Concurrent Intervention Research Articles

Text "HEALER": Using Text Mentorship to Engage American Indians and Alaska Natives Interested in the Health Professions.

ProblemThe persistent underrepresentation of American Indians and Alaska Natives (AIANs) in the health professions and the decline of AIAN matriculants into health-related programs suggest interventions are needed. The authors developed Healers, a text message mentoring service, to engage and support AIANs interested in the health professions.ApproachHealers, launched in 2018, seeks to reach urban and rural high school/college-aged AIANs and other AIANs. Individuals subscribe by texting "HEALER" to a numeric code using their mobile device. Two concurrent intervention strategies include: (1) a 17-week schedule of scripted texts and (2) live weekly office hours with 2 health pathway coaches. During the pilot year (June 2018-June 2019), participants were recruited via national conferences, health fairs, social media, and word of mouth. Intake and exit surveys were conducted. Content analysis of text messages received during office hours was conducted.OutcomesDuring the pilot, 304 subscribers opted into Healers and generated 2,933 text messages. Intake survey respondents included high school students (n = 18/77, 23.4%), college students (n = 29/77, 37.7%), and others (n = 29/77, 37.7%). They represented 60 Tribes from 28 U.S. states. Among exit survey respondents, 26/28 (92.9%) reported Healers was useful, 25/27 (92.6%) reported it exposed them to new health professions, 26/27 (96.3%) expressed stories from AIAN health professionals were valuable, and 25/26 (96.2%) reported pursuing a health professions career seemed possible. Five themes emerged from the analysis of the 346 participant texts received during office hours: cultural support, mentorship, opportunities, wellness, and community building.

Physical activity and heart rate in PTSD inpatients: Moderation by custody of a service dog

Posttraumatic stress disorder is associated with autonomic hyperarousal often shown to involve elevated resting heart rate and, simultaneously if somewhat paradoxically, reduced physical activity. Both are risk factors for cardiovascular disease and so may contribute to its elevated prevalence in persons with this diagnosis. Epidemiological studies have observed dog owners to exhibit lower rates of cardiovascular disease. Non-randomized between-group studies have found service dog companionship to be associated with increased physical activity and with lower resting heart rate. A challenge to research in this area is its vulnerability to selection biases in group assignment which could lead to over-estimation of advantages or disadvantages associated with pet or service dog contact and companionship. The current study executed a within-subjects design investigating physical activity and heart rate in a sample of U.S. military Veterans engaged in residential treatment for PTSD and a concurrent service animal training intervention. A mean of 37 days of continuously-recorded day-time physical activity and heart rate were obtained from 45 participants. On days when they had custody of a familiar service-dog-in-training, participants exhibited increased physical activity accompanied by a small reduction in concurrent, activity-adjusted heart rate. Though observed in a specialized context, these short-term findings align with prior observations of lowered risk of cardiovascular disease in association with pet dog ownership. Extended longitudinal designs will be necessary to determine whether such short-term effects truly mediate lowered long-term risk.

416. SUCCESSFUL TREATMENT OF ESOPHAGO-MEDIASTINAL FISTULA DUE TO ESOPHAGEAL CANCER WITH IMMUNE CHEMOPOINT INHIBITOR FOLLOWED BY ROBOTIC RADICAL ESOPHAGECTOMY

Abstract Background Esophagomediastinal fistula caused by intrathoracic esophageal cancer perforation poses significant challenges in treatment. We present a case of such a patient successfully treated by achieving complete resolution through surgical resection following chemotherapy with 5-FU, cisplatin, and pembrolizumab. Methods Clinical and surgical findings of the patient were reviewed through chart analysis. A 46-year-old male presented to the emergency room with fever and cough. Computed tomography (CT) indicated esophageal-mediastinal fistula due to mid-thoracic esophageal cancer and perforation. Endoscopic examination revealed a 5cm circumferential mass 20cm from the upper incisors, along with perforation. Biopsy confirmed poorly differentiated squamous cell carcinoma, with a PD-L1 CPS score of 80. The patient received multidisciplinary treatment involving chemotherapy followed by planned surgical intervention. Results First of all, the patient underwent peroral endoscopic gastrostomy for dietary intake. After 3-weeks interval three cycles of 5-FU (800mg/BSA, Day1-5), cisplatin (80mg/BSA, Day1), and pembrolizumab (200mg, Day1), complete resolution of the abscess cavity and significant reduction in esophageal cancer lesions were observed. Robotic transthoracic esophagectomy and Mckeown operation were performed, achieving complete resection of the esophagus including the primary lesion. Pathological examination revealed complete remission of the primary lesion and absence of metastatic nodes among the 51 dissected lymph nodes. After subsequent additional three cycles of anticancer-immunotherapy combined therapy were done, no signs of recurrence were found on CT scan performed 3 months post-surgery. Conclusion We report a case of successful treatment of a patient with thoracic esophageal cancer complicated by difficult-to-treat esophago-mediastinal fistula, managed effectively with concurrent chemotherapy and surgical intervention.

