Subsequent Intervals Research Articles

The influence of birth outcomes and pregnancy complications on interpregnancy interval: a quantile regression analysis

To ascertain whether adverse pregnancy outcomes at first pregnancy influence subsequent interpregnancy intervals (IPIs) and whether the size of this effect varies with IPI distribution METHODS: We included 251,892 mothers who gave birth to their first two singletons in Western Australia, from 1980 to 2015. Using quantile regression, we investigated whether gestational diabetes, hypertension, or preeclampsia in the first pregnancy influenced IPI to subsequent pregnancy and whether effects were consistent across the IPI distribution. We considered intervals at the 25th centile of the distribution as 'short' and the 75th centile as 'long'. The average IPI was 26.6 mo. It was 0.56 mo(95% CI: 0.25-0.88 mo) and 1.12 mo(95% CI: 0.56 - 1.68 mo) longer after preeclampsia, and gestational hypertension respectively. There was insufficient evidence to suggest that the association between previous pregnancy complications and IPI differed by the extent of the interval. However, associations with marital status, race/ethnicity and stillbirth contributed to either shortening or prolonging IPIs differently across the distribution of IPI. Mothers with preeclampsia and gestational hypertension had slightly longer subsequent IPIs than mothers whose pregnancies were not complicated by these conditions. However, the extent of the delay was small (<2 mo).

PO-05-222 NOVEL APPROACHES FOR THE DIAGNOSIS OF CONCEALED NODO-VENTRICULAR AND HIS-VENTRICULAR PATHWAYS

Concealed nodo-ventricular (cNV) or His-ventricular (cHV) pathways are rare accessory pathway variants that represent important challenges for the clinician to separate from the more common supraventricular tachycardia arrhythmias. To describe novel observations to aid in diagnosing cNV or cHV pathways. We present a case series of seven patients with re-entrant arrhythmias involving cNV (5 cases) or cHV (2 cases) pathways. We focus on several laboratory observations: (1) differential ventricular overdrive pacing (VOD) from the right ventricular base vs. apex, (2) response to His refractory premature ventricular complexes (PVCs), (3) paradoxical atriohisian (AH) response in long RP tachycardia, and (4) the role of adenosine to aid in the diagnosis. (1) Three cases underwent differential basal vs. apical VOD during tachycardia. All demonstrated a shorter post-pacing interval minus tachycardia cycle length during basal pacing than apical pacing with one case exhibiting apical VOD results compatible with atrioventricular nodal reentrant tachycardia (AVNRT). In one case with a cHV pathway, basal VOD was useful for localizing the ventricular connection and guiding the ablation site. (2) In 3 cases, His refractory PVCs reset the tachycardia without conduction the atrium, which excluded atrioventricular reentry, atrial tachycardia, or AVNRT alone. One case had His refractory PVCs followed by subsequent constant AA and HH intervals and then tachycardia termination, suggesting a bystander cNV pathway involvement. (3) Two cNV pathway cases presented with long RP tachycardia had shorter AH intervals during tachycardia than those during sinus rhythm of >15ms, suggesting parallel activation of the atrium and the atrioventricular node. (4) Low-dose adenosine (3 and 6 mg) terminated the tachycardia with a retrograde block in 2 cases with cNV pathways, while high dose adenosine titrated up to 18 mg failed to convert in a case with a HV pathway. cNV and cHV pathways mediated tachyarrhythmias can present with variable clinical presentations. We emphasized (1) the role of differential VOD and the importance of the basal VOD for a proper diagnosis and pathway localization (Figure, Panel A), (2) the importance of His refractory PVCs that reset or terminate the tachycardia without conducting the atrium (Panel B), (3) the importance of paradoxical AH response in long RP tachycardia (Panel C), and the use of adenosine for possibly distinguishing cNV from cHV pathways (Panel D).

