Wigginslaursen9263
Venous thromboembolism is a serious perioperative complication. We developed a new pre-test probability score for predicting deep vein thrombosis (DVT) before surgery.
Whole leg ultrasonography was performed on 973 inpatients and outpatients with suspected DVT based on a preoperative D-dimer cut-off value of ≥ 1 μg/ml. We allocated two-thirds (n = 651) of the study participants to a derivation cohort and one-third (n = 322) to a validation cohort. The pre-test probability model was developed from the derivation cohort data.
The pre-test probability model for DVT assigned 2 points to D-dimer ≥ 1.5 μg/mL and 1 point each to age ≥ 60 years, female sex, ongoing glucocorticoid therapy, prolonged immobility, and cancer with high risk of DVT. The area under the curve of the pre-test probability score was 0.72 and 0.70 in the derivation and validation cohorts, respectively. The rates of DVT according to pre-test probability scores in the derivation and validation cohorts were 7% and 6% in the low (score = 0-2), 23% and 22% in the intermediate (score = 3-4), and 47% and 50% in the high probability group (score ≥ 5), respectively (p < 0.0001).
The pre-test probability score (Kagoshima-DVT score) was helpful in detecting preoperative DVT in both inpatients and outpatients. We identified low probability group to reduce whole-leg ultrasonography and high probability group to detect more DVT before surgery.
The pre-test probability score (Kagoshima-DVT score) was helpful in detecting preoperative DVT in both inpatients and outpatients. We identified low probability group to reduce whole-leg ultrasonography and high probability group to detect more DVT before surgery.Dystrophin deficiency results in cardiomyopathy and fibrosis with variable onset. Little is known about electrocardiographic abnormalities in Becker muscular dystrophy and their relationship to underlying cardiac pathology. We hypothesized QRS fragmentation is associated with myocardial fibrosis on cardiac magnetic resonance imaging in Becker muscular dystrophy patients. We retrospectively evaluated 44 patients, and extracted data from clinically obtained electrocardiogram and cardiac magnetic resonance. Ventricular function and presence or absence late gadolinium enhancement representing myocardial fibrosis were recorded from imaging. Nearly half (19/42, 45%) of patients interrogated had myocardial fibrosis on cardiac magnetic resonance. Total number of electrocardiogram leads with QRS fragmentation (median 1 vs 4, p less then 0.001) and either right or left axis deviation from median was significantly increased (13.6 vs. 44.8°, p less then 0.001) in patients with myocardial fibrosis. Decreased leftward voltage in V6 correlated to both increased fibrosis and decreased cardiac function (p less then 0.01). Leukadherin-1 mouse The positive likelihood ratio for underlying myocardial fibrosis in patients with two of the three findings on electrocardiogram was 8.47 (p less then 0.0001). QRS fragmentation and axis deviation on electrocardiography are strongly predictive of myocardial fibrosis in Becker muscular dystrophy and may inform the use of advanced imaging in evaluation of these patients.
To examine the effect of a vocal loading task on measures of vocal structure and function in females with benign vocal fold lesions (BVFLs) and determine if change is observed in voice and lesion characteristics.
Prospective cohort study.
Twenty-eight (n=28) female subjects with phonotraumatic BVFLs completed a vocal loading task of 30 minutes of reading aloud at 75-85 dBA. Multidimensional voice evaluation was completed pre- and post-load, including audio and videostroboscopy recordings and images for expert perceptual ratings and acoustic and aerodynamic evaluation. Subjects also scored themselves using a 10 cm visual analogue scale for Perceived Phonatory Effort, and completed the Evaluation of Ability to Voice Easily, a 12 item self-report scale of current perceived speaking voice function. An exploratory rather than confirmatory approach to data analysis was adopted. The direction and magnitude of the change scores (pre- to post-load) for each individual, across a wide variety of instrumental and sr most participants. Some participants perceived this change to be an increase in effort, some a reduction in effort and some perceived no change. Improved vocal function despite relative lesion stability can seemingly occur after loading in some pathological voices.
Subjects with BVFLs demonstrate change in vocal function following 30 minutes of vocal load. While this change can be variable and multidirectional, overall improvement was observed in instrumental measures of function and efficiency for most participants. Some participants perceived this change to be an increase in effort, some a reduction in effort and some perceived no change. Improved vocal function despite relative lesion stability can seemingly occur after loading in some pathological voices.The epigenome plays a crucial role in modulating the activity of regulatory elements, thereby orchestrating diverse transcriptional programs during embryonic development. Human (h)PSC stepwise differentiation provides an excellent platform for capturing dynamic epigenomic events during lineage transition in human development. Here we discuss how recent technological advances, from epigenomic mapping to targeted perturbation, are providing a more comprehensive appreciation of remodeling of the chromatin landscape during human development with implications for aberrant rewiring in disease. We predict that the continuous innovation of hPSC differentiation methods, epigenome mapping, and CRISPR (clustered regularly interspaced short palindromic repeats) perturbation technologies will allow researchers to build toward not only a comprehensive understanding of the epigenomic mechanisms governing development, but also a highly flexible way to model diseases with opportunities for translation.
