DigitalCommons@KCU (Kansas City Univ.)
Not a member yet
2803 research outputs found
Sort by
Maternal Tobacco Use During Pregnancy and Child Neurocognitive Development
Get PDFImportance: Maternal tobacco use during pregnancy (MTDP) persists across the globe. Longitudinal assessment of the association of MTDP with neurocognitive development of offspring at late childhood is limited.
Objectives: To examine whether MTDP is associated with child neurocognitive development at ages 9 to 12 years.
Design, setting, and participants: This cohort study included children aged 9 and 10 years at wave 1 (October 2016 to October 2018) and aged 11 to 12 years at a 2-year follow-up (wave 2, August 2018 to January 2021) across 21 US sites in the Adolescent Brain Cognitive Development (ABCD) Study. Data were analyzed from June 2022 to December 2023.
Exposure: MTDP.
Main outcomes and measures: Outcomes of interest were neurocognition, measured by the National Institutes of Health (NIH) Toolbox Cognition Battery, and morphometric brain measures through the region of interest (ROI) analysis from structural magnetic resonance imaging (sMRI).
Results: Among 11 448 children at wave 1 (mean [SD] age, 9.9 [0.6] years; 5990 [52.3%] male), 1607 children were identified with MTDP. In the NIH Toolbox Cognition Battery, children with MTDP (vs no MTDP) exhibited lower scores on the oral reading recognition (mean [SE] B = -1.2 [0.2]; P \u3c .001), picture sequence memory (mean [SE] B = -2.3 [0.6]; P \u3c .001), and picture vocabulary (mean [SE] B = -1.2 [0.3]; P \u3c .001) tests and the crystallized cognition composite score (mean [SE] B = -1.3 [0.3]; P \u3c .001) at wave 1. These differential patterns persisted at wave 2. In sMRI, children with MTDP (vs no MTDP) had smaller cortical areas in precentral (mean [SE] B = -104.2 [30.4] mm2; P = .001), inferior parietal (mean [SE] B = -153.9 [43.4] mm2; P \u3c .001), and entorhinal (mean [SE] B = -25.1 [5.8] mm2; P \u3c .001) regions and lower cortical volumes in precentral (mean [SE] B = -474.4 [98.2] mm3; P \u3c .001), inferior parietal (mean [SE] B = -523.7 [136.7] mm3; P \u3c .001), entorhinal (mean [SE] B = -94.1 [24.5] mm3; P \u3c .001), and parahippocampal (mean [SE] B = -82.6 [18.7] mm3; P \u3c .001) regions at wave 1. Distinct cortical volume patterns continued to be significant at wave 2. Frontal, parietal, and temporal lobes exhibited differential ROI, while there were no notable distinctions in the occipital lobe and insula cortex.
Conclusions and relevance: In this cohort study, MTDP was associated with enduring deficits in childhood neurocognition. Continued research on the association of MTDP with cognitive performance and brain structure related to language processing skills and episodic memory is needed
Prenatal Tobacco Exposure, Brain Subcortical Volumes, and Gray-White Matter Contrast
Get PDFImportance Maternal tobacco use during pregnancy (MTDP) remains a major public health challenge. However, the complete spectrum of effects of MTDP is not fully understood.
Objectives To examine the longitudinal associations of MTDP and children’s brain morphometric subcortical volume and gray-white matter contrast (GWC) development.
Design, Setting, and Participants Cohort study of children aged 9 to 10 years at wave 1 (October 2016 to October 2018) and at a 2-year follow-up (wave 2; August 2018 to January 2021; aged 11-12 years) across 21 US sites in the Adolescent Brain Cognitive Development (ABCD) Study. Data were analyzed from October 2023 to October 2024.
Exposure MTDP.
Main outcomes and measures Morphometric brain measures of subcortical volume and GWC.
Results Among the 11 448 children (51.5% male; 13.1% Black; 24.0% Hispanic; and 52.9% White) at wave 1, 1607 (16.6%; 95% CI, 13.0%-20.2%) were identified with MTDP exposure. At wave 1, children with MTDP exposure (vs no exposure) exhibited lower GWC in widespread brain regions primarily located in the frontal (eg, superior frontal; regression coefficient [B] = −0.0019; SE, 0.0006; P = .004), parietal (eg, supramarginal; B = −0.0021; SE, 0.0007; P = .002) and temporal lobes (eg, middle temporal; B = −0.0024; SE, 0.0007; P \u3c .001). These differences in GWC continued to be significant at wave 2. In regard to subcortical volume, children with MTDP exposure demonstrated smaller volume of the lateral ventricle (B = −257.5; SE, 78.6; P = .001) and caudate (B = −37.7; SE, 14.0; P = .01) in the left hemisphere at wave 1, and lower volume of the caudate in both left (B = −48.7; SE, 15.9; P = .002) and right hemisphere (B = −45.5; SE, 16.1; P = .01) at wave 2.