The MS-LINK Outcomes Study Cohort: Study design and a descriptive analysis of baseline key PROs, disease, and sociodemographic characteristics (P13-3.010)

The MS-LINK Outcomes Study Cohort: Study design and a descriptive analysis of baseline key PROs, disease, and sociodemographic characteristics (P13-3.010)

Novel Approaches for the Diagnosis of Concealed Nodo-Ventricular and His-Ventricular Pathways

Confirming the presence and participation of concealed nodo-ventricular (cNV) or concealed His-ventricular (cHV) pathways in tachyarrhythmias is challenging. We describe novel observations to aid in diagnosing cNV or cHV pathways. We present 7 cases of cNV and cHV pathway-mediated arrhythmias and focus on several laboratory observations: (1) differential ventricular overdrive pacing (VOD) from the base versus apex, (2) response to His refractory premature ventricular complexes, (3) paradoxical atriohisian response (shorter atriohisian interval during tachycardia than that during sinus rhythm) in long RP tachycardia, and (4) the role of adenosine to aid in the diagnosis. Three cases underwent differential VOD during tachycardia. All demonstrated a shorter postpacing interval minus tachycardia cycle length during basal pacing than apical pacing with one case exhibiting apical VOD results compatible with atrioventricular nodal reentrant tachycardia. Basal VOD was useful for localizing the ventricular connection in a case with cHV pathway. In 3 cases, His refractory premature ventricular complexes reset the tachycardia without conduction to the atrium, which excluded the involvement of an atrioventricular pathway or atrial tachycardia, or atrioventricular nodal reentrant tachycardia alone. One case had His refractory premature ventricular complexes followed by subsequent constant AA interval and then tachycardia termination, suggesting a bystander cNV pathway involvement. Two cNV pathway cases presented with long RP tachycardia had paradoxical atriohisian shortening of >15 ms, suggesting parallel activation of the atrium and the atrioventricular node. Adenosine terminated the tachycardia with retrograde block in 2 cases with cNV pathways but had no response on a cHV pathway. cNV and cHV pathways mediated tachyarrhythmias can present with variable clinical presentations. We emphasize the important role of differential VOD sites, His refractory premature ventricular complexes that reset or terminate the tachycardia without conduction to the atrium, paradoxical atriohisian response in long RP tachycardia, and the use of adenosine for diagnosing cNV and cHV pathways.

Relative efficiency of three mechanisms of vector field growth in a random media.

We consider a model of a random media with fixed and finite memory time with abrupt losses of memory (renovation model). Within the memory intervals we can observe either amplification or oscillation of the vector field in a given particle. The cumulative effect of amplifications in many subsequent intervals leads to amplification of the mean field and mean energy. Similarly, the cumulative effect of intermittent amplifications or oscillations also leads to amplification of the mean field and mean energy, however, at a lower rate. Finally, the random oscillations alone can resonate and yield the growth of the mean field and energy. These are the three mechanisms that we investigate and compute analytically and numerically the growth rates based on the Jacobi equationwith a random curvature parameter.

Peripheral Intravenous Waveform Analysis Responsiveness to Subclinical Hemorrhage in a Rat Model.

