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In patients with moderate obstructive sleep apnea, does treatment with CPAP decrease the risk of major adverse cardiovascular events (MACEs)?
No full textCombined heart and liver transplant in a patient with failing Fontan and total situs inversus
No full textDistal tibial osteophytes are more accurate than medial malleolar anatomy when using patient specific instrumentation in total ankle replacement
No full textTotal ankle replacement (TAR) is a treatment for end stage ankle arthritis. Patient specific instrumentation (PSI) has been used and shown to allow for accurate placement and alignment in TAR in the coronal and sagittal plane. PSI systems are available and use different anatomic landmarks for the cutting guides. This is a retrospective matched case control study comparing accuracy in alignment using 2 different PSI systems. The case series uses a medial malleolar landmark (MM Group), and each case patient was matched based on preoperative coronal plane alignment with 2 ankles in the control series using the distal tibial osteophytes as landmarks (DT Group), as this system has been in use and studied more. A total of 48 ankles were studied, 16 in the MM Group and 32 in the DT Group matched by coronal plane alignment. There was a difference in accuracy of postoperative coronal plane alignment, with the MM Group deviated from expected by 1.6° ± 1.3° compared to the DT Group at 1.1° ± 0.6°, p=0.04. This corresponded to 68.8% of MM Group ankles being within 2° of expected compared to 93.4% of DT Group ankles. There was no statistically significant difference in sagittal plane alignment between the groups, p=0.57. Procedure time was the only other statistically significant difference with the MM Group taking longer than the DT Group, 97.4 minutes and 80.6 minutes, respectively, p=0.04. While both groups show good accuracy, alignment based on the distal tibial osteophytes is more accurate than using the medial malleolus. Level of Clinical Evidence: 3, Retrospective Matched Case Control Study
Automatic laplacian-based shape optimization for patient-specific vascular grafts
No full textCognitional heart disease is one of the leading causes of mortality among newborns. Tissue-engineered vascular grafts offer the potential to help treat cognitional heart disease through patient-specific vascular grafts. However, current methods often rely on non-personalized designs or involve significant human intervention. This paper presents a computational framework for the automatic shape optimization of patient-specific tissue-engineered vascular grafts for repairing the aortic arch, aimed at reducing the need for manual input and improving current treatment outcomes, which either use non-patient-specific geometry or require extensive human intervention to design the vascular graft. The paper\u27s core innovation lies in an automatic shape optimization pipeline that combines Bayesian optimization techniques with the open-source finite volume solver, OpenFOAM, and a novel graft deformation algorithm. Specifically, our framework begins with Laplacian mode computation and the approximation of a computationally low-cost Gaussian process surrogate model to capture the minimum weighted combination of inlet-outlet pressure drop (PD) and maximum wall shear stress (WSS). Bayesian Optimization then performs a limited number of OpenFOAM simulations to identify the optimal patient-specific shape. We use imaging and flow data obtained from six patients diagnosed with cognitional heart disease to evaluate our approach. Our results showcase the potential of online training and hemodynamic surrogate model optimization for providing optimal graft shapes. These results show how our framework successfully reduces inlet-outlet PD and maximum WSS compared to pre-lofted models that include both the native geometry and human-designed grafts. Furthermore, we compare how the performance of each design optimized under steady-state simulation compares to that design\u27s performance under transient simulation, and to what extent the optimal design remains similar under both conditions. Our findings underscore that the automated designs achieve at least a 16% reduction in blood flow pressure drop in comparison to geometries optimized by humans
A multidimensional tool for quantifying structural racism: Application to adverse pregnancy outcomes in Chicago, Illinois
No full textUnderstanding the relationship between structural racism and health is essential for identifying practice- and policy-based interventions to reduce health inequities. We developed neighborhood-based measures of structural racism and tested their associations with adverse pregnancy outcomes, health outcomes characterized by some of the most pronounced racial inequities. We leveraged electronic health records from 89,410 pregnant patients at six Chicago-area hospitals. Patients were linked with neighborhood exposure to 22 experiences reflective of structural racism based on home address, geocoded to the census tract. Measures were summarized into six domains identified as salient to Black women in the literature: law enforcement, housing, medical, employment, education, and community infrastructure. The primary outcome was preterm birth and models were stratified by race and ethnicity. After adjustment for neighborhood socioeconomic status, Black patients in neighborhoods with unfavorable law enforcement practices and school characteristics were more likely to deliver preterm (law RR: 1.07; 95 % CI: 1.02, 1.12; education RR: 1.08; 95 % CI: 1.03, 1.14). This study developed an approach for quantifying multiple domains of structural racism and illustrated its value in the context of preterm birth risk among Black patients
Trends in outcomes of cardiogenic shock in pateints with end-state renal disease after acute myocardial infarction
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Prolonged symptom relief from symphysis pubis dysfunction (aka Lightning Crotch) with chiropractic treatment for low back pain
No full textMeasuring disparities in out of hospital cardiac arrest outcomes in Chicago community areas
No full textBackground:Advances in resuscitation science have improved survival rates after an out-of-hospital cardiac arrest (OHCA) in select geographies, but survival rates vary widely by community. The purpose of this study was to assess the variations in bystander interventions and subsequent OHCA outcomes by predominance of a race/ethnicity within community areas in a large city.
