The R value between mortality at 30 days and mortality at one year was 0.53, which improved to 0.7 and 0.76 at 60 and 90 days.

Mortality at 30 days correlated poorly with mortality at one year. Hospitals that were high- or low-performing at 30 days frequently were no longer within the same performance group at one year.

Mortality at 30 days correlated poorly with mortality at one year. Hospitals that were high- or low-performing at 30 days frequently were no longer within the same performance group at one year.The SARS-COV-2 pandemic has brought unparalleled challenges to healthcare provision. Being a newly discovered virus, there is a lack of previous experience and published evidence to guide healthcare providers on how to deliver services. We would like to share our approach to service delivery in a newly open children’s hospital in the United Arab Emirates with a particular focus on paediatric orthopaedic services.

Major trauma has seen a demographic shift in recent years and it is expected that the elderly population will comprise a greater burden on the major trauma service in the near future. However, whether a similar trend exists in those undergoing operative intervention for spinal trauma remains to be elucidated.

To compare the presentation and outcomes of patients ≥65 years of age sustaining spine trauma to those <65 years at a national tertiary referral spine centre.

The local Trauma Audit Research Network (TARN) database was analysed to identify spinal patients referred to our institution, a national tertiary referral centre, between 01/2016 and 05/2019. Patients were divided into a young cohort (16-64 years old) and an elderly cohort (> 64 years old). No explicit distinction was made between major and minor spine trauma cases. Variables analysed included patient demographics, injury severity, mortality, interventions, mechanism of injury and length of hospital stay.

A total of 669 patients were ion. Even though severity of injury is similar for both young and old patients, the mechanism of injury for the older population is of typically much lower energy compared to the high energy trauma affecting younger patients.

Chest drains are placed after surgery to enable lung re-expansion. However, there remains little guidance on optimal placement. This study aims to identify the ideal size and position for chest drain insertion with regards to post-operative outcomes.

383 patients undergoing lobectomy in 1-year had their chest drain size and x-ray position noted (1 (apical), 2 (mid-zone) or 3 (basal)). Primary outcome was residual air space on immediate post-operative x-ray. Secondary outcomes were length of drain in situ (<72 versus ≥72h), persisting pleural effusion, surgical emphysema, post-operative pneumonia (POP), and length of hospital stay (<5 versus ≥5 days). Fisher’s exact analysis for the primary outcome and binary logistic regression analysis for all outcomes were used. Results presented as odds ratios (OR±95%CI).

Univariate analysis for residual air space showed increased risk in area 2 (OR=1.61, p=0.041) and 3 (OR=2.59, p=0.0043) compared with area 1. Multivariate analysis for residual air space showed increased risk in area 2 (OR=2.39, p<0.001) and 3 (OR=2.86, p<0.001) compared with area 1. Drain size had no impact on residual air space in univariate or multivariate analysis. Multivariate analysis showed area 2 drains remained in situ for >72h (OR=1.49, p=0.017), had persisting effusions (OR=2.03, p=0.004) and POP (OR=2.10, p=0.023) compared with area 1. This risk is magnified further for drains in area 3. Drains ≥28F had reduced risk of surgical emphysema (OR=0.23, p=0.027) in multivariate analysis.

A ≥28F, apical chest drain reduces the risk of post-operative complications, allowing early removal and discharge.

A ≥28F, apical chest drain reduces the risk of post-operative complications, allowing early removal and discharge.

In the present study, we investigated the effect of carbohydrate responsive element binding protein (ChREBP) on the TXNIP/oxidative stress and apoptosis in diabetic nephropathy.

ChREBP

mice (8-week old) were produced using the CRISPR/Cas9 gene editing approach. Diabetes was induced in C57BL/6 mice with streptozotocin. HK-2 cells was transfected with plasmid containing either ChREBP shRNA or TXNIP siRNA.

Renal expression of ChREBP and thioredoxin-interacting protein (TXNIP) was increased in patients with type 2 diabetes mellitus (T2DM) and diabetic mice. ChREBP deficiency improved renal function, apoptosis as well as endoplasmic reticulum (ER) stress in diabetic mice. In addition, ChREBP deficiency prevented expression levels of TXNIP and NADPH oxidase 4 (Nox4), 8-hydroxydeoxyguanosine (8-OHdG) and heme oxygenase-1 (HO-1) in diabetic kidneys. The increased urinary 8-OHdG level induced by diabetes was also attenuated in ChREBP deficiency mice. Similarly, HG was shown to induce ChREBP expression and nuclear translocation in HK-2 cells. HG-induced apoptosis was inhibited by transfection of ChREBP shRNA plasmid. Moreover, we found that knockdown of ChREBP suppressed HG-induced TXNIP and Nox4 expression, reactive oxygen species (ROS) generation and ER stress in HK-2 cells. Furthermore, TXNIP knockdown effectively abrogated HG-induced apoptosis in HK-2 cells.

These results suggest that ChREBP deficiency prevents diabetes-induced apoptosis via inhibiting oxidative stress and ER stress, highlighting ChREBP as a potential therapy target for diabetic nephropathy.

These results suggest that ChREBP deficiency prevents diabetes-induced apoptosis via inhibiting oxidative stress and ER stress, highlighting ChREBP as a potential therapy target for diabetic nephropathy.

Decreased sleep quality and lower heart rate variability (HRV) have both independently been associated with diabetes and may contribute to risks for cardiovascular disease. Although poor sleep quality has been associated with lower HRV in adults with type 2 diabetes (T2D), studies of sleep quality in adolescents with (T2D) or studies examining the possible association of poor sleep quality with lower HRV in adolescents with T2D or T1D are not available.