Early detection and quantification of perioperative hemorrhage remains challenging. Peripheral intravenous waveform analysis (PIVA) is a novel method that uses a standard intravenous catheter to detect interval hemorrhage. We hypothesize that subclinical blood loss of 2% of the estimated blood volume (EBV) in a rat model of hemorrhage is associated with significant changes in PIVA. Secondarily, we will compare PIVA association with volume loss to other static, invasive, and dynamic markers. Eleven male Sprague Dawley rats were anesthetized and mechanically ventilated. A total of 20% of the EBV was removed over ten 5 minute-intervals. The peripheral intravenous pressure waveform was continuously transduced via a 22-G angiocatheter in the saphenous vein and analyzed using MATLAB. Mean arterial pressure (MAP) and central venous pressure (CVP) were continuously monitored. Cardiac output (CO), right ventricular diameter (RVd), and left ventricular end-diastolic area (LVEDA) were evaluated via transthoracic echocardiogram using the short axis left ventricular view. Dynamic markers such as pulse pressure variation (PPV) were calculated from the arterial waveform. The primary outcome was change in the first fundamental frequency (F1) of the venous waveform, which was assessed using analysis of variance (ANOVA). Mean F1 at each blood loss interval was compared to the mean at the subsequent interval. Additionally, the strength of the association between blood loss and F1 and each other marker was quantified using the marginal R2 in a linear mixed-effects model. PIVA derived mean F1 decreased significantly after hemorrhage of only 2% of the EBV, from 0.17 to 0.11 mm Hg, P = .001, 95% confidence interval (CI) of difference in means 0.02 to 0.10, and decreased significantly from the prior hemorrhage interval at 4%, 6%, 8%, 10%, and 12%. Log F1 demonstrated a marginal R2 value of 0.57 (95% CI 0.40-0.73), followed by PPV 0.41 (0.28-0.56) and CO 0.39 (0.26-0.58). MAP, LVEDA, and systolic pressure variation displayed R2 values of 0.31, and the remaining predictors had R2 values ≤0.2. The difference in log F1 R2 was not significant when compared to PPV 0.16 (95% CI -0.07 to 0.38), CO 0.18 (-0.06 to 0.04), or MAP 0.25 (-0.01 to 0.49) but was significant for the remaining markers. The mean F1 amplitude of PIVA was significantly associated with subclinical blood loss and most strongly associated with blood volume among the markers considered. This study demonstrates feasibility of a minimally invasive, low-cost method for monitoring perioperative blood loss.

The Continued Forecasting Effectiveness of a Real Earnings Model of the Equity Premium

This article empirically demonstrates the continued forecasting effectiveness of a simple theory modeling expected stock returns as the sum of the earnings yield on the S&amp;P 500 (measured as the highest past annual earnings on the index divided by the current index value) and a market-based forecast of the inflation rate. Besides having retained its significant one-to-one relationship with subsequent excess annual stock returns, this model’s estimate of the equity premium is discovered to have a correlation of 0.85 with S&amp;P 500 excess returns over subsequent five-year intervals ever since market data for the estimator became available in 1997.

Impact of Smoking on the Healing of Apical Periodontitis after Nonsurgical Endodontic Treatment.

The aim of this prospective study was to compare the healing of periapical bone between smokers and nonsmokers after root canal therapy. The effects of duration and intensity of smoking on the healing rate of apical periodontitis were analyzed. Fifty-five smokers were included in this study. The control group consisted of healthy nonsmokers who matched the smoker group in age and sex. Only teeth with a favorable periodontal prognosis and adequate coronal restoration were included in the study. The periapical status of treated teeth was assessed using the periapical index system at follow-ups after 6 and 12 months. The chi-squared test and Mann-Whitney U test were used to assess the changes in periapical index score at baseline and in subsequent time intervals between the two groups examining dichotomized and ordinal data, respectively. Multivariate logistic regression analysis was used to test the association of independent variables age, gender, tooth type, arch type, and smoking index with the outcome variable. The outcome variable was set as the presence versus absence of apical periodontitis. The analysis at 12-month follow-up revealed a significantly higher healing rate in control group than in smokers (90.9 vs. 58.2; χ2 = 13.846; p < 0.001). Smokers had significantly higher periapical index scores than the control group (p = 0.024). The multivariate logistic regression analysis demonstrated that an increase in the value of the smoking index significantly increases the risk of apical periodontitis persistence (odds ratio [OR] =7.66; 95% confidence interval [CI]: 2.51-23.28; p < 0.001) for smoking index < 400 and (OR = 9.65; 95% CI: 1.45-64.14; p = 0.019) for smoking index 400 to 799. The results from this study show a lower rate of apical periodontitis healing in a group of smokers at 1-year follow-up. Delayed periapical healing seems to be associated with the cigarette smoking exposure.

