Mean Delta Research Articles

Hallux Valgus Interphalangeus Measurement: Comparison of the 2 Radiographic Methods.

To determine the reliability of Delta PP (difference in medial and lateral proximal phalanx wall length) compared with HIA (hallux interphalangeal angle) in the assessment of HVI (hallux valgus interphalangeus) in both preoperative and postoperative radiographs. This was a retrospective observational study of 186 feet with hallux valgus. The number of cases required to adequately power the study was 128. Preoperative and postoperative hallux alignment were evaluated by 2 different radiological parameters, Delta PP and HIA. Interobserver variability was assessed independently by 2 authors and compared using a intraclass correlation coefficient. The intraclass correlation coefficient was more than 0.8 for all parameters, thus both HIA and Delta PP measurement provide reliable and reproducible data. Mean HIA significantly increased following surgical correction of hallux valgus. In comparison, the mean Delta PP decreased after correction. This postoperative increase in HIA indicates that preoperative HIA underestimates the magnitude of HVI and therefore is an inaccurate tool for measuring HVI's contribution to the TVDH (total valgus deformity of the hallux) and to preoperative planning. However, the Delta PP was a greater determinant of the phalanx deformity's contribution to the TVDH. The outcome of our study shows that both HIA and Delta PP are reproducible when assessing the HVI deformity; however, Delta PP quantifies the amount of correction obtained more precisely. The additional benefit of measuring the Delta PP is that it allows for accurate planning in determining the dimensions of the medial-based wedge of the Akin osteotomy that needs to be resected. Level 4.

Effect of Oral Nutritional Supplementation on National Institute of Health Stroke Scale in Acute Ischemic Stroke

BACKGROUND: Approximately, 6-31% of nutritional deficits are present before the stroke and worsen during hospitalization. Besides affecting the patient’s physical and mental abilities, stroke can also cause a decrease in nutritional status, which has a major influence on the rate of death and disability. One intervention to overcome stroke patients’ nutritional problems is giving oral nutritional supplementation. The role of oral nutritional supplementation in stroke severity in patients with acute ischemic stroke has not yet been extensively studied. AIM: This study aimed to evaluate the effect of oral nutritional supplementation on the National Institute of Health Stroke Scale (NIHSS) in patients with acute ischemic stroke. METHODS: This was an experimental study with a pre- and post-study group method. Twenty-eight patients with acute ischemic stroke were referred to Adam Malik General Hospital, Medan, Indonesia, and were allocated randomly into two groups. Fourteen patients as control group received the normal hospital diet and 14 patients as intervention group received normal hospital diet plus oral nutritional supplementation for 7 days. The NIHSS scores were assessed on the first day and the eighth day after intervention in each group. RESULTS: There were significant reductions in NIHSS scores between day 1 and day 8 in both groups (p < 0.001). The mean delta NIHSS scores were −2.28 ± 1.63 and −2.57 ± 1.98 in the intervention and control groups, respectively. There was no significant difference in NIHSS scores between the intervention and control groups (p = 0.682). CONCLUSION: The effect of oral nutritional supplementation significantly reduced the NIHSS scores in acute ischemic stroke, but there was no significant difference compared to the normal hospital diet.

Prospective real-time evaluation of the QTc interval variation after low-dose droperidol among emergency department patients.

To assess the QTc interval variation after low-dose droperidol in a population of undifferentiated, stable, and non-agitated patients receiving droperidol in the emergency department. Prospective cohort study of patients aged ≥12years of age who received low-dose droperidol (≤ 2.5mg) for indications other than acute behavioral disturbances. QTc intervals were monitored in real-time during pre-specified observation periods in the ED. Primary outcome was variation of QTc interval after droperidol administration, defined as the maximum delta (change) of QTc interval. Other outcomes included proportion of patients with a QTc≥500ms after droperidol, delta≥+60ms, and incidence of clinical adverse events. Patients were monitored up to 30min after IV bolus and up to 46min after infusion. A total of 68 patients were included (mean age 42.1years, 66.2% females). The median dose of droperidol was 1.875mg (range 0.625mg, 2.5mg) and 94.1% received droperidol for headache management. Most patients received droperidol as a 2-min bolus (n=41, 60.3%). The mean maximum delta of QTc interval after droperidol across all 68 patients was +29.9ms (SD 15). A total of 12 patients (17.6%) experienced a QTc interval≥500ms during the observation period after droperidol, and 3 patients (4.4%) had a delta QTc≥+60ms. There were no serious arrhythmias, such as TdP, or deaths among the 68 participants in this study (0/68). However, 13.2% (n=9) had at least one non-serious adverse event including restlessness and/or anxiety. The QTc interval slightly increased after droperidol administration, but these prolongations were brief, mostly below 500msec and did not lead to serious arrhythmias. The yield of continuous cardiac monitoring in patients receiving low doses of droperidol is likely low.

