Comprehensive Follow-up Study Research Articles

Long-Term Pulmonary Sequelae and Immunological Markers in Patients Recovering from Severe and Critical COVID-19 Pneumonia: A Comprehensive Follow-Up Study.

Background and Objectives: Severe and critical COVID-19 pneumonia can lead to long-term complications, especially affecting pulmonary function and immune health. However, the extent and progression of these complications over time are not well understood. This study aimed to assess lung function, radiological changes, and some immune parameters in survivors of severe and critical COVID-19 up to 12 months after hospital discharge. Materials and Methods: This prospective observational cohort study followed 85 adult patients who were hospitalized with severe or critical COVID-19 pneumonia at a tertiary care hospital in Vilnius, Lithuania, for 12 months post-discharge. Pulmonary function tests (PFTs), including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and diffusion capacity for carbon monoxide (DLCO), were conducted at 3, 6, and 12 months. High-resolution chest computed tomography (CT) scans assessed residual inflammatory and profibrotic/fibrotic abnormalities. Lymphocyte subpopulations were evaluated via flow cytometry during follow-up visits to monitor immune status. Results: The median age of the cohort was 59 years (IQR: 51-64). Fifty-three (62.4%) patients had critical COVID-19 disease. Pulmonary function improved significantly over time, with increases in FVC, FEV1, VC, TLC, and DLCO. Residual volume (RV) did not change significantly over time, suggesting that some aspects of lung function, such as air trapping, remained stable and may require attention in follow-up care. The percentage of patients with restrictive spirometry patterns decreased from 24.71% at 3 months to 14.8% at 12 months (p < 0.05). Residual inflammatory changes on CT were present in 77.63% at 6 months, decreasing to 69.62% at 12 months (p < 0.001). Profibrotic changes remained prevalent, affecting 82.89% of patients at 6 months and 73.08% at 12 months. Lymphocyte counts declined significantly from 3 to 12 months (2077 cells/µL vs. 1845 cells/µL, p = 0.034), with notable reductions in CD3+ (p = 0.040), CD8+ (p = 0.007), and activated CD3HLA-DR+ cells (p < 0.001). This study found that higher CD4+ T cell counts were associated with worse lung function, particularly reduced total lung capacity (TLC), while higher CD8+ T cell levels were linked to improved pulmonary outcomes, such as increased forced vital capacity (FVC) and vital capacity (VC). Multivariable regression analyses revealed that increased levels of CD4+/CD28+/CD192+ T cells were associated with worsening lung function, while higher CD8+/CD28+/CD192+ T cell counts were linked to better pulmonary outcomes, indicating that immune dysregulation plays a critical role in long-term respiratory recovery. Conclusions: Survivors of severe and critical COVID-19 pneumonia continue to experience significant long-term impairments in lung function and immune system health. Regular monitoring of pulmonary function, radiological changes, and immune parameters is essential for guiding personalized post-COVID-19 care and improving long-term outcomes. Further research is needed to explore the mechanisms behind these complications and to develop targeted interventions for long COVID-19.

Conversion of sleeve gastrectomy to Roux-en-Y laparoscopic gastric bypass: a comprehensive 14-year follow-up study on efficacy and outcomes

Failed sleeve gastrectomy (SG), defined by inadequate weight loss or weight regain and by reflux and structural complications, can be treated by a laparoscopic conversion to Roux-en-Y gastric bypass (RYGB). To examine the efficacy and outcomes of conversion surgery over a 14-year follow-up period. Government and private medical centers in university settings. We conducted a cohort study of 58 patients who underwent conversion of SG to RYGB for 2 indications: invalidating reflux or weight recurrence during 2009-2023. Weight dynamics analysis was performed with 2 references of weight: before SG (with intention to treat) and before conversion. At conversion surgery, the mean weight, body mass index (BMI), percentage of excess weight loss (%EWL), and percentage of total weight loss (%TWL) (calculated with intention to treat, from the weight before SG) were 92.2 ± 25.2 kg, 34.3 ± 8.0 kg/m2, 55.2% ± 39.9%, and 22.8% ± 15.2%, respectively. Mean nadir weight, BMI, %EWL, and %TWL after conversion (calculated from the weight before SG) were 71.1 ± 18.4 kg, 26.7 ± 5.5 kg/m2, 96.5% ± 30.5%, and 40.2% ± 10.6%, respectively. At follow-up, the mean weight, BMI, %EWL, and %TWL (calculated from the weight before SG) were 80.4 ± 17.7 kg, 29.6 ± 5.4 kg/m2, 78.9% ± 26.8%, and 33.3% ± 11.2%, respectively. The mean percentages of %EWLio and %TWLio (calculated from the weight before conversion = EWL from index operation) at nadir were 73.2% ± 92.7% and 20.1% ± 12.2% after conversion, respectively, and decreased to 41.9% ± 94.0% and 13.2% ± 15.2% at last follow-up (mean 6.6 yr), respectively. SG to RYGB conversion provides moderate to low complementary weight loss in the short term. By 3-4 years, there is a clear trend toward weight gain.

