were used to determine T2 relaxation time of the NP and disc height index, respectively. Disc condition was then further assessed using semi-quantitative histological grading. Bilateral AF puncture with either 27 or 29G needles resulted in significantly lower T2 relaxation times compared to uninjured controls, while disc height index was not significantly affected by any injury type. There was a strong, inverse linear relationship between histological grade and NP T2 relaxation time. In this study, we demonstrated that quantitative MRI can detect disc degeneration in the mouse caudal spine 4 weeks following percutaneous needle injury, and may therefore serve as a surrogate for histology in longitudinal studies of both disc degeneration and cell-based therapies for disc regeneration using this model. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2771-2779, 2018.
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Affiliation(s)
- Matthew Piazza
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sun H. Peck
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Sarah E. Gullbrand
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Justin R. Bendigo
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Toren Arginteanu
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yejia Zhang
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, USA,Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Harvey E. Smith
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Neil R. Malhotra
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Correspondence:, Lachlan J. Smith, Ph.D., Department of Neurosurgery, University of Pennsylvania, 110 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA, 19104; Neil R. Malhotra, M.D., Department of Neurosurgery, University of Pennsylvania, 3rd Floor Silverstein Pavilion, 3400 Spruce St, Philadelphia, PA, 19104
| | - Lachlan J. Smith
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, USA,Correspondence:, Lachlan J. Smith, Ph.D., Department of Neurosurgery, University of Pennsylvania, 110 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA, 19104; Neil R. Malhotra, M.D., Department of Neurosurgery, University of Pennsylvania, 3rd Floor Silverstein Pavilion, 3400 Spruce St, Philadelphia, PA, 19104
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Piazza M, Sharma N, Osiemo B, McClintock S, Missimer E, Gardiner D, Maloney E, Callahan D, Smith JL, Welch W, Schuster J, Grady MS, Malhotra NR. Initial Assessment of the Risk Assessment and Prediction Tool in a Heterogeneous Neurosurgical Patient Population. Neurosurgery 2018; 85:50-57. [DOI: 10.1093/neuros/nyy197] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/13/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Matthew Piazza
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - Nikhil Sharma
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - Benjamin Osiemo
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
- Department of Mathematics, Westchester University, Westchester, Pennsylvania
| | - Scott McClintock
- Department of Mathematics, Westchester University, Westchester, Pennsylvania
| | - Emily Missimer
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - Diana Gardiner
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - Eileen Maloney
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - Danielle Callahan
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - J Lachlan Smith
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - William Welch
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - James Schuster
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - M Sean Grady
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - Neil R Malhotra
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
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Abstract
Two cases of meningeal melanocytoma, both localized in the cerebellopontine angle, were studied. The patients underwent surgical excision, and in one case there was a recurrence. All the pathologic criteria of melanocytoma were fulfilled by the 2 reported cases. Immunohistochemical stainings were very important ancillary tools in the differential diagnosis with other pigmented meningeal tumors.
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Affiliation(s)
- M Gardiman
- Istituto di Anatomia Patologica, Università di Padova, Italy
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Abstract
Only 9 oncocytic neoplasms of true adrenal origin have been described to date. It therefore seemed of interest to study the histochemical and ultrastructural features of a non-functioning monolateral adrenocortical oncocytoma which was incidentally detected by ultrasonography and magnetic resonance imaging in a 28-year-old woman. The tumor was round, well encapsulated and weighed 73 g. It consisted of islets of eosinophilic cells, and did not display any sign of necrosis. The proliferation rate (as evaluated by mitotic index and percentage of MIB-1 Ki67 positive cells) was low, and atypic mitoses were absent; some rare cells with nuclear atypias were observed and the capsule was focally invaded by oncocytes. Immunocytochemistry did not show expression of vimentin or cytokeratin. The oncocytes had an abundant cytoplasm packed with mitochondria containing plate-like cristae. Smooth endoplasmic reticulum was virtually absent, while rough endoplasmic reticulum cisternae and free ribosomes were abundant. Although the classic histological approach clearly indicates the benign nature of the tumor, the immunocytochemical and ultrastructural features of oncocytes may suggest their potential for malignant behavior.
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Affiliation(s)
- C Macchi
- Department of Anatomy, University of Padua, Italy
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Abstract
The clinico-radiologic, gross, microscopic and ultrastructural findings in 2 cases of renal oncocytoma are reported. The diagnosis of renal oncocytoma has important clinical and prognostic implications, since the neoplasia is usually benign despite its often large size. The differential diagnosis with other renal neoplasms, in particular renal cell carcinoma, is discussed. The problem of the pre-operatory diagnosis of renal oncocytoma is explored on the basis of clinico-radiologic findings and/or histologic examination of pre- or intraoperatory biopsy. In view of the tumor's benign nature, this diagnosis implies tumorectomy, but its close resemblance to renal cell carcinoma at present counsels nephrectomy. A final diagnosis of oncocytoma may be formulated only after histologic examination of several specimens and ultrastructural confirmation.