Thus, we conducted a secondary analysis of data from an existing study to determine if there were associations between sleep quality and HRV in adolescents with T1D or T2D.

Adolescents with T1D (n=101) or T2D (n=37) completed 24-h HRV Holter monitoring and analysis and a self-reported global measure of sleep quality.

Poor sleep quality was significantly associated with lower HRV, a known predictor for CV risk. Those with T2D had lower measures of HRV.

The evaluation of sleep quality and early signs of cardiovascular autonomic changes should be considered in routine assessments of adolescents with diabetes. Future research is warranted to examine more robust measures of sleep and HRV in adolescents with diabetes.

The evaluation of sleep quality and early signs of cardiovascular autonomic changes should be considered in routine assessments of adolescents with diabetes. Future research is warranted to examine more robust measures of sleep and HRV in adolescents with diabetes.

To compare the outcomes of sodium glucose linked cotransporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase 4 inhibitors (DPP4i) in hospitalized patients.

Electronic medical records-based cohort study. Identification of patients with type 2 diabetes and treatment with SGLT2i (n=466) or DPP4i (n=1541). Outcomes compared between those who received SGLT2i and those who received DPP4i. The primary outcome adjusted percentage of blood glycemia within 4-10mmol/L.

After adjustment, SGLT2i use had a statistically equivalent percentage of glycemia within range (coefficient 4.55, 95% CI -3.23 to 12.32, p=0.25) or <4mmol/L (coefficient -0.17, 95% CI -0.71 to 3.72, p=0.54). There were no significant differences in hospital length of stay (p=0.22), complications, (p=0.11) or mortality (p=0.57). When measured, ketone levels were higher in the SGLT2i group on admission, but lower on days 3, 4 and 5 (p<0.001 for interaction). Bicarbonate levels were not statistically different between groups. Finally, 54% of patients whose SGLT2i was ceased during admission, were discharged home without it.

Among inpatients with type 2 diabetes, SGLT2i use was associated with equivalent within-target glycaemia and no significant increase in hypoglycemia, ketonemia, or lower bicarbonate levels. These hypothesis-generating findings support further investigation of SGLT2i therapy in inpatients.

Among inpatients with type 2 diabetes, SGLT2i use was associated with equivalent within-target glycaemia and no significant increase in hypoglycemia, ketonemia, or lower bicarbonate levels. These hypothesis-generating findings support further investigation of SGLT2i therapy in inpatients.

Obese patients with respiratory failure need more intensive care and invasive mechanical ventilation than their non-obese counterparts. We aimed to evaluate the impact of body mass index and obesity related conditions on fatal outcome during a hospitalization for COVID-19.

From March 1 to April 30, 2020, 425 consecutive patients with severe acute respiratory syndrome coronavirus 2 were hospitalized at University Medical Center, in New Orleans. Clinical variables, comorbidities, and hospital course were extracted from electronic medical records. Special attention was given to obesity related conditions like hypertension, type 2 diabetes, and dyslipidemia. Severe obesity was defined as a body mass index ≥35-<40kg/m

and morbid obesity as body mass index ≥40kg/m

. Risk of mortality was determined by applying multivariate binary logistic regression modeling to risk factor variables (age, sex, race, and Charlson comorbid score).

Patients were mostly African American (77.9%) and 51.0% were women. Age and Charlson comorbidity index scores averaged 60 (50-71years) and 3.0 (1.25-5), respectively. In-hospital mortality was greater in morbidly obese than non-morbidly obese patients. Of the 64 severely obese patients, 16 had no obesity related conditions, and 48 had at least one obesity related condition hypertension (60%), type 2 diabetes mellitus (28%), and dyslipidemia (20%). In-hospital mortality was greater in severely obese patients with than without at least one obesity related condition.

During a hospitalization for COVID-19, severely obese patients with at least one obesity related condition and morbidly obese patients have a high mortality.

During a hospitalization for COVID-19, severely obese patients with at least one obesity related condition and morbidly obese patients have a high mortality.

To describe injury profiles of Australian football players and explore trends across five, women’s and girls’ competition levels.

Prospective cohort study.

Injuries were prospectively recorded by team personnel across one or two seasons of Australian football (2017-18 and/or 2018-19) including five, women’s and girls’ competition levels (elite senior, non-elite senior, high-level junior, non-elite junior (14-17 years), and non-elite junior (10-13 years)). Injury incidence rates were calculated per 1000 h and injury prevalence calculated for pre-season, early-season, mid-season, and late-season. Descriptive statistics present injury profiles according to activity, body region, pathology, mechanism, and severity.

From the 392 included players, 760 injuries were recorded. Overall injury incidence was 20.9 injuries per 1000 h. Injury prevalence was highest during pre-season (64.1%). Most injuries were to the lower extremity (n = 440; 58.0%). Ligament/joint sprain injuries were common (n = 147, 19.3%). Several injuries resulted from contact mechanisms (n = 314, 61.4%), with many due to contact with another player (n = 131, 52.8%). Injuries resulting in time lost from participation were common (n = 444, 58.9%). Competition level injury trends were observed, with elite senior (125.1 injuries per 1000 h) and high-level junior (116.9 injuries per 1000 h) players having greater match injury incidence compared to their non-elite counterparts (15.5-41.4 injuries per 1000 h).