Outcomes of omega variant keystone flap in conjunction with single fraction radiotherapy for helical keloids: A comprehensive one-year follow-up study

Achieving esthetically pleasing results for helical keloids can be challenging. This study aims to share the results of a treatment approach for helical keloids, which involves complete excision and reconstruction using an omega variant keystone flap, followed by a single fractional radiotherapy. The current study is a retrospective review of 25 helical keloids in 21 patients from May 2021 to March 2023. All keloid cases were excised entirely. We covered the defect with an omega variant keystone flap followed by a single fraction of 9.5 or 10Gy radiotherapy within 24h after surgery. The mean follow-up period was 12 months. The primary outcome was recorded as recurrence versus non-recurrence. The secondary outcome was scores assessed by the Patient and Observer Scar Assessment Scale. All 25 keloids in 21 patients completed the treatment protocol, with a follow-up interval of 12 months. Of these patients, 100% had successful treatment of their keloids without any keloid recurrence. The postoperative course was uneventful except for one case of early postoperative flap congestion, which was spontaneously healed without any interventions. Scores obtained from the Patient and Observer Scar Assessment Scale showed that pain, itchiness, color, stiffness, thickness, irregularity, vascularity, pigmentation, thickness, relief, and pliability significantly improved. (p<0.001). We successfully reconstructed helical keloids using an omega variant keystone flap after keloid removal followed by 9.5 or 10Gy single fractional radiotherapy without any keloid recurrence in one-year follow-ups.

Retrospective Evaluation of Cytogenetic Effects Induced by Internal Radioiodine Exposure: A 27-Year Follow-Up Study

Radioiodine (131I) is widely used in the treatment of hyperthyroidism and as an effective ablative therapy for differentiated thyroid cancer. Radioiodine (131I) constitutes 90% of the currently used therapies in the field of nuclear medicine. Here, we report the cytogenetic findings of a long-term follow-up study of 27 years on a male patient who received two rounds of radioiodine treatment within a span of 26 months between 1992 and 1994 for his papillary thyroid cancer. A comprehensive cytogenetic follow-up study utilizing cytokinesis blocked micronucleus assay, dicentric chromosome assay, genome wide translocations and inversions was initiated on this patient since the first administration of radioiodine in 1992. Frequencies of micronuclei (0.006/cell) and dicentric chromosomes (0.008/cell) detected in the current study were grossly similar to that reported earlier in 2019. The mFISH analysis detected chromosome aberrations in 8.6% of the cells in the form of both unbalanced and balanced translocations. Additionally, a clonal translocation involving chromosomes 14p; 15q was observed in 2 of the 500 cells analyzed. Out of the 500 cells examined, one cell showed a complex translocation (involving chromosomes 9, 10, and 16) besides 5 other chromosome rearrangements. Collectively, our study indicates that the past radioiodine exposure results in long-lasting chromosome damage and that the persistence of translocations can be useful for both retrospective biodosimetry and for monitoring chromosome instability in the lymphocytes of radioiodine exposed individuals.

Impact of thoracic endovascular aortic repair following blunt traumatic thoracic aortic injury on blood pressure