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Abstract
A case of malignant Brenner tumor of the ovary is reported. From a survey of the literature some anatomo-clinical considerations are drawn and the histopathologic criteria for diagnosis are discussed.
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Rosellini AJ, Liu H, Petukhova MV, Sampson NA, Aguilar-Gaxiola S, Alonso J, Borges G, Bruffaerts R, Bromet EJ, de Girolamo G, de Jonge P, Fayyad J, Florescu S, Gureje O, Haro JM, Hinkov H, Karam EG, Kawakami N, Koenen KC, Lee S, Lépine JP, Levinson D, Navarro-Mateu F, Oladeji BD, O’Neill S, Pennell BE, Piazza M, Posada-Villa J, Scott KM, Stein DJ, Torres Y, Viana MC, Zaslavsky AM, Kessler RC. Recovery from DSM-IV post-traumatic stress disorder in the WHO World Mental Health surveys. Psychol Med 2018; 48:437-450. [PMID: 28720167 PMCID: PMC5758426 DOI: 10.1017/s0033291717001817] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors. METHODS The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD. RESULTS 20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2-0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66-55% v. 43%) and later-recovery (75-68% v. 39%). CONCLUSIONS We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.
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Affiliation(s)
- A. J. Rosellini
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - H. Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - M. V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - N. A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - S. Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA
| | - J. Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Pompeu Fabra University (UPF), and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - G. Borges
- National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - R. Bruffaerts
- Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - E. J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - G. de Girolamo
- IRCCS St John of God Clinical Research Centre/IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - P. de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - J. Fayyad
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
| | - S. Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - O. Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - J. M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - H. Hinkov
- National Center for Public Health and Analyses, Sofia, Bulgaria
| | - E. G. Karam
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - K. C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S. Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - J. P. Lépine
- Hôpital Lariboisière-Fernand Widal, Assistance Publique Hôpitaux de Paris, Universités Paris Descartes-Paris Diderot, INSERM UMR-S 1144, Paris, France
| | - D. Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - F. Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
| | - B. D. Oladeji
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - S. O’Neill
- School of Psychology, Ulster University, Londonderry, UK
| | - B.-E. Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - M. Piazza
- Universidad Cayetano Heredia, National Institute of Health, Lima, Peru
| | | | - K. M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - D. J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - Y. Torres
- Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia
| | - M. C. Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - A. M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Piazza M, McShane BJ, Ramayya AG, Sullivan PZ, Ali ZS, Marcotte PJ, Welch WC, Ozturk AK. Posterior Cervical Laminectomy Results in Better Radiographic Decompression of Spinal Cord Compared with Anterior Cervical Discectomy and Fusion. World Neurosurg 2018; 110:e362-e366. [DOI: 10.1016/j.wneu.2017.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/30/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
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Koenen KC, Ratanatharathorn A, Ng L, McLaughlin KA, Bromet EJ, Stein DJ, Karam EG, Ruscio AM, Benjet C, Scott K, Atwoli L, Petukhova M, Lim CC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bunting B, Ciutan M, de Girolamo G, Degenhardt L, Gureje O, Haro JM, Huang Y, Kawakami N, Lee S, Navarro-Mateu F, Pennell BE, Piazza M, Sampson N, ten Have M, Torres Y, Viana MC, Williams D, Xavier M, Kessler RC. Posttraumatic stress disorder in the World Mental Health Surveys. Psychol Med 2017; 47:2260-2274. [PMID: 28385165 PMCID: PMC6034513 DOI: 10.1017/s0033291717000708] [Citation(s) in RCA: 540] [Impact Index Per Article: 77.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking. METHODS Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics. RESULTS The cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was roughly double that in low-lower middle income (22.8%) and upper-middle income (28.7%) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed. CONCLUSIONS PTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD.
