To assess the effect of treating pulmonary hypertension (PH) in infants younger than 1 year of age with systemic glucocorticoids while using echocardiographic and diagnostic biomarkers as measures of ...efficacy.
A retrospective chart review was performed on 17 hospitalized infants younger than 1 year of age at St Louis Children’s Hospital who received a 5- to 7-day course of systemic glucocorticoid treatment followed by a 3-week taper with no significant intracardiac shunts from January 1, 2017, to December 31, 2021. Quantitative echocardiographic indices for PH, N-terminal pro b-type natriuretic peptide, and/or b-type natriuretic peptide levels were collected before glucocorticoid treatment, after the glucocorticoid burst, and after the 21-day taper.
Mean (±SD) gestational age was 32.1 (±5.8) weeks, 5 infants were (29%) concomitantly treated with sildenafil, and 8 were male. Twelve were classified as World Health Organization group 3 PH (71%) and 5 as World Health Organization group 1 PH. There were significant improvements 30 days after glucocorticoid initiation in b-type natriuretic peptide levels (P = .008), PCO2 (P = .03), eccentricity index (P = .005), right ventricular ejection time (P = .04), pulmonary artery acceleration time (P = .002), and pulmonary artery acceleration time-to-right ventricular ejection time ratio (P = .02). Tricuspid regurgitation velocity was not able to be assessed. There were no mortalities during the study timeline.
In our retrospective study, systemic glucocorticoid therapy was well tolerated and appeared to be associated with significant improvement in cardiopulmonary function in infants with PH. Further prospective study in a larger sample is warranted.
Background:
There is a current crisis in children’s mental health. Defining social determinants of mental health (SDMH) facilitates investigations of social impact on mental health.
Aims:
To examine ...associations between nine SDMH and adolescent depression and anxiety in a U.S. nationally representative sample.
Methods:
Poor access to health care, caregiver underemployment, food insecurity, poorly built environment, housing insecurity, household dysfunction adverse childhood experiences (ACEs), racism, caregiver poor education, and poverty/income inequality were assessed from the 2018 to 2019 National Survey of Children’s Health (NSCH) (N = 24,817).
Results:
The likelihood of reporting adolescent depression and/or anxiety was assessed for each SDMH using multinomial logistic regressions. All SDMH, besides caregiver underemployment, were associated with increased odds of reporting adolescent anxiety, depression, or anxiety and depression. Only household dysfunction ACEs and racism had statistically significant associations for all three mental health outcomes.
Conclusions:
Interventions targeting ACEs and racism may be more impactful in mitigating mental health challenges associated with SDMH during adolescence. The NSCH may provide an important public health tool to investigate SDMH in children.
Objective
Endoscopic Zenker's diverticulotomy (EZD) is typically performed via stapling (endoscopic staple diverticulotomy; ESD) or CO2 laser (endoscopic laser diverticulotomy; ELD). Conflicting ...reports exist on which approach provides optimal outcomes. This investigation compared objective fluoroscopic data between ESD and ELD.
Methods
A retrospective review of all patients undergoing primary EZD at a tertiary center between January 1, 2014 and January 10, 2022 was performed. Patients undergoing ESD and ELD were matched by preoperative diverticulum size. Primary outcome measures were postoperative diverticulum size and change in diverticulum size from pre‐ to postoperative swallowing fluoroscopy. Secondary outcome measures were the Eating Assessment Tool (EAT‐10) score, penetration aspiration scale (PAS), pharyngeal constriction ratio (PCR), and pharyngoesophageal segment opening (PESo).
Results
Thirteen matched pairs with complete fluoroscopic data were identified. The mean (±SD) age of the cohort was 74.0 (±8.5) years. There were no age or gender differences between groups (p > 0.05). The mean pre‐operative ZD size was 1.98 (±0.69) cm for ESD and 1.97 (±0.72) cm for ELD; the mean postoperative size was 0.84 (±0.62) cm for ESD and 0.34 (±0.27) cm for ELD (p < 0.05). Mean diverticulum size improved by 1.14 (±0.59) cm after ESD and 1.62 (±0.59) cm after ELD (p < 0.05). There were no significant differences in postoperative EAT‐10, PAS, PCR, or PESo between groups.
