Similar Rates Research Articles

Collegiate Athletes’ Perceptions of the Connection Between Mental Health and Sport Performance: A Qualitative Investigation

Prevalence of mental health (MH) concerns among young adults is high and continues to increase. As a specific subset of young adults, National Collegiate Athletic Association (NCAA) athletes seem to experience these concerns at a similar or greater prevalence rate than their nonathlete, age-matched peers. Yet, how MH affects sport performance has not been robustly studied, and existing studies have not included the diversity of identities present in the collegiate athlete population. Thus, via online survey, this study explored the beliefs of 249 collegiate athletes representing diverse identities and sports regarding how MH affects sport performance. Regardless of demographic variable, 96.4%–100.0% of participants believed that MH affects sport performance. Three themes were identified: (a) collegiate athletes affirm that MH affects sport performance, (b) collegiate athletes’ perceptions of how MH affects sport performance, and (c) collegiate athletes believe that being a collegiate athlete exacerbates their MH concerns. The universality of endorsement and the themes represent novel findings that warrant further exploration of the MH–sport performance connection.

Does decreased fetal growth estimation in the appropriate for gestational age range affect delivery outcomes?

To study the effect of decreased estimated fetal weight (EFW) percentiles in appropriate for gestational age fetuses. This retrospective cohort study included women who had second and third trimester ultrasound examinations. Delivery and neonatal outcomes of pregnancies with decreased EFW of ≥ 30 percentiles in EFW between ultrasound examinations (decreased growth group) and those without such a decrease (control group) were compared. Deliveries with EFW or birthweight below the 10th percentile were excluded. Among 1610 deliveries, 57 were in the decreased growth group and 1553 in the control group. Maternal characteristics did not differ between the groups except for higher rate of nulliparity in the decreased growth group. We found similar rates of Category II/III monitoring, cesarean deliveries due to non-reassuring fetal heart rate and adverse neonatal outcomes. Neonatal birthweight was lower in the decreased growth group as compared to controls. This study did not find association between the group of appropriate for gestational age fetuses with decreased growth, with adverse outcomes.

Incidence and Severity of Adverse Drug Reactions in Medical Intensive Care Unit.

Adverse drug reactions (ADRs) curtail patients' quality of life by virtue of increasing therapeutic complexity and rising multimorbidity. In India, the frequency of ADRs for individual drugs and their economic burdens are rarely evaluated. This study aimed at identifying the incidence and severity of ADRs leading to hospitalization (ADRA) and occurring during a hospital stay (ADRH). The objective of this study is to evaluate the incidence the incidence and severity of ADRs in the ICU and their impact on the duration of hospitalization, along with the cost incurred to treat ADRs in the ICU. Demographic, clinical, and pharmacological data on patients admitted to the ICU were collected, analyzed and evaluated for ADRs. According to the setting analyzed, a descriptive analysis of the reactions, suspected medicines, and associated factors was undertaken. A total of 208 patients were admitted to the ICU during the study period, of which ADRA contributed 9.1% of the incidence rate and 8.1% of ADRH in 36 patients. Males had a higher incidence of ADRs than females. Patients who had ADRs had a substantially longer length of stay than those who did not. Electrolyte disturbance was the most commonly found ADR. According to the Hartwig scale and WHO-causality scale, 88.9% were moderate, and 97.2% were possible ADRs, respectively. In this study, a similar incidence rate of ADRA and ADRH was observed. The average cost for treating ADRA was higher than that for treating ADRH. As a result, identifying and preventing these reactions is critical, as they cause the patient greater suffering.

Left atrial appendage thrombus in patients with atrial fibrillation who underwent oral anticoagulation.

