1
|
Optimal Sequence of Corrective Surgeries for Concomitant Valgus Knee and Rigid Pes Planus Deformities: The Knee-First Approach. Arthroplast Today 2023; 24:101265. [PMID: 38023651 PMCID: PMC10652122 DOI: 10.1016/j.artd.2023.101265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/08/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
In patients requiring surgical correction of ipsilateral valgus knee and rigid pes planovalgus deformities, the optimal operative sequence is controversial. Growing evidence suggests these 2 deformities are related in etiology and interrelated in disease course. We present the case of a 72-year-old female with concomitant valgus knee and rigid pes planovalgus deformities successfully treated with total knee arthroplasty followed by triple arthrodesis and Achilles lengthening. Surgical correction of these deformities must be carefully planned between the operating surgeons to avoid over- or under-correction of alignment that could further impact gait. In contrast with the limited available literature, the authors recommend correction at the knee first and the foot and ankle second. Further prospective studies are needed to elucidate the best operative sequence in these patients.
Collapse
|
2
|
A Rare Periprosthetic Knee Joint Infection With Clostridium perfringens, the Result of 2-Stage Exchange Treatment: A Case Report and Review of Current Literature. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202307000-00007. [PMID: 37467312 DOI: 10.5435/jaaosglobal-d-22-00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/23/2023] [Indexed: 07/21/2023]
Abstract
Prosthetic joint infections (PJIs) commonly result from aerobic gram-positive organisms and can lead to detrimental outcomes. However, it is rare for Clostridium perfringens to cause a PJI. Owing to its rarity, current literature lacks a comprehensive guide for the proper management of these PJIs. We report on the case of an 80-year old man who presented to our institution with concerns for sepsis secondary to a PJI with C. perfringens 25 years status post total knee arthroplasty. The patient was managed with two-stage revision and exchange. After stage one, the patient developed cholecystitis, which has been reported in prior cases of PJI due to C. perfringens. After concerns for sepsis had resolved and stage 1 was complete, the patient was managed with 6 weeks of IV antibiotics. Treatment was directed at gram-positives with IV vancomycin along with anerobic coverage determined by anerobic susceptibility testing. After the second stage, the patient was discharged with 3 months of oral antibiotic therapy. At the final 1-year follow-up, the patient was doing well without residual infection. This report reviews previous evidence on the management of C. perfringens PJI and presents a case demonstrating the successful diagnostic, surgical, and antimicrobial management of a PJI with C. perfringens.
Collapse
|
3
|
Intensity noise in difference frequency generation-based tunable femtosecond MIR sources. OPTICS EXPRESS 2023; 31:12693-12702. [PMID: 37157425 DOI: 10.1364/oe.486509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We characterize the intensity noise of two mid-infrared (MIR) ultrafast tunable (3.5-11 μm) sources based on difference frequency generation (DFG). While both sources are pumped by a high repetition rate Yb-doped amplifier delivering 200 μJ 300 fs at a central wavelength of 1030 nm, the first is based on intrapulse DFG (intraDFG), and the second on DFG at the output of an optical parametric amplifier (OPA). The noise properties are assessed through measurement of the relative intensity noise (RIN) power spectral density and pulse-to-pulse stability. The noise transfer mechanisms from the pump to the MIR beam is empirically demonstrated. As an example, improving the pump laser noise performance allows reduction of the integrated RIN (IRIN) of one of the MIR source from 2.7% RMS down to 0.4% RMS. The intensity noise is also measured at various stages and in several wavelength ranges in both laser system architectures, allowing us to identify the physical origin of their variation. This study presents numerical values for the pulse to pulse stability, and analyze the frequency content of the RINs of particular importance for the design of low-noise high repetition rate tunable MIR sources and future high performance time-resolved molecular spectroscopy experiments.
Collapse
|
4
|
Hemodynamic Response after Intra-Aortic Balloon Counter-Pulsation in Cardiac Amyloidosis and Cardiogenic Shock. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
5
|
Neoatal nephrotoxic medication exposure and early acute kidney injury: Results from the AWAKEN study. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
6
|
Prediction of cardiac outcomes in 600 adult patients with mitochondrial diseases. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2023. [DOI: 10.1016/j.acvdsp.2022.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
7
|
Incidence and predictors of transthyretin cardiac amyloidosis in patients with degenerative aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The approval of new therapies for treating transthyretin (TTR) cardiac amyloidosis has led to significant interest in identifying patients at high risk for this disease. Investigators have identified a correlation between severe degenerative aortic stenosis (AS) and TTR cardiac amyloidosis in older patients, with several studies finding up to 20% of patients who undergo transcatheter aortic valve replacement (TAVR) having TTR cardiac amyloidosis. These initial TAVR studies were conducted when TAVR was performed almost exclusively in high surgical risk populations. Therefore, the true incidence of TTR cardiac amyloidosis in an all-comers with severe degenerative AS referred for TAVR is unknown.