This study provides preliminary insight into injury profiles of Australian football players in women’s and girls’ competitions. These findings can drive future injury risk reduction research specific to this population across the developmental pathway.

This study provides preliminary insight into injury profiles of Australian football players in women’s and girls’ competitions. These findings can drive future injury risk reduction research specific to this population across the developmental pathway.

The aim of this study was to explore expert opinion to identify the components of sprinting technique they believed to be risk factors for hamstring strain injuries (HSI).

Mixed-method research design.

The Concept Systems groupwisdom™ web platform was used to analyse and collect data. Participants brainstormed, sorted and rated the components of sprinting technique to consider in a HSI prevention strategy.

Twenty-three experts (academic/researcher, physiotherapist, strength and conditioning coaches and sprint coaches) brainstormed 66 statements that were synthesised and edited to 60 statements. Nineteen participants sorted the statements into clusters and rated them for relative importance and confidence they could be addressed in a hamstring injury prevention program. Multidimensional scaling and cluster analysis identified a 8-cluster solution modified to a 5-cluster solution by the research team Training prescription (10 statements, mean importance 3.79 out of 5 and mean confidence 3.79); Neuromuscular and tendon properties (9, 3.09, 3.08); Kinematics parameters/Technical skills (27, 2.99, 2.98); Kinetics parameters (10, 2.85, 2.92); and Hip mechanics (4, 2.70, 2.63). The statement „low exposure to maximal sprint running” located in the cluster „Training prescription” received the highest mean importance (4.55) and confidence ratings (4.42) of all statements.

The five clusters of components of sprinting technique believed to be risk factors for HSIs in order of most to least important were training prescription, neuromuscular and tendon properties, kinematics parameters/technical drills, kinetics parameters and hip mechanics.

The five clusters of components of sprinting technique believed to be risk factors for HSIs in order of most to least important were training prescription, neuromuscular and tendon properties, kinematics parameters/technical drills, kinetics parameters and hip mechanics.

Currently, there is no effective therapy for mucopolysaccharidosis IIIA (MPS IIIA). Intravenously-administered enzyme replacement therapies, while effective in other forms of MPS without neurological involvement, have not been successful in patients with MPS IIIA, as they are unable to cross the blood-brain barrier to improve neurological symptoms. We evaluated the long-term safety, tolerability, and clinical outcomes of recombinant human heparan-N-sulfatase (rhHNS) administered intrathecally (IT) in children with MPS IIIA in a phase 1/2 extension study.

Patients aged ≥3years with MPS IIIA who had previously completed a phase 1/2 study and received ≥5 of the 6 planned rhHNS infusions via IT administration, were eligible for inclusion. Patients who received 10mg in the phase 1/2 study had their dose increased to 45mg. Patients who were treated with 45mg or 90mg rhHNS IT in the phase 1/2 study remained on this monthly dose in the extension study. rhHNS was administered via an intrathecal drug delivery devic12% in the 10/45, 45, and 90mg groups, respectively, at Month 54.

Overall, rhHNS IT was well tolerated in the extension study. However, rhHNS IT was unable to slow the neurocognitive decline of patients with MPS IIIA. This study was subsequently terminated early because pre-specified efficacy criteria were not met, and the study did not yield clinical proof of concept. (Clinicaltrials.gov Identifier NCT01299727).

Overall, rhHNS IT was well tolerated in the extension study. However, rhHNS IT was unable to slow the neurocognitive decline of patients with MPS IIIA. This study was subsequently terminated early because pre-specified efficacy criteria were not met, and the study did not yield clinical proof of concept. (Clinicaltrials.gov Identifier NCT01299727).

Impaired cognition increases suicide risk while social connectedness protects against suicide risk in late life. We examined the independent and interactive effects of social connectedness and cognition on suicide risk in late life.

Participants included 570 individuals aged 50+ from a late-life suicide study. The Interpersonal Support Evaluation List and Social Network Index were used to assess perceived and objective social connectedness, respectively, while the Mattis Dementia Rating Scale and Executive Interview were used to assess cognition.

Suicide attempters and ideators reported lower perceived social connectedness and exhibited worse executive function than non-suicidal depressed and healthy comparison participants, while only attempters had worse objective social connectedness relative to the other groups. Executive dysfunction was linked to low objective social connectedness in attempters but higher objective social connectedness in healthy comparisons.

Interventions targeting suicide risk may consider bolstering social connectedness, particularly in those with low cognitive health.