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Affiliation(s)
- K. C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - A. Ratanatharathorn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - L. Ng
- Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - K. A. McLaughlin
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - E. J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - D. J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - E. G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - A. Meron Ruscio
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C. Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - K. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - L. Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
| | - M. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - C. C.W. Lim
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
- Queensland Brain Institute, University of Queensland, St Lucia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - S. Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - A. Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania governorate, Iraq
| | - J. Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Pompeu Fabra University (UPF); CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - B. Bunting
- School of Psychology, Ulster University, Londonderry, UK
| | - M. Ciutan
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - G. de Girolamo
- IRCCS St John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - L. Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - O. Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - J. M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Y. Huang
- Institute of Mental Health, Peking University, Beijing, China
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - S. Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - F. Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud IMIB-Arrixaca; CIBERESP-Murcia, Murcia, Spain
| | - B.-E. Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - M. Piazza
- Universidad Cayetano Heredia, Lima, Peru
- National Institute of Health, Lima, Peru
| | - N. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - M. ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Y. Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - M. C. Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - D. Williams
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massaschusetts, USA
| | - M. Xavier
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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Bodini A, Tenero L, Sandri M, Maffeis C, Piazza M, Zanoni L, Peroni D, Boner A, Piacentini G. Serum and exhaled breath condensate leptin levels in asthmatic and obesity children: a pilot study. J Breath Res 2017; 11:046005. [PMID: 28952460 DOI: 10.1088/1752-7163/aa61c5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Recent studies have highlighted the possible involvement of leptin in inflammation. The leptin receptor is also expressed by alveolar macrophages, T lymphocytes and bronchial epitelial cells, suggesting a possible role in the cascade of airway inflammation. OBJECTIVES The aim of the study was to evaluate the levels of leptin in exhaled breath condensate (EBC) from asthmatic, normal- and overweight children, in relationship with airway inflammation. METHODS 15 asthmatic non-obese children, 15 healthy non-asthmatic non-obese children, 11 obese children with asthma (OA) and 20 obese children without asthma (ONA) were enrolled. Body impedance of body weight, EBC collection, FeNO, spirometry and a blood sampling for serum leptin were assessed. RESULTS Leptin EBC levels were significantly higher (3.9 ng ml-1 ± 1.3) in overweight children than those obese with asthma (3.6 ng ml-1 ± 1.6; p = 0.97), non-owerweight asthmatics (2.2 ng ml-1 ± 1.2; p < 0.0001) and in healthy children (0.9 ng ml-1 ± 0.6; p < 0.001). Leptin EBC levels in asthmatic children were significantly higher than in healthy children (p = 0.05). Leptin serum levels were significantly higher in the overweight children compared with the asthmatics (12.7 ng ml-1 ± 13.2; p < 0.001) and the healthy group (11.1 ng ml-1 ± 11.2; p < 0.001). We observed a significant correlation between EBC-leptin levels and the serum-leptin levels (p = 0.001). No correlations were found between EBC-leptin levels, FeNO and lung function. CONCLUSIONS This study shows that leptin is measurable in EBC in children and that EBC-leptin levels are significantly higher in the obese subjects and in asthmatic ones compared with healthy subjects. Leptin may therefore represent a non-invasive marker of non-specific airway inflammation in children.
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Affiliation(s)
- A Bodini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
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Piazza M, Squizzato F, Dall’Antonia A, Lepidi S, Menegolo M, Grego F, Antonello M. Outcomes of Self Expanding PTFE Covered Stent Versus Bare Metal Stent for Chronic Iliac Artery Occlusion in Matched Cohorts Using Propensity Score Modelling. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.07.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Piazza M, Sinha S, Agarwal P, Mallela A, Nayak N, Schuster J, Stein S. Post-operative bracing after pedicle screw fixation for thoracolumbar burst fractures: A cost-effectiveness study. J Clin Neurosci 2017; 45:33-39. [PMID: 28800928 DOI: 10.1016/j.jocn.2017.07.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/21/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE While frequently prescribed to patients following fixation for spine trauma, the utility of spinal orthoses during the post-operative period is poorly described in the literature. In this study, we calculated rates of reoperation and performed a decision analysis to determine the utility of bracing following pedicle screw fixation for thoracic and lumbar burst fractures. METHODS Pubmed was searched for articles published between 2005 and 2015 for terms related to pedicle screw fixation of thoracolumbar fractures. Additionally, a database of neurosurgical patients operated on within the authors institution was also used in the analysis. Incidences of significant adverse events (wound revision for either dehiscence or infection or re-operation for non-union or instability due to hardware failure) were determined. Pooled means and variances of reported parameters were obtained using a random-effects, inverse variance meta-analytic model for observational data. Utilities for surgical outcome and complications were assigned using previously published values. RESULTS Of the 225 abstracts reviewed, 48 articles were included in the study, yielding a total of 1957 patients. After including patients from the institutional registry, together a total of 2081 patients were included in the final analysis, 1328 of whom were braced. Non-braced patients were older then braced patients, although this only approached significance (p=0.051). Braced patients had significantly lower rates of re-operation for non-union or clinically significant hardware failure (1.3% vs. 1.8%, p<0.001) although the groups had comparable rates of operative wound dehiscence and infection (p=1.000). These two approaches yielded comparable utility scores (p=0.120). Costs between braced and non-braced patients were comparable excluding the cost of the brace (p=0.256); hence, the added cost of the brace suggests that bracing post-operatively is not a cost effective measure. CONCLUSIONS Bracing following operative stabilization of thoracolumbar fracture does not significantly improve stability, nor does it increase wound complications. Moreover, our data suggests that post-operative bracing may not be a cost-effective measure.