To investigate the value of body composition changes measured by quantitative computer tomography (QCT) in evaluating the prognosis of advanced epithelial ovarian cancer (AEOC) patients who underwent primary debulking surgery (PDS) and adjuvant platinum-based chemotherapy, and constructed a nomogram model for predicting survival in combination with prognostic inflammation score (PIS).
Fifty-seven patients with AEOC between 2012 and 2016 were retrospectively enrolled. Pre- and post-treatment CT images were used to analyze the body composition biomarkers. The subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), cross-sectional area of paraspinal skeletal muscle area (PMA), skeletal muscle density (SMD), body mineral density (BMD) were measured from two sets of CT images.
In multivariate analyses, VFA gain, PMA loss, BMD loss, and PIS were independent risk factors of overall survival (OS) (HR=3.7, 3.0, 2.8, 1.9, respectively, all p < 0.05). Receiver operating characteristic (ROC) curves showed that the prognostic model combining body composition changes (BCC) and PIS had the highest predictive performance (area under the curve=0.890). The concordance index (C-index) of the prognostic nomogram was 0.779 (95% CI, 0.673-0.886). Decision curve analysis (DCA) demonstrated the prognostic nomogram had a great distinguishing performance.
CT-based body composition analyses and PIS were associated with poor OS for AEOC patients who underwent PDS and adjuvant platinum-based chemotherapy. The prognostic nomogram with a combination of BCC and PIS was dependable in predicting survival for AEOC patients during treatment.
CT-based body composition analyses and PIS were associated with poor OS for AEOC patients who underwent PDS and adjuvant platinum-based chemotherapy. The prognostic nomogram with a combination of BCC and PIS was dependable in predicting survival for AEOC patients during treatment.
We aimed to compare the diagnostic performance of an automated breast ultrasound system (ABUS) with handheld ultrasound (HHUS) in the detection and characterization of lesions regarding BI-RADS classification in women with dense breasts.
After ethical approval, from July 2017 to August 2019, 592 consecutive patients were enrolled in this prospective study. On the same day, patients underwent ABUS followed by HHUS. Three breast radiologists participated in this study. The number and type of lesions and BI-RADS categorization of both ABUS and HHUS examinations of each patient were recorded in an excel file. The level of agreement between the two ultrasound systems in terms of lesion number and BI-RADS category were analyzed statistically.
ABUS and HHUS detected 1005 and 1491 cystic and 270 and 336 mass lesions in 592 patients respectively. ABUS and HHUS detected 171 and 167 positive/suspicious cases (BIRADS 0/3/4/5). Forty suspicious lesions underwent core needle biopsy whereas 11 malignant lesions were dons. ABUS is a reliable method for the detection of malignancy in dense breasts.
The objective of this investigation was to evaluate the effects of high-intensity light-emitting diode (LED) light from a curing device on the retinas of Wistar rats.
Six male Wistar rats were used, and their ocular structures were the focus of this study. During the photostimulation of each animal, the right eye of the animal, considered the control sample, was covered with a removable polyvinyl chloride cap, and the contralateral eye, the experimental sample, was exposed to high-intensity LED light, 3200 mW/cm
(VALO Ortho; Ultradent Products, South Jordan, Utah) for 144 seconds from a distance of 30 cm. The animals were exposed to the LED light 3 times on the same day to investigate if any acute inflammatory changes in the retina occurred. Seven days after the photostimulation sessions, the animals were anesthetized and perfused with paraformaldehyde solution. After which, the eyes were resected and processed histologically. The histologic sections were analyzed stereologically and histomorphometrically to measure the parameters of the retina under investigation.
There was a statistically significant increase in total retinal volume in the experimental group because of the increased volume of the ganglion cell layers, inner plexiform layers, outer nuclear layers, and the cone and rod extensions. There was no statistically significant difference in terms of density. However, there was a statistically significant increase in the nuclear area of the cells in all the studied layers in the group exposed to high-intensity LED light. In addition, hyperchromatic cells that are suggestive of pyknosis were observed.
An acute but short protocol of exposure of high-intensity LED light to the eye caused morphometric alterations in the retinal structures, specifically in the nuclear area of the photosensitive cells.
An acute but short protocol of exposure of high-intensity LED light to the eye caused morphometric alterations in the retinal structures, specifically in the nuclear area of the photosensitive cells.
The training practices and the level of medical oversight of search and rescue (SAR) organizations in the US National Park Service (NPS) Pacific west region is not known.
A database of SAR teams in the NPS Pacific west region was assembled using public sources. SAR team leaders received an electronic survey between May and December 2019. A descriptive analysis characterizing team size, technical and medical training protocols, and medical oversight was completed. Results are reported as median (interquartile range, range).
Of the 250 SAR teams contacted, 39% (n=97) completed our survey. Annual mission volume was 25 (10-50, 1-200). Team size was 30 members (22-58, 1-405). SAR teams most frequently trained in helicopter operations (77%), low-angle rope rescue (75%), and avalanche rescue (43%). Nearly all teams (99%) had members with some medical training first aid or cardiopulmonary resuscitation (89%), emergency medical technicians (75%), registered nurses or midlevel providers (52%), and physicians (40%).
