Tannerodgaard2520
Cage subsidence is a known complication of spinal fusion. Various aspects of cage design have been investigated for their influence on cage subsidence, whereas the potential contribution of graft material to load sharing is often overlooked. We aimed to determine whether graft in the aperture affects endplate pressure distribution.
The pressure distributions of a polyetheretherketone interbody cage with 3 different aperture graft conditions were evaluated empty, demineralized bone matrix, and supercritical CO
-treated allograft bone crunch (SCCO
).
Graft materials contributed as much as half the load transmission for SCCO
, whereas demineralized bone matrix contributed one third. check details Endplate areas in contact with the cage demonstrated decreased areas within the highest-pressure spectrum with SCCO
graft materials compared with empty cages.
Graft choice plays a role in reducing peak endplate pressures. This finding is relevant to implant subsidence, as well as graft loading and remodeling.
Graft choice plays a role in reducing peak endplate pressures. This finding is relevant to implant subsidence, as well as graft loading and remodeling.
In this study, we evaluated the changes in resting-state networks (RSNs) under anesthesia in neurosurgical patients.
RSNs were analyzed in 12 patients with pituitary adenoma presented by chiasma compression operated via standard transsphenoidal approach under propofol anesthesia before and after tumor resection. All the patients had suprasellar tumor extension with compression of the optic chiasma. We investigated second-level effects by contrasting dummy-encoded covariates representing the effects of the sessions (first vs. second) on RSNs. We corrected for multiple comparisons using a false discovery rate of 0.05 (2-sided).
Connectivity between the right and left precentral gyri (motor network) decreased significantly from the first to the second session (P= 0.0002), as did the connectivity between the postcentral gyri (P= 0.009). The same was valid for connectivity between the visual cortices (P= 0.0002). The salience network showed a significant decrease in the connectivity of the anterior part of the cingulate gyrus and insular cortex (P= 0.0001). The default mode network showed a decrease in the connectivity between the posterior part of the cingulate gyrus, parietal, and frontal cortices (P= 0.0002). There was no significant correlation between the reduction in connectivity and dose or duration of anesthesia.
Different RSNs could be identified under anesthesia and used for intraoperative brain mapping and remapping during tumor resection. However, RSNs showed a significant decrease in connectivity with the continuation of anesthesia.
Different RSNs could be identified under anesthesia and used for intraoperative brain mapping and remapping during tumor resection. However, RSNs showed a significant decrease in connectivity with the continuation of anesthesia.We report the case of a child who, shortly after undergoing suboccipital craniotomy for resection of a medullary cavernoma, developed corneal and conjunctival epithelial breakdown of the right eye with ipsilateral facial hypoesthesia as well as erosions and crusting of the eyelids, nostril, and lips on the right side. This combination of findings likely results from acute injury to the ipsilateral trigeminal ganglion, leading to acute neurotrophic keratitis and trigeminal trophic syndrome.
Older adult patients with frailty are rarely involved in rehabilitation programs after myocardial infarction. Our aim was to investigate the benefits of exercise intervention in these patients.
A total of 150 survivors after acute myocardial infarction, ≥70 years and with pre-frailty or frailty (Fried scale ≥1 points), were randomized to control (n=77) or intervention (n=73) groups. The intervention consisted of a 3-month exercise program, under physiotherapist supervision, followed by an independent home-based program. The main outcome was frailty (Fried scale) at 3 months and 1 year. Secondary endpoints were clinical events (mortality or any readmission) at 1 year.
Mean age was 80 years (range=70-96). In the intervention group, 44 (60%) out of 73 patients participated in the program and 23 (32%) completed it. Overall, there was a decrease in the Fried score in the intervention group at 3 months, with no effect at 1 year. However, in the intention-to-treat analysis, such change did not achieve statisti However, in the intention-to-treat analysis, such change did not achieve statistical significance (P = 0.110). Only treatment comparisons made among the subgroups that participated in (P = 0.033) and completed (P = 0.018) the program achieved statistical significance. There were no differences in clinical events. Worse Fried score trajectory along follow-up increased mortality risk (hazard ratio [HR] = 2.38, 95% confidence interval [CI] 1.24-4.55, P = 0.009) CONCLUSIONS Recruitment and retention for a physical program in older adult patients with frailty after myocardial infarction was challenging. Frailty status improved in the subgroup that participated in the program, although this benefit was attenuated after shifting to a home-based program. A better frailty trajectory might influence midterm prognosis. (ClinicalTrials.govNCT02715453).
The aim of the study is to determine if barium esophagram (BE) alone is sufficient to diagnose esophageal dysmotility when compared to the gold standard, high-resolution manometry (HRM).
