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Surgical lung biopsy remains the standard procedure for the subset of patients with fibrosing interstitial lung disease (F-ILD) who require a lung biopsy to secure a confident diagnosis. Little is known about the pathologic features of samples obtained via non-intubated/"awake" surgical lung biopsy and the diagnostic accuracy of awake biopsy in patients with F-ILD. Two expert thoracic pathologists blinded to the type of lung biopsy compared the clinical-pathologic features of 120 conventional VATS biopsies with those of 21 consecutive non-intubated/"awake" VATS biopsies. No statistically significant differences between the two procedures were observed with regard to identification of histopathological features. Biopsy length, average of sampled lobes and mean number of slides were similar with the two procedures, while the width of the biopsies was significantly deeper with conventional VATS (31.5 mm versus 25.6 mm; p = 0.01). By contrast, the mean age of patients (69.5 versus 64.5 years; p = 0.02) and the level of diagnostic confidence (100% versus 75%; p = 0.007) were significantly higher among patients undergoing the "awake" procedure. Diagnostic yield was 100% in both groups, with a similar distribution of ILD diagnoses. Non-intubated/"awake" biopsy has the potential to become the standard surgical procedure in patients with F-ILD requiring a histological confirmation of their diagnosis. However, larger prospective studies are needed to validate the safety and diagnostic yield of "awake" compared to conventional VATS.
The heightened risk of COVID-19 infection and mortality in prisons is well documented, but COVID-19's impact on all-cause mortality in incarcerated populations has not yet been studied. This study analyzed mortality records from the Florida State Department of Corrections prison system population to evaluate the impact COVID-19 had on all-cause mortality and compare mortality rates and life expectancy with that of the overall state of Florida population.
Population age and sex data for Florida State Department of Corrections were ascertained from the Florida State Department of Corrections Offender Based Information System. Death data by age, sex, and cause of death were acquired from medical records and Florida State Department of Corrections offender reports. The state of Florida demographic and death data were collected from the Census Bureau, Florida Department of Health, and Centers for Disease Control and Prevention. Age- and sex-standardized life table measures were calculated, and COVID-19 contribial increase in mortality driven solely by COVID-19 mortality, leading to an overall 4-year decline in life expectancy. Given the findings and continued threat of COVID-19 outbreaks, Florida State Department of Corrections and other prison systems should strive to increase vaccination uptake, decrease prison populations, and commit to COVID-19 data transparency.
Differences in healthcare utilization and medical expenditures associated with perinatal depression are estimated.
Using the MarketScan Multi-State Medicaid Database, the analytic cohort included individuals aged 15-44 years who had an inpatient live birth delivery hospitalization between January 1, 2017 and December 31, 2018. Multivariable negative binomial regression models were used to estimate the differences in utilization associated with perinatal depression, and multivariable generalized linear models were used to estimate the differences in expenditures associated with perinatal depression. Analyses were conducted in 2021.
The cohort included 330,593 individuals. Nearly 17% had perinatal depression. Compared with individuals without perinatal depression individuals with perinatal depression had a larger number of inpatient admissions (0.19, 95% CI=0.18, 0.20), total inpatient days (0.95, 95% CI=0.92, 0.97), outpatient visits (14.02, 95% CI=13.81, 14.22), emergency department visits (1.70, 95% CIation and medical expenditures than individuals without perinatal depression, and differences varied by race/ethnicity. The findings highlight the need to ensure comprehensive and equitable mental health care to address perinatal depression.
Cancer patients suffer high risk of venous thromboembolism (VTE). Cancer-associated VTE (CAT) causes hospitalization, morbidity, delayed cancer treatment, and mortality; therefore, exceptional CAT prevention and management are imperative.
This review offers practical recommendations and treatment algorithms for eight complex, clinically relevant situations posing great uncertainty regarding management and requiring an urgent decision VTE prophylaxis in ambulatory cancer patients with pancreatic pancreas (1) or lung cancer with molecular alterations (2); optimal management of VTE during antineoplastic treatment with antiangiogenics (3) or chemotherapy (4); protracted VTE treatment, determinants; (5) drugs used (6), and optimal VTE management in situations of high bleeding risk (7) or recurrent VTE (8).
With the evidence available, primary thromboprophylaxis in patients with lung cancer harbouring ALK/ROS1 translocations or pancreatic cancer receiving ambulatory chemotherapy must be appraised. If antiangicommended. Renal impairment associated with thrombosis must be treated with LMWHs; there is no need to adjust the dose in patients with CrCl>30; with CrCl=15-30, dose adjustment is advised, and suspended when CrCl is <15.
We provide useful advice for complex, clinically relevant situations that clinicians treating CAT must face devoid of any unequivocal, strong, evidence-based recommendations.
We provide useful advice for complex, clinically relevant situations that clinicians treating CAT must face devoid of any unequivocal, strong, evidence-based recommendations.
There are few reports concerning determinants of the surgical outcome of anterior decompression and fusion (ADF) when performed for ossification of the posterior longitudinal ligament of the thoracic spine (T-OPLL). We investigated prognostic factors associated with neurological recovery in the patients with T-OPLL.