Interventions targeting suicide risk may consider bolstering social connectedness, particularly in those with low cognitive health.The aim is to present a single-center case series of patients with symptomatic hyperpronated feet treated with arthroereisis by using a second generation extra-osseous talo-tarsal stabilization device. This case series enrolled 123 feet in 87 patients (20 [6-75] years) treated with arthroereisis, either isolated (76 cases) or combined procedure (47 cases). At their final follow-up, a patient reported questionnaire (overall satisfaction, foot stability and shape, activities of daily living, pain level, and analgesics usage) was distributed. The average postoperative follow-up period was 30 (13-55) months. Nineteen (15%) cases required at least one revision surgery the implant was manipulated in 5 (4%), while 14 cases (11%) required definitive implant removal. The predominant reason for implant removal was pain (50%), followed by implant migration (27%). The pediatric population with isolated procedure showed lowest revision rate (5%), while adults with combined ankle/hindfoot procedures demonstrated revision rate of 50%. The overall patient satisfaction after arthroereisis was 84%. The patients’ perceived improvement in foot stability was 75%, foot shape 85%, and activities of daily living 64%. Eighty-two percent of cases reported no analgesics usage in the last month and mean visual analogue scale (0-10) pain level decreased from 5.5 to 2.2 (p less then .001). The subgroup analyses of patient-reported questionnaires revealed the best outcome in the pediatric-isolated cases, while adults with combined procedures reported the lowermost outcome. Extra-osseous talo-tarsal stabilization demonstrated a low rate of revisions surgery and a high satisfaction rate as an isolated procedure. Patients with conjoined procedures experienced more revisions and considerably lower satisfaction rates.The aim of this study was to evaluate the value of intraoperative conebeam computed tomography (CBCT) imaging in the treatment of zygomaticomaxillary complex (ZMC) fractures. A prospective single center cohort study was performed. Included were consecutive patients who underwent surgery for a unilateral ZMC fracture. An intraoperative CBCT scan was performed after reduction of the ZMC fracture. Revision reduction was performed of the ZMC and/or orbital floor (OF) on indication. The preoperative and postoperative asymmetry of the outer surface of the ZMC was measured on digital 3D-models of CBCT scans, using a mirroring and surface-based matching technique. The postoperative asymmetry of the ZMC in the study group was compared to the asymmetry of the ZMC in the control group with healthy individuals. A total of 38 patients with a unilateral ZMC fracture were included. The mean postoperative asymmetry in the study group (1.67 mm, SD 0.89) was less than the mean preoperative asymmetry (2.69 mm, SD 0.95) (paired samples T-test p less then 0.01) but showed no statistically significant difference with the mean asymmetry in the healthy control group (1.40 mm, SD 0.54) (independent samples T-test p = 0.31). Revision reduction of the ZMC and/or OF fracture had been performed in 11 cases after malalignment was noted on the intraoperative CBCT. The indication for intraoperative revision reduction was associated with comminuted ZMC fractures and/or fractures with indication for OF reduction (Pearson Chi Square p less then 0.01). Within the limitations of the study, intraoperative CBCT imaging seemed to have a positive influence on ZMC fracture treatment, especially in the case of comminuted ZMC fractures and/or fractures with indication for OF treatment.

Accumulating data have suggested that long non-coding RNAs (lncRNAs) play important roles in regulating tumor cell growth. This study was designed to investigate the role of SNHG16 in hepatocellular carcinoma (HCC).

SNHG16 expression was detected with real-time polymerase chain reaction (PCR). The cutoff value of SNHG16 for tumor-free survival (TFS) was determined with receiver operating characteristic curve analysis. Small interfering RNA was used to inhibit the expression of SNHG16 in HCC cell lines. The biologic behavior of HCC cell was determined with cell viability assay and Transwell assay in vitro. The potential predictive value of SNHG16 on prognosis was analyzed by Kaplan-Meier curves and Cox proportional hazards regression model.

SNHG16 expression was upregulated in tumor tissues and HCC cell lines. High expression of SNHG16 was associated with tumor recurrence and poor prognosis after surgery. Multivariate analysis revealed that SNHG16 was an independent prognostic factor for poor recurrence-free survival. Moreover, inhibition of SNHG16 in HepG2, Hep3B, and BEL-7402 cells significantly reduced cell invasiveness and proliferation. Mechanistic analyses indicated that the ECM-receptor interaction pathway was remarkably activated by SNHG16.

SNHG16 might be a promising biomarker for predicting tumor recurrence in HCC patients after surgery and a potential therapeutic target for HCC.

SNHG16 might be a promising biomarker for predicting tumor recurrence in HCC patients after surgery and a potential therapeutic target for HCC.

There is some interest in long-term survival after various cardiac surgical strategies, including off-pump versus on-pump coronary artery surgery (CAG), mitral valve (MV) repair versus replacement, and aortic valve (AV) bioprosthetic versus mechanical replacement.

We studied patients older than 49 years of age, recording risk factors and surgical details at the time of surgery. We classified procedures as MV surgery with or without concurrent grafts or valves; AV surgery with or without concurrent CAG; or isolated CAG. Follow-up was through the state death register and state-wide hospital attendance records. Risk-adjusted survival was estimated using Cox proportional hazards. Observed survival was compared to the expected age- and sex- matched population survival.

During a median follow-up of 14.8 years 5,807 of 11,718 patients died. The difference between observed and expected survival varied between 3.4 years for AV surgery and 9.6 years for females undergoing MV surgery. The risk-adjusted mortality hazard rate after off-pump CAG was 0.93 (95% CI 0.8-1.0, p=0.84), MV repair 0.67 (95% CI 0.6-0.8, p<0.0001), MV bioprosthesis 0.82 (95% CI 0.81 (0.6-1.0, p=0.11) and bioprosthetic AV replacement 1.02 (95% CI 0.9-1.2, p=0.82).

Compared to the general population, cardiac surgical patients have a shorter than expected life expectancy. We observed a survival benefit of mitral valve repair over replacement. We did not observe significant survival differences between off-pump and on-pump CAG, nor between bioprosthetic and mechanical replacement.

Compared to the general population, cardiac surgical patients have a shorter than expected life expectancy. We observed a survival benefit of mitral valve repair over replacement. We did not observe significant survival differences between off-pump and on-pump CAG, nor between bioprosthetic and mechanical replacement.Minimally invasive cardiac surgery is mainly dedicated to acquired left-sided valve diseases. Ministernotomy is widely used for aortic valve repair or replacement, whereas pulmonary valve repair via this approach has been reported only recently. This article aims to describe the use of ministernotomy for pulmonary valve replacement in adult congenital patients.