Blunt traumatic thoracic aortic injuries (BTAIs) are associated with a high mortality rate. Thoracic endovascular aortic repair (TEVAR) is the most frequently used surgical strategy in patients with BTAI, as it offers good short- and middle-term results. Previous studies have reported an abnormally high prevalence of hypertension (HT) in these patients. This work aimed to describe the long-term prevalence of HT and provide a comprehensive evaluation of the biomechanical, clinical,and functional factors involved in HT development. Twenty-six patients treated with TEVAR following BTAI with no history of HT at the time of trauma were enrolled. They were matched with 37 healthy volunteers based on age, sex, and body surface area and underwent a comprehensive follow-up study, including cardiovascular magnetic resonance, 24-hour ambulatory blood pressure monitoring, and assessment of carotid-femoral pulse wave velocity (cfPWV, a measure of aortic stiffness) and flow-mediated vasodilation. The mean patient age was 43.5 ± 12.9years, and the majority were male (23 of 26; 88.5%). At a mean of 120.2 ±69.7months after intervention, 17 patients (65%) presented with HT, 14 (54%) had abnormal nighttime blood pressure dipping, and 6 (23%) high cfPWV. New-onset HT was related to a more proximal TEVAR landing zone and greater distal oversizing. Abnormal nighttime blood pressure was related to high cfPWV, which in turn was associated with TEVAR length and premature arterial aging. HT frequently occurs otherwise healthy subjects undergoing TEVAR implantation after BTAI. TEVAR stiffness and length, the proximal landing zone, and distal oversizing are potentially modifiable surgical characteristics related to abnormal blood pressure.

Analysis of energy carbon emissions from agroecosystems in Tarim River Basin, China: A pathway to achieve carbon neutrality

Accounting for energy carbon emissions and analyzing the driving factors from a watershed perspective is necessary and helpful for achieving emission reduction targets in arid regions. Based on Sustainable Development Goals and socioeconomic data, the spatiotemporal characteristics of energy carbon emissions, driving factors, and future trends in the Tarim River Basin (TRB) were analyzed by constructing an index system, and using a Bayesian network and Tapio model. The results indicated that from 1989 to 2018, the energy carbon emissions in the TRB increased (0.75 tCO2/capita per year) because of the unreasonable structure of agricultural economic development. We conducted a sensitivity analysis and found that the primary influencing factors of energy carbon emissions in the TRB are low water utilization efficiency (Water) and rapid GDP growth (sdg8_adjgrowth). Although technological progress (sdg9_rdex) has little impact on energy carbon emissions in the short term, its impact cannot be ignored in the long run. In addition, the energy carbon emissions in the TRB will peak in 2030 (66.08 tCO2/capita), and then decrease in following years. The continuous increase in energy carbon emissions in the TRB has greatly increased the difficulty for achieving the dual carbon goals. Water resource utilization and economic structure determine the changes in energy carbon emissions. Our findings have important implications for the continued implementation of stringent carbon emissions policies. However, owing to data limitations, only general trends in energy carbon emissions were obtained, and a comprehensive follow-up study is required.

Parental Involvement in Young Children’s Learning of Numeracy

This study seeks to assess the Malaysian parental involvements in young children's numeracy learning. A questionnaire was administered to 327 parents of kindergarten-going children. The data then analysed descriptively using Statistical Package for the Social Sciences version-26. The present survey shows that the parents' knowledge, understanding, and attitude towards preschoolers' numeracy are high. Despite the positive findings, the parents' attitudes and experience in mathematics are moderate. The analysis found that parents need a relevant guide to support their children learning at home using effective instructional strategies. This research's data formed an initial insight to support a comprehensive follow-up study in parental involvement in young children’s numeracy learning. Based on these findings, it is pertinent to investigate the underlying factors and constraints behind these results. The study will benefit researchers, parents, children, school, as well as the entire community in general. Conclusion and future recommendation are further discussed.

A Comprehensive Prospective Study to Understand Chikungunya Infection in Delhi Region during 2010-2011