Spatially and temporally precise microbiome profiling in the small intestine using the SIMBA capsule with X-ray tracking

IntroductionFew minimally invasive options for sampling the small intestinal (SI) luminal fluid exist to study the SI microbiota in health and disease. To address the lack of tools and methods to study GI regions that are difficult to access, Nimble Science developed a fully autonomous and passive sampling method, the Small Intestine MicroBiome Aspiration (SIMBA™) capsule, for convenient, high-quality, and reliable sampling to study the diet-microbiota interactions in the SI. MethodsThe sealing efficacy and microbial DNA preservation capacity of the SIMBA capsules was first validated through in vitro simulation assays. Then, a clinical study was conducted with 20 healthy participants to validate the in vivo use of SIMBA capsules to reliably capture samples for SI microbiome analysis before and after an intervention (NCT04489329). Briefly, participants ingested the capsules at baseline and 7 days later, with a probiotic capsule containing a blend of L. rhamnosus R0011 and B. longum R0175. Following baseline SIMBA capsule ingestion, multiple low-dosage x-ray scans were performed to track the sampling location. Fecal samples corresponding with the baseline and intervention capsule were analyzed for comparison. ResultsThe SIMBA capsules’ performance in vitro demonstrated the potential for contamination-free sampling with preservation of the microbial communities. Within the clinical study, the capsules performed safely and reliably for collection of SI content. X-ray tracking confirmed that 97.2% of the capsules completed sample collection in the SI regions before reaching the colon. Importantly, our data showed that the capsules sampled in the right area of the intestines and that baseline SIMBA microbiome profile is significantly different from fecal microbiome profile. SIMBA successfully detected a concurrent probiotic intervention in the small intestine, which was not detectable using stool samples. DiscussionsThe high accuracy of sampling location and sealing efficacy of the SIMBA capsules makes them potentially useful research tools in clinical trials for studying diet-microbiota interactions in health and disease, and perhaps eventually for the clinical diagnosis of GI tract conditions affecting the SI such as SIBO.

Adherence to Supervised and Unsupervised Exercise Programmes in Ageing Population with Intermittent Claudication: A Randomized Controlled Trial.

Background: Intermittent Claudication symptomatic peripheral arterial disease (ICSPAD) is associated with reduced mobility, functional capacity, and quality of life. Physical exercise is an effective non-pharmacological intervention for the management of ICSPAD. Adherence to exercise programs is challenging, due to the nature of the disease and the complex comorbidities associated with it. This study aimed to determine adherence to three supervised physical exercise programs (a walking intervention, strength intervention, and concurrent intervention) and an unsupervised exercise program (standard advice) in individuals with ICSPAD. Methods: In this clinical trial, 122 patients were divided into four groups based on the type of exercise program they followed: standard advice, walking intervention, strength intervention, and concurrent intervention. Results: The results revealed that while the demographic characteristics were similar, the strength intervention group had a younger mean age, and the walking group had a higher prevalence of hypertension and increased usage of anti-hypertensive drugs. Adherence to physical exercise and pedometer wearing was highest in the standard advice group. Logistic regression analysis showed lower odds of adherence to exercise and pedometer wearing in the intervention groups compared to the standard advice group. Adherence did not significantly vary across ankle-brachial index categories. Furthermore, there was no significant difference in adherence between the severity levels of intermittent claudication, though mild cases tended to exhibit higher adherence. Conclusions: The results show that the standard advice from healthcare professionals positively influences treatment adherence.