Cardioplegia is one of the most studied fields of myocardial protection during cardiac surgery. However, the most effective cardioplegia for protection in adult cardiac surgery remains unknown.

PubMed and other databases were searched and a network meta-analysis with a Bayesian framework was performed. The primary outcomes were the serum concentrations of creatine kinase-myocardial band (CK-MB), cardiac troponin I, and cardiac troponin T (cTnT) at four time points. Several clinical outcomes were evaluated, including low output syndrome, myocardial infarction, and risk of early mortality. All studies that involved crystalloid cardioplegia without reference to St Thomas cardioplegia or histidine-tryptophan-ketoglutarate solution, and if the cardioplegia was used at a temperature between 4°C and 16°C were classified as cold crystalloid (cCCP) or cold blood cBCP cardioplegia. Warm blood cardioplegia (wBCP) was defined as the blood cardioplegia used at a temperature between 32°C and 37°C.

Forty-seven (47) studies with a total of 4,175 patients were included. Seven (7) cardioplegia solutions were used, including cold CCP or BCP, del Nido solution, histidine-tryptophan-ketoglutaratesolution, St Thomas cardioplegia, wBCP and warm terminal blood cardioplegia (wtBCP).Theserum concentrations of CK-MB at 2 hours (mean difference [MD], 213.56; 95% confidence interval [CI],-25.79 to-1.59) and cTnT at 24 hours of wBCP (MD,-1.50; 95% CI,-2.69 to-0.31) were significantly lower than that of cCCP. There were no significant differences in other outcomes of these six cardioplegia solutions, when compared to cCCP.

The seven cardioplegia solutions analysed had similar myocardial protective effects after adult cardiac surgery, although wBCP had a lower CK-MB at 2 hours and lower cTnT at 24 hours.

The seven cardioplegia solutions analysed had similar myocardial protective effects after adult cardiac surgery, although wBCP had a lower CK-MB at 2 hours and lower cTnT at 24 hours.

Wheezing may lead to asthma and reduced pulmonary function in later life. The study aims to identify wheezing trajectories and investigate their relation with pulmonary function and asthma-related outcomes at 22 years of age.

Individuals from a population-based cohort in Brazil (1993 Pelotas Birth Cohort) with post-bronchodilator pulmonary function data at 22 years (3350) were included in the study. From parentally reported (4 and 11 years) and self-reported (15, 18 and 22 years) history of wheezing in the last 12 months, we used a group-based trajectory modelling approach to derive wheezing trajectories.

Four trajectories were identified never/infrequent, transient-early, late-onset and persistent wheeze. After adjustments, wheezing trajectories remained associated with lower post-bronchodilator values of pulmonary function. Individuals in the persistent wheeze trajectory had a markedly poorer pulmonary function and also showed greater odds of asthma-related outcomes compared to other trajectories groups. Those following this trajectory had on average-109 ml (95% CI-188;-35),-1.80 percentage points (95% CI-2.73;-0.87) and-316ml/s (95% CI-482;-150) lower FEV

, FEV

/FVC ratio and FEF

respectively; higher odds of self-reported medical diagnosis of allergy (OR 6.18; 95% CI 3.59; 10.61) and asthma (OR 12.88; 95% CI 8.91; 18.61) and asthma medication use (OR 9.42; 95% CI 5.27; 16.87) compared to the never/infrequent group.

Wheezing trajectories, especially the persistent wheeze trajectory, were related to lower pulmonary function values and increased risk of asthma and allergy diagnosis in early adulthood.

Wheezing trajectories, especially the persistent wheeze trajectory, were related to lower pulmonary function values and increased risk of asthma and allergy diagnosis in early adulthood.

To assess the effects of two sizes of silicone endotracheal tubes with internal diameter 26 mm (ETT

) and 30 mm (ETT

) inflated to minimum occlusive volume on tracheal and laryngeal mucosa of adult horses anesthetized for 2 hours with isoflurane.

Prospective, randomized, blinded, crossover experimental study.

A total of eight healthy adult mares.

Upper airway endoscopy and ultrasound measurements of internal tracheal diameter were performed the day before anesthesia. Horses were anesthetized and orotracheally intubated with ETT