INTRODUCTION: Chikungunya is an arbovirus causing febrile illness with high strike rate and is known for outbreaks in more than 60 countries globally. During 2010-2011 unusual high number of suspected Chikungunya infection patients attended AIIMS OPD, Delhi, India. The NCR region with its semiarid geography restricts arbovirus outbreaks to monsoon months and is previously known for Dengue outbreaks although Chikungunya outbreaks were previously unknown to the region. The surge in suspected Chikungunya infection cases indicates a possible outbreak in the NCR region. This comprehensive prospective and follow-up study was designed to understand the Chikungunya infection among patients attending AIIMS OPD during 2010-11. METHOD: During June 2010 to Dec 2011, 2346 blood samples were collected from outpatients and inpatients attending AIIMS OPD, New Delhi. Samples were grouped in acute and chronic cases. Some patients were also enrolled for year-long follow-up study. Serum samples were tested for CHIKV using PCR and for IgM antibodies to chikungunya virus by IgM-capture ELISA. Real-time PCR was performed targeting the E1 gene for viral load determination in patient sera. RESULT: CHIKV positivity of 35% (746/2112) in acute and 67% (156/234) in chronic suspected cases were found by ELISA. most affected patients belonged to the age group >30-45 yrs. and above in both genders. Acute confirmed cases included 383 (51.3%) females and 363 (48.7%) males and chronic includes 92 (58.9%) females and 64 (41.1%) males. Clinical symptoms include polyarthralgia, fever, and rashes. Maximum positivity was seen in Oct-Nov of both years. During follow-up study, 118 patients enrolled, persisting polyarthralgia and anti-CHIKV IgM was detected up to 2 years while circulating CHIKV was detected by PCR up to 3 months in few patients. CONCLUSION: Chikungunya virus has emerged in Delhi during 2010 and contributed to about 30-40% of fever and arthralgia. CHIKV prevalence is highest in post monsoon month of October. The virus can remain in blood circulation for weeks, while anti-CHIKV IgM can persist for more than a year with complaints of periodic polyarthralgia.

Gen1 mutation caused kidney hypoplasia and defective ureter-bladder connections in mice.

Limited genetic factors were uncovered for the development of congenital anomalies of the kidney and urinary tract (CAKUT). We previously reported that a Holliday junction resolvase Gen1 was essential for early metanephric development in mice. This comprehensive follow-up study focused on the roles of Gen1 in late metanephric development. We found that Gen1 mutation impaired the late development of both kidney and urinary tract. In vivo and ex-vivo kidney primordia culture confirmed decreased ureteric bud branching in Gen1 mutants, which consequently caused hypoplasia. We also observed abnormal urinary tract development. Programmed apoptosis at the end of nephric duct disappeared in Gen1 mutants, which caused abnormal ureter-bladder connections, leading to vesicoureteral reflux (VUR) or ureterovesical junction obstruction (UVJO). Mechanistically, RNA-seq analysis proved that Gen1 mutation impaired the expression of multiple regulatory genes for the metanephric development, including Six2. Taken together, our study provides more insight into the roles of Gen1 in the development of the kidney and urinary tract, which may have potential clinical significance in the treatment and/or prevention of CAKUT.

Social Mapping of Clean and Healthy Life Behavior of Remote Indigenous Communities in Kampung Ulakin Kolf Brasa District Asmat Regency Papua Province

&#x0D; &#x0D; &#x0D; This social mapping aims to collect data and information about clean and healthy life behavior (PHBS) of Remote Indigenous Communities (KAT) in Ulakin Village, Kolf Brasa District, Asmat Regency, Papua Province. The method of data collection in this study is survey method. Data collection techniques used; 1) observation, 2) interviews with leaders and community members, and 3) focus group discussions. The results of the study show that; 1) childbirth assistance has not been carried out by health workers, 2) babies have been breastfed, 3) the community does not have health insurance, 4) the community still utilizes the availability of rainwater and rivers, 5) some houses have used healthy toilets as facilities from the local government, but not yet utilized as appropriate, 6) the average floor area of a house is 36 m2 with an average occupant of 3-5 people, 7) the floor of the house is made of wooden boards which are assistance from the government, 8) the community still smokes in any place, including inside the house, 9) the community always engages in physical activities in the context of hunting and gathering activities, 10) the community eats fruit and vegetables irregularly, adapted to natural resources and the environment. Suggestions for this research; 1) the parties involved have to carry out a more comprehensive follow-up study, and 2) the community as beneficiaries should receive information, services, guidance and social assistance in a participatory, measurable and sustainable manner.&#x0D; &#x0D; &#x0D;