Concurrent Percutaneous Intervention for Simultaneous Acute Myocardial Infarction and Acute Bifurcated Graft Thrombosis of Lower Extremities

Concurrent Percutaneous Intervention for Simultaneous Acute Myocardial Infarction and Acute Bifurcated Graft Thrombosis of Lower Extremities

Reduction in systemic muscle stress markers after exercise-induced muscle damage following concurrent training and supplementation with specific collagen peptides - a randomized controlled trial.

Collagen peptide supplementation in conjunction with exercise has been shown to improve structural and functional adaptations of both muscles and the extracellular matrix. This study aimed to explore whether specific collagen peptide (SCP) supplementation combined with a concurrent training intervention can improve muscular stress after exercise-induced muscle damage, verified by reliable blood markers. 55 sedentary to moderately active males participating in a concurrent training (CT) intervention (3x/week) for 12 weeks were administered either 15 g of SCP or placebo (PLA) daily. Before (T1) and after the intervention (T2), 150 muscle-damaging drop jumps were performed. Blood samples were collected to measure creatine kinase (CK), lactate dehydrogenase (LDH), myoglobin (MYO) and high-sensitivity C-reactive protein (hsCRP) before, after, and at 2 h, 24 h and 48 h post exercise. A combination of concurrent training and SCP administration showed statistically significant interaction effects, implying a lower increase in the area under the curve (AUC) of MYO (p = 0.004, ηp2 = 0.184), CK (p = 0.01, ηp2 = 0.145) and LDH (p = 0.016, ηp2 = 0.133) in the SCP group. On closer examination, the absolute mean differences (ΔAUCs) showed statistical significance in MYO (p = 0.017, d = 0.771), CK (p = 0.039, d = 0.633) and LDH (p = 0.016, d = 0.764) by SCP supplementation. In conclusion, 12 weeks of 15 g SCP supplementation combined with CT intervention reduced acute markers of exercise-induced muscle damage and improved post-exercise regenerative capacity, as evidenced by the altered post-exercise time course. The current findings indicate that SCP supplementation had a positive effect on the early phase of muscular recovery by either improving the structural integrity of the muscle and extracellular matrix during the training period or by accelerating membrane and cytoskeletal protein repair. https://www.clinicaltrials.gov/study/NCT05220371?cond=NCT05220371&rank=1, NCT05220371.

Our 10-Year Experience with Atrial Myxomas: Is Concurrent Valve Intervention Really Warranted?

Primary cardiac myxomas are rare tumors. Concurrent valvular lesion is a common finding on evaluation which is thought to be due to annular dilatation secondary to tumor movement across the valve, functional obstruction across the valve, and severe pulmonary hypertension secondary to chronic obstruction. A common belief among surgeons is that excision of myxoma leads to abatement of symptoms, and further valve intervention may not be warranted. A 10-year retrospective descriptive study was designed to analyze patients who underwent excision of cardiac myxoma at our center. Data was analyzed regarding presenting features, echocardiographic findings of myxoma and valve morphology, intraoperative assessment, and postoperative outcome with/without valve repair/replacement in all patients. A total of 22 patients underwent surgery for myxoma. Six patients underwent successful mitral valve repair with ring annuloplasty, two had moderate mitral regurgitation, three had severe mitral regurgitation, and one patient had no mitral regurgitation on preoperative assessment, but moderate mitral regurgitation was found intraoperatively. Four of these patients had no residual mitral regurgitation in follow-up period while two had mild residual mitral regurgitation. One patient had severe mitral stenosis of concurrent rheumatic etiology and successfully underwent mitral valve replacement. Cardiac myxomas are rare benign tumors commonly associated with mitral valve insufficiency. Mitral valve should be assessed intraoperatively after excision of mass as preoperative assessment might often be insufficient. Concomitant mitral valve intervention might be needed with a case-specific tailored approach, and mitral valve repair with ring annuloplasty offers best surgical outcome in such cases.

Effect of suprachoroidal triamcinolone on intraocular pressure: a systematic review and meta-analysis.