Methods:This is a retrospective cohort study of OHCA treated by Chicago Fire Department EMS from January 1st 2014 through December 31st 2021. Community areas were grouped into categories based on having a majority (\u3e50%) of a race or ethnicity (i.e., predominantly White, Black, Hispanic, Integrated or Asian).
Results:Of the 13,778 OHCA cases meeting inclusion criteria, 62.1% were male, and 47.5% were from predominantly Black community areas, 17.9% from predominantly Hispanic community areas, 20.0% from White, and 14.0% from Integrated; the remaining 0.6% were from Asian community areas. Mean age was lowest (59.9 years) in Hispanic followed by Black (61.8 years) community areas compared to White (62.4 years) community areas. Cases from Black and Hispanic community areas had lower rates of shockable rhythms (12.6% and 14.9% versus 19.8%). Bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use was lowest in Black community areas. OHCA in Hispanic and Black community areas \u3e 30% less likely to have favorable neurologic survival compared to White community areas. Females were more likely to survive to hospital admission across all community areas; however, neurologic survival in females was better only in White and Integrated community areas. Public location and shockable rhythm were significant predictors of favorable neurologic survival across all community area categories; AED use before EMS was a significant predictor in Black, Hispanic and Integrated community areas but not in White community areas. Bystander CPR was associated with favorable neurologic survival White (aOR = 1.40) and Integrated (aOR = 2.02) community areas, but there was no significant association in Black or Hispanic community areas.
Conclusion:Our study revealed significant variations in favorable OHCA characteristics across different community areas. While certain cardiac arrest features and modifiable factors play a significant role in some community areas, their effect may be less pronounced in other community areas
Racial disparities in utilization of medications and disease outcomes in inflammatory bowel disease patients
No full textBackground:Although traditionally associated with White European ancestry, inflammatory bowel disease (IBD) has increased among different races and ethnicities. Large studies conducted in the United States and Canada have identified more complex disease phenotypes among Black patients. Our study aimed to investigate disparities in IBD treatments and outcomes between Black and White patients in the United States.
Methods:Using the TriNetX database, adult IBD patients were divided into 2 groups based on race: Black and White patients with IBD, Crohn\u27s disease (CD), or ulcerative colitis (UC). Medical therapy and disease outcomes were evaluated in both groups with 1:1 propensity-score matching. Methodologic limitations include the potential for missing data, lack of information on socioeconomic strata, and patient-level medication coverage plans.
Results:In comparison to White patients, Black patients with CD were less likely to receive advanced therapies; Adalimumab (adjusted odds ratio- aOR 0.89), Certolizumab (0.81), Vedolizumab (0.66), Ustekinumab (0.82), or Tofacitinib (0.58). Black patients with UC were less likely to receive advanced therapies; Adalimumab (0.83), Golimumab (0.62), Vedolizumab (0.69), Ustekinumab (0.73), or Tofacitinib (0.55). Black patients with IBD were at higher odds of utilizing corticosteroids (CD 1.18 and UC 1.20) and opioids (CD 1.26 and UC 1.09). Black patients with CD had higher rates of hospitalization (1.35) and perianal abscess (1.56), perianal fistula (1.28), and intestinal fistula (1.38). Black patients with UC had higher rates of hospitalization (1.29), Clostridioides difficile infection (1.11), and toxic megacolon (1.34).
Conclusions:There were racial disparities in IBD medical therapy and disease outcomes. Black IBD patients had lower treatment with advanced therapies, higher opioid and corticosteroid use, and higher IBD-related complications