or ETT

. Ease of intubation was scored. The cuff was inflated in 10 mL increments to produce a seal. Final volume of air used and intracuff (IC) pressure (measured by pressure transducer) were recorded. At the end of anesthesia, a manometer was used to measure IC pressure and these measurements compared against measurements from the pressure transducer. Laryngeal and tracheal mucosa were assessed via endoscopy and assigned a score 0-3 before anesthesia, and at 2 and 24 houndotracheal intubation is properly applied and IC pressure is carefully monitored. However, given that ETT26 was associated with the highest observed IC pressures and the only observed incidents of tracheal circumferential erythema, the larger ETT30 may be the better choice in most cases where tracheal size is sufficient.Emerging concern about the emergence of antimicrobial resistance has limited the use of antibiotics in calves. Hence, there is a need to find suitable alternatives to antibiotics to manage gastrointestinal infections in neonatal calves. The objective of the present study was to develop a probiotic of calf-origin for its potential application in calf nutrition. Accordingly, 69 lactic acid bacteria (LAB) strains were isolated from faeces of newborn calves, out of which 10 strains were short-listed for further in vitro testing based on the aggregation time and cell surface hydrophobicity. The results of acid-, bile- and phenol-tolerance tests indicated that out of the ten strains, the isolate CPN60 had better resistance to these adverse conditions likely to be encountered in the gastrointestinal tract. The isolate also showed an optimal ability to produce biofilm. Further assessments reiterated its superiority in terms of co-aggregation and antagonistic activity against pathogenic strains of Escherichia coli. Sudition to possessing all the in vitro functional attributes of a candidate probiotic, also has desirable potential for its future use in young calves to promote gut health and immunity.The demand for the amino acid l-cysteine is increasing in the food, cosmetic, and pharmaceutical industries. Conventionally, the commercial production of l-cysteine is achieved by its extraction from the acid hydrolysate of hair and feathers. However, this production method is associated with the release of environmentally hazardous wastewater. Additionally, l-cysteine produced from animal sources cannot be halal-certified, which limits the market size. Although recent studies have developed an alternative commercial l-cysteine production method based on microbial fermentation, the production yield was insufficient owing to the cytotoxicity of l-cysteine against the host cells. In a previous study, we had developed an in vitrol-cysteine production method with a combination of 11 thermophilic enzymes, which yielded 10.5 mM l-cysteine from 20 mM glucose. In this study, we performed re-screening for enzymes catalyzing the rate-limiting steps of the in vitro pathway. Subsequently, the genes encoding enzymes necessary for the in vitro synthesis of l-cysteine were assembled in an expression vector and co-expressed in a single strain. To prevent the synthesis of hydrogen peroxide (H2O2), which is a byproduct and inhibits the enzyme activity, the redox balance in this biosynthetic pathway was maintained by replacing the H2O2-forming NADH oxidase with another enzymatic reaction in which pyruvate was used as a sacrificial substrate. The re-designed in vitro synthetic pathway resulted in the production of 28.2 mM l-cysteine from 20 mM glucose with a molar yield of 70.5%.

To develop and validate a radiomic model, with radiomic features extracted from breast Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) from a 1.5T scanner, for predicting the malignancy of masses with enhancement. Images were acquired using an 8-channel breast coil in the axial plane. The rationale behind this study is to show the feasibility of a radiomics-powered model that could be integrated into the clinical practice by exploiting only standard-of-care DCE-MRI with the goal of reducing the required image pre-processing (ie, normalization and quantitative imaging map generation).

107 radiomic features were extracted from a manually annotated dataset of 111 patients, which was split into discovery and test sets. A feature calibration and pre-processing step was performed to find only robust non-redundant features. An in-depth discovery analysis was performed to define a predictive model for this purpose, a Support Vector Machine (SVM) was trained in a nested 5-fold cross-validation scheme, by exploiting several unsupervised feature selection methods. The predictive model performance was evaluated in terms of Area Under the Receiver Operating Characteristic (AUROC), specificity, sensitivity, PPV and NPV. The test was performed on unseen held-out data.

The model combining Unsupervised Discriminative Feature Selection (UDFS) and SVMs on average achieved the best performance on the blinded test set AUROC=0.725±0.091, sensitivity=0.709±0.176, specificity=0.741±0.114, PPV=0.72±0.093, and NPV=0.75±0.114.

In this study, we built a radiomic predictive model based on breast DCE-MRI, using only the strongest enhancement phase, with promising results in terms of accuracy and specificity in the differentiation of malignant from benign breast lesions.

In this study, we built a radiomic predictive model based on breast DCE-MRI, using only the strongest enhancement phase, with promising results in terms of accuracy and specificity in the differentiation of malignant from benign breast lesions.Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which require customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.

Financial toxicity is an underappreciated component of cancer survivorship. Treatment-specific out-of-pocket costs for patients undergoing localized prostate cancer treatment have not, to date, been described and may influence patient’s decision making.

We performed a retrospective cohort study among commercially-insured patients in the United States with incident prostate cancer from 2013 to 2018. We captured out-of-pocket and total costs in the year following diagnosis and compared these between patients receiving radical prostatectomy, radiotherapy, and no local treatment using propensity-score weighting adjusting for patient demographics and pre-diagnosis health utilization costs.

Among 30,360 included men [median age 59 years, 83% Charlson score 0], 15,854 underwent surgery, 5,265 radiotherapy, and 9,241 no local therapy in the year following diagnosis. In the 6-months preceding diagnosis, median overall and out-of-pocket health care costs were $2022 (interquartile range $3778) and $466 (interquartficantly higher out-of-pocket costs versus those who received no treatment, with little difference observed between treatment approaches.

In tumor immune microenvironment, the functions of tumor-associated macrophages (TAMs), including phagocytosis and immunomodulatory, have attracted increasing attention recently. With the discovery of CD47-signal regulatory protein-α (SIRPα) as „don’t eat me” signaling pathway, the role of novel subpopulation of TAMs expressing SIRPα has not been fully elucidated in a wide spectrum of solid tumors including bladder cancer. In this study, we investigated the prognostic and predictive implication of SIRPα

TAMs regarding clinical outcomes and adjuvant chemotherapeutic benefit in muscle-invasive bladder cancer (MIBC), and preliminarily characterized the phenotypic features of SIRPα

TAMs and its relationship with immune contexture.