Impact of Heart Rate and Rhythm on Corrected QT Interval During Paroxysmal Atrial Fibrillation

Current knowledge on the dynamic changes of corrected QT (QTc) before, during, and after an atrial fibrillation (AF) episode is limited. It remains controversial which of the presently available formulas performs the best in calculating QTc during AF. This study was designed to explore whether an AF attack would affect QTc and to determine the performance of 6 available formulas in correcting QT before, during, and after AF. A total of 101 patients with Holter-documented paroxysmal AF were enrolled. QT interval before, during, and after AF was measured and corrected to heart rate (HR) by using Bazett, Fridericia, Framingham, Hodges, Dmitrienko, and RTHa formulas. In 40 patients, QTc under AF was compared with under sinus rhythm (SR) with identical HR. Although QT was significantly longer before AF and after AF compared with during AF; there was no difference in QTc between SR and AF with identical HR regardless of the formulas used. QTc calculated by the Framingham formula showed excellent homogeneity with a mean delta difference of -0.2 ± 41.6ms (before AF vs AF) and -6.6 ± 35.4ms (after AF vs AF), respectively. QTc corrected by the Bazett formula (before AF vs AF -38.7 ± 52.3ms; after AF vs AF -42.6 ± 46.9ms) yielded significant heterogeneity among the 3 time points. In conclusion, AF does not influence QTc. The Framingham formula accurately corrects QT without being affected by the AF episode. The Bazett formula significantly overestimated QTc during AF.

Identifying Trends of Dysautonomia Signs and Symptoms Associated with Protracted Concussion Recovery during the Buffalo Concussion Treadmill Test: A Retrospective Study

Objective: To identify trends of provoked dysautonomia signs and symptoms during the Buffalo Concussion Treadmill Test (BCTT). Subjects: This is a retrospective cohort study of 101 patient charts post-concussion who were screened for suspected dysautonomia. Methods: Patients with suspected dysautonomia were assessed for exercise intolerance using a BCTT. Symptoms and rate of perceived exertion were recorded on a standardized form. Digital pulse oximetry was used to collect heart rate (HR) and oxygen saturation. Descriptive analyses were conducted on BCTT results. Results: Of 101 patient charts, 57 were excluded from analysis, including four patients who completed the BCTT by asymptomatically reaching the target HR zone for their estimated HR max. The remaining 44 patients demonstrated: 35 (79.5%) poor HR stabilization defined as a drop or plateau in HR during exercise, 28 (63.8%) exacerbated concussion symptoms, 13 (29.5%) autonomic nervous system response such as hot flushed sensation, 12 (27.3%) rebound symptoms during recovery phases, and 8 (18.2%) desaturation of 90% or below. The mean delta (80% expected HR max – 80% achieved HR max) on the initial test was 80.66 (± 23.08) beats per minute. Conclusions: This study is the first to identify trends of signs and symptoms during the BCTT in an expanded population with suspected dysautonomia after concussion. Future studies are indicated to validate these findings and contribute to development of modified termination criteria for the BCTT in individuals with suspected dysautonomia associated with protracted concussion recovery.

Are we late in treating with growth hormone short small for gestational age children? Experience of a tertiary care centre