Purpose
To identify the true burden of TTR cardiac amyloidosis in a contemporary population of severe degenerative AS undergoing TAVR screening.
Methods
All patients ≥70 years with severe native valve degenerative AS seen in a multidisciplinary valve clinic were referred for technetium-99m pyrophosphate cardiac scintigraphy (PYP scan) for evaluation of cardiac amyloidosis. Diagnosis was made via combination of planar grade and heart to contralateral lung ratio, confirmed on single positron emission computed tomography/computed tomography (SPECT/CT). Patients with a positive PYP scan were referred to a heart failure clinic where they underwent testing for AL amyloidosis.
Results
Over a 10 month period, 247 patients seen in valve clinic underwent a PYP scan. Of this cohort, 203 patients ultimately underwent TAVR, 15 surgical aortic valve replacement, and 2 balloon valvuloplasty with 27 patients having not yet undergone a procedure. The positivity rate was 4% (10/247) with 1 patient having an equivocal result. The patients with a positive PYP scan had higher rate of low-flow low-gradient (LFLG) AS (64% vs 29%, p=0.006) and classical LFLG AS (27% vs 8%, p=0.02). Echocardiographic measures associated with a positive PYP scan include a lower global longitudinal strain (−10.0% vs −16.1%, p=0.008), lower average e' (4.5 vs 6.5, p=0.003), and an increased E/A ratio (1.8 vs 1.1, p=0.018).
Conclusions
The incidence of TTR amyloidosis in a contemporary, severe AS population ≥70 years undergoing TAVR screening appears much lower than previously described in the literature. Echocardiographic traits may be able to predict which patients with severe AS should undergo evaluation for TTR cardiac amyloidosis.
Funding Acknowledgement
Type of funding sources: None.
Collapse
|
8
|
Inline amplification of mid-infrared intrapulse difference frequency generation. OPTICS LETTERS 2022; 47:4885-4888. [PMID: 36181142 DOI: 10.1364/ol.467792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
We demonstrate an ultrafast mid-infrared source architecture that implements both intrapulse difference frequency generation (iDFG) and further optical parametric amplification (OPA), in an all-inline configuration. The source is driven by a nonlinearly compressed high-energy Yb-doped-fiber amplifier delivering 7.4 fs pulses at a central wavelength of 1030 nm, at a repetition rate of 250 kHz. It delivers 1 µJ, 73 fs pulses at a central wavelength of 8 µm, tunable over more than one octave. By enrolling all the pump photons in the iDFG process and recycling the long wavelength pump photons amplified in the iDFG in the subsequent OPA, we obtain an unprecedented overall optical efficiency of 2%. These performances, combining high energy and repetition rate in a very simple all-inline setup, make this technique ideally suited for a growing number of applications, such as high harmonic generation in solids or two-dimensional infrared spectroscopy experiments.
Collapse
|
9
|
Association entre la consommation de vitamine D et de calcium, la densité mammaire, l'involution lobulaire et la présence de microcalcifications. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
10
|
Editorial Commentary: In-Office Needle Ankle Arthroscopy May Be Better, Simpler, and Less Expensive. Arthroscopy 2022; 38:1312-1314. [PMID: 35369927 DOI: 10.1016/j.arthro.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
Orthopaedic surgeons have always been on the cutting edge of innovation in health care delivery and technology. In turn, the orthopaedic device industry has responded with new products that deliver better quality at competitive prices. Numerous examples of collaboration exist such as in outpatient joint replacement and minimally invasive orthopaedic procedures. In-office needle arthroscopy (IONA) for knees and ankles has been in existence since the 1990s but was hampered by poor image quality and a cumbersome-to-use technology. Now with improved technology for IONA, ankle IONA allows adequate visualization of all pertinent ankle joint structures, allowing reach of 96% of the talus surface and 85% of the tibia plafond, and may show greater accuracy than preoperative magnetic resonance imaging. The majority of cost of an arthroscopy episode of care may reside with the "facility" fee charged for the use of an operating room, personnel, and related equipment. Surgeons and their patients pay higher fees to use hospital or outpatient centers, sometimes with increased inefficiency or more adverse events. IONA may allow orthopaedic surgeons to deliver better services at a reduced cost for ankle arthroscopy.
