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BACKGROUND Factors associated with visual outcomes after transcranial surgery for large-to-giant pituitary adenomas have not been fully elucidated. METHODS We recruited 37 patients with large-to-giant pituitary adenomas between January 2014 and December 2016 and assessed their tumor characteristics and surgical outcomes. Visual acuity and visual field were evaluated by Visual impairment score (VIS) before and 3-6 months after transcranial surgery. Multivariable logistic regression analysis was applied to reveal the factors associated with visual outcomes after surgery. RESULTS The severity levels of visual impairment before surgery were mild, moderate, severe, and complete in 24.3% (9/37), 24.3% (9/37), 35.1% (13/37), and 16.2% (6/37), respectively. After surgery, the visual function was improved, stabilized, and worsened in 43.2% (16/37), 43.2% (16/37), and 13.5% (5/37) of patients, respectively. Multivariable logistic regression analysis showed that subarachnoid space invasion was the only independent prognostic factor adversely influencing the postoperative visual outcomes. Patients with subarachnoid space invasion had a higher possibility of visual deterioration (36.4% vs. 3.8%, p = 0.021) after transcranial surgery, compared with those without subarachnoid space invasion. CONCLUSIONS Visual compromise is still an unignorable complication during transcranial surgery for large-to-giant pituitary adenomas. Subarachnoid space invasion indicated by preoperative MRI was an independent negative predictor for visual outcomes after surgery. find more INTRODUCTION Despite increasing interest in endovascular therapy (EVT) for large-core strokes, little is known about the predictors of good outcome in these patients. The aim of this study was to analyze patients with large core strokes post-EVT and to define the predictors of favorable outcome in this population. METHODS A retrospective analysis of prospectively-collected data on anterior circulation strokes undergoing EVT between January 2015 and February 2018 was performed. Patients with good baseline functional status who underwent EVT for occlusion of an anterior circulation artery and achieved successful recanalization (mTICI ≥2b) but had large follow-up infarcts (FIV ≥70 cm3) were included in the study. Demographic characteristics, clinical and radiological data, treatment and post-procedural outcomes were extracted and analyzed. The primary outcome was 90-day mRS, stratified by favorable (mRS 0-3) versus unfavorable (mRS 4-6). link2 RESULTS Of 355 patients meeting inclusion criteria, 85 (24%) had large FIV on follow-up imaging after EVT and constituted the study cohort. No patients achieved mRS 0-2 at hospital discharge; 32% had 90-day mRS 0-3. On multivariate logistic regression analysis, lower FIV [OR-0.96 (0.95-0.99), p=0.007], male sex [OR-1.29 (1.07-12.3), p=0.026] and IV t-PA use [OR=3.6 (2.01-8.9), p=0.003] were independent predictors of favorable outcome. Independent predictors of mortality on multivariate analysis were higher FIV [OR-1.01 (1.007-1.02), p=0.001] and female sex [OR=4.08 (1.25-13.3), p=0.02]. CONCLUSION For patients with large-core strokes (≥70 cm3) after EVT, approximately one-third have favorable outcome at 90 days. Independent predictors of favorable 90-day outcomes include male sex, IV-tPA use, and lower FIV. INTRODUCTION Management of small unruptured aneurysms is controversial. Small aneurysms and those with low PHASES scores are often observed. The primary aim of this study was to assess whether the PHASES score classified our subarachnoid hemorrhage patients as high risk for rupture. MATERIALS AND METHODS We retrospectively reviewed a consecutive series of 628 aneurysmal subarachnoid hemorrhage neurosurgical cases over a 10-year period between 2008 and 2018. We collected patient and aneurysm characteristics and calculated PHASES scores. RESULTS The median aneurysm size was 5.3 (IQR 3.5-7). 75% (473/628) of aneurysms were less than 7 mm in size. Nearly half of aneurysms were less than 5 mm (48%, 302/628). The median PHASES score was 5 (IQR 4-6), corresponding to a 5-year risk of rupture of only 1.3%. Discussion The majority of ruptured aneurysms in our series were small with low PHASES scores, suggesting a low risk of rupture. Many of these patients would have been conservatively managed. CONCLUSIONS PHASES is inadequate in management of unruptured aneurysms, as it fails to identify many patients at risk for subarachnoid hemorrhage. A more nuanced assessment of rupture risk should be undertaken. PURPOSE To evaluate the agreement between detection of activity of choroidal neovascularization (CNV) in neovascular age-related macular degeneration (AMD) by fundus fluorescein angiography (FFA) and spectral domain (SD)- optical coherence tomography (OCT) in the HARBOR study. Most retina specialists rely on OCT to guide treatment decisions in neovascular AMD. However, OCT may not always detect exudative activity. Traditionally, FFA was frequently performed in clinical practice, but its use has diminished due to reliance on OCT. DESIGN Retrospective Post Hoc Analysis of Prospective Clinical Trial (HARBOR; clinicaltrials.gov identifier, NCT00891735) PARTICIPANTS Baseline to Month 24 data from all randomized study eyes in HARBOR with both FFA and SD-OCT data were analyzed for 1) Evidence of CNV activity on SD- OCT (presence of subretinal fluid, intraretinal fluid, and/or cystoid spaces); 2) Evidence of CNV activity on FFA identified by the presence of leakage 3) Cross tabulation of CNV activity identified by FFns that appear quiescent on SD-OCT, as this type of lesion may show leakage on FFA. BACKGROUND & Aims There is debate over the optimal method for colonoscopic surveillance of patients