Electric cardioversion of atrial fibrillation (AF) is associated with an increased risk of embolism, with embolic material existing in the heart cavities. The initiation of oral anticoagulation therapy reduces the risk of thromboembolic events. The aims of this study were to evaluate the prevalence of left atrial appendage (LAA) thrombi in non-valvular AF, to compare vitamin K antagonists (VKAs) and non-vitamin K oral anticoagulants (NOACs) with respect to thrombus prevalence, and to evaluate the rate of LAA thrombus persistence on repeat transesophageal echocardiography (TEE) after treatment change. We enrolled 160 consecutive AF patients who presented with an AF duration > 48 h and had undergone TEE before cardioversion. Left atrial appendage thrombus was observed in 12 (7.5%) patients, and spontaneous echo contrast 4 was observed in 19 (11.8%) patients; the incidence was similar between the NOAC and VKA groups (8.9% vs. 3.6% and 12.4% vs. 18.5 %, respectively). Among patients on NOAC, thrombus prevalence was detected in 8.4% of users of rivaroxaban, 8% of users of dabigatran, and 12.5% of users of apixaban. The LAA thrombus developed in 7.5% of patients despite anticoagulation therapy, demonstrating similar prevalence rates among patients either on NOAC or VKA. Lower mean LAA flow velocity and a history of vascular disease were independent predictors of embolic material in the LAA. It seems that in the case of embolic materials in LAA under NOAC treatment, switching to VKA provides additional clinical benefit to the patients.

Matched-pair analysis of patients with ischemic stroke undergoing thrombectomy using next-generation balloon guide catheters

BackgroundBalloon guide catheters (BGCs) have not been widely adopted, possibly due to the incompatibility of past-generation BGCs with large-bore intermediate catheters. The next-generation BGC is compatible with large-bore catheters. We...

Motivations, Barriers, and Supports: An Examination of the Experiences of Women of Color Recreational Sport Coaches

Coaches play an instrumental role in the experiences of youth sport participants. Though girls participate in youth sport at similar rates as boys, coaching positions continue to be dominated by men. Existing research supports the value of diverse role models, especially for culturally diverse youth, and women coaches of color are especially important in sport given the low participation rates of ethnocultural minorities. Given the importance of diverse role models as sport coaches, this study investigates the experiences of women of color who coach sport at the recreational level. Based on interviews with 14 individuals, and grounded in socioecological theory, our findings describe the experience of research participants at each level (individual, interpersonal, organizational, and sociocultural) with a focus on the entry experience, barriers, and supports. Findings suggest that gendered and racial norms influence experiences across the model, and further lead to practical implications for sport managers.

Standardised training for endoscopic mucosal resection of large non-pedunculated colorectal polyps to reduce recurrence (*STAR-LNPCP study): a multicentre cluster randomised trial

ObjectiveEndoscopic mucosal resection (EMR) is the preferred treatment for non-invasive large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs) but is associated with an early recurrence rate of up to 30%. We...

A signal detection-based confidence-similarity model of face matching.

Face matching consists of the ability to decide whether two face images (or more) belong to the same person or to different identities. Face matching is crucial for efficient face recognition and plays an important role in applied settings such as passport control and eyewitness memory. However, despite extensive research, the mechanisms that govern face-matching performance are still not well understood. Moreover, to date, many researchers hold on to the belief that match and mismatch conditions are governed by two separate systems, an assumption that likely thwarted the development of a unified model of face matching. The present study outlines a unified unequal variance confidence-similarity signal detection-based model of face-matching performance, one that facilitates the use of receiver operating characteristics (ROC) and confidence-accuracy plots to better understand the relations between match and mismatch conditions, and their relations to factors of confidence and similarity. A binomial feature-matching mechanism is developed to support this signal detection model. The model can account for the presence of both within-identities and between-identities sources of variation in face recognition and explains a myriad of face-matching phenomena, including the match-mismatch dissociation. The model is also capable of generating new predictions concerning the role of confidence and similarity and their intricate relations with accuracy. The new model was tested against six alternative competing models (some postulate discrete rather than continuous representations) in three experiments. Data analyses consisted of hierarchically nested model fitting, ROC curve analyses, and confidence-accuracy plots analyses. All of these provided substantial support in the signal detection-based confidence-similarity model. The model suggests that the accuracy of face-matching performance can be predicted by the degree of similarity/dissimilarity of the depicted faces and the level of confidence in the decision. Moreover, according to the model, confidence and similarity ratings are strongly correlated. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

468 Does the Choice of C2 Versus Subaxial Upper Instrumented Vertebrae Impact 24-month Outcome and Satisfaction in Patients With Cervical Myelopathy? A QOD Study