A123 COMPARING SIZE MEASUREMENT OF SIMULATED COLORECTAL POLYPS WHEN USING A NOVEL VIRTUAL SCALE ENDOSCOPE, ENDOSCOPIC RULER OR FORCEPS: A BLINDED RANDOMIZED TRIAL

Abstract Background Accurate polyp size measurement is important for guideline conforming choice of polypectomy techniques and subsequent surveillance interval assignments. Some endoscopic tools (forceps or endoscopic rulers [ER]) exist to help with visual size estimation. A virtual scale endoscope (VSE) has been developed that allows superimposing a virtual measurement scale during live endoscopies. Purpose Our aim was to evaluate the performance of VSE when compared to ER and forceps-based measurement. Method We conducted a randomized trial to evaluate the relative accuracy of size measurement of simulated colorectal polyps when using: VSE, ER, and forceps. Six endoscopists performed 60 measurements randomized at a 1:1:1 ratio using each method. Primary outcome was relative accuracy in polyp size measurement. Secondary outcomes included misclassification of sizes at the 5, 10, and 20mm thresholds. Result(s) A total of 360 measurements were performed. The relative accuracy of biopsy forceps, ER, and VSE was 78.9% (95%CI=76.2-81.5), 78.4% (95%CI=76.0-80.8), and 82.7% (95%CI=80.8-84.8). VSE had significantly higher accuracy compared to biopsy forceps (p=0.02) and ER (p=0.006). VSE misclassified a lower percentage of polyps &amp;gt;5mm as ≤5mm (9.4%) compared to forceps (15.7%) and ER (20.9%). VSE misclassified a lower percentage of ≥20mm polyps as &amp;lt;20mm (8.3%) compared with forceps (66.7%) and ER (75.0%). 25.6%, 25.5%, and 22.5% of polyps ≥10mm were misclassified as &amp;lt;10mm with ER, forceps, and VSE, respectively. Conclusion(s) VSE had significantly higher relative accuracy in measuring polyps compared to ER or forceps assisted measurement. VSE improves correct classification of polyps at clinically important size thresholds. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest R. Djinbachian: None Declared, M. Taghiakbari: None Declared, C. Haumesser: None Declared, M. Zarandi-Nowroozi: None Declared, M. Abou-Khalil: None Declared, S. Sidani: None Declared, J. Liu: None Declared, B. Panzini: None Declared, D. von Renteln Grant / Research support from: Daniel von Renteln is supported by a “Fonds de Recherche du Québec Santé” (FRQS) career development award and has received research funding from ERBE, Ventage, Pendopharm, Fujifilm, and Pentax., Consultant of: Boston Scientific and Pendopharm,

On forecasting of COVID-19 transmission in Saudi Arabia and Egypt using reservoir computing model

This work is devoted to introduce a reliable, fast and highly accurate reservoir computer machine learning scheme to forecast time evolution of COVID-19 pandemic. In particular, the COVID-19 official data related to susceptible cases, confirmed cases, and recovered cases in Egypt and Saudi Arabia are collected. They employed as the training data for suggested reservoir computer (RC) model. Then, detailed simulation experiments are carried out within specified time periods. The evolution of COVID-19 in Egypt and Saudi Arabia are predicted on the subsequent times intervals and compared with real validation test data. The forecasting accuracy is improved by computing the optimal output matrix which minimizes the normalized root mean square errors (NRMSEs). The performance of RC scheme is evaluated when different-size training data, different-size test data, and different number of internal nodes are used. The comparisons with the robust LSTM deep learning techniques are performed. It is shown that the presented RC-based forecasting technique is more accurate for long-time forecasting, faster, and has lower computational cost.

Abstract 51: Better Sleep Health is Associated With Greater Adherence to Lifestyle Modification During a 12-month Behavioral Weight Loss Intervention