Collapse
|
11
|
Enhanced intrapulse difference frequency generation in the mid-infrared by a spectrally dependent polarization state. OPTICS LETTERS 2022; 47:261-264. [PMID: 35030582 DOI: 10.1364/ol.444908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/28/2021] [Indexed: 06/14/2023]
Abstract
We present a technique to optimize the intrapulse difference frequency generation efficiency for mid-infrared generation. The approach employs a multi-order wave plate that is designed to selectively rotate the polarization state of the incoming spectral components on the relevant orthogonal axes for subsequent nonlinear interaction. We demonstrate a significant increase of the mid-infrared average power generated, of a factor ≥2.5 compared with the conventional scheme, owing to an optimally distributed number of photons enrolled in the difference frequency generation process.
Collapse
|
12
|
Two Epidemics and a Pandemic: The Collision of Prescription Drug Misuse and Racism during COVID-19. J Psychoactive Drugs 2021; 53:413-421. [PMID: 34694200 DOI: 10.1080/02791072.2021.1992048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study investigated the relationship between perceived racial discrimination and prescription drug misuse (PDM) among Asian, Black, and Latinx Americans during the COVID-19 crisis. U.S. racial/ethnic minorities may have been uniquely affected by two national and one global pandemic: the opioid crisis, racism, and COVID-19. Opioid death rates increased among many groups prior to the pandemic. This country witnessed an increase in racialized acts against people of color across the spectrum in the spring and summer months of the world's COVID-19 outbreak. While studies have shown a clear link between perceived racial discrimination and substance abuse outside of the global pandemic, no identified studies have done so against the backdrop of a global health pandemic. Separate hierarchical regressions revealed a significant association between perceived racial discrimination and PDM for Black Americans, Asian Americans, and Latinx individuals. Findings build on the scant literature on PDM in diverse samples and establish a relationship between perceived racial discrimination and PDM, as previously identified for other abused substances. Future post-pandemic substance misuse interventions should consider the influence of perceived racial discrimination as they help individuals recover from the aftermath of this stressful trifecta.
Collapse
|
13
|
1364 Quality Control of Discharge Summaries for Endocrine Surgery Patients; A Closed Loop Audit. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
A patient's discharge summary (TTO) should be accurate. Most of them are conducted by junior doctors at the beginning of their medical training. The information mentioned in a TTO ensures patient safety, continuity of care as well as correct clinical coding for the NHS. Therefore, a re-audit was designed to check the quality of the discharge summaries of endocrine surgical patients In Nottingham City Hospital i.e., the type of operation, diagnosis, or postoperative instructions.
Method
The first cycle included all the TTOs for the endocrine surgical patients operated from April 2018 to November 2018. Then we re-audited those who had endocrine surgeries from April 2019 to November 2019. NOTIS e-TTO, Bluespier theatre lists and Medway were used to retrieve the data. All general surgery patients were excluded.
Results
142 and 104 patients TTOs were included in each audit cycle, respectively. Type of operation was improved from 84% to 95% in the second cycle. Correct diagnosis was reported from 68% to 72% in the second cycle audit.
Conclusions
The introduction of electronic operation notes in our practice improved the correct clinical coding for the type of operation mentioned in the TTO. The accuracy of correct diagnosis remains suboptimal. Therefore, education of junior doctors and an idea of double-checking from a more senior colleague should be assessed.
Collapse
|
14
|
746 Single-Centre Experience with Three Metallic Ureteric Stents (Allium URS, Memokath-051 and Resonance) for Chronic Ureteric Obstruction. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
To evaluate efficacy of Allium URS, Memokath 051 and Resonance metallic ureteric stents as an alternative to polymer stents/nephrostomy in managing chronic ureteric obstruction (CUO).
Method
Retrospective analysis of consecutive patients with CUO managed with Allium URS, Memokath-051 or Resonance (September 2015/July 2020). Baseline patient variables (age, gender, underlying aetiology, ASA) and stricture characteristics (length, level, continuity) were recorded. Intra- and post-operative clinical and radiological follow-up assessments at 6 weeks, 3 months and then every 6 months, as well as any emergency attendances, were reviewed for placement success, stent complications, serum creatinine, and mortality. Outcomes included placement success rate, functional stent survival, and mean renal function.