INTRODUCTION: There is limited data on the outcomes regarding the effect of upper instrumented vertebrae (UIV) selection in patients with cervical spondylotic myelopathy (CSM). METHODS: This was an analysis of the prospective Quality Outcomes Database Cervical Spondylotic Myelopathy (QOD CSM) cohort which included adult patients who were diagnosed with primary CSM undergoing elective surgery. Patient-reported outcomes including VAS neck and arm pain, NDI, mJOA, EQ-5D, and NASS patient satisfaction were collected at baseline and 24 months. RESULTS: Of the 239 patients with CSM who underwent PCF, 48 (20.1%) had UIV of C2 and 191 (79.9%) had UIV of C3/below. The 24-month follow-up rate was 87.4% for patient-reported outcomes. At baseline, C2 group had a higher frequency of motor deficit (83.3% vs 68.1%, p = 0.04) compared to the C3/below group; otherwise, there was no difference in pain, function, and quality of life. C2 group had greater number of treated levels (6.1 ± 2.0 vs 4.5 ± 1.3, p < 0.01) compared to the C3/below group. At 24-month follow-up, the two groups achieved similar rates of satisfaction and MCID for pain, disability, myelopathy, and quality of life (all p > 0.05) postoperatively. CONCLUSIONS: Although the C2 group had greater number of treated levels compared to the C3/below group, the two cohorts had overall similar baseline characteristics and achieved similar MCID rates of the measured outcomes. The results of this study suggest that UIV of C2 may not have appreciable benefit over subaxial UIV in patient-reported outcomes.

Robotic or open superficial inguinal lymph node dissection as staging procedures for clinically node negative high risk penile cancer

ObjectiveTo evaluate perioperative and oncologic outcomes of a cohort of clinically node negative high-risk penile cancer patients undergoing robotic assisted inguinal lymph node dissection (RAIL) compared to patients undergoing open superficial inguinal lymph node dissection (OSILND). Patients and methodsWe retrospectively reviewed the clinical characteristics and outcomes of clinically node negative high-risk penile cancer patients undergoing RAIL at MDACC from 2013-2019. We sought to compare this to a contemporary open cohort of clinically node negative patients treated from 1999 to 2019 at MDACC and Moffit Cancer Center (MCC) with an OSILND. Descriptive statistics were used to characterize the study cohorts. Comparison analysis between operative variables was performed using Fisher's exact test and Wilcoxon's rank-sum test. The Kaplan-Meier method was used to estimate survival endpoints. ResultsThere were 24 patients in the RAIL cohort, and 35 in the OSILND cohort. Among the surgical variables, operative time (348.5 minutes vs. 239.0 minutes, P < 0.01) and the duration of operative drain (37 vs. 22 days P = 0.017) were both significantly longer in the RAIL cohort. Complication incidences were similar for both cohorts (34.3% for OSILND vs. 33.3% for RAIL), with wound complications making up 33% of all complications for RAIL and 31% of complications for OSILND. No inguinal recurrences were noted in either cohort. The median follow-up was 40 months for RAIL and 33 months for OSILND. ConclusionsWe observed similar complication rates and surgical variable outcomes in our analysis apart from operative time and operative drain duration. Oncological outcomes were similar between the two cohorts. RAIL was a reliable staging and potentially therapeutic procedure among clinically node negative patients with penile squamous cell carcinoma with comparable outcomes to an OSILND cohort.

A 3D reconstruction-based method using unmanned aerial vehicles for the representation and analysis of road sections

Due to the fast growth of cities worldwide, roads are increasing daily, and pavement maintenance has become very heavy and costly. Despite all efforts made under the pavement management system to keep the road surface in good shape, several road sections need to be in better condition, which presents a danger for drivers and pedestrians. This paper proposes a novel pavement 3D reconstruction and segmentation approach using the structure from motion technique, unmanned aerial vehicle, and digital camera. The method consists of the 3D modeling of the road by using images taken from different perspectives and the structure from motion technique. In this method, points cloud is sampled and cleaned using statistical outlier removal and noise filters. After that, duplicated and isolated points are eliminated to retain only significant data. The normal road plane is estimated using the principal component analysis technique and the remaining points. This plan presents a root mean square less than 0.85 cm. Finally, distances from those points to the normal plane are calculated and clustered to segment the road into distressed and non-distressed areas. The proposed approach presents a similarity rate to the survey measurement passed 95%. It has demonstrated promising results and has the potential for further improvement by optimizing various steps.