Introduction: Consistent evidence suggests that poor sleep may impede weight loss efforts; however, the impact of poor sleep on lifestyle modification during attempted weight loss is unclear. Purpose: To examine the relationship between sleep health and measures of lifestyle modification in a sample of adults who participated in a 12-month behavioral weight loss intervention. Methods: Adults (N=125) with overweight or obesity (50.3±10.6 years, 91% female, 81% White) participated in a 12-month behavioral weight loss intervention. Assessments occurred at baseline, 6 months, and 12 months. Six dimensions of sleep were included in our operationalization of sleep health: regularity, satisfaction, alertness, timing, efficiency, and duration. Sleep dimensions were assessed using validated questionnaires and actigraphy, with values dichotomized into ‘good’ and ‘poor’ sleep. A composite sleep health score was calculated based upon the count of the ‘good’ individual dimensions (range: 0-6), with higher scores indicating better sleep health. Measures of lifestyle modification included attendance at group intervention sessions, daily adherence to caloric intake goals (% of days), and change in average daily moderate-vigorous physical activity (MVPA). Linear mixed modeling was used to examine the relationship between baseline and 6-month sleep health and lifestyle modification during the subsequent 6-month interval with adjustment for age, gender, bed partner, and race. The composite sleep health score and individual sleep health dimensions were evaluated in separate models. Results: Mean sleep health was 4.5±1.1 (mean±standard deviation) at baseline and 4.5±1.2 at 6 months; from 0-6 months and 6-12 months, participants attended 79.4±15.0% and 62.3±32.3% of the group intervention sessions, adhered to caloric intake goals on 35.6±23.3% and 21.1±23.3% of the days, and changed MVPA by 8.7±13.6 min/day and -3.7±13.6 min/day. Better sleep health was associated with higher rates of attendance at group intervention sessions (b=2.71, SE=1.29; P=.038), greater adherence to caloric intake goals (b=4.60, SE=1.34; P&lt;.001), and a trend for greater change in MVPA (b=1.41, SE=0.82; P=.088). Associations with lifestyle modification outcomes were observed with the following individual sleep dimensions (each P&lt;.05): regularity with attendance and caloric intake, satisfaction with caloric intake, and duration with MVPA. Conclusions: Better sleep health was associated with greater adherence to lifestyle modification during a 12-month behavioral weight loss intervention. Whether improving sleep health prior to or during a weight loss intervention facilitates better lifestyle modification outcomes merits examination. Support: NIH R01HL107370.

The Impact of Alar Flare Reduction Goes Beyond Just the Ala.

Alar flare reduction (AFR) is a widely used technique in rhinoplasty. Although the impact of AFR on the alar base has been well studied, its effect on the surrounding tissues is largely unknown. This study aims to elucidate the potential effect of AFR on the overall nasal and perinasal anatomy. AFR was performed on cadavers ( n = 7) with sequential crescent-shaped alar excisions of 2, 4, and 6 mm. Two- and three-dimensional photographs were obtained at baseline and subsequent intervals. Analysis was performed with Adobe Photoshop and Vectra. Standardized landmarks were placed at the nasal tip point (NTP) and alar base point to quantify NTP vector distances, NTP surface distances, and alar crease angle. The surface and vector distances between the NTP and alar base point decreased for increasing AFR intervals. AFR created a surface decrease of 1.90 ± 1.60, 3.54 ± 1.85, and 4.91 ± 1.89 mm, respectively. AFR created a vector decrease of 1.50 ± 1.14, 2.83 ± 1.37, and 3.97 ± 1.38 mm, respectively. NTP projection decreased by 0.54 ± 0.31 mm for 6-mm excision. AFR led to cheek elevation of 0.87 ± 0.70, 1.25 ± 0.60, and 1.96 ± 0.48 mm, respectively. This alar crease elevation blunted the transition between the cheek and upper lip skin at the level of the alar rim with the angle of this transition increasing 26.62 ± 12.78 degrees from baseline to 6 mm. Three-dimensional analysis demonstrates the influence of AFR on the alar base and surrounding perinasal contour. AFR results in nasal tip deprojection, alar crease elevation, and alar flare width narrowing. Further investigation into the impact of modifying the alar base on surrounding structures is warranted.