This is a retrospective review of patients that underwent laparoscopic fundoplication by two surgeons at a single institution from 10/1/2015-6/29/2019. Patients with large paraesophageal hernias and patients without both BE and HRM were excluded.
Forty-six patients met the inclusion criteria. BE was found to be concordant with HRM for esophageal motility in only 21 patients (46%). Setting HRM as the gold standard, BE had a sensitivity of 14% (95% CI 5%-35%), specificity of 72% (95% CI 52%-86%), PPV of 30% (95% CI 11%-60%), and NPV of 50% (95% CI 35%-66%). The accuracy was 46%, while a McNemar test showed p=0.028.
Traditional BE should not be used in place of HRM for assessing pre-operative motility in patients undergoing anti-reflux surgery.
Traditional BE should not be used in place of HRM for assessing pre-operative motility in patients undergoing anti-reflux surgery.Advances in technology, methodology, and deep phenotyping are increasingly driving the understanding of the pathologic basis of disease. Improvements in patient identification and treatment are impacting survival. This is true in endocrinology and inborn errors of metabolism, where disease-modifying therapies are developing. Inherent to this evolution is the increasing awareness of the respiratory manifestations of these rare diseases. This review updates clinicians, stratifying diseases spirometerically; pulmonary hypertension and diseases with a predisposition to recurrent pulmonary infection are discussed. This division is artificial; many diseases have multiple pathologic effects on respiration. This review does not cover the impact of obesity.Pulmonary complications are common in children with hematologic or oncologic diseases, and many experience long-term effects even after the primary disease has been cured. This article reviews pulmonary complications in children with cancer, after hematopoietic stem cell transplant, and caused by sickle cell disease and discusses their management.Pulmonary manifestations of gastrointestinal (GI) diseases are often subtle, and underlying disease may precede overt symptoms. A high index of suspicion and a low threshold for consultation with a pediatric pulmonologist is warranted in common GI conditions. This article outlines the pulmonary manifestations of different GI, pancreatic, and liver diseases in children, including gastroesophageal reflux disease, inflammatory bowel disease, pancreatitis, alpha1-antitrypsin deficiency, nonalcoholic fatty liver disease, and complications of chronic liver disease (hepatopulmonary syndrome and portopulmonary hypertension).The coronavirus disease 2019 (COVID-19) pandemic has affected hundreds of thousands of people. The authors performed a comprehensive literature review to identify the underlying mechanisms and risk factors for severe COVID-19 in children. Children have accounted for 1.7% to 2% of the diagnosed cases of COVID-19. They often have milder disease than adults, and child deaths have been rare. The documented risk factors for severe disease in children are young age and underlying comorbidities. It is unclear whether male gender and certain laboratory and imaging findings are also risk factors. Reports on other potential factors have not been published.Healthy children may present acute mountain sickness (AMS) within a few hours after arrival at high altitudes. In few cases, serious complications may occur, including high-altitude pulmonary edema and rarely high-altitude cerebral edema. Those with preexisting conditions especially involving hypoxia and pulmonary hypertension shall not risk travelling to high altitudes. Newborn from low altitude mothers may have prolonged time to complete postnatal adaptation. The number of children and adolescents traveling on commercial aircrafts is growing, and this poses a need for their treating physicians to be aware of the potential risks of hypoxia while air traveling.Social inequality refers to disparities in society that have the effect of limiting a group's socioeconomic, educational, and intellectual potential. Inequity in health means any limitation to access comprehensive health services that also hinders the achievement of well-being and favorable health outcomes. Strategies for more equitable growth to eradicate global poverty would contribute to reducing health inequities and improve health care outcomes. Coordinated efforts between governments, private sector, families, and interested stakeholders are needed. This article discusses inequality and inequity in pediatric respiratory diseases, the challenges confronted, and the strategies needed to mitigate these disparities.The burden imposed by pollution falls more on those living in low-income and middle-income countries, affecting children more than adults. Most air pollution results from incomplete combustion and contains a mixture of particulate matter and gases. Air pollution exposure has negative impacts on respiratory health. This article concentrates on air pollution in 2 settings, the child's home and the ambient environment. There is an inextricable 2-way link between air pollution and climate change, and the effects of climate change on childhood respiratory health also are discussed.Systemic diseases often manifest with cutaneous findings. Many pediatric conditions with prominent skin findings also have significant pulmonary manifestations. These conditions include both inherited multisystem genetic disorders such as yellow-nail syndrome, neurofibromatosis type 1, tuberous sclerosis complex, hereditary hemorrhagic telangiectasia, Klippel-Trénaunay-Weber syndrome, cutis laxa, Ehlers-Danlos syndrome, dyskeratosis congenita, reactive processes such as mastocytosis, and aquagenic wrinkling of the palms. This overview discusses the pulmonary manifestations of skin disorders.