Triamcinolone acetonide is a synthetic corticosteroid with multiple ocular uses. Like other corticosteroids, it too is associated with ocular side effects such as increased intraocular pressure (IOP), glaucoma and cataracts. Suprachoroidal administration of triamcinolone is hoped to reduce the ocular side effects of the drug, especially rises in IOP. Our systematic review and meta-analysis aims to study this phenomenon. The purpose of this study was to evaluate the effect of suprachoroidal triamcinolone injections on IOP. Systematic review and meta-analysis. We utilized the Medline, Scopus and Cochrane databases for this review. Studies published till June 2023, which fulfilled the eligibility criteria, were included. Studies in the English language with adult participants who were administered suprachoroidal triamcinolone without any concurrent intervention were included, whereas studies that did not report the mean and standard deviation for IOP were excluded. The outcome of interest was IOP at 1, 3 and 6 months post-suprachoroidal triamcinolone injection. IOP values from included studies were extracted onto Review Manager version 5.4 for analysis. Our search yielded 104 results, from which 22 papers were shortlisted for full-text screening. Finally, 12 studies were included in the analysis. Our analysis suggests a statistically significant increase in IOP in the first month after suprachoroidal triamcinolone injection but no significant differences at 3 and 6 months post-injection as compared to baseline. Elevated IOP at 1 month post-injection must be considered when using suprachoroidal triamcinolone and adequate safety measures must be taken. However, the absence of a significant rise at 3 and 6 months post-injection indicates that this modality is safer than other existing drug delivery methods. Registered with the Research Registry with the unique identifying number 'reviewregistry1656.' https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/648eefe65b6523002995eb21/.

Same-day discharge after elective open arterial surgery

ObjectiveTo evaluate the feasibility of same-day discharge (SDD) after open peripheral arterial surgery (OAS) in a veteran population. MethodsThis is a single-center, retrospective study. Starting September 2021, veterans who underwent elective OAS were selectively chosen for planned SDD. Eligible procedures included popliteal artery aneurysm repair, common femoral/superficial femoral/popliteal artery endarterectomy ± concurrent endovascular intervention, bypass graft revision, femoral-femoral bypass, and axillofemoral bypass. All patients who underwent eligible procedures were compared across three eras based on the primary location of postoperative admission: intensive care unit era (ICUE, September 2016-December 2018), inpatient ward era (WARDE, January 2019-August 2021), and SDD era (SDDE, September 2021-December 2022). Demographics, comorbidities, indication for procedures, operative times, complications, readmissions, and length of stay (LOS) were analyzed. ResultsNinety-nine male patients underwent eligible procedures during the 6-year study period (ICUE: 32, WARDE; 41, and SDDE: 26). ICUE had higher rates of tobacco use (P = .04) with no differences in age or other comorbidities between the eras. Indications were claudication, bypass graft stenosis, popliteal aneurysm, ischemic rest pain, and tissue loss. Twenty patients were selected for SDD, and 18 were successfully discharged same day. Operative times were not significantly different between the eras. SDDE patients were more likely to undergo monitored anesthesia care (P = .04). The mean LOS was significantly lower in SDDE (0.54 days, P < .001) compared with WARDE (2.9 days) and ICUE (2.8 days). The mean ICU LOS was lower in SDDE (0.2 days, P <.001) compared with ICUE (1.1 days). There was no difference in postoperative complications (P = .30), reoperation (P = .51), or readmission rates (P = .35). ConclusionsSDD is safe and feasible after elective OAS in a veteran population with a low unplanned admission rate.

Is maxillary sinusitis and radiographic maxillary sinus opacification associated with an altered microbiology of MRONJ?

ObjectiveMaxillary sinusitis can be a sequela of medication-related osteonecrosis of the jaw (MRONJ). This study aims to characterize the microbiome of maxillary MRONJ with concurrent maxillary sinusitis and radiographic maxillary sinus opacification to determine if there is a relationship between the microbiome of MRONJ and sinus disease. Study DesignThis retrospective case series was conducted using electronic health records from the University of Pennsylvania and affiliated hospitals. The target population was surgically managed maxillary MRONJ patients. The primary predictor variables were tissue culture results. The primary outcomes were maxillary sinusitis or maxillary sinus opacification. Statistical analysis was performed using chi-squared tests at the 95% confidence interval. ResultsThirty-nine subjects were selected: 25 had sinus opacification and 11 had sinusitis. Resident bacteria were present in 90% of subjects, non-resident bacteria in 74%, and opportunistic organisms in 15%. There were significantly more subjects with chronic sinusitis microbes (79%) than without. There were significantly more gram-positive anaerobes, specifically Propionibacterium, as well as the gram-negative facultative anaerobe, Capnocytophaga, in subjects with concurrent sinusitis. ConclusionsMaxillary MRONJ with concurrent maxillary sinusitis may be associated with gram-positive anaerobic species, Propionibacterium, and Capnocytophaga colonization. Maxillary MRONJ patients may benefit from sinus evaluation and concurrent surgical intervention.