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Affiliation(s)
- Matthew Piazza
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States.
| | - Saurabh Sinha
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - Prateek Agarwal
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - Arka Mallela
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - Nikhil Nayak
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - James Schuster
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - Sherman Stein
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
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Piazza M, Squizzato F, Dall’Antonia A, Lepidi S, Menegolo M, Grego F, Antonello M. Editor's Choice – Outcomes of Self Expanding PTFE Covered Stent Versus Bare Metal Stent for Chronic Iliac Artery Occlusion in Matched Cohorts Using Propensity Score Modelling. Eur J Vasc Endovasc Surg 2017; 54:177-185. [DOI: 10.1016/j.ejvs.2017.03.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/21/2017] [Indexed: 12/13/2022]
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Piazza M, Nayak N, Ali Z, Heuer G, Sanborn M, Stein S, Schuster J, Grady MS, Malhotra NR. Trends in Resident Operative Teaching Opportunities for Treatment of Intracranial Aneurysms. World Neurosurg 2017; 103:194-200. [DOI: 10.1016/j.wneu.2017.03.124] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/23/2017] [Accepted: 03/25/2017] [Indexed: 11/16/2022]
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McGrath JJ, McLaughlin KA, Saha S, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bruffaerts R, de Girolamo G, de Jonge P, Esan O, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Kovess-Masfety V, Lee S, Lepine JP, Lim CCW, Medina-Mora ME, Mneimneh Z, Pennell BE, Piazza M, Posada-Villa J, Sampson N, Viana MC, Xavier M, Bromet EJ, Kendler KS, Kessler RC. The association between childhood adversities and subsequent first onset of psychotic experiences: a cross-national analysis of 23 998 respondents from 17 countries. Psychol Med 2017; 47:1230-1245. [PMID: 28065209 PMCID: PMC5590103 DOI: 10.1017/s0033291716003263] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations. METHOD We assessed CAs, PEs and DSM-IV mental disorders in 23 998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models. RESULTS Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.9-2.6]. CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR 8.5, 95% CI 3.6-20.2), whereas Other CA types were associated with PE onset in adolescence. Associations of other CAs with PEs disappeared in adolescence after adjustment for prior-onset mental disorders. The population attributable risk proportion (PARP) for PEs associated with all CAs was 31% (24% for MFF). CONCLUSIONS Exposure to CAs is associated with PE onset throughout the life-course, although sexual abuse is most strongly associated with childhood-onset PEs. The presence of mental disorders prior to the onset of PEs does not fully explain these associations. The large PARPs suggest that preventing CAs could lead to a meaningful reduction in PEs in the population.
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Affiliation(s)
- J J McGrath
- Queensland Centre for Mental Health Research, andQueensland Brain Institute,University of Queensland,Australia
| | - K A McLaughlin
- Department of Psychology,University of Washington,Seattle,Washington,USA
| | - S Saha
- Queensland Centre for Mental Health Research, andQueensland Brain Institute,University of Queensland,Australia
| | - S Aguilar-Gaxiola
- Center for Reducing Health Disparities,UC Davis Health System,Sacramento,California,USA
| | - A Al-Hamzawi
- College of Medicine, Al-Qadisiya University,Diwaniya governorate,Iraq
| | - J Alonso
- Health Services Research Unit,IMIM-Hospital del Mar Medical Research Institute,Barcelona,Spain
| | - R Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL),Campus Gasthuisberg,Leuven,Belgium
| | - G de Girolamo
- IRCCS St John of God Clinical Research Centre,IRCCS Centro S. Giovanni di Dio Fatebenefratelli,Brescia,Italy
| | - P de Jonge
- Department of Developmental Psychology,Research Program Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen,Groningen,The Netherlands
| | - O Esan
- Department of Psychiatry,University of Ibadan,Nigeria
| | - S Florescu
- National School of Public Health, Management and Professional Development,Bucharest,Romania
| | - O Gureje
- Department of Psychiatry,University College Hospital,Ibadan,Nigeria
| | - J M Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona,Barcelona,Spain
| | - C Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital,Shenzhen,China
| | - E G Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine,Balamand University,Beirut,Lebanon
| | - V Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University,Paris,France
| | - S Lee
- Department of Psychiatry,Chinese University of Hong Kong,Tai Po,Hong Kong
| | - J P Lepine
- Hôpital Lariboisière Fernand Widal,Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144,University Paris Diderot and Paris Descartes,Paris,France
| | - C C W Lim
- Queensland Brain Institute, The University of Queensland,St. Lucia, Queensland,Australia
| | - M E Medina-Mora
- National Institute of Psychiatry Ramón de la Fuente,Mexico City,Mexico
| | - Z Mneimneh
- Survey Research Center,Institute for Social Research,University of Michigan,Ann Arbor,Michigan,USA
| | - B E Pennell
- Survey Research Center,Institute for Social Research,University of Michigan,Ann Arbor,Michigan,USA
| | - M Piazza
- Universidad Cayetano Heredia,Lima,Peru
| | - J Posada-Villa
- Colegio Mayor de Cundinamarca University,Bogota,Colombia
| | - N Sampson
- Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA
| | - M C Viana
- Department of Social Medicine,Federal University of Espírito Santo,Vitoria,Brazil
| | - M Xavier
- Department of Mental Health,Faculdade de Ciências Médicas,Chronic Diseases Research Center (CEDOC) and Universidade Nova de Lisboa,Campo dos Mártires da Pátria,Lisbon,Portugal
| | - E J Bromet
- Department of Psychiatry,Stony Brook University School of Medicine,Stony Brook,New York,USA
| | - K S Kendler
- Department of Psychiatry,Virginia Commonwealth University,USA
| | - R C Kessler
- Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA
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Roest AM, de Jonge P, Lim C, Stein DJ, Al-Hamzawi A, Alonso J, Benjet C, Bruffaerts R, Bunting B, Caldas-de-Almeida JM, Ciutan M, de Girolamo G, Hu C, Levinson D, Nakamura Y, Navarro-Mateu F, Piazza M, Posada-Villa J, Torres Y, Wojtyniak B, Kessler RC, Scott KM. Fear and distress disorders as predictors of heart disease: A temporal perspective. J Psychosom Res 2017; 96:67-75. [PMID: 28545795 PMCID: PMC5674522 DOI: 10.1016/j.jpsychores.2017.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Few studies have been able to contrast associations of anxiety and depression with heart disease. These disorders can be grouped in fear and distress disorders. Aim of this study was to study the association between fear and distress disorders with subsequent heart disease, taking into account the temporal order of disorders. METHODS Twenty household surveys were conducted in 18 countries (n=53791; person years=2,212,430). The Composite International Diagnostic Interview assessed lifetime prevalence and age at onset of disorders, and respondents were categorized into categories based on the presence and timing of fear and distress disorders. Heart disease was indicated by self-report of physician-diagnosed heart disease or self-report of heart attack, together with year of onset. Survival analyses estimated associations between disorder categories and heart disease. RESULTS Most respondents with fear or distress disorders had either pure distress or pure fear (8.5% and 7.7% of total sample), while fear preceded distress in the large majority of respondents with comorbid fear and distress (3.8% of total sample). Compared to the "no fear or distress disorder" category, respondents with pure fear disorder had the highest odds of subsequent heart disease (OR:1.8; 95%CI:1.5-2.2; p<0.001) and compared to respondents with pure distress disorder, these respondents were at a significantly increased risk of heart disease (OR:1.3; 95%CI:1.0-1.6; p=0.020). CONCLUSION This novel analytic approach indicates that the risk of subsequent self-reported heart disease associated with pure fear disorder is significantly larger than the risk associated with distress disorder. These results should be confirmed in prospective studies using objective measures of heart disease.
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Affiliation(s)
- AM Roest
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - P de Jonge
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - C Lim
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - DJ Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - A Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania governorate, Iraq
| | - J Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar; Pompeu Fabra University (UPF); and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - C Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - R Bruffaerts
- Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg Leuven, Belgium
| | - B Bunting
- Psychology Research Institute, Ulster University, Northern Ireland
| | - JM Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - M Ciutan
- National School of public Health, Management and Professional Development, Bucharest, Romania
| | - G de Girolamo
- IRCCS St John of God Clinical Research Centre, IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - C Hu
- Shenzhen Insitute of Mental Health & Shenzhen Kanging Hospital, Shenzhen, China
| | - D Levinson
- Ministry of Health Israel, Mental Health Services, Israel
| | - Y Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - F Navarro-Mateu
- IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Spain
| | - M Piazza
- National Institute of Health, Peru, Universidad Cayetano Hereidia, Peru
| | - J Posada-Villa
- Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Y Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - B Wojtyniak
- Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - RC Kessler
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, United States
| | - KM Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
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Abstract
Cranioplasty following craniectomy for trauma is a common, safe neurosurgical procedure that restores the natural cosmesis and protective barrier of the skull and may be instrumental in normalizing cerebrospinal fluid dynamics after decompressive surgery. Understanding the factors influencing patient selection and timing of cranioplasty, the available materials and methods of skull reconstruction, and the technical nuances is critical for a successful outcome. Neurosurgeons must be prepared to manage the complications specific to this operation. This article reviews the indications, preoperative assessment and timing, most commonly used materials, operative technique, postoperative care, and complication management for cranioplasty.
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Affiliation(s)
- Matthew Piazza
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3rd Floor Silverstein, Philadelphia, PA 19104, USA
| | - M Sean Grady
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3rd Floor Silverstein, Philadelphia, PA 19104, USA.
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Agarwal P, Burke JF, Abdullah KG, Piazza M, Smith BP, Thawani JP, Malhotra NR. Stab wound to the intramedullary spinal cord: Presurgical and surgical management options for a retained blade to optimize neurological preservation. Surg Neurol Int 2016; 7:S1096-S1098. [PMID: 28144493 PMCID: PMC5234291 DOI: 10.4103/2152-7806.196769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/19/2016] [Indexed: 11/30/2022] Open
Abstract
Background: We present a rare case of an intraparenchymal nonmissile penetrating spinal injury (NMPSI) occurring at the T11 level in a patient presenting without neurological deficit. Case Description: The patient sustained a knife wound that penetrated the lamina without incurring bony injury and entered the spinal cord at the T11 level. During surgery, the intramedullary penetration of the cord was confirmed, and following surgical removal of the knife, the patient fully recovered without losing any neurological function. Conclusions: The surgical management of NMPSI in patients who are neurologically intact is controversial. Here, we report surgical excision of a knife that penetrated the spinal cord at the T11 level, without the patient incurring further neurological deterioration.