A total of 141 histochemical MIBC samples from Zhongshan Hospital (ZS), 45 fresh tissue samples, and 391 MIBC patients from TCGA database were enrolled in this study. SIRPα

TAMs was evaluated by immunohistochemical staining of CD68 and SIRPα, and flow cytometry fluorescence std T cells states, suggesting the prospect of SIRPα+ TAMs as a potential therapeutic target in MIBC.The epidemic of opioid use in the United States has been declared a national public health crisis due to the rapid increase in drug overdose mortality. Physician overprescribing has been identified as one of many contributing factors, with most patients receiving excess opioid pain medication. Furthermore, there is a significant correlation between prescribed opioid dosage and mortality. Postoperative pain is a well-recognized clinical problem, but little has been done to advance or standardize pain management protocols. The purpose of this study was to determine the expected postoperative pain severity and quantity of opioid analgesic required for adequate pain management after laryngeal surgery.

Adult voice center patients who had recently undergone laryngeal surgery were included in this retrospective review. Tylenol #3 had been prescribed for all patients for pain management and they had been instructed to take additional over-the-counter acetaminophen as needed. In the senior author’s (RTS) practice, pan medications than men.

Most patients in this study reported mild to moderate postoperative pain. Adequate pain management was achieved using less pain medication tablets than the number prescribed. Type I thyroplasty was associated with more severe pain than other surgeries. Women used more OTC pain medications than men with no significant difference in reported pain level.

Most patients in this study reported mild to moderate postoperative pain. Adequate pain management was achieved using less pain medication tablets than the number prescribed. Type I thyroplasty was associated with more severe pain than other surgeries. Women used more OTC pain medications than men with no significant difference in reported pain level.Prevention of the recurrence of recurrent respiratory papillomatosis (RRP), a neoplasm of the respiratory tract, is a challenge. Human papillomavirus (HPV) vaccine has been expected to suppress the aggressiveness of RRP. However, there has been insufficient data to verify whether HPV vaccination can serve as an adjuvant therapy option for RRP. The aim of this study was to add our data on the efficacy of HPV vaccination for RRP to the academic discipline. Twenty-four RRP patients were treated with a combination therapy of surgery and three sessions of quadrivalent HPV vaccine. The patients’ clinical courses, which were HPV infection status changes, intersurgical interval, and disease severity score (Derkay’s site score), were statistically analyzed before and after combination therapy. Twelve of the 24 (52.5%) RRP patients who were HPV-DNA positive turned negative after the combination therapy. The mean of intersurgical interval was significantly extended from 6.85 ± 4.49 months to 30.5 ± 27.6 months after the therapy (P less then 0.01). The median of Derkay’s score of the participants also significantly decreased from 7.5 (interquartile range, 5-12) to 1 (interquartile range, 0-4.25) after the therapy (P less then 0.01). Thus, combination therapy comprising of surgery and HPV vaccination can postpone the recurrence and lessen the severity of RRP.

Preservation of natural hearing during cochlear implantation is associated with improved speech outcomes, however more than half of implant recipients lose this hearing. Real-time electrophysiological monitoring of cochlear output during implantation, made possible by recording electrocochleography using the electrodes on the cochlear implant, has shown promise in predicting hearing preservation. Sudden drops in the amplitude of the cochlear microphonic (CM) have been shown to predict more severe hearing losses. Here, we report on a randomized clinical trial investigating whether immediate surgical intervention triggered by these drops can save residual hearing.

A single-blinded placebo-controlled trial of surgical intervention triggered when CM amplitude dropped by at least 30% of a prior maximum amplitude during cochlear implantation. Intraoperative electrocochleography was recorded in 60 adults implanted with Cochlear Ltd’s Thin Straight Electrode, half randomly assigned to a control group and half to tly different (median gain required for speech reception score of 50% above noise of 6.9 dB for no drop, 8.6 for recovered CM, and 9.8 for CM drop, χ²=6.8, p=.032). Angular insertion depth was not significantly different between control and interventional groups.

This is the first demonstration that surgical intervention in response to intraoperative hearing monitoring can save residual hearing during cochlear implantation.

This is the first demonstration that surgical intervention in response to intraoperative hearing monitoring can save residual hearing during cochlear implantation.Selective serotonin reuptake inhibitors (SSRIs) have been the cornerstone for the treatment of depression, anxiety, obsessive-compulsive disorder, and panic disorder for a wide spectrum of age groups. Although the beneficial therapeutic properties are well recognized by the medical community, it also possesses many undesirable adverse effects with clinical manifestations. Some of the effects can be severe. This chapter highlights use of SSRIs, the mechanism of action, medication dosages, common drug to drug interactions, and recommendations on management of the oral and maxillofacial surgery patient on SSRIs.

In 2019, the total National Healthcare Expenditure (NHE) reached $3.8 trillion, or nearly 20% of the total Gross Domestic Product. This represents a 4-fold increase in its Gross Domestic Product share since 1960. Given the magnitude and growth of such expenditures, healthcare cost containment is central to the country’s financial sustainability. Moreover, as Medicare represents nearly 20% of the total NHE, it is a primary target for piloting, implementing and scaling initiatives that reduce expenditures.

To assess trends in Medicare Physician Fee Schedule for Service (Part B) payments and utilization for Imaging relative to other services from 2009 through 2019.

We conducted a retrospective observational study of annual expenditures and utilization of imaging services using data from Centers for Medicare and Medicaid Services Medicare Part B. Data was grouped according to the Berenson-Eggers Type of Service Classification. The values were adjusted for inflation and we calculated the annual changes and the compound annual growth rates and the price elasticity of supply.