281 Does Smoking Status Affect Achievement of Satisfaction and Minimum Clinically Important Difference in Outcomes in Patients With Cervical Myelopathy at 24 Months? A QOD Study

INTRODUCTION: It is not clear whether smoking impacts patient-reported outcomes (PROs) in patients with cervical spondylotic myelopathy (CSM). METHODS: This was an analysis of the prospective Quality Outcomes Database CSM module. Patients of age = 18 years diagnosed with primary CSM who underwent elective surgery were included. PROs (VAS neck and arm pain, NDI, mJOA, EQ-5D, and NASS patient satisfaction) were collected at baseline and 24 months. RESULTS: Of the 1,141 patients with CSM, 202 (17.7%) were smokers and 939 (82.3%) were non-smokers. Compared to the non-smokers, smokers were younger (56.3 ± 11.3 vs 61.5 ± 11.7, p&lt;0.01) and had lower BMI (29.3 ± 6.8 vs 30.3 ± 6.3, p=0.04). A higher number of smokers had depression, anxiety, and COPD (all p&lt;0.01). At baseline, smokers had worse pain (neck: 6.0 ± 3.2 vs 5.1 ± 3.3; arm: 5.7 ± 3.2 vs 4.7 ± 3.5), disability (NDI: 45.2 ± 20.0 vs 37.1 ± 20.6), myelopathy (mJOA: 11.5 ± 2.9 vs 12.2 ± 2.8), and quality of life (EQ-5D: 0.51 ± 0.23 vs 0.57 ± 0.22) (all p &lt; 0.01). At 24-month follow-up, a higher proportion of smokers achieved MCID in mJOA (69.4% vs 56.6%, p &lt; 0.01) compared to non-smokers. Otherwise, there was no significant difference in the PROs at 24-month follow-up between the two groups (all p &gt; 0.05). The two groups were also similarly satisfied (NASS 1-2: smoker 81.2% vs non-smoker 84.6%, p = 0.29) 24 months after surgery. CONCLUSIONS: Despite smokers having worse baseline characteristics in terms of comorbidities and outcomes of interest, both smokers and non-smokers experienced improvement in all the PROs and achieved similar rates of MCID and satisfaction. Although smoking continues to be an important risk factor for poor surgical outcome, it may not have significant impact on PROs and satisfaction in this patient population.

High-grade liver injuries with contrast extravasation managed initially with interventional radiology versus observation: A secondary analysis of a WTA multicenter study

BackgroundHigh-grade liver injuries with extravasation (HGLI ​+ ​Extrav) are associated with morbidity/mortality. For low-grade injuries, an observation (OBS) first-strategy is beneficial over initial angiography (IR), however, it is unclear if OBS is safe for HGLI ​+ ​Extrav. Therefore, we evaluated the management of HGLI ​+ ​Extrav patients, hypothesizing IR patients will have decreased rates of operation and mortality. MethodsHGLI ​+ ​Extrav patients managed with initial OBS or IR were included. The primary outcome was need for operation. Secondary outcomes included liver-related complications (LRCs) and mortality. ResultsFrom 59 patients, 23 (39.0%) were managed with OBS and 36 (61.0%) with IR. 75% of IR patients underwent angioembolization, whereas 13% of OBS patients underwent any IR, all undergoing angioembolization. IR patients had an increased rate of operation (13.9% vs. 0%, p ​= ​0.049), but no difference in LRCs (44.4% vs. 43.5%) or mortality (5.6% vs. 8.7%) versus OBS patients (both p ​> ​0.05). ConclusionOver 60% of patients were managed with IR initially. IR patients had an increased rate of operation yet similar rates of LRCs and mortality, suggesting initial OBS reasonable in appropriately selected HGLI ​+ ​Extrav patients.

Young and resilient: Unraveling papillary thyroid cancer outcomes in males under 40.

While males present with more adverse clinicopathologic features in papillary thyroid carcinoma (PTC), younger age has previously been shown to be a favorable prognostic factor. We examined the combined effect of male sex and young age on PTC outcomes. We conducted a retrospective analysis of a prospectively maintained database of thyroid cancer surgery patients (2000-2020) at a single quaternary care institution. We included papillary thyroid carcinoma cases and excluded those with prior cancer-related thyroid surgery. We examined demographics, cancer stage, surgical outcomes, and complications by age and sex, analyzing groups below and above the age of 40years. A total of 680 patients with PTC were included. Females constituted 68% (age ≥40years: 44% and <40years: 24%) and males 32% (≥40years: 24% and <40years: 8%). A significant difference (p<0.001) of N1 disease distribution was found between the groups. N1a metastasis was greater in patients younger than 40 regardless of sex ((M<40 (15%), F<40 (15%), M≥40 (12%), and F≥40 (9%)). While, M<40 had greater N1b metastasis (36%) than all other groups (M≥40 (28%), F<40 (22%), and F≥40 (10%)). There was no significant difference in the distribution ofT stages between groups. Groups showed no differences in 30-day outcomes, recurrence at 1year, reoperation, mortality, nerve injury, or hypocalcemia. Young males with PTC face increased occurrence of nodal metastasis yet experience similar recurrence rates as their female and older counterparts. Subgroup analysis underscores the predictive role of sex and age in advanced PTC cases.