Conclusion
The data suggest that endoscopic laser Zenker's diverticulotomy results in a greater improvement in diverticulum size than endoscopic staple diverticulotomy. The data did not suggest a difference in postoperative dysphagia symptom scores or other objective fluoroscopic parameters between staple and laser diverticulotomy.
Level of Evidences
Level 3 Laryngoscope, 133:3057–3060, 2023
This investigation was a retrospective review comparing objective fluoroscopic outcomes between endoscopic staple diverticulotomy (ESD) and endoscopic laser diverticulotomy (ELD) for treatment of Zenker's diverticulum. The mean pre‐operative ZD size was 1.98 (±0.69) cm for ESD and 1.97 (±0.72) cm for ELD; mean postoperative size was 0.84 (±0.62) cm for ESD and 0.34 (±0.27) cm for ELD (p < 0.05); mean diverticulum size improved by 1.14 (±0.59) cm after ESD and 1.62 (±0.59) cm after ELD (p < 0.05). The results suggested that ELD resulted in a greater reduction in diverticulum size and smaller residual diverticulum compared to ESD.
Objectives/Hypothesis
The Laryngopharyngeal Measure of Perceived Sensation (LUMP) is a recently validated patient‐reported outcome measure (PROM) aimed at evaluating the symptom severity of patients ...with globus pharyngeus (GP). The objective of this study was to define the normative values for the LUMP questionnaire.
Study Design
Prospectively collected, descriptive research/scale development.
Methods
The LUMP questionnaire was completed by 88 subjects. Individuals without throat‐related symptoms such as dysphagia, dysphonia, or cough were provided LUMP. The results of the eight‐item questionnaire were analyzed for standard error of the mean (SEM), mean, and standard deviation (SD).
Results
Review of the 88 LUMP questionnaires elucidated a mean of 0.42 (SEM = 0.10, SD = 0.96) in the normative population. By gender, the female (n = 50) mean was 0.24, SD = 0.66, SEM = 0.09; for males (n = 38), the mean was 0.66, SD = 1.21, SEM = 0.20.
Conclusions
This study provides normative data for the LUMP, a recently established PROM useful in patients with GP. A LUMP score greater than or equal to 3 should be considered abnormal and warrants additional attention.
Level of Evidence
3 Laryngoscope, 132:398–400, 2022
Objectives/Hypothesis
Few studies address the demographics/epidemiology/socioeconomic status of patients presenting to a laryngologist at a tertiary care center for treatment. To identify any ...possible disparities in voice, airway, and swallowing care, we sought to analyze the aforementioned data for new patients presenting to the voice center at an academic medical center.
Methods
This is a retrospective cohort study of prospectively collected data from an institutional database of 4,623 new adult patients presenting for laryngological care at a tertiary care, academic medical center from 2015 to 2020. Demographic data were analyzed.
Results
Of 4,623 patients, 62.8% were female and 37.2% were male with ages ranging from 19 to 99 years (Avg 59.51, standard deviation 15.83). Patients were 81.8% white, 13% black, and 5.2% other, compared with 56.3% white, 34.8% black, 20% other in the local municipality from US Census Data. Payer mix included 46.98% Medicare, 42.59% commercial insurance, 3.22% Medicaid, 5.19% other, and 2.01% uninsured/self‐insured. Patient demographics based on primary diagnosis codes were also examined. A majority of patients presented with voice‐related complaints.
Conclusions
Understanding the demographics of those with laryngological disorders will help to develop targeted interventions and effective outreach programs for underrepresented patient populations. Future multicenter studies could provide further insight into the distribution of healthcare disparities in laryngology.