Results
Overall, 129 stent insertion episodes (SIEs) (Allium URS: 23, Memokath 051: 48, Resonance: 58) occurred in 76 patients (Allium URS: 16; Memokath-051: 31; Resonance: 29). Placement success was high (Allium URS: 95.7%; Memokath-051 and Resonance: both 100%). Median functional stent survival was 11.4 months for Allium URS, 5.5 months for Memokath-051 and 11.7 months for Resonance. 47.8% of Allium URS SIEs (11/23), 64.6% of Memokath-051 SIEs (31/48) and 19% of Resonance SIEs (11/58) experienced complication (most frequently obstruction followed by migration and infection). There were no complications for Resonance SIEs for benign indication. In the first year following SIE, serum creatinine ranged from +21.3% to + 46.7% for Allium URS, -7.8% to + 8.9% for Memokath-051, and -9.4% to + 27.3% for Resonance.
Conclusions
Allium URS, Memokath 051 and Resonance metallic ureteric stents are all viable management options of CUO. Resonance was particularly efficacious for patients with benign aetiology.
Collapse
|
15
|
FSHD. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Sport activity levels following ankle fusion. INTERNATIONAL ORTHOPAEDICS 2021; 45:2347-2354. [PMID: 34228148 DOI: 10.1007/s00264-021-05100-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/25/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Ankle arthrodesis (AA) is frequently employed in the treatment of end-stage ankle arthritis, which is common following trauma and athletic injuries. While AA remains a popular therapeutic option, little data exists about activity and sporting capacity following AA. The objective of this research was to determine functional outcomes and sporting activity levels in patients following Ankle Arthrodesis. METHODS Validated questionnaires were emailed to 35 patients with a history of AA at an average follow-up of 52 months. Functional outcomes were assessed using the Foot and Ankle Disability Index (FADI), as well as the associated FADI-Sport. Responses were compared to those from a control population of RESULTS: 24 patients scheduled for AA, at an average pre-operative visit of three months. Activity levels were assessed prior to injury as well as pre- and post-operatively using the Tegner activity level scale. Average Tegner scores of the 35 surgical patients decreased from 3.82 ± 0.38 before their injury, to 1.15 ± 0.19 immediately pre-op, with recovery to 2.67 ± 0.26 following fusion. Average post arthrodesis FADI and FADI-sport scores in our patients were 76.5 ± 3.19% and 33.8 ± 23.06%. For the pre-operative control population, corresponding scores were 47.41 ± 2.61% and 22.24 ± 1.03%. Following AA, we found that patients improved upon their pre-op Tegner score, although they did not return to their pre-injury level of sporting participation. Additionally, patients reported that they had no current dysfunction with their lower leg. CONCLUSION Patients undergoing Ankle Arthrodesis should expect improved lower leg function, though will not likely return to their pre-injury level of activity.
Collapse
|
17
|
A Systematic and Anatomic Approach to Acetabular Preparation During Total Hip Arthroplasty. BULLETIN OF THE HOSPITAL FOR JOINT DISEASE (2013) 2021; 79:163-166. [PMID: 34605753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Proper acetabular preparation is critical to successful total hip arthroplasty (THA). As there is a paucity of literature offering technical guidance on cementless acetabular preparation during THA, we provide a systematic approach herein that utilizes anatomic cues to maximize reproducibility. Common dilemmas during acetabular preparation are addressed, including how to medialize, position sequential reamers, and determine the final reamer size. Considerations unique to arthroplasty in cases of protrusio or dysplasia, as well as acetabular component revision, are also discussed.
Collapse
|
18
|
Abstract
Abstract
Background
In the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT), tafamidis was shown to be an effective treatment for patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Further assessment of the efficacy of tafamidis in patients with more advanced ATTR-CM would aid treatment decisions.
Purpose
To characterize the benefits of tafamidis in patients with advanced ATTR-CM.
