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Correlating Movement Impairments As Potential Risk Factors for Musculoskeletal Dysfunction: A Retrospective Cross-Sectional Analysis in a Rehabilitation Setting
No full textBACKGROUND: Mechanical musculoskeletal disorders diminish quality of life and increase healthcare costs but lack prevention strategies. The lack of validated risk factors may be a reason. This study supports the previously hypothesized motion impairments as one potential risk factor in causing mechanical musculoskeletal disorders.
METHODS: A retrospective chart review of individuals in a rehabilitation setting with mechanical musculoskeletal disorders was done to identify the presence of co-existing motion impairments. A correlational analysis of their co-existing presence with a description of how they may directly contribute to those disorders followed.
RESULTS: All individuals with mechanical musculoskeletal disorders whose charts were reviewed, presented with co-existing motion impairments. Pearson\u27s correlation coefficient (R) was 1 indicating a strong positive correlation between variables. Linear regression revealed a coefficient of determination (R2) of 1 suggesting that variation in the dependent variable was explained by the independent variable.
CONCLUSION: The results of this study may be of value as a hypothesis generator highlighting the need for the investigation of motion impairments as a potential risk factor for musculoskeletal dysfunction
Can iodixAnol ReducE the incidence of adverse renal or cardiac events in chronic total occlusion interventions (CARE-CTO): a substudy of the PROGRESS-CTO registry
No full textOBJECTIVES: The impact of contrast type in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains controversial. The authors sought to evaluate the impact of contrast medium selection on patients undergoing CTO PCI.
METHODS: The authors examined the outcomes of patients who underwent CTO PCI using iso-osmolar (iodixanol) vs pooled low-osmolar contrast media (LOCM) using data from the PROGRESS-CTO registry.
RESULTS: Iodixanol was used in 1007 (18.1%) of 5558 CTO PCIs. Compared with pooled LOCM, iodixanol-treated patients were more likely to be women, were older, and more likely to have diabetes, dyslipidemia, hypertension, history of heart failure, myocardial infarction, coronary artery bypass graft surgery, and stroke. Iodixanol cases had higher complexity, with longer lesion length (35.25 ± 25.16 vs 28.91 ± 19.46 mm, P less than .001), higher prevalence of moderate or severe calcification (43% vs 37%, P less than .001) and moderate or severe proximal tortuosity (30% vs 24%, P less than .001), and higher Japanese-CTO (2.52 vs 2.17, P less than .001) and PROGRESS-CTO scores (1.30 vs 1.16, P less than .001). Iodixanol cases required longer procedure times but similar contrast volumes. Technical (85.3% vs 89.2%, P = .001) and procedural success (83.4% vs 87.3%, P = .001) were lower in iodixanol cases. Acute kidney injury (AKI) occurred in 6.4% of cases. After propensity score matching, the patients who received iodixanol had lower incidence of AKI (odds ratio [OR]: 0.67; 95% CI, 0.47, 0.97; P = .032) and a trend for lower incidence of major adverse renal or cardiovascular events (OR: 0.75; 95% CI, 0.56, 1.0; P = .061).
CONCLUSIONS: AKI occurred in approximately 6% of CTO PCI cases. Iodixanol use was associated with a lower incidence of AKI, despite being used in more complex patients
A Quality Analysis of the Measurement Properties of the Clinician-Reported Outcome Measures for Vitiligo and of the Studies Assessing Them: A Systematic Review
No full textBackground/Objective: Evaluating the measurement properties (MPs) of Clinician-Reported Outcome Measures (ClinROMs) is crucial for selecting appropriate instruments for vitiligo assessment. This review critically appraises the existing evidence on the MPs of the ClinROMs used in vitiligo.
Methods: A systematic search was conducted in PubMed, Embase, and the Cochrane Library up to 20 February 2024, identifying validated ClinROMs in vitiligo. Studies were included if they provided original data on ClinROM development or analysis, excluding those solely validating other instruments. The assessment of ClinROM quality and risk of bias analysis followed COSMIN guidelines, and ClinROMs with the highest number of sufficiently rated MPs supported by a moderate/high Quality of Evidence (QoE) were identified per construct category (extent/repigmentation and evolution/activity).
Results: This review included 22 studies evaluating 12 ClinROMs. For extent/repigmentation, the Vitiligo Area and Severity Index (VASI), Vitiligo Extent Score (VES), and VESplus each had four MPs rated sufficient with a moderate/high QoE. For evolution, the Vitiligo Disease Improvement Score (VDIS) and Vitiligo Disease Activity Score (VDAS) similarly had four MPs rated sufficient with a moderate/high QoE. For activity evaluated based on a single time point, the Vitiligo Signs of Activity Score (VSAS), the only validated ClinROM for visible signs of disease activity, had three MPs rated sufficient with a moderate/high QoE.