Abstract 031: Onyx versus nBCA in MMA Embolization for cSDH: A Single Center Experience of 234 hemispheres

Introduction There is growing evidence supporting endovascular treatment with middle meningeal artery embolization (MMAE) for the treatment of chronic subdural hematoma (cSDH). We aimed to compare Onyx vs. N‐Butyl cyanoacrylate (n‐BCA) as liquid embolic materials for MMAE. Methods We included all eligible patients undergoing MMAE for cSDH at University of Pittsburgh Medical Center from April 2019 to December 2022. The main outcomes included radiographic resolution of cSDH with at least 50% reduction of hematoma thickness as a surrogate for treatment success in addition to the need for rescue surgical intervention. Additional outcomes including complication rates and hematoma thickness at the last available follow up. Results A total of 195 patients underwent embolization of 234 hemispheres including 39 bilateral procedures and had available data for final analysis (168 (71.8%) in Onyx group vs. 66 (28.2%) in n‐BCA group). There were no significant differences in age, sex, co‐morbidities, prior SDH/evacuation, pre‐operative cSDH thickness, or use of antithrombotic therapy(P&gt;0.05) while concurrent surgical intervention and midline shift showed a statistically significant difference (P&lt;0.05). On last follow‐up imaging, radiographical treatment success defined as ≥ 50% reduction in hematoma thickness was comparable in Onyx and the n‐BCA groups (50.9% vs 54.8%, P=0.6). Similarly, there was no statistically significant difference in the proportion of patients requiring rescue surgery between both groups (4.8% vs. 7.6%, P=0.4). Excluding concurrent surgical intervention patients yielded similar comparable results. Hematoma thickness at late follow‐up was not statistically significant between both group (8.25 (4.8‐12) mm vs 6.9 (3.1‐11) mm, P =0.11). There was no statistically significant difference in procedural complications between both groups (1.2% vs 1.5%, P=0.84). Conclusion Onyx and n‐BCA in MMAE seem to have comparable outcomes when used in the endovascular treatment of cSDH treatment. Further prospective studies with larger sample sizes are needed to confirm these findings.

Far-Infrared Ameliorates Pb-Induced Renal Toxicity via Voltage-Gated Calcium Channel-Mediated Calcium Influx.

Far-infrared (FIR), characterized by its specific electromagnetic wavelengths, has emerged as an adjunctive therapeutic strategy for various diseases, particularly in ameliorating manifestations associated with renal disorders. Although FIR was confirmed to possess antioxidative and anti-inflammatory attributes, the intricate cellular mechanisms through which FIR mitigates lead (Pb)-induced nephrotoxicity remain enigmatic. In this study, we investigated the effects of FIR on Pb-induced renal damage using in vitro and in vivo approaches. NRK52E rat renal cells exposed to Pb were subsequently treated with ceramic-generated FIR within the 9~14 μm range. Inductively coupled plasma mass spectrometry (ICP-MS) enabled quantitative Pb concentration assessment, while proteomic profiling unraveled intricate cellular responses. In vivo investigations used Wistar rats chronically exposed to lead acetate (PbAc) at 6 g/L in their drinking water for 15 weeks, with or without a concurrent FIR intervention. Our findings showed that FIR upregulated the voltage-gated calcium channel, voltage-dependent L type, alpha 1D subunit (CaV1.3), and myristoylated alanine-rich C kinase substrate (MARCKS) (p < 0.05), resulting in increased calcium influx (p < 0.01), the promotion of mitochondrial activity, and heightened ATP production. Furthermore, the FIR intervention effectively suppressed ROS production, concurrently mitigating Pb-induced cellular death. Notably, rats subjected to FIR exhibited significantly reduced blood Pb levels (30 vs. 71 μg/mL; p < 0.01), attenuated Pb-induced glomerulosclerosis, and enhanced Pb excretion compared to the controls. Our findings suggest that FIR has the capacity to counteract Pb-induced nephrotoxicity by modulating calcium influx and optimizing mitochondrial function. Overall, our data support FIR as a novel therapeutic avenue for Pb toxicity in the kidneys.