Conclusions and Relevance This cohort study found that MTDP exposure was associated with lower GWC across the whole cortex and smaller caudate nuclei volume compared with no exposure, signifying the importance of preventing MTDP and necessitating further research on this topic
A One-Year Relapse Prediction Model for Acute Ischemic Stroke (AIS) Based on Clinical Big Data
Get PDFObjective
To develop and evaluate a nomogram prediction model for recurrence of acute ischemic stroke (AIS) within one year.
Method
Patients with AIS treated at the second affiliated hospital of Xuzhou Medical University from August 2017 to July 2019 were enrolled. Clinical data such as demographic data, risk factors, laboratory tests, TOAST etiological types, MRI features, and treatment methods were collected. Cox regression analysis was done to determine the parameters for entering the nomogram model. The performance of the model was estimated by receiver operating characteristic curves, decision curve analysis, calibration curves, and C-index.
Result
A total of 645 patients were enrolled in this study. Side of hemisphere (SOH, Bilateral, HR = 0.35, 95 % CI = 0.15–0.84, p = 0.018), homocysteine (HCY, HR = 1.38, 95 % CI = 1.29–1.47, p \u3c 0.001), c-reactive protein (CRP, HR = 1.04, 95 % CI = 1.01–1.07, p = 0.013) and stroke severity (SS, HR = 3.66, 95 % CI = 2.04–6.57, p \u3c 0.001) were independent risk factors. The C-index of the nomogram model was 0.872 (se = 0.016). The area under the receiver operating characteristic (ROC)curve at one-year recurrence was 0.900. Calibration curve, decision curve analysis showed good performance of the nomogram. The cutoff value for low or high risk of recurrence score was 1.73.
Conclusion
The nomogram model for stroke recurrence within one year developed in this study performed well. This useful tool can be used in clinical practice to provide important guidance to healthcare professionals
Osteochondral Allograft or Autograft Transplantation of the Femoral Head Leads to Improvement in Outcomes But Variable Survivorship: A Systematic Review
No full textPurpose: To review patient-reported outcomes (PROs) and survivorship in patients undergoing osteochondral autograft or allograft transplantation(OAT) of the femoral head.
Methods: Pubmed, Cochrane Center for Register of Controlled Trials (CENTRAL), and Scopus databases were searched in November 2022 with an updated search extending to December 2023 using criteria from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the following keywords: (hip OR femoral head) AND (mosaicplasty OR osteochondral allograft OR osteochondral autograft OR osteochondral lesion). Articles were included if they evaluated postoperative PROs in patients who underwent OAT of the femoral head and had a study size of five or more hips (n ≥ 5). Survivorship was defined as freedom from conversion to THA. For PROs evaluated in three studies or more, forest plots were created and I2 was calculated.
Results: 12 studies were included in this review with a total of 156 hips and an average follow-up time ranging between 16.8 months and 222 months. 104(66.7%) hips were male while 52(33.3%) were female. Age of patients ranged from 17.0 to 35.4 years while BMI ranged from 23.3 to 28.1. Eight studies reported on osteochondral autograft transplantation and four studies on osteochondral allograft transplantation. Three studies reported significant improvement in at least one PRO. Survivorship ranged from 61.5% to 96% at minimum two-year follow-up and from 57.1% to 91% at minimum five-year follow-up. At follow-up of less than five years, osteochondral allograft transplantation studies showed 70% to 87.5% survivorship, while autograft varied from 61.54% to 96%.
Conclusion: Patients with osteochondral lesions of the femoral head who underwent osteochondral autograft or allograft transplantation demonstrated improved patient-reported outcomes but variable survivorship rates.