Background: Short small for gestational age (SGA) children not showing a catch-up growth by 2–4 years of age is an indication for growth hormone (GH) therapy. Objective: The objective of this study was to evaluate at what age short SGA patients present to our paediatric endocrine clinic and start on GH therapy. In addition, we aim to assess their GH response during the 1st year of therapy. Materials and Methods: This retrospective observational study included 108 'SGA' children with 'short stature' who were managed in the paediatric endocrine clinic at Tawam Hospital within 5 years. Patients' electronic medical records were reviewed and their data were retrieved. Results: The median (interquartile range) age at the time of presentation was 6.8 years (3.3, 10.0), with a statistically significant difference between the non-syndromic and syndromic patients, 7.3 (5.2, 10.7) versus 3.2 (1.8, 5.9) years, respectively, whereas the median age at the time of starting GH treatment was 10.7 years (8.1, 13.6), with 47.4% treated at 5–10 years of age and 42.1% at >10 years of age. The mean (±standard deviation) delta height z-score for all treated patients was 0.58 ± 0.40 at 1 year. There was a significant difference in both the mean height at pre and post 1 year of starting GH treatment between the non-syndromic and syndromic groups (P < 0.0001 and 0.003, respectively). Conclusion: The majority of our short SGA patients presented late and were subsequently treated with GH later than the international consensus or guideline recommendations. There is a need for increased awareness to refer these children earlier for a better outcome.

Automatic Clustering of Students by Level of Situational Interest Based on Their EEG Features

The usage of physiological measures in detecting student’s interest is often said to improve the weakness of psychological measures by decreasing the susceptibility of subjective bias. The existing methods, especially EEG-based, use classification, which needs a predefined class and complex computational to analyze. However, the predefined classes are mostly based on subjective measurement (e.g., questionnaires). This work proposed a new scheme to automatically cluster the students by the level of situational interest (SI) during learning-based lessons on their electroencephalography (EEG) features. The formed clusters are then used as ground truth for classification purposes. A simultaneous recording of EEG was performed on 30 students while attending a lecture in a real classroom. The frontal mean delta and alpha power as well as the frontal alpha asymmetry metric served as the input for k-means and Density-Based Spatial Clustering of Applications with Noise (DBSCAN) clustering algorithms. Using the collected data, 29 models were trained within nine domain classifiers, then the classifiers with the highest performance were selected. We validated all the models through 10-fold cross-validation. The high SI group was clustered to students having lower frontal mean delta and alpha power together with negative Frontal Alpha Asymmetry (FAA). It was found that k-means performed better by giving the maximum performance assessment parameters of 100% in clustering the students into three groups: high SI, medium SI and low SI. The findings show that the DBSCAN had reduced the performance to cluster dataset without the outlier. The findings of this study give a promising option to cluster the students by their SI level, as well as address the drawbacks of the existing methods, which use subjective measures.

Brain-derived neurotrophic factor in blood increases transiently after single sessions of moderate intensity exercise in obese females

This study aimed to analyze the increase in serum BDNF levels after moderate-intensity exercise in obese females. This study used the True-Experimental method with the Randomized Control Group Pre-test-Post-test design. A total of 14 obese female adolescents aged 19-24 years participated in this study and were divided into two groups, i.e., the control group (CG, n=7) and the moderate-intensity exercise group (MIEG, n=7). The exercise was performed with an intensity of 64 – 76 HRmax for 40 minutes using a Richter Treadmill (4.0 HP DC). Moderate-intensity exercise was carried out in one intervention. Blood sampling was carried out before and after moderate-intensity exercise on the cubital vein as much as 3 ml. Examination of serum BDNF levels using the ELISA method. The results of statistical analysis show that the mean pre-test serum BDNF levels were CG (258.66±27.11 pg/mL), MIEG (252.48±23.17 pg/mL), and (p=0.865). The mean post-test serum BDNF levels were CG (236.22±20.83 pg/mL), MIEG (497.73±59.55 pg/mL), and (p=0.001). The mean delta of serum BDNF levels on CG (-22.43±26.04), MIEG (245.25±61.57 pg/mL), and (p=0.002). Based on the study results, it is concluded that a single session of moderate-intensity exercise in the morning increases serum BDNF levels in obese females.

Clinical impact of a prehospital trauma shock bundle of care in South Africa.