Level of Evidence
3 Laryngoscope, 132:626–632, 2022
Nontraumatic major lower extremity amputations (LEAs) have been reported to be declining nationally; however, trends in Texas have been less well described. We evaluated demographic and clinical risk ...factors and revascularization associations for LEAs by using inpatient hospital discharge data in Texas from 2005 to 2014.
Inpatient hospital discharge data were obtained from the Texas Center for Health Statistics. Multivariate logistic regression analyses were performed to evaluate clinical, ethnic, and socioeconomic risk factors associated with LEA. The impact of revascularization (surgical and/or endovascular) on LEA was analyzed.
Between 2005 and 2014, of 19,939,716 admissions, 46,627 were for nontraumatic major LEAs. Over time, LEAs were constant, and revascularization rates during index admission declined. The majority of LEAs occurred in males and in individuals aged 60-79 years. Risk factors associated with LEA included diabetes, peripheral arterial disease, chronic kidney disease, and male sex (
< 0.001). Insurance status, hyperlipidemia, coronary artery disease, and stroke/transient ischemic attack were associated with lower odds of amputation (
< 0.001). Hispanic (odds ratio OR 1.51 95% CI 1.48, 1.55,
< 0.001) and black (OR 1.97 95% CI 1.92, 2.02,
< 0.001) ethnicities were associated with a higher risk for amputation when compared with non-Hispanic whites. Revascularization, either surgical or endovascular (OR 0.52 95% CI 0.5, 0.54,
< 0.001), was also associated with lower odds for amputation.
Amputation rates in Texas have remained constant, whereas revascularization rates are declining. A higher risk for LEA was seen in minorities, including Hispanic ethnicity, which is the fastest growing demographic in Texas. Revascularization and having insurance were associated with lower odds for amputation.
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood with an unmet clinical need for decades. A single oncogenic fusion gene is associated with treatment resistance and a 40 to ...45% decrease in overall survival. We previously showed that expression of this
fusion oncogene in alveolar RMS (aRMS) mediates tolerance to chemotherapy and radiotherapy and that the class I-specific histone deacetylase (HDAC) inhibitor entinostat reduces PAX3:FOXO1 protein abundance. Here, we established the antitumor efficacy of entinostat with chemotherapy in various preclinical cell and mouse models and found that HDAC3 inhibition was the primary mechanism of entinostat-induced suppression of PAX3:FOXO1 abundance. HDAC3 inhibition by entinostat decreased the activity of the chromatin remodeling enzyme SMARCA4, which, in turn, derepressed the microRNA miR-27a. This reexpression of miR-27a led to
mRNA destabilization and chemotherapy sensitization in aRMS cells in culture and in vivo. Furthermore, a phase 1 clinical trial (ADVL1513) has shown that entinostat is tolerable in children with relapsed or refractory solid tumors and is planned for phase 1B cohort expansion or phase 2 clinical trials. Together, these results implicate an HDAC3-SMARCA4-miR-27a-PAX3:FOXO1 circuit as a driver of chemoresistant aRMS and suggest that targeting this pathway with entinostat may be therapeutically effective in patients.
COVID-19 vaccination rates among pregnant women remain low, despite increased risk of COVID-19-related illness and death and demonstrated vaccine safety and efficacy in this population. The objective ...of this study is to identify sociodemographic predictors of COVID-19 vaccine hesitancy and elucidate important concerns among the pregnant population in light of evolving conversations regarding COVID-19.
A prospective survey of pregnant women at a single urban clinic in South Texas was conducted August to September 2021 to identify predictors of COVID-19 vaccine hesitancy among the pregnant population. Collected variables included demographics, COVID-19 beliefs, tetanus-diphtheria-pertussis (Tdap)/influenza vaccine hesitancy, and primary vaccine concerns. Statistical analyses included Fisher's exact test, asymptotic two-sample Brown-Mood median test, and multinomial logistic regression.