Amyloid Cardiomyopathy in the Emergency Department

Cardiac amyloidosis is an underdiagnosed cause of restrictive cardiomyopathy resulting from the infiltration of the myocardium by amyloid proteins. We report the case of an 83-year-old woman who presented with increasing dyspnea and lower-extremity swelling. She reported a medical history of unspecified heart failure. Evaluation in the Emergency Department (ED) revealed evidence of heart failure on physical examination, low-voltage electrocardiogram, chest x-ray study with mild pulmonary edema, and laboratory evaluation with elevated brain natriuretic peptide and troponin. Bedside cardiac ultrasound illustrated severe concentric ventricular hypertrophy and interventricular septal wall thickening with "sparkling" hyperechoic appearance of the myocardium, mildly reduced left ventricular ejection fraction, and small pericardial effusion. Inpatient comprehensive echocardiogram and follow-up nuclear medicine cardiac amyloid pyrophosphate study were suggestive of cardiac amyloidosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians commonly treat acute on chronic systolic heart failure with diuresis and reductions in preload and afterload with nitrates. Identifying amyloid cardiomyopathy in the ED is of clinical significance because treatment should include loop diuretics but should avoid β-blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, and digoxin. Atrioventricular nodal blocking agents may have detrimental effects in cardiac amyloidosis because the cardiac output in this patient population is dependent on heart rate due to a significantly reduced stroke volume from the concentric hypertrophy minimizing diastolic filling. Also, caution should be taken when initiating nitrates in amyloid cardiomyopathy because further reducing preload in an already preload-depleted state can result in hypotension.

Patients with abdominal-based free flap breast reconstruction a decade after surgery: A comprehensive long-term follow-up study

Abdominal-based free flap has increasingly become the gold standard for breast reconstruction, however long-term evidence of the aesthetic outcome and quality of life is lacking. The present study aims to gain an overview of patients with abdominal-based free flap breast reconstructions in a long-term perspective. Seventy-five patients who received abdominal-based free flap breast reconstructions between 2000-2007 in Uppsala, Sweden were invited back for photographs, 3D imaging and questionnaires. A retrospective chart review was conducted. Patient satisfaction with appearance and quality of life were assessed using the Breast-Q questionnaire. A layman panel and a professional panel rated the aesthetic appearance of the reconstructed breast from photographs and 3D images. Fifty-five patients participated with a mean age of 52 ± 8 years at the time of reconstruction and a mean follow-up time of 11.4 ± 1.8 years completed the study. The majority of the patients had received unilateral (85%), delayed reconstructions (73%) with prior radiation (55%). There were 53 patients with DIEP flaps, one with free TRAM flap and one with SIEA flap. Breast-Q scores in the cohort were comparable to normative values of women without breast cancer (p < 0.001). There was a high level of agreement for the aesthetic results of the reconstructions between patient, professionals and layman panels (0.89 ICC, 95% CI: 0.83 - 0.93). Abdominal-based free flap reconstructions were effective in achieving a lasting positive aesthetic result and a high quality of life in patients a decade after surgery.

A Chronic Disease Management Program at the Rowan School of Osteopathic Medicine’s Student-Run Free Clinic

In the United States, one out of every four adults is living with at least one chronic disease. Treatment of these chronic conditions accounts for 84% of healthcare spending. Successful treatment of chronic diseases involves support from family, the community, and the healthcare system. In this descriptive report, we outline the beginning steps of implementing a new program aimed at addressing a pervasive chronic disease in the population seen at our student-run clinic. The Rowan University School of Osteopathic Medicine’s Camden Community Health Center in conjunction with the Camden Area Health Education Center gathered information from a community needs assessment and focus group to better direct efforts at optimizing healthcare delivery to the priorities of the community. After collecting the data, a chronic disease management pilot program targeting patients with chronic hypertension was created. The program included a course run over a six-week period, in which a peer-run educational group focused on lifestyle changes and medical management of hypertension. This plan utilized community health workers, a “buddy system,” and family support. At the end of the program, participants were provided with a weekly blood pressure log, action plan for their disease management, and specific follow-up appointments. Furthermore, we briefly share preliminary data that allowed us to gauge success of the pilot program and form the basis for a larger, more comprehensive follow-up study.

The second Sandia Fracture Challenge: blind prediction of dynamic shear localization and full fracture characterization

In the context of the second Sandia Fracture Challenge, dynamic tensile experiments performed on a Ti–6Al–4V alloy with a complex fracture specimen geometry are modeled numerically. Sandia National Laboratories provided the participants with limited experimental data, comprising of uniaxial tensile test and V-notched rail shear test results. To model the material behavior up to large plastic strains, the flow stress is described with a linear combination of Swift and Voce strain hardening laws in conjunction with the inverse method. The effect of the strain rate and temperature is incorporated through the Johnson–Cook strain rate hardening and temperature softening functions. A strain rate dependent weighting function is used to compute the fraction of incremental plastic work converted to heat. The Hill’48 anisotropic yield function is adopted to capture weak deformation resistance under in-plane pure shear stress. Fracture initiation is predicted by the recently developed strain rate dependent Hosford–Coulomb fracture criterion. The calibration procedure is described in detail, and a good agreement between the blind prediction and the experiments at two different speeds is obtained for both the crack path and the force–crack opening displacement (COD) curve. A comprehensive experimental and numerical follow-up study on leftover material is conducted, and plasticity and fracture parameters are carefully re-calibrated. A more elaborate modeling approach using a non-associated flow rule is pursued, and the fracture locus of the Ti–6Al–4V is clearly identified by means of four different fracture specimens covering a wide range of stress states and strain rates. With the full characterization, a noticeable improvement in the force–COD curve is obtained. In addition, the effect of friction is studied numerically.