IntroductionPatients experiencing traumatic shock are at a higher risk for death and complications. We previously designed a bundle of emergency medical services traumatic shock care (“EMS-TruShoC”) for prehospital providers in resource-limited settings. We assess how EMS-TruShoC changes clinical outcomes of critically injured prehospital patients.MethodsThis is a quasi-experimental educational implementation of a simplified bundle of care using a pre-post design with a control group. The intervention was delivered to EMS providers in Western Cape, South Africa. Delta shock index (heart rate divided by systolic blood pressure, reported as change from the scene to facility arrival) from the 13 months preceding intervention were compared to the 13 months post-implementation. A difference-in-differences analysis examined the difference in mean shock index change between the groups.ResultsData were collected from 198 providers who treated 770 severe trauma patients. The patient groups had similar demographic and clinical characteristics at baseline. Over all time-points, both groups had an increase in mean delta shock index (worsening shock), with the largest difference occurring 4-months post-implementation (0.047 change in control arm, 0.004 change in intervention arm; −0.043 difference-in-differences, P = 0.27). In pre-specified subgroup analyses, there was a statistically significant improvement in delta shock index in the intervention arm in patients with penetrating trauma cared for by basic providers immediately post-implementation (−0.372 difference-in-differences, P = 0.02).DiscussionOverall, there was no significant difference in delta shock index between the EMS-TruShoC intervention versus control groups. However, significant improvement in shock index in one subgroup suggests the intervention may be more likely to benefit penetrating trauma patients and basic providers.

Toric Intraocular Lenses for the Management of Corneal Astigmatism at the Time of Cataract Surgery

Methods This audit was conducted in a UK ophthalmology department and included 48 eyes of 42 patients. Surgery was performed during 2019 in patients with 2.50 diopters (D) or more corneal astigmatism. Anterior keratometry readings were used to determine the toric IOL power. Vector analysis using the Alpins method was used to assess changes in astigmatism pre to postoperatively. Results There were 18 right and 26 left eyes included. In terms of gender, 61% of patients were female and 39% were male. The mean (±standard deviation (SD)) age was 70 (±11) years. The mean (±SD) axial length, K1, K2, and delta K was 23.55 (±1.4) mm, 42.71 (±1.39) D, 45.78 (±1.60) D, and 3.01 (±0.89) D, respectively. Postoperatively, the median spherical, cylinder, and spherical equivalent refraction was 0.00 D, −1.00 D, and 0.00 D, respectively. Postoperatively, 41% of the eyes had ≤0.50 D of spectacle astigmatism and 80% had ≤1.00 D. No patient required a secondary procedure to reposition the IOL from rotation. In vector analysis with the use of polar diagrams, there was a tendency for overcorrection of with-the-rule astigmatism and undercorrection of against-the-rule astigmatism. Conclusions Significant reductions in astigmatism can be achieved with the use of toric IOLs in patients undergoing cataract surgery. Further improvements may be possible with surgeon-specific determination of their surgically induced astigmatism and flattening effect from the main corneal incision. Furthermore, the use of an optical biometer that directly measures the posterior corneal curvature and permits automatic toric IOL power determination with modern formulas avoiding the need for manual data entry may reduce the risk of human error and improve visual and refractive outcomes.

Single-level TLIF Versus LLIF at L4-5: A Comparison of Patient-reported Outcomes and Recovery Ratios.

Both transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are suitable for achievement of lumbar arthrodesis. Comparative studies have observed complications and outcomes without stratification by lumbar level. This study aims to assess patient-reported outcome measures (PROMs) and recovery in TLIF and LLIF at L4-5. Patients undergoing primary, elective, single-level, TLIF or LLIF procedures at L4-5 were grouped. Demographics, perioperative characteristics, and postoperative complication rates were collected. PROMs included Patient-Reported Outcome Measurement Information System Physical Function, visual analog scale (VAS) back and leg, Oswestry Disability Index, and 12-Item Short-Form Physical Component Summary, and Mental Component Summary and were collected at preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year time points. Delta values and recovery ratios (RRs) were calculated for all PROMs at all time points. Demographics, perioperative characteristics, and postoperative complications were compared using chi-squared and Student t-test for categorical and continuous variables, respectively. Differences in mean PROMs, delta values, and RR at each time point were evaluated using unpaired Student's t-test. Three hundred sixty TLIF and 46 LLIF patients were included. Most (54.3%) were men, mean age 56.3 years, and mean body mass index 30.8 kg/m2. Body mass index and insurance significantly differed (P ≤ 0.045, all). TLIF showed significantly greater mean operative time, length of stay, and postoperative narcotic consumption (P < 0.033, all) and greater postoperative nausea/vomiting (P = 0.004). No preoperative PROMs significantly differed. TLIF cohort had significantly greater VAS back at 6 months and VAS leg at 12 weeks and 6 months (P < 0.034, all). No mean delta PROMs or RRs significantly differed. LLIF demonstrated significantly reduced length of stay, postoperative narcotic consumption, and postoperative nausea/vomiting and significantly improved VAS back at 6 months and VAS leg at 12 weeks and 6 months versus TLIF. Although 2-year PROMs and RRs did not significantly differ, our findings may suggest improved midterm follow-up pain scores for LLIF patients.