Abstract 4409: FBXW7 and BCL9L altered pathways as hallmarks of early-onset colorectal cancer

Abstract Background: The incidence of early-onset colorectal cancer (EO-CRC) has been alarmingly increasing, particularly among non-Hispanic Whites (NHWs), resulting in similar rates to ones in African Americans (AAs). Overall, the median age of diagnosis has decreased from 72 to 66 years. The molecular features that could potentially distinguish this phenotype are still not well-established. This study aimed to identify genetic, epigenetic, and transcriptomic factors associated with EO-CRC. Methods: 510 patients with microsatellite-stable tumors analyzed for somatic mutations, targeting 20 cancer driver genes. We included a cohort of 175 AAs from the Yale New Haven Health System, a previously studied cohort of 51 AAs from the Chicago Colorectal Cancer Consortium, and the publicly available molecular data from TCGA COAD-READ PanCancer cohort (50 AAs and 229 NHWs). We analyzed the transcriptomic and methylation profiles from the Yale cohort using Tempo-SeqTM and Illumina EPIC array, respectively. Results: Of the 510 patients, 18% were diagnosed with EO-CRC. Using a multiple variant analysis, adjusting for sex, race, tumor location, and stage, EO-CRC patients were less likely to be male (OR = 0.59, 95% CI: 0.37-0.94, p-value = 0.03), their tumors lacked mutations in APC (OR = 0.37, 95% CI: 0.22-0.63, p-value = 0.0002), and they were more likely to have mutations in FBXW7 (OR = 3.1, 95% CI: 1.60-6.00, p-value = 0.0007) and BCL9L (OR = 3.1, 95% CI: 1.00-8.72, p-value = 0.04). We compared tumors with and without mutations in FBXW7 or BCL9L in two independently analyses. Combining transcriptomics and methylation data, we identified 10 candidate genes that showed significant gene downregulation with hypermethylation or upregulation with hypomethylation. Among FBXW7 mutant tumors, we found the Cartilage oligomeric matrix protein (COMP) gene was significantly downregulated and hypermethylated. In CRC, COMP has been associated with a crosstalk between the TGF-β pathway and immune cell infiltration. Moreover, inactivation of FBXW7 resulted in the accumulation of phosphorylated TGIF1 molecules and repression of TGFβ-dependent transcription in cancer cell lines. Deficiency of FBXW7 is a key element in the phosphorylation-dependent ubiquitination and subsequent proteasome degradation of oncoproteins, such as c-MYC, NOTCH, and Cyclin E. Among BCL9L mutant tumors, keratin 20 (KRT20), the intermediate filament protein and marker of intestinal differentiation in CRC, was downregulated and hypermethylated. BCL9L plays an important role in tumorigenesis induced by aberrant Wnt signaling or aneuploidy tolerance. Conclusion: Our findings further demonstrate the importance of specific etiologic mechanisms in EO-CRC at the level of somatic alterations, providing new ways to understand the biology of EO-CRC and prospects for the development of targeted therapies. Citation Format: Reger Mikaeel, Dante Bellomo, Seeta Rajpara, David Buckley, Mary Yagle, Baris Kerimoglu, Curtis Thorne, Megha Padi, Bodour Salhia, Nathan A. Ellis, Xavier Llor, Rosa Xicola. FBXW7 and BCL9L altered pathways as hallmarks of early-onset colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4409.

Early Marginal Ulcer After Roux-en-Y Gastric Bypass: MBSAQIP Database Analysis of Trends and Predictive Factors.