Effect of varying recovery intensities on power outputs during severe intensity intervals in trained cyclists during the Covid-19 pandemic

PurposeThe study aimed to investigate the effects of different recovery intensities on the power outputs of repeated severe intensity intervals and the implications for W′ reconstitution in trained cyclists.MethodsEighteen trained cyclists (FTP 258.0 ± 42.7 W; weekly training 8.6 ± 1.7 h∙week−1) familiar with interval training, use of the Zwift® platform throughout the Covid-19 pandemic, and previously established FTP (95% of mean power output from a 20-min test), performed 5 × 3-min severe intensity efforts interspersed with 2-min recoveries. Recovery intensities were: 50 W (LOW), 50% of functional threshold power (MOD), and self-selected power output (SELF).ResultsWhilst power outputs declined as the session progressed, mean power outputs during the severe intervals across the conditions were not different to each other (LOW 300.1 ± 48.1 W; MOD: 296.9 ± 50.4 W; SELF: 298.8 ± 53.3 W) despite the different recovery conditions. Mean power outputs of the self-selected recovery periods were 121.7 ± 26.2 W. However, intensity varied during the self-selected recovery periods, with values in the last 15 s being greater than the first 15 s (p < 0.001) and decreasing throughout the session (128.7 ± 25.4 W to 113.9 ± 29.3 W).ConclusionReducing recovery intensities below 50% of FTP failed to enhance subsequent severe intensity intervals, suggesting that a lower limit for optimal W′ reconstitution had been reached. As self-selected recoveries were seen to adapt to maintain the severe intensity power output as the session progressed, adopting such a strategy might be preferential for interval training sessions.

Clinical Predictors of Intensive Care Unit Transfer in Admitted Patients with Cirrhosis.

Patients with cirrhosis are at high risk of mortality after organ failure that requires ICU care. There have been attempts to predict which patients are at highest risk, with some success found in adapting liver disease-specific scoring systems with clinical variables commonly associated with critical illness. However, the clinical factors predictive of which patients with cirrhosis are most at-risk of needing ICU level care are unknown. Our study set out to better understand which clinical variables were associated with need for ICU care in patients with cirrhosis. Retrospective analysis of admitted patients with cirrhosis at single tertiary care center. Patients with cirrhosis admitted to our center were categorized into three groups: those without ICU transfer, those admitted to the ICU directly from the emergency department (ED), and those admitted to the ICU from the medicine floor. These groups differed in mortality at 30days (3.5% vs. 15% vs. 25%, P < 0.001) and at subsequent intervals up to 1year. These groups differed in indication for ICU transfer, with GI bleed, hemorrhagic shock, hepatic encephalopathy, and hyponatremia occurring more in the ED-to-ICU group, while respiratory failure was more common in the floor-to-ICU group. In multivariable analysis, factors associated with ICU transfer included worsened kidney function, anemia, hyponatremia, leukocytosis, and the decision to obtain a lactate level. Similar analysis with only floor-to-ICU patients found that ICU transfer was associated with hypoalbuminemia, hyponatremia, hypotension, and SIRS score. Our study found significant differences in mortality among three distinct groups of patients with cirrhosis. A risk factor model for ICU transfer found that variables both specific and nonspecific to liver disease were associated with ICU transfer, with between-group differences supporting the idea of different clinical phenotypes and suggesting factors that should be considered in early triage and assessment of hospitalized patients with cirrhosis.

The Impacts of Computer-Aided Detection of Colorectal Polyps on Subsequent Colonoscopy Surveillance Intervals: Simulation Study.

Computer-aided detection (CADe) of colorectal polyps has been shown to increase adenoma detection rates, which would potentially shorten subsequent surveillance intervals. The purpose of this study is to simulate the potential changes in subsequent colonoscopy surveillance intervals after the application of CADe in a large cohort of patients. We simulated the projected increase in polyp and adenoma detection by universal CADe application in our patients who had undergone colonoscopy with complete endoscopic and histological findings between 2016 and 2020. The simulation was based on bootstrapping the published performance of CADe. The corresponding changes in surveillance intervals for each patient, as recommended by the US Multi-Society Task Force on Colorectal Cancer (USMSTF) or the European Society of Gastrointestinal Endoscopy (ESGE), were determined after the CADe was determined. A total of 3735 patients who had undergone colonoscopy were included. Based on the simulated CADe effect, the application of CADe would result in 19.1% (n=714) and 1.9% (n=71) of patients having shorter surveillance intervals, according to the USMSTF and ESGE guidelines, respectively. In particular, all (or 2.7% (n=101) of the total) patients who were originally scheduled to have 3-5 years of surveillance would have their surveillance intervals shortened to 3 years, following the USMSTF guidelines. The changes in this group of patients were largely attributed to an increase in the number of adenomas (n=75, 74%) rather than serrated lesions being detected. Widespread adoption of CADe would inevitably increase the demand for surveillance colonoscopies with the shortening of original surveillance intervals, particularly following the current USMSTF guideline.