This retrospective study included consecutive cases of T-OPLL patients from January 2002 to January 2020 and minimum one-year follow-up. Data were collected for sex, age, body mass index, preoperative manual muscle test score for the weakest muscle, surgical data, and preoperative and postoperative findings on radiographs, magnetic resonance images, and computed tomography scans. Imaging data were also collected, including preoperative kyphotic angles, canal occupancy ratio, type of OPLL, and high-intensity areas on T2-weighted images. The Japanese Orthopaedic Association score for thoracic myelopathy (T-JOA) was used to evaluate the recovery of the thoracic myelopathy. The patients were categh of these features.Over the past 30 years, accumulating evidence has shown that three main therapies including angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, ß-blockers, and mineralocorticoid receptor antagonists are the standard treatment for patients with heart failure (HF) who exhibit reduced ejection fraction (EF). However, lessons learned from recent large-scale clinical trials have added a paradigm shift including angiotensin receptor-neprilysin inhibitor, sodium glucose co-transporter 2 inhibitor, and ivabradine. In addition, soluble guanyl cyclase stimulator and omecamtiv mecarbil are also suggested as next generation therapeutic measures for these patients. From these clinical trials, we learned some patients with preserved EF will benefit from certain agents, which has been one of the largest unmet needs over these decades. This article will review these paradigm shifts over the past 10 years and address a new therapeutic algorithm for patients with HF.
Highly cross-linked polyethylene with vitamin E (VE-HXLPE) has shown superior tribological properties and has been rapidly adopted in total hip arthroplasty. However, the majority of studies compare VE-HXLPE to conventional or moderately cross-linked polyethylene using standard femoral head sizes. This study's purpose was 2-fold (1) compare radiographic femoral head penetration (FHP) between VE-HXLPE and HXLPE and (2) evaluate FHP in large femoral heads ≥40 mm.
One hundred forty-two consecutive primary total hip arthroplasties using ceramic femoral heads (n = 84 VE-HXLPE; n = 58 HXLPE) in a single implant system were retrospectively reviewed. FHP was measured radiographically utilizing Martell method at 4-week, 1-year, and latest radiographs. FHP, cup position, and demographic variables were compared between VE-HXLPE and HXLPE liners.
Median linear FHP was lower for VE-HXLPE compared to HXLPE during the initial "bedding-in" period between 4-week and 1-year (0.383 vs 0.551 mm, P = .650) and between 1-year and latest follow-up (0.131 vs 0.270 mm/y, P = .636) although without statistical significance. Acetabular cup inclination and anteversion did not influence linear or volumetric FHP (P ≥ .204). Large femoral heads (≥40 mm) were predictive of higher FHP during the early bedding-in period (P ≤ .025) but did not have an effect beyond 1 year in multivariate regression with numbers available. No radiographic osteolysis was observed in any case.
These findings support others that VE-HXLPE is the optimal polyethylene bearing surface to minimize FHP during the bedding-in period and beyond. Selleck INCB054329 Surprisingly, large ceramic femoral heads appear to influence FHP during the initial bedding-in period but do not increase FHP beyond 1 year. Further longer term follow-up remains warranted.
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Hip abductor complex tears remain an injury without a clear consensus on management. Surgical treatment has been recommended after unsuccessful nonoperative management. This study evaluates both tenodesis and bone trough techniques, with treatment choices guided by previously described tear classification.
This is a retrospective cohort study of 45 hips in 44 patients who underwent surgical treatment for symptomatic, chronic hip abductor tear unresponsive to nonoperative treatment. Demographics and preoperative and postoperative values (including visual analog scale pain scores, gait assessment, and muscle strength) were evaluated. Type I tears were treated using tendon tenodesis. Type II tears were treated through a bone trough repair.
Forty-five hips (44 patients) were operated on with a minimum of 6-month follow-up. There were 27 type I and 18 type II tears. Eighty-seven percent of patients were female. Twenty-eight percent of type II patients (5/18) had a preexisting arthroplasty in place. Significa clearly denote repair failure.Blood group has been found to be important in the development of many diseases and the outcome of several disease processes, especially cardiovascular morbidity and mortality, such as caused by trauma and sepsis. The main reason is claimed to be related to glycobiology and effects mediated through the endothelium. This study investigated the possible effect of blood group (ABO) on burn care outcome. Burn outcome prediction models are extremely accurate and as such can be used to identify outcome effects even in single centre settings. In this retrospective risk adjusted observational study, we investigated the effect of ABO blood group on ventilatory time, length of hospital stay (LOS), and 90 day mortality among patients with burns. RESULTS A total of 225 patients were included (2008-2019) with median TBSA of 26%; interquartile range (IQR) of 20-37%; median age 45 years (IQR 22-65 years); median Baux score (age + TBSA%); 76 (IQR 53- 97); 168 (75%) were male; median duration of hospital stay was 31 days (IQR 19-56); a total of 138 (61%) received treatment with mechanical ventilation; and 29 (13%) died.
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