Marginal ulcer (MU) is a known complication after Roux-en-Y gastric bypass (RYGB) that carries significant morbidity. First, we aimed to determine the trends and the rates of readmission, reintervention, and reoperation of 30-day MU. Second, we aim to determine the predictive factors associated with this complication. Patients who had 30-day marginal ulcer (MU) after LRYGB were identified using the 2015-2021 MBSAQIP database. Those who had a 30-day complication other than MU were excluded. Bivariate and logistic regression analyses were performed. Among 213,104 patients undergoing laparoscopic RYGB, 638 (0.3%) showed 30-day MU. This group of patients required endoscopic interventions, readmissions, and reoperations at rates of 88%, 72%, and 9%, respectively. Predictive factors for 30-day MU after RYGB were renal insufficiency, history of DVT, previous cardiac stent, African American race, chronic steroid use, COPD, therapeutic anticoagulation, anastomotic leak test, GERD, and operative time > 120min. Additionally, patients who had 30-day MU showed significantly higher rates of overall complications such as pulmonary, cardiac and renal complications, unplanned ICU admission, blood transfusions, venous thromboembolism (VTE), and non-home discharge (p < 0.05). The MU group showed similar rates of 30-day mortality as those without this complication (0.2% vs 0.1%, p = 0.587). The incidence of 30-day MU following RYGB was 0.3%. Patients with MU required endoscopic interventions, readmissions, and reoperations at rates of 88%, 72%, and 9%, respectively. Some preoperative and intraoperative factors contributed to an increased risk of 30-day MU.

Left-digit bias in surgical decision-making for lumbar spinal stenosis

BACKGROUND CONTEXTLeft-digit bias is a behavioral heuristic or cognitive “shortcut” in which the leftmost digit of a number, such as patient age, disproportionately influences surgical decisions. PURPOSETo determine if left-digit bias in patient age influences the decision to perform arthrodesis with instrumentation vs decompression in lumbar spinal stenosis (LSS). DESIGNRetrospective cohort. PATIENT SAMPLEPatients with an ICD-10 diagnosis of lumbar stenosis or spondylolisthesis identified in the 2017-2021 National Surgical Quality Improvement Program (NSQIP) database. OUTCOME MEASURESThe primary outcome was the percent of patients who underwent arthrodesis with instrumentation (AwI). Matched age group comparisons without left-digit differences (ie, 76/77 vs 78/79, 80/81 vs 82/83, etc.) were performed to isolate the effect of the heuristic. Secondary outcomes including peri-operative events and complications were also compared within AwI and decompression cohorts. METHODSUsing CPT codes, procedures were classified as either AwI or decompression. Patients were grouped into 6 cohorts based on 2-year age windows (74/75, 76/77, 78/79, 80/81, 82/83, 84/85). The cohorts were propensity matched with neighboring age groups based on the presence of spondylolisthesis, demographics, and comorbidities. The primary comparison was between those aged 78/79 vs 80/81. RESULTSAfter matching, the primary cohort consisted of two groups of 1,550 patients (aged 78/79 and 80/81). Patients aged 80/81 were less likely to undergo AwI than patients aged 78/79 (23.5% vs 27.2%, p=.021). AwI procedures occurred at similar rates between age groups with the same left digit. Within the decompression and AwI cohorts, there were no differences in secondary outcomes between patients aged 78/79 and 80/81. CONCLUSIONSLSS patients aged 80/81 are less likely to undergo AwI than patients aged 78/79, regardless of comorbidities. This was not seen when comparing patients with similar left digits in age. Until objective measures of physiologic capacity are established, left-digit bias may influence clinical decisions.

Guillain-Barre in the long-term acute care hospital setting: Ventilation does not prolong stay

Objective Guillain-Barre Syndrome (GBS) is a rare acute inflammatory demyelinating polyneuropathy, resulting in loss of muscle function and potentially respiratory failure requiring prolonged mechanical ventilation. Data describing the demographics and outcomes of patients with severe GBS requiring prolonged ventilation in the long-term acute care hospital (LTACH) setting is limited. We hypothesized that patients with GBS requiring prolonged mechanical ventilation require longer lengths of stay in an LTACH and are discharged with poorer functional status than GBS patients who do not require mechanical ventilation. Design, Setting, and Participants We conducted a retrospective study of GBS patients admitted over a 9-year period at an independent, large LTACH and compared ventilated versus non-ventilated GBS patients’ lengths of stay and functional ability at the time of admission and discharge. Interventions Not Applicable Main Outcome Measures and Results We found no significant difference in mean (standard error of means) lengths of stay between ventilated and non-ventilated GBS patients admitted to an LTACH (48.4 (± 8.0) vs. 38.8 (± 5.7) days, P 0.37). We also found that ventilated patients with GBS were discharged from an LTACH with similar functional ability than non-ventilated GBS patients (4.5 vs. 4.0, P 0.43 on 10 ft walk; 4.7 vs. 4.5 on P 0.70; 5.0 vs. 4.2, P 0.21 on 150 ft walk). Conclusion These findings suggest that GBS patients suffering from prolonged mechanical ventilation may expect similar lengths of stay in an LTACH as non-ventilated GBS patients and a similar or greater rate of functional improvement during their stay. These data support admission of chronically ventilated GBS patients to an LTACH for ongoing care after their acute care without the anticipation of greater length of stay or less rehabilitation outcomes with respect to non-ventilated GBS patients. Keywords: Guillain-Barre Syndrome, Assisted Ventilation, Pulmonary Rehabilitation, LTACH, Critical Care