Methods
In ATTR-ACT, ATTR-CM patients were randomized to tafamidis (n=264) or placebo (n=177) for 30 months. Efficacy outcomes included all-cause mortality and frequency of cardiovascular (CV)-related hospitalisations. Key secondary endpoints were change from baseline to Month 30 in 6MWT distance and KCCQ-OS score. Efficacy assessments in NYHA Class III patients at baseline (n=141) were a pre-specified analysis. In a post-hoc analysis, mortality and CV-related hospitalizations were assessed in all patients grouped into quartiles of increasing disease severity based on 6MWT distance at baseline. Longer-term all-cause mortality (as of 1 Aug 2019) was assessed in NYHA Class III patients utilizing data from ATTR-ACT patients who enrolled in a long-term, extension study (LTE) and continued treatment with higher dose tafamidis (n=55; median treatment duration 51.6 months); or, if previously treated with placebo, started tafamidis treatment (placebo/tafamidis; n=63 [50.1 months]).
Results
In advanced ATTR-CM patients (NYHA Class III), tafamidis reduced the risk of death (HR [95% CI] 0.837, [0.541, 1.295], P=0.4253), and the decline in 6MWT distance (LS mean [SE], 31.6 (22.1) m; P=0.1526) and KCCQ-OS score (LS mean [SE], 13.1 (5.0); P=0.0090), vs placebo. Paradoxically, there was a higher frequency of CV-related hospitalizations with tafamidis (RR [95% CI] vs placebo, 1.411 [1.048, 1.900]). In all patients by 6MWT quartile, CV-related hospitalizations/year with tafamidis and placebo increased with disease severity, with the exception that placebo-treated patients in the highest severity quartile had fewer CV-related hospitalisations (0.73) than those in the third quartile (0.92). Mortality with tafamidis and placebo increased, and was greater with placebo, in every quartile (Figure). Survival (NYHA Class III patients in ATTR-ACT and LTE) was improved with high dose tafamidis with longer term follow-up (HR vs placebo/tafamidis [95% CI], 0.6569 [0.4175, 1.0336]; P=0.0692).
Conclusions
These analyses, including longer-term follow-up, demonstrate that patients with advanced ATTR-CM benefit from tafamidis. The decrease in CV-related hospitalisations in more severe patients treated with placebo suggests that the comparatively greater hospitalisation frequency in NYHA Class III patients treated with tafamidis is a consequence of their lower mortality rate.
Figure 1
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): This study was sponsored by Pfizer
Collapse
|
19
|
The Chronic Urticaria Registry: rationale, methods and initial implementation. J Eur Acad Dermatol Venereol 2020; 35:721-729. [DOI: 10.1111/jdv.16947] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
|
20
|
Abdominal adiposity assessed using CT angiography associates with acute kidney injury after trans-catheter aortic valve replacement. Clin Radiol 2020; 75:921-926. [PMID: 32782129 DOI: 10.1016/j.crad.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
Abstract
AIM To determine if there is an association between area-based visceral abdominal adipose tissue (VAT), subcutaneous abdominal adipose tissue (SAT), and abdominal circumference measured on computed tomography (CT) angiography before trans-catheter aortic valve replacement (TAVR) and post-TAVR acute kidney injury (AKI). MATERIALS AND METHODS In this retrospective cohort study of 106 TAVR patients, SAT and VAT areas and abdominal circumference was measured on a single CT section at L4 vertebral level. Univariate comparisons between patients who did and did not develop AKI were undertaken for radiological measurements. Multivariable logistic regression was used to assess association between CT measurements and the development of post-TAVR AKI. RESULTS Post-TAVR AKI occurred in 20 of 106 patients (19%). In univariate comparisons, body mass index (BMI) did not differ significantly between patients who did and did not develop AKI (p=0.14); however, VAT+SAT (443.2±163.7 versus 351±168.7 cm2; p=0.03), VAT (213.9±110.6 versus 153.9±96.1 cm2; p=0.03), and outer abdominal circumference (100.2±14.4 cm versus 91.8±13.3 cm; p=0.02) were significantly higher in the patients who did not develop post-TAVR AKI. These three measures on pre-TAVR CT angiogram remained significantly associated with reduced post-TAVR AKI with a lower incidence of post-TAVR AKI after multivariable adjustment for pre-TAVR estimated glomerular filtration rate and patient height (p<0.05). CONCLUSION This study found that increased abdominal obesity as assessed by measures on pre-TAVR CT angiogram is associated with a significantly lower incidence of AKI.