Granulocyte transfusions made with modified fluid gelatin in pediatric and adolescent patients with prolonged neutropenia.

Granulocyte transfusions (GT) are used to treat progressive systemic or local infections in prolonged neutropenic patients with antibiotic or antifungal resistance. Granulocytes are most commonly collected from whole blood by apheresis using hydroxyethyl starch (HES) as the red blood cell (RBC) sedimentation agent. This is the first study on the safety and efficacy of transfusing granulocytes collected with modified fluid gelatin (MFG) instead of HES to pediatric patients. Clinical data from 46 pediatric and adolescent patients receiving at least one MFG-based granulocyte transfusion and in total 295 granulocyte concentrates from July 2013 to August 2019 at our local university medical center were evaluated retrospectively. Forty-one patients (89%) survived at least 21 days after their last granulocyte transfusion. These survivors had lower CRP values and higher leukocyte counts after GT than non-survivors (mean delta of -5.34 mg/dl vs. -11.99 mg/dl and +0.62 × 103 /μl vs. +0.18 × 103 /μl of all GT, respectively). The neutrophil corrected count increment (CCI) was 68.72 mm2 /ml in survivors versus 28.00 mm2 /ml in non-survivors. There were no major or severe adverse events. This study suggests that modified fluid gelatin is a safe and effective alternative to hydroxyethyl starch for the collection of granulocytes for transfusion to prolonged neutropenic patients with progressive systemic or local infections refractory to antibiotic or antifungal therapy.

Skin Color Match in Head and Neck Reconstructive Surgery.

To quantify the degree of color match achieved during microvascular facial reconstruction, and to describe a novel technique for improving reconstructive skin color match. We hypothesize that split-thickness skin grafts (STSG) placed atop de-epithelialized free tissue produces better facial skin color match than free tissue with intact epithelium. Cross sectional photographic study of reconstructed facial skin color match. Sixty-eight adults, who underwent head and neck reconstructive surgery, were divided into six categories based on cutaneous reconstructive technique: cervicofacial flap, radial forearm free flap (RFFF), fibula free flap, anterolateral thigh free flap (ALT), STSG over adiopofascial flap (STAFF), and STSG over myogenous flap (STMF). Averaged color samplings of the reconstructed defect and adjacent normal skin were taken from digital photographs. The color difference was calculated using the delta-E calculation. Blinded expert observers also rated the degree of color match. Nonparametric cohort contrast and correlation statistical analyses were performed. The mean delta-E's and 10-point Likert ratings for the ALT, fibula, RFFF, STAFF, STMF, and cervicofacial flaps were 11.6, 10.0, 7.7, 6.3, 8.8, and 4.7, and 5.1, 6.4, 2.4, 3.2, 2.7, and 1.1, respectively. Likert scale inter-rater correlation was strong, with coefficient=0.80. On average, STSG over de-epithelialized myogenous and adipofascial free tissue transfers produced a better color match than the skin paddles of donor sites, with the exception of the radial forearm donor site. Delta-E values obtained from photos correlated well with expert ratings of color match. This reliable technique for quantifying color match may be used in future studies. 3 Laryngoscope, 132:1753-1759, 2022.

Does Cervical Spondylolisthesis Influence Patient-Reported Outcomes After Anterior Cervical Discectomy and Fusion Surgery?