The Evaluation of Effects of Electrical Stimulation in Treatment of Patients with Chronic Tinnitus with Normal Hearing Sensitivity.

Tinnitus is usually associated with different comorbidities such as anxiety, annoyance and depression. Evidences have targeted two main places for tinnitus treatment, namely the auditory cortex and the dorsolateral prefrontal cortex (DLPFC). Transcranial direct current stimulation (tDCS) has been reportedly associated with improvement of cognitive functions in individuals. This study was conducted to evaluate the therapeutic effects of repeated sessions of anodal bifrontal tDCS on tinnitus symptoms. Furthermore, the tDCS impacts on the comorbid depression and anxiety of the patients were investigated. Forty-two voluntaries that suffers from chronic tinnitus were randomly assigned into "real tDCS" (n = 21) and "sham tDCS" (n = 21) groups. The tDCS group, received tDCS with the protocol consisted of 2mA current, daily one session of 20min, 6 consecutive days per week and for 4 consecutive weeks. The tinnitus handicap inventory (THI) scale, was measured before the first tDCS session and at one-week and two weeks follow-up. With the same intervals; the distress-related tinnitus was evaluated using visual analogue scale. Depression and anxiety scores were also measured using the Beck depression inventory and Beck anxiety inventory scales, respectively. Our findings indicated that THI score, depression and anxiety level has been gradually diminished across subsequent measurement intervals. We also find significant reduction of distress-related tinnitus in the real-tDCS group after treatment. We conclude that application of tDCS to the bilateral DLPFC region alleviates chronic tinnitus and it should be considered in patients with refractory tinnitus.

Long-term Persistence of Opisthorchis viverrini Antigen in Urine: A Prospective Study in Northeast Thailand.

Antigen detected in urine for the diagnosis of opisthorchiasis has a low daily variation; however, the longer term variability in antigen concentrations is unknown. In this study, we prospectively monitored Opisthorchis viverrini antigen concentrations for 30 consecutive days and at subsequent monthly intervals in a cohort of opisthorchiasis-positive individuals. On the basis of the monoclonal antibody-based ELISA, the profiles of antigen-positive rate and antigen concentration exhibited no significant change over 30 days with a mean proportion positive of 87.1% (range 73.7%-100%), and the average antigen concentration was 29.7 ± 2.2 ng/mL (mean ± SE). The urine antigen concentration at baseline was similar to the subsequent measurements at 2, 4, 6, and 10 months in the follow-up study (P > 0.05). The consistency and low daily and long-term fluctuation of O. viverrini antigen in urine demonstrates the reliability of urine assay for diagnosis of opisthorchiasis.

Functional outcomes of pediatric hemispherotomy: Impairment, activity, and medical service utilization