Collapse
|
21
|
Abstract
Introduction Morel-Lavallée lesions (MLLs) are a post-traumatic degloving injury which the superficial fascia and skin are separated from the deep fascia through shearing forces. This process leads to the development of a potential space in which blood products and necrotic material can collect, potentially resulting in abscesses, cellulitis, or osteomyelitis. Most of these cases occur at the greater trochanter, gluteal musculature, proximal femur, and around the knee. However, there have been few reports of MLLs occurring in the lumbar region. In this report, we seek to present our experience with a case of a lumbar MLL and outline the diagnostic and operative management utilized. Case Report A 48-year-old female presented to our clinic with complaints of persistent low back and swelling 1 month after sustaining a fall from stand resulting in an L5 transverse process fracture. The patient was treated non-operatively but continued to have swelling noted to the lower back. A computed tomography scan demonstrated a large subcutaneous fluid collection measuring 15 cm×16 cm×7 cm centralized over the lower lumbar region. We elected to proceed with operative evacuation of the fluid collection. A 2 cm midline incision over the proximal aspect of the fluid collection was made and approximately 900 ml of serosanguinous fluid was evacuated. The cavity was then irrigated with a normal saline 0.9%/betadine solution and a wound vacuum-assisted closure (VAC) sponge was placed. The post-operative course was unremarkable and the wound VAC was discontinued at the first post-operative visit. The surgical incision went on to heal uneventfully with no signs of infection or fluid reaccumulation. Conclusion Although MLLs are rare, clinicians should maintain a high clinical suspicion in patients presenting after blunt trauma injuries with persistent pain, and fluid collections noted on advanced imaging. Conservative management can be initiated if discovered acutely, but if left untreated may require surgical intervention and evacuation of fluid as described in this case.
Collapse
|
22
|
An Analysis of Our Ten-Year Cohort of Patients with Cardiac Amyloidosis Supported by the Continuous-Flow Left Ventricular Assist Device. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
23
|
EP.74Review of glucocorticoid treatment effects in an adult population of Duchenne muscular dystrophy attending the National Hospital for Neurology and Neurosurgery in London. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
24
|
|
25
|
EP.103Genetic and phenotypic characterisation of inherited myopathies in a tertiary neuromuscular centre. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
26
|
P.02Phase 2/3 study of Arimoclomol in sporadic inclusion body myositis: study design. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
27
|
CEP-stable high-energy ytterbium-doped fiber amplifier. OPTICS LETTERS 2019; 44:3909-3912. [PMID: 31415509 DOI: 10.1364/ol.44.003909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/10/2019] [Indexed: 06/10/2023]
Abstract
We report on the carrier-envelope phase (CEP) stabilization of a Yb-doped fiber amplifier system delivering 30 μJ pulses at 100 kHz repetition rate. A single-shot, every-shot measurement of the CEP stability based on a simple f-2f interferometer is performed, yielding a CEP standard deviation of 320 mrad rms over 1 s. Long-term stability is also assessed, with 380 mrad measured over 1 h. This level of performance is allowed by a hybrid architecture, including a passively CEP-stabilized front-end based on difference frequency generation and an active CEP stabilization loop for the fiber amplifier system, acting on a telecom-grade integrated LiNbO3 phase modulator. Together with recent demonstrations of temporal compression down to the few-cycle regime, the presented results demonstrate the relevance of the Yb-doped high repetition rate laser for attoscience.
Collapse
|
28
|
Abstract
Background: Open reduction and internal fixation (ORIF) methods, primarily plates and screws, remain the standard of treatment for distal fibular fractures. This study evaluates the use of a cannulated intramedullary screw as a minimally invasive treatment method for distal fibular fractures, which has not been reported in the current literature. Methods: This retrospective study included 45 patients with distal fibular fractures treated with cannulated intramedullary screw fixation. All patients included in the cohort had a soft-tissue condition and/or comorbidity. The mean age was 54 years. The Weber classification system was used to assess the type of fracture. Average time to union, average time to weight bearing, and complications were monitored. Results: Reduction quality criteria were collected using previously published guidelines. Accordingly, reduction was determined to be good in 25 cases, fair in 15, and poor in 5. A low complication rate of 4% was reported. Average time to union was 10 weeks (range = 8-36 weeks), whereas average time to weight bearing was 14 weeks (range = 8-40 weeks). Conclusion: Cannulated intramedullary screw fixation can serve as a minimally invasive, safe, and satisfactory treatment for distal fibular fractures with resulting high union rates and low complication rates. Levels of Evidence: Level IV: Retrospective, case series.