No prior work has explored whether the presence of degenerative spondylolisthesis impacts patient-reported outcome measurements (PROMs) after an anterior cervical discectomy and fusion (ACDF); therefore, the goal of the current study was to determine whether the presence of a spondylolisthesis affects PROMs after an ACDF. A retrospective cohort study was conducted on patients over the age of 18 who underwent a 1- or 2-level ACDF. All patients received preoperative standing lateral x-rays and were placed into 1 of 2 groups based on the presence of cervical spondylolisthesis from C2-T1: (1) no spondylolisthesis (NS) group or (2) spondylolisthesis (S) group. Preoperative, postoperative, and delta (postoperative minus preoperative) were recorded and compared between groups via univariate and multivariate analysis. Outcomes reported were the Physical Component Scores of the Short Form-12 (PCS-12), the Mental Component Scores of the Short Form-12 (MCS-12), the Neck Disability Index (NDI), and visual analog scale (VAS) Arm/Neck. A total of 202 patients were included in the final analysis with 154 in the NS group and 48 in the S group. Both patient cohorts reported significant postoperative improvement in PCS-12, NDI, and VAS Arm/Neck. When comparing outcome scores between groups, only MCS-12 delta scores were different between groups, with the S group exhibiting a greater mean delta score (8.3 vs 1.3, P = 0.024) than the NS group after ACDF. Multiple linear regression analysis indicated having spondylolisthesis at baseline was a significant predictor of greater change in MCS-12 than the NS group (β = 4.841; 95% CI, 0.876, 8.805; P = 0.017). Both groups demonstrated significant postoperative improvement in PCS-12, NDI, or VAS Neck/Arm pain scores with no significant differences between groups. Patients with spondylolisthesis were found to have significantly greater improvement scores in MCS-12 scoring than those without spondylolisthesis after ACDF surgery.

The Relationship Between Chronic Kidney Disease and Weight Loss in Children

Background: Weight loss often occurs in children with Chronic Kidney Disease (CKD). Provision of proper nutrition is necessary for growth and development and weight gain of patients with chronic kidney disease in children. Objectve: To aimed the relationship between chronic kidney disease and weight loss in children Methods: An observational analytic study with a retrospective cohort design in outpatients and inpatients with chronic kidney disease aged 5 to 18 years at the H. Adam Malik Medan General Hospital and USU Hospital in December 2019 to March 2021. Results: This study was followed by 29 CKD children. Subjects who experienced weight loss were 16 (55.2%) children and 13 (44.8%) children who did not experience weight change after 3 months follow-up. There was a significant difference between the mean weight at baseline and after the 3-month follow-up period (p<0.001). There was no difference in the stage of CKD between initial examination and after 3-month follow-up (p = 0.877). There was no significance between the stage of chronic kidney disease and weight loss (p = 0.096). there was no significant relationship between chronic kidney disease stage and weight loss (p = 0.343), with the same nutritional status after 3 months follow-up. Other results showed that there was no difference in urea and creatinine levels between the start of the study and after 3 months of follow-up (p>0.05). The mean delta weight loss was 0.87 kg with the largest decrease being around 3 kg and 13 subjects did not show any weight loss. Conclusion: There was a significant association between initial weight loss and after 3 months of follow-up but not for height. There is no relationship between the initial examination stage of CKD and weight loss. There was no significant relationship between the initial examination of body weight, nutritional status, urea and creatinine levels and after 3 months of follow-up.

Predicting acute respiratory distress syndrome in influenza pneumonia patients using delta mean platelet volume

BackgroundPatients with influenza pneumonia are at high risk of rapid progression to acute respiratory distress syndrome (ARDS). Mean platelet volume (MPV), which reflects platelet size, is considered to be a crucial inflammatory marker. The study aim was to investigate the role of delta mean platelet volume (delta MPV) in predicting ARDS in patients with influenza pneumonia.MethodsThis retrospective study was conducted in a tertiary care centre in southern Thailand. Adult patients diagnosed with influenza pneumonia were enrolled from January 2015 to December 2020. Demographic data, laboratory investigations including delta MPV (MPV on day 2 minus MPV on day 1), management records, and clinical outcomes were collected for analysis. The study population was divided into two groups according to the development of ARDS.ResultsDuring the study, 1240 patients with laboratory-confirmed influenza were screened and 212 pneumonia patients were enrolled. Fifty-six patients (26.4%) met the diagnostic criteria for ARDS during hospitalization. Delta MPV was significantly higher in the ARDS group compared to that in the non-ARDS group (1.0 fL vs 0.2 fL, p < 0.001). Multivariable logistic regression revealed that delta MPV is an independent predictor of ARDS (OR 17.37; 95% CI 6.5–46.4; p < 0.001). Receiver operating characteristic curve analysis indicated a cut-off value of 0.7 fL for delta MPV (sensitivity 80.36%, specificity 80.77%) to predict ARDS in patients with influenza pneumonia.ConclusionsDelta MPV strongly predicts ARDS in influenza pneumonia patients. Implementation of delta MPV may be useful in identifying at-risk patients who will require intensive care and ARDS prevention.

