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The role of residential distance in maternal breast milk intake in preterm and very low birthweight infants.
No full textOBJECTIVE: Study the association of residential distance in the context of other socioeconomic factors with the availability of maternal breast milk (MBM) to reduce barriers and improve outcomes for very low birthweight preterm infants.
STUDY DESIGN: This prospective cohort study analyzed demographic, socioeconomic, and clinical data from 300 maternal-preterm infant dyads with infants born \u3c 1500 g. Data included residential distance from the hospital, comorbidities, and infant MBM intake measured as a percentage of total enteral intake.
RESULTS: Bivariate analysis revealed that maternal race, median income by zip code, marital status, and residential distance were significantly associated with MBM intake. In a multivariate regression model, only residential distance and marital status remained significant predictors, with greater distance from the hospital and marriage status associated with higher MBM intake.
CONCLUSION: Residential distance from the studied hospital was not a significant barrier to breastfeeding. Hospitals need to examine their own barriers to breastfeeding
Survival with one versus three centimeters of active decompression during automated head-up CPR in a porcine cardiac arrest model.
No full textBACKGROUND: Automated head-up (AHUP) CPR, combining controlled head/thorax elevation, active compression-decompression CPR, and an impedance threshold device, has shown improved survival with favorable neurological outcomes versus conventional (C) CPR. The optimal amount of active lift (AD) during AHUP-CPR to optimize survival remains unknown. This study focused primarily on 24-h survival with 1-cm of active lift (AL-1 cm) with a rectilinear waveform versus 3-cm of active lift (AL-3 cm) with a trapezoidal waveform during AHUP-CPR.
METHODS: Anesthetized pigs (
RESULTS: ROSC occurred in 6/12 pigs with AL-1 cm vs 12/12 with AL-3 cm (
CONCLUSION: 24-h survival rates were significantly higher with AL-3 cm vs AL-1 cm during AHUP-CPR. Together with improved hemodynamics observed with AL-3 cm, these outcomes underscore the critical importance of AL-3 cm to optimize AHUP-CPR
Moving the Door-to-Needle: Structured Process Improvements Reduce Acute Ischemic Stroke Treatment Times
No full textTraumatic coronal spondyloptosis of the spine: case report and review of the literature.
No full textBACKGROUND: Traumatic coronal spondyloptosis (TCS) describes complete coronal subluxation of a vertebral body relative to an adjacent segment secondary to high-energy trauma. TCS commonly associates with orthopedic, intraabdominal, and thoracic solid organ injury, nuancing overall management. Surgery is indicated for subluxation reduction, deformity correction, and stabilization. Thoracolumbar junctional TCS has a sparse description in the literature. As a complex deformity encounterable by spinal surgeons regularly managing spinal cord injury and spinal trauma, appropriate surgical management requires an understanding of the various operative approaches as well as available intraoperative technical adjuncts. We accordingly discuss our surgical technique for subluxation reduction, deformity correction, and stabilization, and review approaches employed for similar reported cases.
CASE DESCRIPTION: We describe the case of a 36-year-old female presenting to Temple University Hospital after an automotive versus pedestrian injury. She demonstrated gross traumatic spinal deformity, secondary intraabdominal injuries, and was paraplegic on initial neurologic examination. After abdominal solid organ injury management and hemodynamic stabilization, the patient underwent standard pedicle screw fixation spanning the thoracolumbar junction from T9-L4, with complete coronal spondyloptosis correction achieved via manual caudal reduction after completion of a single-level unilateral facetectomy at T12-L1.
CONCLUSIONS: This complex traumatic spinal deformity underwent reduction and stabilization via techniques accessible to most spinal surgeons. Paraplegia on presentation obviated the need for intraoperative neuromonitoring and enabled muscle relaxant use to facilitate deformity correction. When requiring either neuromonitoring or a higher magnitude of distraction, we advise usage of distraction instrumentation and consideration of vertebrectomy for safe reduction. Understanding the variety of surgical options in the operative management of TCS is critical for safe and effective correction
Predictors of Postoperative Complications Following Cranioplasty.
No full textBACKGROUND AND OBJECTIVES: Cranioplasty is performed to restore the bone flap after previous brain surgery or trauma. Despite its elective nature, patients may be at risk for complications. Our study analyzes predictors of adverse events after cranioplasty and compares outcomes among patients undergoing very-early and standard cranioplasty.
METHODS: Patients who underwent cranioplasty were retrospectively identified from the TriNetX Research Network. A Cox proportional hazards model was used to assess the risk of mortality, surgical site infection (SSI), and need for revision cranioplasty. Propensity score matching was performed to compare adverse events based on timing of cranioplasty: very-early (≤1 month) and standard (\u3e1 month).