Feasibility, tolerability, and preliminary effectiveness of a concurrent cognitive and physical training intervention in young healthy adults

Feasibility, tolerability, and preliminary effectiveness of a concurrent cognitive and physical training intervention in young healthy adults

Effect of a 24-Week Concurrent Exercise Intervention on Neck Adiposity and Its Distribution in Young Adults: The ACTIBATE Randomized Controlled Trial.

Neck adipose tissue (NAT) accumulation and neck circumference are independent predictors of cardiometabolic risk (CMR) and low-grade chronic inflammation in young adults. The present study examines whether a 24-week concurrent exercise intervention can reduce NAT volume and neck circumference in young adults, and whether any changes in these variables are related to changes in body composition, CMR, and the inflammatory profile. Seventy-four participants (51 women, age 22 ± 2years) were included in the main analyses, after being randomly assigned to either a (a)control (n = 34), (b)moderate-intensity exercise (n = 19), or (c)vigorous-intensity exercise (n = 21) group. Participants in the exercise groups trained 3-4days/week (endurance + resistance exercise training). NAT volume and NAT distribution across different depots were estimated using computed tomography before and after the intervention. Anthropometric variables, body composition (determined by dual-energy X-ray absorptiometry), and CMR/inflammatory markers were also recorded. The exercise intervention did not reduce the total NAT volume, nor was NAT distribution affected (p > .05). However, it did reduce neck circumference in the vigorous-intensity exercise group compared with the moderate-intensity exercise and control groups (by 0.8 and 1cm, respectively, p ≤ .05). Changes in total NAT and neck circumference were positively, albeit weakly, related (adj. R2: .05-.21, all p ≤ .05) to changes in body weight and adiposity, leptin (only total NAT), and CMR (only neck circumference). Altogether 24weeks of concurrent exercise does not appear to reduce NAT accumulation in young adults, but may slightly reduce neck circumference in those who partake in vigorous exercise.

Influence of a concurrent exercise training program during pregnancy on the placenta mitochondrial DNA integrity and content of minerals with enzymatic relevance. The GESTAFIT project

IntroductionWe aimed i) to investigate the effects of a concurrent (aerobic plus strength) exercise intervention during pregnancy on placental mtDNA copy number, proportion of deleted mtDNA, and on the content of some trace and ultra-trace minerals with coenzymatic relevance; ii) to explore the association of such mitochondrial markers with the concentration of these minerals. MethodsFor the present study specific aims, 47 placentas were randomly selected from women that participated in the GESTAFIT project into exercise (n = 24) or control (n = 23) groups. The exercise group followed a concurrent aerobic and strength training program, three 60-min sessions/week, from the 17th gestational week until birth. Placenta tissue was collected and processed for minerals determination by the inductively coupled plasma mass spectrometry technique. RT-PCR was used to determine placentas mtDNA copy number and ND1/ND4 deletion. ResultsAfter adjusting for potential confounders, the mothers who participated in the exercise program had placentas with greater mtDNA copy number (p = 0.04) and lower mtDNA deletion (p = 0.003). Placentas from mothers in the exercise group presented higher manganese content than those from the controls (0.26 ± 0.03 mg/dL vs. 0.13 ± 0.03 mg/dL, p = 0.003). Placenta manganese content was significantly associated with lower mtDNA deletions (r = −0.382) and greater mtDNA copy number (r = 0.513). Iron content was associated with higher mtDNA copy number (r = 0.393). Selenium content was associated with lower mtDNA deletion (r = −0.377) and greater mtDNA copy number (r = 0.442). Finally, zinc and magnesium content were associated with higher mtDNA copy number (r = 0.447 and r = 0.453, respectively). DiscussionThis concurrent exercise training program induced a better placental status, which might be mediated through an improvement of mitochondrial bioenergetics and antioxidative capacity.

