Mcintyrepetty6973
To determine the relationship between central drusen volume and low-luminance deficit (LLD) in visual acuity (VA) in patients with intermediate age-related macular degeneration (AMD).
In this cross-sectional study, 42 patients with intermediate AMD underwent testing for VA and low-luminance VA (LLVA), as well as spectral-domain optical coherence tomography. LLD was calculated as the difference between VA and LLVA. Central drusen volume was measured in the central 3 mm of the macula, defined as the volume between the inner border of the retinal pigment epithelium and Bruch's membrane.
Mean ± standard deviation (SD) LLD was 0.32 ± 0.12 logMAR and mean ± SD drusen volume was 0.18 ± 0.09 mm
. No linear relationship was identified between central 3 mm drusen volume and LLD (
= 0.215). R
for the bivariate linear model was 0.038 (95% confidence interval 0-0.222). Limitation of the analysis to drusen volumes measured in the central 1 mm of the macula did not impact results (R
= 0.075), nor did incorporation of lens status into the model (R
= 0.067) or censoring of patients with nonfoveal subretinal drusenoid deposits (R
= 0.071).
The amount of drusen within the central 3 mm of the macula does not appear to be related to LLD in intermediate AMD. These measures may be manifestations of different underlying pathophysiological mechanisms.
Understanding relationships between markers for AMD progression may help guide development of improved clinical grading scales for AMD.
Understanding relationships between markers for AMD progression may help guide development of improved clinical grading scales for AMD.
In cases of optic disc swelling, segmentation of projected retinal blood vessels from optical coherence tomography (OCT) volumes is challenging due to swelling-based shadowing artifacts. Based on our hypothesis that simultaneously considering vessel information from multiple projected retinal layers can substantially increase vessel visibility, in this work, we propose a deep-learning-based approach to segment vessels involving the simultaneous use of three OCT en-face images as input.
A human expert vessel tracing combining information from OCT en-face images of the retinal pigment epithelium (RPE), inner retina, and total retina as well as a registered fundus image served as the reference standard. The deep neural network was trained from the imaging data from 18 patients with optic disc swelling to output a vessel probability map from three OCT en-face input images. The vessels from the OCT en-face images were also manually traced in three separate stages to compare with the performance of the proposed approach.
On an independent volume-matched test set of 18 patients, the proposed deep-learning-based approach outperformed the three OCT-based manual tracing stages. read more The manual tracing based on three OCT en-face images also outperformed the manual tracing using only the traditional RPE en-face image.
In cases of optic disc swelling, use of multiple en-face images enables better vessel segmentation when compared with the traditional use of a single en-face image.
Improved vessel segmentation approaches in cases of optic disc swelling can be used as features for an improved assessment of the severity and cause of the swelling.
Improved vessel segmentation approaches in cases of optic disc swelling can be used as features for an improved assessment of the severity and cause of the swelling.
This study sought to investigate whether a validated trauma triage risk assessment tool can predict time to surgery and delay to surgery.
Patients aged 55 and older who were admitted for operative repair or arthroplasty of a hip fracture over a 3-year period at a single academic institution were included. Risk quartiles were constructed using Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) calculations. Negative binomial and multivariable logistic regression were used to evaluate time to surgery and delay to surgery, respectively. Pairwise comparisons were performed to evaluate 30-day mortality rates and demonstrate the effectiveness of the STTGMA tool in triaging mortality risk.
Six hundred eleven patients met inclusion criteria with mean age 81.1 ± 10.5 years. Injuries occurred mainly secondary to low-energy mechanisms (97.9%). Median time to surgery (31.9 hours overall) was significantly associated with STTGMA stratification (
= .002). Moderate-risk patients had 33% longer (
= .019) and high-risk patients had 28% longer time to surgery (
= .041) compared to minimal risk patients. Delay to surgery (26.4% overall) was significantly associated with STTGMA stratification (
= .015). Low-risk patients had 2.14× higher odds (
= .009), moderate-risk patients had 2.70× higher odds (
= .001), and high-risk patients had 2.18× higher odds of delay to surgery (
= .009) compared to minimal risk patients. High-risk patients experienced higher 30-day mortality compared to minimal (
< .001), low (
= .046), and moderate-risk patients (
= .046).
Patients in higher STTGMA quartiles encountered longer time to surgery, greater operative delays, and higher 30-day mortality.
Score for Trauma Triage in the Geriatric and Middle-Aged can quickly identify hip fracture patients at risk for a delay to surgery and may allow treatment teams to optimize surgical timing by proactively targeting these patients.
Prognostic Level III.
Prognostic Level III.
Cephalomedullary nailing presents several biomechanical benefits for treatment of intertrochanteric fractures, but posterior sagging (PS) of the proximal fragment occurs postoperatively in some patients despite intraoperative achievement of an adequate reduction. We investigated the risk factors for PS in those patients, with specific attention to posterior split fragment involving the greater trochanter (GT separation) as a possible significant risk factor.
We retrospectively reviewed 50 (12 males, 38 females) patients ≥50 years old at diagnosis of an intertrochanteric fracture after low-energy trauma who underwent cephalomedullary nailing between April 2015 and February 2017 and were not lost to follow-up within 12 months postoperatively.