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Affiliation(s)
- Prateek Agarwal
- Department of Neurological Surgery, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John F Burke
- Department of Neurological Surgery, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kalil G Abdullah
- Department of Neurological Surgery, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Piazza
- Department of Neurological Surgery, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian P Smith
- Department of Traumatology, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jayesh P Thawani
- Department of Neurological Surgery, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil R Malhotra
- Department of Neurological Surgery, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Thawani JP, Ramayya AG, Abdullah KG, Hudgins E, Vaughan K, Piazza M, Madsen PJ, Buch V, Sean Grady M. Resident simulation training in endoscopic endonasal surgery utilizing haptic feedback technology. J Clin Neurosci 2016; 34:112-116. [PMID: 27473019 DOI: 10.1016/j.jocn.2016.05.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
Abstract
Simulated practice may improve resident performance in endoscopic endonasal surgery. Using the NeuroTouch haptic simulation platform, we evaluated resident performance and assessed the effect of simulation training on performance in the operating room. First- (N=3) and second- (N=3) year residents were assessed using six measures of proficiency. Using a visual analog scale, the senior author scored subjects. After the first session, subjects with lower scores were provided with simulation training. A second simulation served as a task-learning control. Residents were evaluated in the operating room over six months by the senior author-who was blinded to the trained/untrained identities-using the same parameters. A nonparametric bootstrap testing method was used for the analysis (Matlab v. 2014a). Simulation training was associated with an increase in performance scores in the operating room averaged over all measures (p=0.0045). This is the first study to evaluate the training utility of an endoscopic endonasal surgical task using a virtual reality haptic simulator. The data suggest that haptic simulation training in endoscopic neurosurgery may contribute to improvements in operative performance. Limitations include a small number of subjects and adjudication bias-although the trained/untrained identity of subjects was blinded. Further study using the proposed methods may better describe the relationship between simulated training and operative performance in endoscopic Neurosurgery.
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Affiliation(s)
- Jayesh P Thawani
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 Silverstein Pavillion - Neurosurgery, Philadelphia, PA 19103, USA.
| | - Ashwin G Ramayya
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 Silverstein Pavillion - Neurosurgery, Philadelphia, PA 19103, USA
| | - Kalil G Abdullah
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 Silverstein Pavillion - Neurosurgery, Philadelphia, PA 19103, USA
| | - Eric Hudgins
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 Silverstein Pavillion - Neurosurgery, Philadelphia, PA 19103, USA
| | - Kerry Vaughan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 Silverstein Pavillion - Neurosurgery, Philadelphia, PA 19103, USA
| | - Matthew Piazza
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 Silverstein Pavillion - Neurosurgery, Philadelphia, PA 19103, USA
| | - Peter J Madsen
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 Silverstein Pavillion - Neurosurgery, Philadelphia, PA 19103, USA
| | - Vivek Buch
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 Silverstein Pavillion - Neurosurgery, Philadelphia, PA 19103, USA
| | - M Sean Grady
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 Silverstein Pavillion - Neurosurgery, Philadelphia, PA 19103, USA
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Benjet C, Bromet E, Karam EG, Kessler RC, McLaughlin KA, Ruscio AM, Shahly V, Stein DJ, Petukhova M, Hill E, Alonso J, Atwoli L, Bunting B, Bruffaerts R, Caldas-de-Almeida JM, de Girolamo G, Florescu S, Gureje O, Huang Y, Lepine JP, Kawakami N, Kovess-Masfety V, Medina-Mora ME, Navarro-Mateu F, Piazza M, Posada-Villa J, Scott KM, Shalev A, Slade T, ten Have M, Torres Y, Viana MC, Zarkov Z, Koenen KC. The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychol Med 2016; 46:327-343. [PMID: 26511595 PMCID: PMC4869975 DOI: 10.1017/s0033291715001981] [Citation(s) in RCA: 584] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs. METHOD General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure. RESULTS Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types - witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury - accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events. CONCLUSIONS Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.