Collapse
|
29
|
|
30
|
High-power two-cycle ultrafast source based on hybrid nonlinear compression. OPTICS EXPRESS 2019; 27:1958-1967. [PMID: 30732241 DOI: 10.1364/oe.27.001958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/30/2018] [Indexed: 06/09/2023]
Abstract
We demonstrate a hybrid dual-stage nonlinear compression scheme, which allows the temporal compression of 330 fs-pulses down to 6.8 fs-pulses, with an overall transmission of 61%. This high transmission is obtained by using a first compression stage based on a gas-filled multipass cell, and a second stage based on a large-core gas-filled capillary. The source output is fully characterized in terms of spectral, temporal, spatial, and short- and long-term stability properties. The system's compactness, stability, and high average power makes it ideally suited to drive high photon flux XUV sources through high harmonic generation.
Collapse
|
31
|
Universal intracellular biomolecule delivery with precise dosage control. SCIENCE ADVANCES 2018; 4:eaat8131. [PMID: 30402539 PMCID: PMC6209385 DOI: 10.1126/sciadv.aat8131] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/02/2018] [Indexed: 05/06/2023]
Abstract
Intracellular delivery of mRNA, DNA, and other large macromolecules into cells plays an essential role in an array of biological research and clinical therapies. However, current methods yield a wide variation in the amount of material delivered, as well as limitations on the cell types and cargoes possible. Here, we demonstrate quantitatively controlled delivery into a range of primary cells and cell lines with a tight dosage distribution using a nanostraw-electroporation system (NES). In NES, cells are cultured onto track-etched membranes with protruding nanostraws that connect to the fluidic environment beneath the membrane. The tight cell-nanostraw interface focuses applied electric fields to the cell membrane, enabling low-voltage and nondamaging local poration of the cell membrane. Concurrently, the field electrophoretically injects biomolecular cargoes through the nanostraws and into the cell at the same location. We show that the amount of material delivered is precisely controlled by the applied voltage, delivery duration, and reagent concentration. NES is highly effective even for primary cell types or different cell densities, is largely cargo agnostic, and can simultaneously deliver specific ratios of different molecules. Using a simple cell culture well format, the NES delivers into >100,000 cells within 20 s with >95% cell viability, enabling facile, dosage-controlled intracellular delivery for a wide variety of biological applications.
Collapse
|
32
|
CONGENITAL MUSCULAR DYSTROPHIES. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
33
|
CONGENITAL MYASTHENIC SYNDROMES AND MYASTHENIA. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
34
|
192 Utility of Unmanned Aircraft Systems (Drones) in Inner City Emergent Response During Peak Rush Hour. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
35
|
THE EFFICACY AND SAFETY OF APIXABAN VERSUS WARFARIN ARE PRESERVED IN PATIENTS WITH ATRIAL FIBRILLATION AND EXTREME BODY WEIGHT: INSIGHTS FROM THE ARISTOTLE STUDY. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
36
|
P976Elevated biomarkers are associated with increased risk of death and heart failure hospitalization in patients with atrial fibrillation: insights from the ARISTOTLE trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
37
|
Nonlinear pulse compression based on a gas-filled multipass cell. OPTICS LETTERS 2018; 43:2252-2255. [PMID: 29762565 DOI: 10.1364/ol.43.002252] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/05/2018] [Indexed: 06/08/2023]
Abstract
We demonstrate nonlinear temporal compression of a high-energy Yb-doped fiber laser source in a multipass cell filled with argon. The 160 μJ 275 fs input pulses are compressed down to 135 μJ 33 fs at the output, corresponding to an overall transmission of 85%. We also analyze the output beam, revealing essentially no space-time couplings. We believe this technique can be scalable to higher pulse energies and shorter pulse durations, enabling access to a wider parameter range for a large variety of ultrafast laser sources.
Collapse
|
38
|
An incidental finding of severe hyperferritinaemia: a lesson to be learned. J R Coll Physicians Edinb 2018; 48:30-32. [PMID: 29741522 DOI: 10.4997/jrcpe.2018.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Haemophagocytic lymphohistiocytosis is a rare, under-recognised and often misdiagnosed condition, characterised by a hyperinflammatory response to malignancy or infection. In this case, the cause was a bone marrow isolated anaplastic large cell lymphoma without radiological evidence of systemic disease, a phenomenon rarely described. We present the case of a previously fit and well 64-year-old female who presented on multiple occasions to primary and secondary care in a stable condition with an undifferentiated illness with the only consistent feature being a marked, unexplained hyperferritinaemia. The history highlights the importance of ferritin as a marker of phagocytic activity and how severely high levels, even in the well patient, should prompt early bone marrow biopsy. The prognosis of haemophagocytic lymphohistiocytosis is invariably poor as the condition is usually secondary to a serious underlying disease such as haematological malignancy as in this case. The diagnostic difficulty often leads to delayed recognition and treatment.