One hundred and nine participants completed the survey, 35 vaccinated and 74 unvaccinated, with a response rate of 91.6%. Women who were COVID-19 vaccine hesitant were more likely to be younger (28.0 vs. 31.0 years, p < .004) and further along in pregnancy (30.0 vs. 20.0 weeks, p = .001). They were also more likely to report influenza (odds ratio (OR) 6.3; 95% confidence interval (CI) 2.5-17.1) and Tdap (OR 4.1; 95% CI 1.75-10.7) vaccine hesitancy. Furthermore, women who were vaccine hesitant were more likely to believe they did not have enough information to confidently make their decision (OR 4.0; 95% CI 1.4-11.4). Primary concerns with COVID-19 vaccines included: short- and long-term side effects on the pregnancy, personal long-term side effects, and harmful ingredients.
COVID-19 vaccine hesitant pregnant women were more likely to be younger, hesitant toward other vaccines, and concerned with pregnancy impact and harmful ingredients. Personal knowledge of other vaccinated pregnant women was associated with significantly higher vaccine acceptance rates. Access to vaccines and concerns about quality control were not cited as reasons for vaccine hesitancy, in contrast to earlier studies on this topic.
A fractional-order approach to cardiac rhythm analysis Templos-Hernández, Diana J.; Quezada-Téllez, Luis A.; González-Hernández, Brian M. ...
Chaos, solitons and fractals,
June 2021, 2021-06-00, Letnik:
147
Journal Article
Recenzirano
•Our model provides further insights into the electrical activity of the heart.•Changes in fractional parameters allow comparison of electrocardiogram recordings.•Changes in delay times allow ...comparison of electrocardiogram recordings.•We analyzed signals from healthy, hypertensive and spider-fearful subjects.
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In this research, fractional dynamics has been incorporated into a nonlinear model of three coupled oscillators to capture cardiac behavior more closely. We observe that in the case of the rhythms associated with a normal heart, the fractional orders are close to 1. For the spider-fearful individuals, fractional dynamics were incorporated into each oscillator. It might be due to that fear is a motivational state induced by specific stimuli which give rise to escape or defensive behavior. Meanwhile, in the cardiac rhythms associated with hypertensive participants, only the first oscillator, sinoatrial node, has fractional dynamic. This may have physiological relevance if we consider that hypertension is, first at all a risk factor for cardiovascular diseases. Second at all, hyperkinetic circulation is orchestrated by the sinoatrial node, in interaction with the autonomic nervous system, which leads to cardiac muscle hypertrophy. Our results show that electrocardiogram (ECG waveforms) can be simulated when various physiological conditions occur in the human heart, which is why the proposed model may find applications in clinical practice.
Monitoring crop growth, soil conditions, and hydrological dynamics are imperative for sustainable agriculture and reduced environmental impacts. This interdisciplinary study integrates remote ...sensing, digital soil mapping, and hydrological data to elucidate intricate connections between these factors in the state of Ohio, USA. Advanced spatiotemporal analysis techniques were applied to key datasets, including the MODIS sensor satellite imagery, USDA crop data, soil datasets, Aster GDEM, and USGS stream gauge measurements. Vegetation indices derived from MODIS characterized crop-specific phenology and productivity patterns. Exploratory spatial data analysis show relationships of vegetation dynamics and soil properties, uncovering links between plant vigor, edaphic fertility, and nutrient distributions. Correlation analysis quantified these relationships and their seasonal evolution. Examination of stream gauge data revealed insights into spatiotemporal relationships of nutrient pollution and stream discharge. By synthesizing diverse geospatial data through cutting-edge data analytics, this work illuminated complex interactions between crop health, soil nutrients, and water quality in Ohio. The methodology and findings provide actionable perspectives to inform sustainable agricultural management and environmental policy. This study demonstrates the significant potential of open geospatial resources when integrated using a robust spatiotemporal framework. Integrating additional measurements and high-resolution data sources through advanced analytics and interactive visualizations could strengthen these insights.
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