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Affiliation(s)
- C. Benjet
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico
| | - E. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, New York, NY, USA
| | - E. G. Karam
- Department of Psychiatry and Clinical Psychology, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - R. C. Kessler
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - K. A. McLaughlin
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - A. M. Ruscio
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - V. Shahly
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - D. J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - M. Petukhova
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - E. Hill
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - J. Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar; Pompeu Fabra University (UPF); and CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - L. Atwoli
- Moi University School of Medicine, Eldoret, Uasin Gishu, Kenya
| | - B. Bunting
- School of Psychology, University of Ulster, Northern Ireland, UK
| | - R. Bruffaerts
- Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - J. M. Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - G. de Girolamo
- IRCCS St John of God Clinical Research Centre, Brescia, Italy
| | - S. Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - O. Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Y. Huang
- Institute of Mental Health, Peking University, Beijing, People’s Republic of China
| | - J. P. Lepine
- Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris, University Paris Diderot and Paris Descartes, Paris, France
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - M. E. Medina-Mora
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico
| | - F. Navarro-Mateu
- IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Spain
| | - M. Piazza
- National Institute of Health, Lima, Peru
| | | | - K. M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - A. Shalev
- NYU School of Medicine, New York, NY, USA
| | - T. Slade
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - M. ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Y. Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - M. C. Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - Z. Zarkov
- Directorate Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - K. C. Koenen
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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Piazza M, Martucci G, Arcadipane A. Postoperative pain management of liver transplantation in cystic fibrosis: Is it time to start US-guided neuraxial blocks? Saudi J Anaesth 2016; 10:456-458. [PMID: 27833495 PMCID: PMC5044736 DOI: 10.4103/1658-354x.177343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cystic fibrosis (CF) is the most common life-limiting genetic disease in Caucasians. Declining lung function is the principal cause of death, but liver involvement can lead to the need for liver transplantation. General anesthesia has detrimental effects on pulmonary function, increasing perioperative morbidity and mortality in CF patients. Regional anesthetic techniques improve outcomes by reducing anesthetic drugs and administration of opioids, and hastening extubation, awakening, and restarting respiratory of physiotherapy. There is a growing evidence that thoracic epidural anesthesia is feasible in pediatric patients. Concerns about coagulopathy and immunosuppression have limited its use in liver transplantation. Ultrasonography is becoming an adjunct tool in neuraxial blocks, allowing faster and easier recognition of the epidural space, and reducing vertebral touch and number of attempts. In pediatric patients, it is still debated whether anesthesia has detrimental effects on cognitive development. Efforts to make regional techniques easier and safer by ultrasonography are ongoing. We report the first case of continuous thoracic epidural analgesia after pediatric liver transplantation in a 10-year-old boy affected with CF with macronodular cirrhosis. Despite a challenging coagulation profile, the echo-assisted procedure was safely performed and allowed extubation in the odds ratio, postoperative awakening and comfort, and quick resumption of respiratory physiotherapy.
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Affiliation(s)
- M Piazza
- Department of Anesthesia and Intensive Care, Mediterranean Institute for Transplantation and specialized Therapies, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS - ISMETT), Via Tricomi 5, Palermo, Italy
| | - G Martucci
- Department of Anesthesia and Intensive Care, Mediterranean Institute for Transplantation and specialized Therapies, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS - ISMETT), Via Tricomi 5, Palermo, Italy
| | - A Arcadipane
- Department of Anesthesia and Intensive Care, Mediterranean Institute for Transplantation and specialized Therapies, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS - ISMETT), Via Tricomi 5, Palermo, Italy
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Marini M, Monaci M, Manetti M, Piazza M, Paternostro F, Sgambati E. Can practice of Dancesport as physical activity be associated with the concept of "successful aging"? J Sports Med Phys Fitness 2015; 55:1219-1226. [PMID: 25295626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Regular and structured physical activity is known to be effective in preventing and/or reducing the physical and mental decline associated with aging. Indeed, such usefulness of physical activity has been associated with the concept of "successful aging". The aim of the present study was to evaluate the possible physical and cognitive effects deriving from the practice of Dancesport in comparison with the participation in adapted physical activity (APA) programs and sedentarity. METHODS A total of 150 healthy older adults were enrolled, consisting of three groups: 1) Dancesport (non-competitive Latin American and Standard dancers); 2) APA (subjects practicing a multicomponent training program adapted to elderly); 3) control (sedentary subjects). All participants were assessed with cognitive computerized tests and underwent motor tests (Tinetti Test [TT] and Sit and Reach [SR] Test), and filled out a questionnaire to evaluate leisure cognitive activities and Short Form-12 (SF-12) questionnaire to assess quality of life. RESULTS Subjects practicing Dancesport and APA performed significantly better in all proposed tests than sedentary subjects. In particular, dancers reported better scores in both cognitive and motor tests as well as in SF-12 compared to APA. CONCLUSION Given its peculiar characteristics, Dancesport represents a feasible, attractive and alternative physical activity to preserve cognitive and physical functions during aging. Increased self-esteem, social contact and psychophysical wellness significantly ameliorate the quality of life during aging.