Collapse
|
39
|
Novel loss-of-function mutation in ACBD5 found in family with ataxia. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30418-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
40
|
Muscle and neuronal peripheral biomarkers for spinal and bulbar muscle atrophy: muscle holds more promise. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30367-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
41
|
Analysis of premature mortality in a cohort of adult Duchenne muscular dystrophy. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30343-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
42
|
Neuro-muscular bridges: development of an evidence based selfmanagement resource for people with neuro-muscular diseases. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30412-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
43
|
Abstract
Aims and MethodQuantifying the relationship between waiting time and clinic attendance in child and adolescent psychiatry would allow better estimation of the resources needed to eliminate waiting lists in specific initiatives. All cases on a waiting list were sent a questionnaire, return of the questionnaire being necessary for an appointment to be made. Those who did not return the questionnaire or did not attend were contacted and a reason obtained whenever possible. The data were analysed using Cox regression.ResultsMost who did not return their questionnaires had been waiting less than four weeks or longer than 30 weeks. Questionnaire return seemed a good estimate of intention to attend. Other factors improving questionnaire return were younger patient age, previous experience of the service, a clear common reason for referral, and a non-general practitioner referral source.Clinical ImplicationsWaiting lists in child and adolescent psychiatry may have a natural ‘endpoint’ at 30 weeks beyond which families give up, while waiting lists of less than one-month may be too short to lose transient problems. Failure to include this and other indicators of non-attendance may lead to overestimates of resources needed to remove queues for treatment. Questionnaires may be useful in identifying those intending to attend.
Collapse
|
44
|
Neonatal Acute Kidney Injury: A Survey of Neonatologists' and Nephrologists' Perceptions and Practice Management. Am J Perinatol 2018; 35:1-9. [PMID: 28709164 DOI: 10.1055/s-0037-1604260] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Neonatal acute kidney injury (AKI) occurs in 40 to 70% of critically ill neonatal intensive care admissions. This study explored the differences in perceptions and practice variations among neonatologists and pediatric nephrologists in diagnostic criteria, management, and follow-up of neonatal AKI. METHODS A survey weblink was emailed to nephrologists and neonatologists in Australia, Canada, New Zealand, India, and the United States. Questions consisted of demographic and unit practices, three clinical scenarios assessing awareness of definitions of neonatal AKI, knowledge, management, and follow-up practices. RESULTS Many knowledge gaps among neonatologists, and to a lesser extent, pediatric nephrologists were identified. Neonatologists were less likely to use categorical definitions of neonatal AKI (p < 0.00001) or diagnose stage 1 AKI (p < 0.00001) than pediatric nephrologists. Guidelines for creatinine monitoring for nephrotoxic medications were reported by 34% (aminoglycosides) and 62% (indomethacin) of respondents. Nephrologists were more likely to consider follow-up after AKI than neonatologists (p < 0.00001). Also, 92 and 86% of neonatologists and nephrologists, respectively, reported no standardization or infrastructure for long-term renal follow-up. CONCLUSION Neonatal AKI is underappreciated, particularly among neonatologists. A lack of evidence on neonatal AKI contributes to this variation in response. Therefore, dissemination of current knowledge and areas for research should be the priority.
Collapse
|
45
|
P297 Topsy-turvy over scurvy: vitamin C deficiency masquerading as systemic lupus erythematosus in a 20-year-old female. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
46
|
55 History, Physical Exam, and Emergency Department Bedside Ultrasound for the Diagnosis of Acute Appendicitis in Pediatric Patients. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
47
|
Functional fatigue in a sample of the UK myasthenic population. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
48
|
|
49
|
Myostatin expression levels in neuromuscular diseases participates in anti-myostatin clinical failure. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
50
|
Reversible endogenous downregulation of myostatin pathway in wasting neuromuscular diseases explains challenges of anti-myostatin therapeutic approaches. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|