with inflammatory bowel diseases. Guidelines recommend chromoendoscopy, but the value of chromoendoscopy in high-definition colonoscopy has not been proven. Furthermore, the value of random biopsies is controversial. METHODS We performed a prospective study of 305 patients with ulcerative colitis or Crohn's colitis referred for surveillance colonoscopy at a university hospital in Sweden, from March 2011 through April 2016. Patients randomly assigned to a group that received high-definition chromoendoscopy with indigo carmine (HD-CE, n=152), collection of 32 random biopsies, and targeted biopsies or polypectomies or to a group that received high-definition white light endoscopy (HD-WLE, n=153), collection of 32 random biopsies, and targeted biopsies or polypectomies. The primary endpoint was number of patients with dysplastic lesions. RESULTS Dysplastic lesions were detected in 17 patients with HD-CE and 7 patients with HD-WLE (P =.032). Dysplasias in random biopsies (n=9760) were detected in 9 patients 6 (3.9%) in the HD-CE group and 3 (2.0%) in the HD-WLE group (P=.72). Of the 9 patients with dysplasia, 3 patients (33%) had primary sclerosing cholangitis-only 18% of patients (54/305) included in the study had primary sclerosing cholangitis. The number of dysplastic lesions per 10 min of withdrawal time was 0.066 with HD-CE and 0.027 with HD-WLE (P=.056). CONCLUSION In a randomized trial, we found HD-CE with collection of random biopsies to be superior to HD-WLE with random biopsies for detection of dysplasia per colonoscopy. These results support the use of chromoendoscopy for surveillance of patients with inflammatory bowel diseases. ClinicalTrials.gov no NCT01505842. BACKGROUND & AIMS We compared rates of relapse of hepatitis B virus (HBV) infection between patients with HBV genotype B vs genotype C infection after cessation of entecavir or tenofovir disoproxil fumarate (TDF) therapy. All patients included in the study were HB e antigen (HBeAg)-negative. METHODS We performed a retrospective study of 460 HBeAg-negative patients without cirrhosis in Taiwan who had stopped entecavir or TDF treatment for at least 12 months; data were collected from 2007 through 2015. All patients fulfilled the stopping criteria proposed by the APASL 2012 guidelines. Patients were evaluated every 1-3 months during the first 6 months after stopping therapy and then every 3 months until their last hospital visit; HB surface antigen (HBsAg) was measured in serum samples collected before treatment, after 12 months of treatment, and at the end of treatment. Virologic relapse was defined as a serum level of HBV DNA >2000 IU/mL after the cessation of treatment; clinical relapse was defined as increasBsAg loss, development of hepatocellular carcinoma, and hepatic decompensation did not differ significantly between patients with HBV genotypes B vs C infection or between the entecavir vs TDF groups. CONCLUSIONS Higher proportions of HBeAg-negative patients with HBV genotype B infection have virologic and clinical relapse and retreatment than patients with HBV genotype C infection, after cessation of entecavir or TDF therapy. Children today are exposed to multiple forms of digital media including traditional (e.g., televisions, computers) and newer mobile devices (e.g., smartphones, tablets, etc.). As the digital media environment evolves, it is important that health care providers and policymakers adapt to develop, implement and evaluate strategies to ameliorate its effects on health. This paper provides an overview of the literature on the relationship between the digital media environment and cardiovascular risk factors in childhood. Existing evidence on the relationship between digital media environment and cardiovascular risk in infants, children, and youth are reported. Potential mechanisms underpinning the relationship between the digital media environment and cardiovascular disease risk in children such as the displacement of movement behaviours, food and beverage marketing to children, and eating while viewing were explored. National and international guidelines aimed at addressing the digital media environment are highlighted, and suggestions for future research and guideline development are provided. Action-oriented professional recommendations for health care providers, families, and children are urgently needed. As the prevalence of screen use in childhood continues to exceed those of past generations, concern about the effects and strategies to reduce harm including cardiovascular outcomes must remain a top public health priority. Through-vial impedance spectroscopy (TVIS) is a new approach for characterizing product attributes during freeze-drying process development. link3 In this study, a pair of copper foil electrodes was attached to the external surface of a Type I glass tubing vial, of nominal capacity 10 mL and containing 3.5 g of an aqueous solution of 5%w/v lactose, and the impedance spectrum of the vial and contents recorded during a lyophilization cycle. The cycle included a temperature ramp in the primary drying stage in order to induce a collapse event in the dry layer. Using the peak in the dielectric loss spectrum, associated with the dielectric relaxation of ice, methods were developed to predict the sublimation rate and the ice interface temperature at the sublimation front, from which the dry layer resistance was then calculated. A four-fold increase in sublimation rate and a reduction in the dry layer resistance was observed once the the ice interface temperature reached -33°C, which coincides with the onset of the glass transition (as determined by DSC) and the time point at which micro-collapse occurred (as evidenced by SEM images at the end of the cycle).
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