Thirteen (26%) patients experienced PS postoperatively. Average time to bone union was significantly longer in the PS (9.5 months) than in the non-PS (4.8 months) groups (
= .002). Three patients in the PS group experienced nonunion compared to none in the non-PS group (
= .015). Significant difference was found in postoperative level of ambulatory ability (Koval score) and deterioration of the score after the injury between 2 groups (4.2 vs 2.8,
= .043 and 2.5 vs 0.8,
= .005). On multivariate logistic regression analysis, GT separation (
= .010) was a significant risk factor for PS.
The presence of GT separation in cases of intertrochanteric fractures seems to weaken posterior stability in the proximal fragment, thus showing poor clinical outcomes.
The presence of GT separation in cases of intertrochanteric fractures seems to weaken posterior stability in the proximal fragment, thus showing poor clinical outcomes.Axin1 is a negative regulator of β-catenin signaling and its role in osteoblast precursor cells remains undefined. In the present studies, we determined changes in postnatal bone growth by deletion of Axin1 in osteoblast precursor cells and analyzed bone growth in newborn and postnatal Axin1 Osx mice and found that hypertrophic cartilage area was largely expanded in Axin1 Osx KO mice. A larger number of chondrocytes and unabsorbed cartilage matrix were found in the bone marrow cavity of Axin1 Osx KO mice. Osteoclast formation in metaphyseal and subchondral bone areas was significantly decreased, demonstrated by decreased TRAP-positive cell numbers, associated with reduction of MMP9- and cathepsin K-positive cell numbers in Axin1 Osx KO mice. OPG expression and the ratio of Opg to Rankl were significantly increased in osteoblasts of Axin1 Osx KO mice. Osteoclast formation in primary bone marrow derived microphage (BMM) cells was significantly decreased when BMM cells were cultured with conditioned media (CM) collected from osteoblasts derived from Axin1 Osx mice compared with BMM cells cultured with CM derived from WT mice. Thus, the loss of Axin1 in osteoblast precursor cells caused increased OPG and the decrease in osteoclast formation, leading to delayed bone growth in postnatal Axin1 Osx KO mice.Healthcare resources have been strained to previously unforeseeable limits as a result of the COVID-19 pandemic of 2020. This has prompted the emergence of critical just-in-time COVID-19 education, including rapid simulation preparedness, evaluation and training across all healthcare sectors. Simulation has been proven to be pivotal for both healthcare provider learning and systems integration in the context of testing and integrating new processes, workflows, and rapid changes to practice (e.g., new cognitive aids, checklists, protocols) and changes to the delivery of clinical care. The individual, team, and systems learnings generated from proactive simulation training is occurring at unprecedented volume and speed in our healthcare system. Establishing a clear process to collect and report simulation outcomes has never been more important for staff and patient safety to reduce preventable harm. Our provincial simulation program in the province of Alberta, Canada (population = 4.37 million; geographic area unique features and advantages of using a centralized provincial simulation response team, preparedness using learning and systems integration methods, and to share the highest risk and highest frequency outcomes from analyzing a mass volume of COVID-19 simulation data across the largest health authority in Canada.Leishmaniases are neglected diseases caused by infection with Leishmania parasites and there are currently no prophylactic vaccines. In this study, we designed in silico a synthetic recombinant vaccine against visceral leishmaniasis (VL) called ChimeraT, which contains specific T-cell epitopes from Leishmania Prohibitin, Eukaryotic Initiation Factor 5a and the hypothetical LiHyp1 and LiHyp2 proteins. Subcutaneous delivery of ChimeraT plus saponin stimulated a Th1 cell-mediated immune response and protected mice against L. infantum infection, significantly reducing the parasite load in distinct organs. ChimeraT/saponin vaccine stimulated significantly higher levels of IFN-γ, IL-12, and GM-CSF cytokines by both murine CD4+ and CD8+ T cells, with correspondingly low levels of IL-4 and IL-10. Induced antibodies were predominantly IgG2a isotype and homologous antigen-stimulated spleen cells produced significant nitrite as a proxy for nitric oxide. ChimeraT also induced lymphoproliferative responses in peripheral blood mononuclear cells from VL patients after treatment and healthy subjects, as well as higher IFN-γ and lower IL-10 secretion into cell supernatants. Thus, ChimeraT associated with a Th1 adjuvant could be considered as a potential vaccine candidate to protect against human disease.The significance of the microbiota-gut-brain axis has been increasingly recognized as a major modulator of autoimmunity. Here, we aim to characterize the gut microbiota of a large cohort of treatment-naïve anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis patients relative to that of healthy controls (HCs). Relative to HCs, anti-NMDAR encephalitis patients had a decreased microbiome alpha-diversity index, marked disturbances of gut microbial composition and intestinal permeability damage. Disturbed microbiota in anti-NMDAR encephalitis patients might be linked with different clinical characteristics. Imputed KEGG analysis revealed perturbations of functional modules in the gut microbiomes of anti-NMDAR encephalitis. Compared to HCs, microbiota-depleted mice receiving fecal microbiota transplantation (FMT) from anti-NMDAR encephalitis patients had hypersensitivity and cognitive impairment. Furthermore, anti-NMDAR encephalitis FMT mice showed altered T cells in the spleen and small intestine lamina propria with an increased Th17 cells.