For the 10-year period, Imaging represented on average 8% of the total Medicare Part B expenditures, an equivalent of 1.4% of total Medicare expenditures or 0.05% of the NHE. While NHE, overall Medicare and overall Part B had positive growth rates of total expenditures, Imaging did not. Moreover, Imaging had the most negative CAGR compared to all other categories, including Drugs, Procedures, Evaluation and Management and Durable Medical Equipment.

Imaging did not contribute to the increase in Medicare Part B expenditures, and it might have been disproportionately affected by cost containment policies.

Imaging did not contribute to the increase in Medicare Part B expenditures, and it might have been disproportionately affected by cost containment policies.

Since its inception, journal club has been a cornerstone to the life-long process of medical education. The virtual journal club (VJC), initiated as a robust solution to many educational challenges encountered during COVID-19 pandemic-related distance learning, provides an enduring and fluid forum for multilevel teaching and learning.

In this manuscript we share our institutions’ reasoning and methods to implement a VJC for multi-level learners. A standardized format applicable to all VJC sessions was adopted to ensure reproducibility from presenter to presenter. Sessions were held via video conference platforms. Pedagogy regularly emphasized in undergraduate medical education was adopted. Informal assessment of each session’s strengths and areas for improvement was performed.

A total of 30 sessions were held prior to manuscript submission, including discussion of 36 refereed journal articles from March 26, 2020, to April 20, 2021. The virtual journal club was very well received by all participants. The medical students and residents found the information current and engaging. The fellows stated that the journal club strengthened their knowledge base and enhanced communication and teaching skills. The attendings learned from its encouraged frank discussion of differing practice patterns. The format of these sessions offers an ideal setting to teach medical students and residents how to evaluate and employ evidence-based medicine and meets multiple LCME and ACGME requirements.

This VJC forum allows for development of essential nonclinical skills including lifelong active learning and analysis, peer collaboration, and technology adaptation and usage.

This VJC forum allows for development of essential nonclinical skills including lifelong active learning and analysis, peer collaboration, and technology adaptation and usage.

The novel SARS-CoV-2 (COVID-19) pandemic has dramatically altered the delivery of healthcare services, resulting in significant referral pattern changes, delayed presentations, and procedural delays. Our objective was to determine the effect of the COVID-19 pandemic on all-cause mortality in patients awaiting commonly performed cardiac procedures.

Clinical and administrative data sets were linked to identify all adults referred for (1) percutaneous coronary intervention; (2) coronary artery bypass grafting; (3) valve surgery; and (4) transcatheter aortic valve implantation, from January 2014 to September 2020 in Ontario, Canada. Piece-wise regression models were used to determine the effect of the COVID-19 pandemic on referrals and procedural volume. Multivariable Cox proportional hazards models were used to determine the effect of the pandemic on waitlist mortality for the 4 procedures.

We included 584,341 patients who were first-time referrals for 1 of the 4 procedures, of whom 37,718 (6.4%) were referal during the pandemic was associated with increased all-cause mortality while awaiting coronary revascularization.

Primary malignant bone tumors of the hand are rare in children. Resection and reconstruction of the digit are challenging and have been described in case reports. This retrospective study describes the functional and oncologic outcomes of resection and reconstruction using a nonvascularized fibular bone graft in a cohort of children.

A total of 5 children were included. The mean age at diagnosis was 7.6 years (range, 1.6-12 years). Histologic diagnosis showed Ewing sarcoma in 3 and osteosarcoma in 2 patients. Four tumors were located in the metacarpal bones of the fingers, and 1 was located in the thumb. Four patients were treated with chemotherapy. All the patients were treated with wide resection and a cement spacer. This was followed by second stage reconstruction using a nonvascularized fibular bone graft. In tumors of the fingers, carpometacarpal joint fusion with a neighboring carpal bone was performed, whereas a pseudoarthrosis was created between the graft and the base of the proximal phalanx. In the thumb’s case, the opposite was done, with fusion at the metacarpophalangeal joint and a pseudoarthrosis at the carpometacarpal joint.

The mean follow-up duration was 5.5 years (range, 2-9 years). Surgical margins were negative in all the patients. At their latest follow-up visit, none of the patients developed systemic or local recurrence. Two complications required a revision surgery, one due to graft subluxation and the other due to nonunion. At their final follow-up examination, the mean total arc of movement was 80° (range, 60°-100°), and all the patients were able to resume their grasping and writing capabilities.

The resection and reconstruction of primary malignant bone tumors of the metacarpals using a nonvascularized fibular bone graft in children can preserve the cosmesis and function of the digit without jeopardizing oncologic outcomes.

Therapeutic V.

Therapeutic V.

Currently, electrodiagnostic testing, which comprises electromyogram (EMG) and nerve conduction studies (NCS), is the most commonly used method for confirming the clinical diagnosis of carpal tunnel syndrome (CTS). Electromyogram and NCS can be costly, can require multiple visits, may induce anxiety, and may be painful for patients. The purpose of this study was to determine whether replacing EMG/NCS with ultrasound (US), performed by the treating surgeon, to diagnose CTS decreases time to surgery and the number of office visits.

We retrospectively reviewed a database that consisted of patients who presented to our department with numbness and/or tingling in the hand(s). We assessed the patients’ histories for any subsequent carpal tunnel release, dates of diagnosis, dates of surgery, the number of CTS-related medical visits, and diagnostic methods employed. A fellowship-trained hand surgeon performed US examination, and the patients were referred for EMG/NCS testing. We collected data prior to surgery using the Boston Carpal Tunnel Questionnaire to evaluate symptom severity scale and functional status scale scores.