Invited Commentary

Rosario-Quinones and colleagues report [1Rosario-Quinones F. Magid M.S. Yau J. Pawale A. Nguyen K. Tissue reaction to porcine intestinal submucosa (CorMatrix) implants in pediatric cardiac patients: a single-center experience.Ann Thorac Surg. 2015; 99: 1373-1378Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar] their experience of using CorMatrix during pediatric cardiac surgery. Six of 25 patients required reoperation and pathology demonstrated inflammation and fibrosis with transient peripheral eosinophilia. It is difficult to know how to interpret these findings. The small intestinal submucosa-extracellular matrix (SIM-ECM) technology has been used in greater than 2,000,000 patients and constructive remodeling has been reported in greater than 800 scientific papers. CorMatrix has been used for reconstruction of all 4 cardiac valves, aorta and pulmonary arteries, septal defect closure, outflow tract repairs, and pericardial reconstruction. In general, clinical reports are few and the concern has been inflammation and fibrosis [2Zaidi A.H. Nathan M. Emani S. et al.Preliminary experience with porcine intestinal submucosa(CorMatrix) for valve reconstruction in congenital heart disease: histologic evaluation of explanted valves.J Thorac Cardiovasc Surg. 2014; 148 (2216-4, 2225.e1)Abstract Full Text Full Text PDF PubMed Scopus (90) Google Scholar]. Negative results reported have ranged from explanted pathology to abnormal imaging (computed tomography, magnetic resonance imaging, and echocardiography) to contraction and thickening noted at reoperation. Techniques of implantation are also variable; continuous versus interrupted suture, circumferential suture lines, eg, mid-leaflet augmentation or blood vessel reconstruction versus an exposed free edge with semilunar leaflet reconstruction, and finally anastomosis to a freshly cut normal endocardium that may be important for porcine scaffold cellularization. Despite concerning reports, CorMatrix implants now exceed 120,000 patients and feedback by many surgeons have been positive (Drs Emile Bacha, James Tweddell, ∗Drs Bacha and Tweddell are both on the Medical Advisory Board for CorMatrix.∗Drs Bacha and Tweddell are both on the Medical Advisory Board for CorMatrix. Patrick McConnell, Frank Scholl and John Kupferschmid, personal communications, February 2 and 3, 2015). Favorable comments include “soft and pliable,” “looks like the native tissue of what was reconstructed,” and “cannot differentiate between CorMatrix and adjacent native tissue.” There are some patients who react adversely to bioprosthetic valves and have early deterioration. Whether this is similar to the negative findings reported with CorMatrix is not clear. It should be emphasized that adherence to proper preparation protocols is essential as inadvertent rinsing of a bioprosthetic valve with antibiotic solution can adversely affect the leaflets [3Hu J.E. Gilmer L. Hopkins R. Wolfinbarger Jr., L. Effects of antibiotics on cellular viability in porcine heart valve tissue.Cardiovasc Res. 1990; 24 ([Erratum]): 168Crossref Scopus (16) Google Scholar]. There is a need for a prosthetic that will remodel, grow, and not calcify. Current materials include synthetic, cross-linked, or glutaraldehyde-treated and all are non-growing. Basic science evidence has demonstrated CorMatrix to be capable of in vivo remodeling and probable growth of new heart muscle [4Yanagawa R. Rao V. Yau T.M. Cusimano R.J. Potential myocardial regeneration with CorMatrix ECM: a case report.J Thorac Cardiovasc Surg. 2014; 147: e41-e43Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar]. It may well be that multiple ECM products will be required and that one design does not fit all needs. Regenerative medicine is the future for many cardiovascular diseases. The negative findings in this review add to the other small series of worrisome anecdotes. The discrepancy between favorable opinions by other surgeons who use CorMatrix enthusiastically contributes to the confusion as to what its role is and should be. More comprehensive follow-up or prospective study is required to determine its place in clinical practice. Tissue Reaction to Porcine Intestinal Submucosa (CorMatrix) Implants in Pediatric Cardiac Patients: A Single-Center ExperienceThe Annals of Thoracic SurgeryVol. 99Issue 4PreviewDecellularized porcine small intestine submucosa (CorMatrix, Atlanta, GA) patches have been used in the repair of congenital heart malformations. Tissue reaction to the material may create hemodynamic dysfunction and necessitate explantation. We reviewed our series of congenital cardiac patients who had a reoperation after the implantation of CorMatrix patches. Full-Text PDF

Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with an intellectual disability who exhibit aggressive behaviour

A high proportion of adults with an intellectual disability (ID) are known to receive psychotropic medications for the management of aggressive behaviour in the absence of any psychiatric diagnosis. Despite this widespread use of psychotropic medication in general and antipsychotic medication in particular, no study has reported the trajectory of psychotropic medication use using a prospective design. We have prospectively studied a community, clinic-based sample of 100 adults with ID and aggressive behaviour over a 6-month period for use of psychotropic medication in general and antipsychotics in particular, and compared them with demographic, psychiatric and behavioural variables. Psychotropic medications were used for 89% of patients at baseline (T1) and 90% at 6 months' (T2) follow-up. Risperidone was the most commonly used antipsychotic medication followed by chlorpromazine, haloperidol, olanzapine, zuclopenthixol and quetiapine. Other commonly used medications were SSRI antidepressants such as citalopram, paroxetine and fluoxetine followed by mood stabilisers such as carbamazepine and sodium valproate. Although in a high proportion of cases carbamazepine and sodium valproate were used to treat epilepsy per se. A high proportion (45%) received more than one (polypharmacy) psychotropic medication at T1; however, this proportion decreased slightly to 41% at T2. As for antipsychotic prescribing specifically, a similar proportion received them at T1 (75%) and T2 (73%), with polypharmacy of antipsychotics remaining similar at T1 (10%) and at T2 (9%). Twenty-three per cent and 20% of patients received over 300 mg/day of chlorpromazine equivalent dose of antipsychotics at T1 and T2 respectively. However, there was an overall significant reduction in the severity of aggressive behaviour between T1 and T2. Higher doses of antipsychotic prescribing were positively correlated with more severe aggressive behaviour, physical aggression towards objects, self-injurious behaviour and increasing age. There was no significant association with other demographic variables, physical health conditions or psychiatric diagnosis. Neither was there any significant correlation between mean aggression severity score change and antipsychotic daily dose change between T1 and T2. To our knowledge, this is the first ever comprehensive follow-up study of use of psychotropic medications in general but antipsychotics in particular over a 6-month period in adults with ID and aggressive behaviour, in a clinic-based community setting which also compared the trajectory of severity of aggressive behaviour with that of antipsychotic medication dose. Our study shows that not only the use of psychotropic medication is common among adults with ID who attend psychiatric clinics for aggressive behaviour, the use of polypharmacy of psychotropic medications in general and high dose of antipsychotics in particular are equally prevalent. However, in some cases two antipsychotics may have been prescribed simultaneously as the psychiatrist is in the process of switching from one to another.

MAP2K3 is associated with body mass index in American Indians and Caucasians and may mediate hypothalamic inflammation

To identify genes that affect body mass index (BMI) in American Indians who are predominately of Pima Indian heritage, we previously completed a genome-wide association study in 1120 American Indians. That study also included follow-up genotyping for 9 SNPs in 2133 additional subjects. A comprehensive follow-up study has subsequently been completed where 292 SNPs were genotyped in 3562 subjects, of which 128 SNPs were assessed for replication in 3238 additional subjects. In the combined subjects (n = 6800), BMI associations for two SNPs, rs12882548 and rs11652094, approached genome-wide significance (P = 6.7 × 10−7 and 8.1 × 10−7, respectively). Rs12882548 is located in a gene desert on chromosome 14 and rs11652094 maps near MAP2K3. Several SNPs in the MAP2K3 region including rs11652094 were also associated with BMI in Caucasians from the GIANT consortium (P = 10−2–10−5), and the combined P-values across both American Indians and Caucasian were P = 10−4–10−9. Follow-up sequencing across MAP2K3 identified several paralogous sequence variants indicating that the region may have been duplicated. MAP2K3 expression levels in adipose tissue biopsies were positively correlated with BMI, although it is unclear if this correlation is a cause or effect. In vitro studies with cloned MAP2K3 promoters suggest that MAP2K3 expression may be up-regulated during adipogenesis. Microarray analyses of mouse hypothalamus cells expressing constitutively active MAP2K3 identified several up-regulated genes involved in immune/inflammatory pathways and a gene, Hap1, thought to play a role in appetite regulation. We conclude that MAP2K3 is a reproducible obesity locus that may affect body weight via complex mechanisms involving appetite regulation and hypothalamic inflammation.