Virtual Surgical Planning of Superior Orbital Rim Fractures in Calvarial and Maxillofacial Trauma

Superior orbital rim fractures are challenging fractures as they often concomitantly occur with additional calvaria fractures. Virtual surgical planning (VSP) has been underutilized in this area of craniomaxillofacial trauma for reconstruction. The purpose of this study is to qualitatively describe the use of VSP and anatomically perfected stereolithic models in treatment of superior orbital rim fractures in combined neurosurgery/oral and maxillofacial surgery cases. This study is a retrospective case series of subjects who were treated at the Massachusetts General Hospital (July 2022 to November 2022). Inclusion criteria include subjects who had both calvaria and maxillofacial injuries requiring concurrent operative intervention on their superior orbital rim fractures and the use of VSP. Not applicable. The outcome variable of interest is the difference in the planned position of the orbital rim repair compared to the actual position achieved. None. Heat map analysis was used to compare the difference in the planned position versus the actual position achieved. There were six orbits (five subjects, mean age 33.8±21.49years) that met the criteria. The mean difference in planned versus actual orbital volume achieved was 2.52±2.48cm3. The superimposition of the postoperative scan to the planned simulation revealed 84%±3.27% of the voxel surface was within+2 and -2millimeters of its planned position. This study has demonstrated the use of VSP in combined neurosurgery and oral and maxillofacial surgery procedures in the fixation of superior orbital rim fractures. This case series highlights that the postoperative position achieved in the six orbits was within 84% of the planned position.

Replication of a single-case design cross-situational statistically based word learning treatment for late talking children

Purpose Late talking children are at risk of ongoing language impairment. This intervention study replicated and extended research based on cross-situational statistical learning principles. Method Three late talking children (age 24–32 months) were enrolled into the concurrent multiple baseline single-case experimental intervention study. The intervention consisted of 16 sessions over eight/nine weeks, including 10–11 pairs of target and control words (three per session). Children heard the target words a minimum of 64 times per session, in sentences with high linguistic variability in varied play activities. Result All children increased production of target words and expressive vocabulary, with statistically significant differences between word acquisition in baseline and intervention phases. One of the three children learnt statistically significantly more target words than control words. Conclusion The results replicated the findings of previous research for some but not all of the participants, providing individual evidence that this approach has promise as a therapy technique for late talking children.

Reciprocal interferences of the left ventricular assist device and the aortic valve competence.

Patients suffering from end-stage heart failure tend to have high mortality rates. With growing numbers of patients progressing into severe heart failure, the shortage of available donors is a growing concern, with less than 10% of patients undergoing cardiac transplantation (CTx). Fortunately, the use of left ventricular assist devices (LVADs), a variant of mechanical circulatory support has been on the rise in recent years. The expansion of LVADs has led them to be incorporated into a variety of clinical settings, based on the goals of therapy for patients ailing from heart failure. However, with an increase in the use of LVADs, there are a host of complications that arise with it. One such complication is the development and progression of aortic regurgitation (AR) which is noted to adversely influence patient outcomes and compromise pump benefits leading to increased morbidity and mortality. The underlying mechanisms are likely multifactorial and involve the aortic root-aortic valve (AV) complex, as well as the LVAD device, patient, and other factors, all of them alter the physiological mechanics of the heart resulting in AV dysfunction. Thus, it is imperative to screen patients before LVAD implantation for AR, as moderate or greater AR requires a concurrent intervention at the time of LVADs implantation. No current strict guidelines were identified in the literature search on how to actively manage and limit the development and/or progression of AR, due to the limited information. However, some recommendations include medical management by targeting fluid overload and arterial blood pressure, along with adjusting the settings of the LVADs device itself. Surgical interventions are to be considered depending on patient factors, goals of care, and the underlying pathology. These interventions include the closure of the AV, replacement of the valve, and percutaneous approach via percutaneous occluding device or transcatheter aortic valve implantation. In the present review, we describe the interaction between AV and LVAD placement, in terms of patient management and prognosis. Also it is provided a comprehensive echocardiographic strategy for the precise assessment of AV regurgitation severity.

Ginkgo biloba for tinnitus.

Ginkgo biloba for tinnitus.