The efficacy of Lactobacillus acidophilus and rhamnosus in the reduction of bacterial load of Helicobacter pylori and modification of gut microbiota-a double-blind, placebo-controlled, randomized trial.

Probiotics may alter the gut microbiota and may reduce antibiotic-related dysbiosis after H.pylori eradication. However, whether probiotics are effective in reducing the bacterial load of H.pylori and modifying the gut microbiota remains unknown. We aimed to assess the efficacy of Lactobacillus acidophilus and Lactobacillus rhamnosus in reducing the bacterial load of H.pylori and modifying the gut microbiota. In this double-blind, randomized, placebo-controlled trial, we recruited 40 adult subjects with moderate to high bacterial loads of H.pylori, defined as a mean delta over baseline (DOB) value of the 13 C-urea breath test (13 C-UBT) of 10 or greater every 4days 6 times. Eligible subjects were randomized in a 1:1 ratio to receive either probiotics containing Lactobacillus acidophilus and Lactobacillus rhamnosus or placebo twice daily for 4weeks. 13 C-UBT was measured weekly from the beginning of treatment to 2weeks after treatment. Amplification of the V3 and V4 hypervariable regions of the 16S rRNA was performed for fecal microbiota. A total of 40subjects were randomized to receive probiotics or placebo. The DOB value was significantly lower in the probiotic group than in the placebo group after 4weeks of treatment (26.0 vs. 18.5, p=.045). The DOB value was significantly reduced compared to that at baseline in the probiotic group (18.5 vs. 26.7, p=.001) but not in the placebo group (26.0 vs. 25.0, p=.648). However, the eradication rate for H.pylori was 0% in both groups. There was no significant difference in the DOB values between the two groups 1 and 2weeks after discontinuation of the probiotics. There were also no significant changes observed in the α-diversity and β-diversity at week 4 compared to baseline in the probiotic group (p=.77 and 0.91) and the placebo group (p=.26 and 0.67). Although the use of Lactobacillus acidophilus and Lactobacillus rhamnosus may reduce the bacterial load of H.pylori, there were no significant changes in the composition of gut microbiota. This trial is registered with ClinicalTrials.gov, NCT02725138.

Robotic-Assisted Laparoscopic Surgery: Lower Insufflation Pressures Reduced the Risk of Hemodynamic Instability

<h3>Study Objective</h3> The objective is to assess hemodynamic changes with lower abdominal insufflation pressures of pneumoperitoneum during robotic-assisted laparoscopic surgery. <h3>Design</h3> Quality improvement project in robotic surgical patients with an intervention to improve hemodynamic changes during insufflation and positioning. <h3>Setting</h3> All patients were placed in standard dorsal lithotomy, standardized to a Trendelenburg position of 23 degrees after abdominal insufflation. <h3>Patients or Participants</h3> A total of 21 patients undergoing robotic-assisted laparoscopic gynecologic surgery were selected, all of which operated on by the same surgeon. <h3>Interventions</h3> Patients were randomized to two groups: (1) standard insufflation pressure of 15 mmHg and, (2) low insufflation pressure of 12 mmHg. <h3>Measurements and Main Results</h3> Baseline hemodynamics and ventilator readings were noted. Changes in these parameters following insufflation and positioning were then recorded, including any interventions necessary to maintain homeostasis over the subsequent 15 minutes. Data were tabulated and compared amongst the two groups. Independent sample T-tests were used to analyze hemodynamic outcome means between groups. Insufflation groups did not differ based on BMI status (p = 0.72) and had equal quality of visualization as determined by a single surgeon. Patients at higher insufflation pressures on average had significantly more hemodynamic instability events requiring treatments than the lower insufflation pressure group, 2.0 vs 0.33, respectively (p=0.005). Systolic blood pressures (BP), Diastolic BP, and mean arterial pressures showed clear trends of improvements in the low-insufflation group, with mean deltas of +10.0, +19.6, and +16.6, respectively. <h3>Conclusion</h3> This quality improvement project showed that a lower abdominal insufflation pressure decreased hemodynamic instability events during robotic-assisted laparoscopic gynecology surgeries without impacting the surgical visualization.