ObjectiveThe purpose of this study was to describe the functional outcomes of hemispherotomy in a pediatric cohort, including impairments, activity limitations, utilization of therapies and medical specialist services, and subsequent surgical intervention. MethodsWe conducted a retrospective review of patients who underwent hemispherotomy at UPMC Children’s Hospital of Pittsburgh from 2001 to 2021. Data on impairments, activity limitations in mobility, self-care, and communication, and use of re/habilitative therapies and medical specialist services were collected pre-operatively and at 1, 5, 10, and 15 years postoperatively. Seizure outcomes were reported via Engel classification at the longest follow-up interval and subsequent surgical procedures were documented through the latest follow-up interval. ResultsA total of 28 patients who underwent hemispherotomy were assessed prior to surgery, 26 at 1 year post-op, 13 at 5 years, 9 at 10 years, and 5 at 15 years. Seizure outcomes at the longest follow-up interval showed that 84.6% of patients were seizure-free. Assessment of impairments to body structure & function from baseline to 1-year post-op revealed increased impairment in 73% of patients, while most patients saw no change in impairment at 5 years (69%), 10 years (100%), and 15 years (100%) post-op compared to the previous time point. Muscle tone abnormalities (100%), hemiparesis (92%), and visual field deficits (85%) were the most frequently observed impairments in the first year following surgery. Most patients saw no change in developmental or cognitive-affective impairments at 1 (65%), 5 (85%), 10 (89%), and 15 years (80%) post-op compared to the previous time point. The only qualitative reports of decreased ability occurred in 2/26 patients whose medical records indicated decreased mobility at the 1-year mark. All further qualitative reports of ability in mobility, self-care, and communication domains indicated increases or no change in ability for all patients at each of the subsequent follow-up intervals. Exploration of the utilization of re/habilitative therapy services shows that 84% of patients received at least one therapy service at baseline, 100% at1 year, 92% at 5 years, 100% at 10 years, and 80% at 15 years post-op. Patients were followed, on average (m), by multiple medical specialist services at baseline (m = 2.58) as well as the 1- (m = 1.70), 5- (m = 2.15), 10- (m = 3.00) and 15-year (m = 3.40) follow-up intervals. Following hemispherotomy, 15 (53.6%) patients required an average of 2.21 additional surgeries. Most often required was orthopedic surgical intervention (n = 16 procedures), followed by shunt placement (n = 7) and revision (n = 14) targeting hydrocephalus. SignificanceThis retrospective study demonstrates expected increases in impairments such as hemiparesis and visual field deficits (i.e., homonymous hemianopia) in the context of increased activity and favorable seizure outcomes for 28 pediatric patients who underwent hemispherotomy for drug-resistant epilepsy. Most patients required rehabilitative therapies prior to surgery and continued to require these services post-operatively. Reported baseline functional status, the persistence of impairments following surgery, and comorbidities among this cohort underscore the medical complexity of this patient population and the importance of multidisciplinary care both pre-and post-operatively.

Stricter treat-to-target in RA does not result in less radiographic progression: a longitudinal analysis in RA BIODAM.

To investigate whether meticulously following a treat-to-target (T2T)-strategy in daily clinical practice will lead to less radiographic progression in patients with active RA who start (new) DMARD-therapy. Patients with RA from 10 countries starting/changing conventional synthetic or biologic DMARDs because of active RA, and in whom treatment intensification according to the T2T principle was pursued, were assessed for disease activity every 3 months for 2 years (RA-BIODAM cohort). The primary outcome was the change in Sharp-van der Heijde (SvdH) score, assessed every 6 months. Per 3-month interval DAS44-T2T could be followed zero, one or two times (in a total of two visits). The relation between T2T intensity and change in SvdH-score was modelled by generalized estimating equations. In total, 511 patients were included [mean (s.d.) age: 56 (13) years; 76% female]. Mean 2-year SvdH progression was 2.2 (4.1) units (median: 1 unit). A stricter application of T2T in a 3-month interval did not reduce progression in the same 6-month interval [parameter estimates (for yes vs no): +0.15 units (95% CI: -0.04, 0.33) for 2 vs 0 visits; and +0.08 units (-0.06; 0.22) for 1 vs 0 visits] nor did it reduce progression in the subsequent 6-month interval. In this daily practice cohort, following T2T principles more meticulously did not result in less radiographic progression than a somewhat more lenient attitude towards T2T. One possible interpretation of these results is that the intention to apply T2T already suffices and that a more stringent approach does not further improve outcome.

Right ventricular cardiac resynchronization therapy in patients with right ventricular conduction delay and heart failure

Right ventricular cardiac resynchronization therapy in patients with right ventricular conduction delay and heart failure