Conclusions: Six ClinROMs demonstrated the highest quality ratings across two key constructs. However, none underwent a complete evaluation of all their MPs, highlighting the need for further validation and refinement
Medical Therapy for Carotid and Vertebral Artery Stenosis
No full textPatients with internal carotid artery or vertebral artery atherosclerotic disease should be treated with medical therapy to prevent disease progression. Antithrombotic therapies, including antiplatelet drugs, are the leading approach for preventing thrombus formation and the subsequent risk of transient ischemic attack or ischemic stroke. However, other complementary approaches to augment drug therapy are recommended, including managing cholesterol levels with statins and maintaining blood pressure control to prevent or slow ongoing vascular injury. Importantly, lifestyle modifications such as smoking cessation and increased physical activity can play a crucial role in slowing or preventing atherosclerotic disease. In this chapter, we will outline the rationale and evidence for the various therapies and treatment strategies currently in use for treating patients with carotid atherosclerosis. Additionally, the most recent clinical trials testing aggressive medical approaches for treating carotid artery stenosis will be discussed
Iatrogenic atrial septal defect closure with PASCAL guide system post-mitral valve transcatheter edge-to-edge repair
No full textResonant acoustic rheometry for assessing plasma coagulation in bleeding patients
No full textDisordered hemostasis associated with life-threatening hemorrhage commonly afflicts patients in the emergency department, critical care unit, and perioperative settings. Rapid and sensitive hemostasis phenotyping is needed to guide administration of blood components and hemostatic adjuncts to reverse aberrant hemostasis. Here, we report the use of resonant acoustic rheometry (RAR), a technique that quantifies the viscoelastic properties of soft biomaterials, for assessing plasma coagulation in a cohort of 38 bleeding patients admitted to the hospital. RAR captured the dynamic characteristics of plasma coagulation that were dependent on coagulation activators or reagent conditions. RAR coagulation parameters correlated with TEG reaction time and TEG functional fibrinogen, especially when stratified by comorbidities. A quadratic classifier trained on selective RAR parameters predicted transfusion of fresh frozen plasma and cryoprecipitate with modest to high overall accuracy. While these results demonstrate the feasibility of RAR for plasma coagulation and utility of a machine learning model, the relative small number of patients, especially the small number of patients who received transfusion, is a limitation of this study. Further studies are need to test a larger number of patients to further validate the capability of RAR as a cost-effective and sensitive hemostasis assay to obtain quantitative data to guide clinical-decision making in managing severely hemorrhaging patients
Even With the CROWN Findings, There Remain Multiple First-Line Treatment Options for Patients With Advanced ALK-Positive NSCLC
No full textRecanalization Outcomes and Procedural Complications in Patients With Acute Ischemic Stroke and COVID-19 Receiving Endovascular Treatment
No full textIllness understanding and religiousness in patients with recurrent glioblastoma
No full textBACKGROUND: Patients with glioblastoma (GBM) often have inaccurate perceptions of prognosis. Strong religious beliefs have been associated with limited illness understanding (IU) in patients with advanced cancer, but IU and religiousness have not been investigated in patients with GBM. The aim of this study was to evaluate the association between religiousness and spirituality and IU in patients with GBM.
METHODS: Patients enrolled in a prospective multicenter study of recurrent GBM (Coping with Glioblastoma, NCT02375841). Within one month of medical visits discussing MRI scans showing GBM progression, patients completed study surveys containing published measures of IU and religiousness. IU was compared between participants with moderate or high versus slight or no religiousness based on several patient-reported prompts using Fisher\u27s exact tests.
RESULTS: Twenty-four patients completed surveys of religiousness and IU. IU was partial within our cohort. Fifteen participants (62.5%) acknowledged that their illness was terminal. Only 6 (25%) correctly acknowledged their prognosis (months). Eleven patients (46%) were moderately or very religious, while 9 (38%) were either slightly religious or not at all religious. High religiousness and spirituality were each associated with partial IU (P = .06 and P = .01, respectively). A belief that God could perform a miracle to cure them of cancer and a belief in sanctity through suffering were also each associated with partial IU.
CONCLUSIONS: This prospective study that suggests religiousness, including the belief in miracles and a belief in sanctification through suffering, might influence patients\u27 IU. Further research is warranted to study this association
Adoption of Single-Port Robotic Partial Nephrectomy Increases Utilization of the Retroperitoneal Approach: A Report from the Single-Port Advanced Research Consortium
No full textIntroduction: Retroperitoneal approach for robotic partial nephrectomy (PN) has been shown to offer shorter operative times and hospital stays without differences in complication rates compared with the transperitoneal approach. The single-port (SP) system may be better suited than multiport (MP) for challenges with the retroperitoneal approach such as narrow access geometry. We evaluated if the adoption of SP PN increased the utilization of retroperitoneal approach.
Methods: We retrospectively reviewed an IRB-approved multi-institutional database of all PN from 2013 to 2023. The date of the first SP PN split the cohorts before and after SP adoption. The percentage of retroperitoneal and transperitoneal approach cases overall and for SP and MP was determined before and after adoption. Joinpoint analysis assessed changes in rates of the retroperitoneal approach. Logistic regression compared patient and tumor characteristics with retroperitoneal approach PN before and after adoption of SP.
Results: Overall 1959 patients were evaluated, of which 654 were performed prior versus 1305 after SP adoption. There was an increased percentage of retroperitoneal approach after adoption, with 7.3% (48/654) before compared with 24.8% (324/1305) after adoption. The percentage of the retroperitoneal approach for SP PN was 52.8% (134/254), increasing over time with 75% (24/32) of SP in 2023 performed with a retroperitoneal approach.
Conclusion: The retroperitoneal approach was used more frequently than the transperitoneal approach in the SP cohort. The adoption of SP increased the incidence of the retroperitoneal approach