Normalization of global longitudinal strain after a 30-seconds exercise bout in elite athletes

Abstract Background/Introduction Transthoracic echocardiography (TTE) is often the first diagnostic imaging modality of choice in athlete care to differentiate between physiological adaptation to sports and pathology. Mechanical strain as outcome measure, i.e. left ventricular (LV) global longitudinal strain (GLS), has been suggested as a tool to detect early signs of myocardial diseases in athletes. However, low or very low rates of myocardial deformation can also be associated with cardiac adaptation to sports. We hypothesize that observing decreased cardiac deformation in elite athletes may be a sign of an outspoken relaxed cardiac state, rather than pathology. Therefore, we investigated whether a short exercise bout can normalize strain values in elite athletes with abnormal resting GLS. Methods We prospectively enrolled elite athletes who participated in the ELITE (Evaluation of Lifetime Participation in Intensive Top-level Sports and Exercise) cohort. In short, ELITE is a prospective athlete cohort, which collects medical history, ECG, TTE and cardiac magnetic resonance (CMR) data in elite athletes (Olympic/Paralympic level or comparable). For this analysis, we analysed TTEs of asymptomatic athletes without cardiovascular disease and with a structurally normal heart on CMR. TTE (Vivid, GE) was performed in each athlete according to guidelines at rest. After a short exercise bout, consisting of 20 squats, additional measurements were performed when heart-rate (HR) was comparable to HR during pre-exercise measurements. TTE data was assessed using EchoPAC (GE). Paired t-tests were calculated for functional parameters; boxplots for pre- and post-exercise measurements; and GLS delta (pre- to post-exercise) for each athlete was calculated were plotted; using R. GLS ≥−16% was considered decreased and −16% ≥ GLS &amp;gt;−18% borderline. Results Our population comprised 51 athletes (35% women), with a mean age (±SD) of 26.4±5.2 years, and mean BSA of 2±0.3m2. Athletic disciplines consisted of road cycling (n=25), hockey (n=7), swimming (n=5), and 7 miscellaneous sports (n=14). We observed an increase of myocardial deformation after a short bout of exercise: mean GLS delta of 2.6±2% (pre- vs post-exercise GLS: −18.2±2.1% vs −20.8±1.9%; P≤0.001; Figure, A). Furthermore, mean LV stroke volumes were 94±19ml vs 103±23ml (P=0.020), ejection fractions (EF) 57±4% vs 60±4% (P≤0.001), and HR 55±10bpm vs 54±13bpm (P=0.8). Finally, we found a decreased strain in 8 athletes (16%), in 7 of which increased to normal values. Mean delta GLS was 4.5±2.2 (pre- vs post-exercise GLS: −14.9±1.1% vs −19.4±2.7%, P=0.002, Figure, B). The athlete who did not show an increase to normal GLS levels had a decreased LV EF (42%), but showed no other signs of cardiac pathology (MRI, biomarkers, complaints). Conclusion In athletes with abnormal GLS at rest, performing a short exercise bout may provide a pragmatic method to separate decreased GLS due to true pathology from sports adaptation. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Amsterdam Movement Sciences

Effect of the Sharrard procedure on hip instability in children with Down syndrome: a retrospective study.

PurposeThe aim of this study was to retrospectively analyze the effect of the Sharrard procedure on hip instability in children with Down syndrome (DS), as measured by the migration index.MethodsIn total, 17 children (21 hips) were included from six hospitals in the Netherlands between 2003 and 2019. The primary outcome, hip instability, was assessed with the Reimers’ migration index on preoperative and postoperative plain anteroposterior pelvic radiographs. The mean age at surgery was 8.1 years, the majority of children were male (64.7%) and the mean follow-up time was 7.3 years.ResultsThe mean preoperative migration index was 46% (sd 23.5) and the mean postoperative migration index was 37% (sd 28.4). The mean Delta migration index (the difference in pre-operative migration index and most recent post-operative migration index) showed an improvement of 9.3% (sd 22.7). An improvement in migration index was observed in 52%, no change in 29% and deterioration in 19% of hips. No (re)dislocations occurred in 91% of the hips. No major complications were observed during the follow-up period.ConclusionEarly intervention is warranted in children with DS showing hip instability or hip migration, in order to succeed with less complex procedures. The Sharrard procedure should be considered in children with DS showing hip instability or hip migration, since it aims to rebalance the muscles of the hip joint, is less complex than bony procedures of the femur and acetabulum, surgery time is often shorter, there are fewer major complications and the rehabilitation period is shorter.Level of EvidenceIV - retrospective case series