RESULTS: In total, 22 347 patients were included. Risk factors for mortality were being overweight/obese (hazard ratio [HR]: 1.15, 95% CI: 1.04-1.28, P \u3c .01), acute kidney failure/chronic kidney disease (HR: 1.28, 95% CI: 1.15-1.42, P \u3c .001), long-term steroid use (HR: 1.47, 95% CI: 1.24-1.75, P \u3c .0001), and history of opioid-related disorders (HR: 1.29, 95% CI: 1.01-1.65, P \u3c .05). Increasing risk of SSI was observed across different age groups. Risk factors for revision cranioplasty were White race (HR: 0.74, 95% CI: 0.62-0.89, P \u3c .01), diabetes mellitus (HR: 1.22, 95% CI: 1.05-1.42, P \u3c .01), and acute kidney failure/chronic kidney disease (HR: 1.30, 95% CI: 1.11-1.52, P \u3c .001). After propensity score matching, 2223 patients were included in each cohort. The very-early cohort had higher risk for all-cause mortality, use of critical care services, sepsis, pneumonia, urinary tract infection, hydrocephalus, epidural hemorrhage, acute kidney failure, headache, nausea, and vomiting compared with the standard cohort. The very-early cohort also had lower risk for revision cranioplasty, SSI, and infection of prosthetic devices.
CONCLUSION: Demographic variables, comorbid conditions, and procedure characteristics predict adverse events after cranioplasty. Very-early cranioplasty may carry increased risk for mortality but decreased risk for revisions compared with standard cranioplasty
Illicit Opioid Adulterant Trends in Patients Presenting with Acute Opioid Overdose.
No full textBACKGROUND: Clandestine fentanyl manufacturing oftentimes introduces adulterants and contaminants. This paper aims to evaluate trends in adulterants from a cohort of patients presenting to the emergency department (ED) with illicit opioid overdose across the United States.
METHODS: The Fentalog Study group is a multicenter toxicology study group which evaluated ED patients with suspected opioid overdose at 10 medical centers across the United States between September 21, 2020 through February 5, 2024. Comprehensive qualitative toxicology testing was performed on residual serum specimens. Study sites were divided into three geographic regions: West (California, Oregon, Colorado), Midwest (Missouri, Michigan), and East (New York, New Jersey, Pennsylvania, Georgia). Illicit opioids were defined as fentanyl and fentanyl analogs, heroin or its metabolites, and/or novel potent opioids such as nitazenes.
RESULTS: 1295 patients with confirmed illicit opioid overdose were included. Males accounted for the majority (73.7%) of patients. The median age was 39 (IQR: 31-54) years. Adulterants were detected in 745 (57.5%) patients. Quinine was the most abundantly encountered adulterant (433; 33.4%). Antihistamines were the most frequently detected class of adulterants (19.6%). There were significant differences in adulterants detected across the three time periods, with notable decreases in adulterants from time-period 1 (79.5%) to time-period 3 (41.7%; p \u3c 0.001). Adulterants were found in 84 (27.0%) of patients that presented to a hospital in the Western United States, compared with 181 (24.3%) in the Midwest, and 480 (64.4%) of patients in the East (p \u3c 0.001). Patients with concurrent cocaine were more likely having an adulterant present than those without cocaine present (OR 1.23; 95% CI 1.15-1.31). In contrast, patients with illicit opioids and concurrent methamphetamine were less likely to have adulterants present (OR 0.89; 95% CI 0.84-0.95).
CONCLUSIONS: Adulteration of illicit opioids was more likely in the Eastern United States and for those with concurrent cocaine and opioid exposures
Self-powered in-stent restenosis diagnosis via magnetoelastic stents.
No full textWidely used in millions of atherosclerosis treatments, conventional metal stents, although pervasive, only provide mechanical support to narrowed arteries. However, many patients experience in-stent restenosis after implantation. Here we developed smart magnetoelastic stents that preserve mechanical functionality while enabling self-powered hemodynamic monitoring for continuous and timely diagnosis of in-stent restenosis. Using a clinical catheter, the smart stent is deployed in the swine carotid artery for in vivo hemodynamic sensing, enabling effective detection of induced stenosis through artificial intelligence-assisted signal interpretation. In vivo and in vitro studies demonstrate the biosafety of the smart stent through immune profiling, human cytokine analysis and single-cell RNA sequencing. These results underscore the smart stent\u27s potential for seamless integration into biological systems as a reliable diagnostic tool. This platform technology could potentially revolutionize current stent technology and contribute to improved strategies for managing atherosclerosis
Cadaveric Quantitative Comparison of Transorbital and Mini-Pterional Approaches for MCA Bifurcation Aneurysms
No full textInfantile Fibrosarcoma of the Hand: Limb-Sparing Treatment With Modern Targeted Oral Chemotherapy and Conservative Surgical Resection.
No full textInfantile fibrosarcoma is a locally aggressive tumor that traditionally requires chemotherapy and radical excision or amputation. Recently, neoadjuvant therapies that exploit it