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Affiliation(s)
- M Marini
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Florence, Italy -
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Galetta F, Franzoni F, D'alessandro C, Piazza M, Tocchini L, Fallahi P, Antonelli A, Cupisti F, Santoro G. Body composition and cardiac dimensions in elite rhythmic gymnasts. J Sports Med Phys Fitness 2015; 55:946-952. [PMID: 26470638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Rhythmic gymnasts are often believed to be a population at risk of malnutrition because of their tendency to keep a low weight and a lean appearance for better athletic performance, and because they start intensive training at a very young age. The purpose of this study was to evaluate in adolescent elite gymnasts the effects of physical activity on body composition and cardiac morphology and function. METHODS Sixteen national level rhythmic gymnasts and 16 control adolescent female underwent anthropometric measurements, bioelectric impedance and echocardiography to assess body composition and cardiac morphology and function. RESULTS As compared to controls, gymnasts had lower body mass index (16.9±1.1 vs. 18.7±1.0, P<0.001), fatty mass (14.2±4.5 vs. 15.8±2.9 %, P<0.05) and greater fat-free mass (84.0±4.7 vs. 80.5±5.0 %, P<0.05), left ventricular end-diastolic dimension (4.7±0.4 vs. 4.4±0.3 cm) and left ventricular mass, as absolute (132.8±21.2 vs. 112.5±22.8 g, P<0.01) and indexed (44.5±9.3 vs. 36.1±8.2 g/m2.7, P<0.01). Left ventricular mass was directly related to fat-free mass as absolute (r=0.37, P<0.05) and indexed (r=0.43, P<0.02). CONCLUSION Body composition analysis showed a lower percentage of body fat in the gymnasts, together with a higher percentage of fat-free mass. Echocardiographic findings indicate that elite rhythmic gymnastics present left ventricular remodeling as training-induced cardiac adaptation. Intensive training, dietary attitude and evident leanness of rhythmic gymnasts are not associated with cardiac abnormalities, as it is the case of pathological leanness.
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Affiliation(s)
- F Galetta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy -
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Hong C, Piazza M, Ho W, Zhuang Z. BI-02 * DISRUPTION OF PERIVASCULAR ASTROCYTIC FOOT PROCESSES CHARACTERIZES MRI ENHANCEMENT IN PEDIATRIC BRAIN TUMORS. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov061.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bonvini S, Wassermann V, Menegolo M, Scrivere P, Grego F, Piazza M. Surgical infrarenal "neo-neck" technique during elective conversion after EVAR with suprarenal fixation. Eur J Vasc Endovasc Surg 2015; 50:175-80. [PMID: 25920632 DOI: 10.1016/j.ejvs.2015.03.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/13/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Conversion of a previous endovascular aneurysm repair (EVAR) with suprarenal fixation is a challenging situation even in the elective setting. The outcomes of a technique based on preservation of the first proximal covered stent of the endograft, used as a "neo-neck" for proximal anastomosis, are presented. METHODS From 2001 to 2014, nine patients underwent elective conversion of a previous suprarenally fixed EVAR. After supraceliac clamping, the aneurysm sac was opened and the endograft identified; the fabric was cut beyond the first covered stent together with its native aortic wall in order to create a "neo-neck." An aortic balloon was inflated into the visceral aorta to avoid back bleeding. A Dacron bifurcated tube graft (Intergard, Maquet) was then sutured to the neo-neck mimicking endobanding, passing the stitches into the aortic wall and the first covered stent. RESULTS The mean age was 68 years (range, 52-84 years). The stent grafts removed were four Zenith (Cook Medical), three Endurant (Medtronic), and two E-vita (Jotec). The indication for conversion was type 1A (n = 2), type 2 (n = 2), and type 3 (n = 1) endoleak, complete endograft thrombosis (n = 2), and abdominal pain with sac enlargement with no radiological sign of endoleak (n = 2). Blood loss was 1,428 mL (range 500-3,000 mL); the visceral ischemic time to perform the proximal anastomosis was 23.5 min ± 2.3 min). The post-operative complication rate was 11% (n = 1/9) related to a case of sac wall bleeding requiring re-intervention; mortality at 30 days was 0%. At 22 months (range, 8-41) the computed tomography angiogram demonstrated no signs of leaks or anastomotic pseudoaneurysm. CONCLUSION Preservation of the proximal covered stent of an endograft with suprarenal fixation used as an infrarenal "neo-neck" with incorporation of the aorta to the suture line during elective surgical explantation simplifies the procedure, and can be achieved with very low early morbidity and mortality; furthermore, it seems to be durable over mid-term follow up.
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Affiliation(s)
- S Bonvini
- Vascular and Endovascular Surgery Clinic, Padova University, Padova, Italy
| | - V Wassermann
- Vascular and Endovascular Surgery Clinic, Padova University, Padova, Italy
| | - M Menegolo
- Vascular and Endovascular Surgery Clinic, Padova University, Padova, Italy
| | - P Scrivere
- Vascular and Endovascular Surgery Clinic, Padova University, Padova, Italy
| | - F Grego
- Vascular and Endovascular Surgery Clinic, Padova University, Padova, Italy
| | - M Piazza
- Vascular and Endovascular Surgery Clinic, Padova University, Padova, Italy.
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Piazza M, Cataldo PT, Chirianni A, Noce S, D'Abbraccio M. Update on AIDS opportunistic infections. Antibiot Chemother (1971) 2015; 43:173-200. [PMID: 1883216 DOI: 10.1159/000419729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- M Piazza
- Clinica delle Malattie Infettive, II Facoltà di Medicina e Chirurgia, Università degli Studi, Napoli, Italy
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