Incidence and risk factors for symptoms from the eyes among professional computer users

Personal computers are used by a majority of the working population in their professions. Little is known about risk-factors for incident symptoms from the eyes among professional computer users. The aim was to study the incidence and risk-factors for symptoms from the eyes among professional computer users.This study is a part of a comprehensive prospective follow-up study of factors associated with the incidence of symptoms among professional computer users. 1531 computer users of different professions at 46 companies were invited, whereof 1283 answered a baseline questionnaire (498 men; 785 women) and 1246 at least one of 10 monthly follow-up questionnaires. The computer work-station and equipment were generally of a good standard. The majority used CRT displays.During the follow-up period 329 subjects reported eye symptoms. The overall incidence rate in the whole study group was 0.38 per person-year, 0.23 in the subgroup of subjects who were symptom free at baseline and 1.06 among subjects who reported eye symptoms at baseline. In the bivariate analyses significant associations were found with all explanatory variables, except BMI. The reduced multivariate model showed significant associations with extended computer work, visual discomfort (dose-response), eye symptoms at baseline (higher risk), sex (women=higher risk) and nicotine use.The incidence of eye problems among professional computer users is high and related to both individual and work-related factors.

School’s out: a comprehensive follow-up study on parents’ perceptions of their child’s school

This longitudinal study set out to examine the changes that took place in parents’ evaluations of their child’s school in the course of the child’s complete 9-year-long compulsory education. Over the follow-up period, academically educated and vocationally educated mothers and fathers (N = 326) were asked to indicate their degree of satisfaction with aspects of their child’s school every 2 years. It was found that the level of parental satisfaction was fairly high at the start, that the general decreasing trend was gradual rather than abrupt, and that the proportion of dissatisfied parents remained low and stable. A pattern of differences emerged to suggest that the parents’ perceptions were structured by their social-psychological distance from the school as measured by their social positions; for instance, the vocationally educated parents, fathers in particular, displayed less satisfaction than the academically educated ones.

Evaluation of Clinical Outcomes for Gastric Bypass Surgery: Results from a Comprehensive Follow-up Study

Laparoscopic gastric bypass (LGB) surgery markedly increases percent excess weight loss (%EWL) and obesity-related co-morbidities. However, poor study quality and minimal exploration of clinical, behavioral, and psychosocial mechanisms of weight loss have characterized research to date. We conducted a comprehensive assessment of n = 100 LGB patients surveyed 2-3 years following surgery using standardized measures. Mean %EWL at follow-up was 59.1 ± 17.2%. This high level of weight loss was associated with a low rate of metabolic syndrome (10.6%), although medications were commonly used to achieve control. Mean adherence to daily vitamin and mineral supplements important to the management of LGB was only 57.6%, and suboptimal blood chemistry levels were found for ferritin (32% of patients), hematocrit (27%), thiamine (25%), and vitamin D (19%). Aerobic exercise level (R (2) = 0.08) and pre-surgical weight (R (2) = 0.04) were significantly associated with %EWL, but recommended eating style, fluid intake, clinic follow-up, and support group attendance were not. Psychosocial adjustment results showed an absence of symptomatic depression (0%), common use of antidepressant medications (32.0%), low emotional distress related to the post-surgical lifestyle (19.8 ± 14.0; scale range 0-100), a high level of perceived benefit from weight loss in terms of functioning and emotional well-being (82.7 ± 17.9; scale range 0-100), and a change in marital status for 26% of patients. At 2-3 years following LGB surgery aerobic exercise, but not diet, fluid intake, or attendance at clinic visits or support groups, is associated with %EWL. Depression is symptomatically controlled by medications, lifestyle related distress is low, and marital status is significantly impacted.