Study design: Systematic Review of Level IV studies, Level of Evidence IV
An Incidental Finding of Idiopathic Hypertrophic Pachymeningitis: A Case Report
No full textIn this case report, we discuss and explore the clinical, laboratory, and imaging findings, as well as the treatment options and follow-up measures, in an 83-year-old patient with idiopathic hypertrophic pachymeningitis (IHP), a rare disorder characterized by fibrosing, hypertrophic inflammation that thickens the dura mater. An 83-year-old female with a medical history of hypertension and hyperlipidemia presented with speech arrest and was taken to the emergency department, where she received a stroke code, a CT scan, and an MRI. The MRI results showed a temporal lobe meningioma and a pan-cranial pachymeningitis encasing the entire brain and cerebellum and extending into the upper cervical spine. Multiple unsuccessful attempts at a lumbar puncture were made, so a dural biopsy specimen was obtained, which revealed no malignant process. A cerebral spinal fluid specimen (CSF) from the biopsy showed minimal white blood cells (WBCs) which ruled out infection. Idiopathic hypertrophic pachymeningitis was the given diagnosis based on the apparent MRI findings. The patient was treated in the hospital for four days with IV methylprednisolone and discharged on oral methylprednisolone for four to six weeks
Degree of Uncertainty in Reporting Imaging Findings for Necrotizing Enterocolitis: A Secondary Analysis from a Pilot Randomized Diagnostic Trial
No full textDiagnosis of necrotizing enterocolitis (NEC) relies heavily on imaging, but uncertainty in the language used in imaging reports can result in ambiguity, miscommunication, and potential diagnostic errors. To determine the degree of uncertainty in reporting imaging findings for NEC, we conducted a secondary analysis of the data from a previously completed pilot diagnostic randomized controlled trial (2019–2020). The study population comprised sixteen preterm infants with suspected NEC randomized to abdominal radiographs (AXRs) or AXR + bowel ultrasound (BUS). The level of uncertainty was determined using a four-point Likert scale. Overall, we reviewed radiology reports of 113 AXR and 24 BUS from sixteen preterm infants with NEC concern. The BUS reports showed less uncertainty for reporting pneumatosis, portal venous gas, and free air compared to AXR reports (pneumatosis: 1 [1–1.75) vs. 3 [2–3], p \u3c 0.0001; portal venous gas: 1 [1–1] vs. 1 [1–1], p = 0.02; free air: 1 [1–1] vs. 2 [1–3], p \u3c 0.0001). In conclusion, we found that BUS reports have a lower degree of uncertainty in reporting imaging findings of NEC compared to AXR reports. Whether the lower degree of uncertainty of BUS reports positively impacts clinical decision making in infants with possible NEC remains unknown
Overcoming High Defibrillation Thresholds With Placement of a Coronary Sinus Lead
No full textBackground: Conventional implantable cardioverter-defibrillators (ICD) lead placement consists of a right ventricular lead with or without superior vena cava lead. Inadequate safety margins for DFTs are encountered in up to 8% of ICD placements, which can result in inability to successfully terminate fatal ventricular arrhythmias. In patients with inadequate DFTs, we proposed placing a lead in the coronary sinus or one of its branches would achieve adequate thresholds.
Methods: Patients who had inadequate DFTs with conventional leads defined by \u3e20 J threshold underwent immediate addition of coronary sinus lead. DFT testing was performed pre- and post-coronary sinus lead implantation. A total of 16 patients underwent coronary sinus lead placement from October 16, 2007 to March 26, 2020. Statistical analysis for pre- and post-coronary sinus lead energy thresholds was performed with a paired T-test.
Results: Fourteen patients at the time of initial ICD implantation and two patients at time of revision with inadequate DFTs with conventional leads underwent coronary sinus lead placement. The mean age was 50 years and the mean left ventricular ejection was 18%. Comparison of DFTs (as shown in Figure 1) showed a reduced energy requirement with a p-value of 0.0025 (95% CI 4.69 - 18.06), a statistically significant improvement in DFT.
Conclusion: Placement of a coronary sinus lead in patients who do not achieve adequate DFT testing with conventional lead placement results in improved defibrillation thresholds
Rule Revision Rumble: Exploring the Impact of Rule Changes on Olympic Judo Injuries
No full textPurpose: After each Olympics, judo undergoes rule changes mainly for spectator appeal. We questioned if these changes inadvertently affected injury rates among Olympic Judo participants. This study reviews data over 4 Olympics (2008-2020) to identify correlations between rule changes and injury trends. Methods and Study Design: We reviewed summary data for each Olympics as reported by the International Olympic Committee Injury and Illness Surveillance system, athlete attendance for each summer game, and rule change records. We calculated injury incidence rates per 100 registered athletes (IIRa), proportions of injuries categorized by body region and injury type, and differences with χ2. Results: About 1/3 of athletes were returning participants, reflecting consistent representation of demographics. IIRa of overall injuries in each Olympic game was 11.2, 12.3, 11.3, 14.6 (P = 0.52), and IIRa of time loss injury was 6.4, 5.7, 4.9, 8.7 (P = 0.16). Data for the 2008 Olympics game regarding specific body parts and injury type was unavailable. Several injury proportions include the proportion of head/neck injuries [10.6, 13.6, 8.7 (P = 0.74)]; upper extremity injury [51.1, 50, 36.8 (P = 0.26)]; lower extremity injury [36.2, 31.8, 40.4 (P = 0.68)]; and joint injury [61.7, 54.5, 59.6 (P =0.78)]. Conclusions: Overall changes included a ban on leg grabbing, stricter regulations for headfirst landings during throws, and alterations to match structure, which did not correlate with significant changes among various injury rates across 4 Olympic games. These findings may be influenced by low overall incidence, high conditioning levels, and unpredictable match dynamics. Significance: Ongoing rule changes for spectator appeal may eventually affect injury incidences as athletes use riskier techniques. Further research exploring associations between rule changes and injury patterns in all competition levels will be important