Frustration can Limit the Adaptation of Promiscuous Enzymes Through Gene Duplication and Specialisation

Virtually all enzymes catalyse more than one reaction, a phenomenon known as enzyme promiscuity. It is unclear whether promiscuous enzymes are more often generalists that catalyse multiple reactions at similar rates or specialists that catalyse one reaction much more efficiently than other reactions. In addition, the factors that shape whether an enzyme evolves to be a generalist or a specialist are poorly understood. To address these questions, we follow a three-pronged approach. First, we examine the distribution of promiscuity in empirical enzymes reported in the BRENDA database. We find that the promiscuity distribution of empirical enzymes is bimodal. In other words, a large fraction of promiscuous enzymes are either generalists or specialists, with few intermediates. Second, we demonstrate that enzyme biophysics is not sufficient to explain this bimodal distribution. Third, we devise a constraint-based model of promiscuous enzymes undergoing duplication and facing selection pressures favouring subfunctionalization. The model posits the existence of constraints between the catalytic efficiencies of an enzyme for different reactions and is inspired by empirical case studies. The promiscuity distribution predicted by our constraint-based model is consistent with the empirical bimodal distribution. Our results suggest that subfunctionalization is possible and beneficial only in certain enzymes. Furthermore, the model predicts that conflicting constraints and selection pressures can cause promiscuous enzymes to enter a ‘frustrated’ state, in which competing interactions limit the specialisation of enzymes. We find that frustration can be both a driver and an inhibitor of enzyme evolution by duplication and subfunctionalization. In addition, our model predicts that frustration becomes more likely as enzymes catalyse more reactions, implying that natural selection may prefer catalytically simple enzymes. In sum, our results suggest that frustration may play an important role in enzyme evolution.

The impact of asymptomatic human immunodeficiency virus (HIV)-positive disease status on inpatient complications following total joint arthroplasty: a propensity score-matched analysis.

The number of patients with asymptomatic human immunodeficiency virus (AHIV) is increasing as the efficacy of antiretroviral therapy improves. While there is research on operative risks associated with having HIV, there is a lack of literature describing the impact of well-controlled HIV on postoperative complications. This study seeks to elucidate the impact of AHIV on postoperative outcomes after total hip (THA) and knee (TKA) arthroplasty. The Nationwide Inpatient Sample was retrospectively reviewed for patients undergoing TKA and THA from 2005 to 2013. Subjects were subdivided into those with AHIV and those without HIV (non-HIV). Patient demographics, hospital-related parameters, and postoperative complications were all collected. One-to-one propensity score-matching, Chi-square analysis, and multivariate logistical regressions were performed to compare both cohorts. There were no significant differences between AHIV and non-HIV patients undergoing TKA or THA in terms of sex, age, insurance status, or total costs (all, p ≥ 0.081). AHIV patients had longer lengths of stay (4.0days) than non-HIV patients after both TKA (3.3days) and THA (3.1days) (p ≤ 0.011). Both TKA groups had similar postoperative complication rates (p > 0.081). AHIV patients undergoing THA exhibited an increased rate of overall surgical complications compared non-HIV patients (0 vs. 4.5%, p = 0.043). AHIV was not associated with increased complications following both procedures. Despite lengthier hospital stays among AHIV patients, baseline AHIV was not associated with adverse outcomes following TKA and THA. This adds to the literature and warrants further research into the impact of asymptomatic, well-controlled HIV infection on postoperative outcomes following total joint arthroplasty.