Years Of Follow-up Visits Research Articles

Early Soft Tissue Response to Immediate Monotype Zirconia Implant: A Metal-Free Restoration

AbstractZirconia in dentistry (zirconium oxide) is an excellent substitute for metal in creating bridges or crowns on both natural teeth and implants and for dental implant fabrication instead of titanium alloys. This case report aims to show the features of zirconia dental implants and prosthodontic restorations to oral soft tissues. Three monotype immediate zirconia implants were placed at the time of tooth extraction. The residual socket gap was treated only by establishing a collagen sponge to stabilize the natural blood clot. Three single zirconia crowns were cemented after 2 months of healing. After 3 years of follow-up, clinical and radiographic stability was demonstrated, confirming the zirconia implants' excellent soft tissue and osseointegration. A zirconia cutback was planned to improve the esthetic result of the whole crown. After 3 years of follow-up visits, clinical and radiographic stability confirmed the optima soft tissue and osseointegration outcome of zirconia implants. Zirconia implants are a valid alternative to titanium implants for treating partial edentulism.

Developing Automated Computer Algorithms to Track Periodontal Disease Change from Longitudinal Electronic Dental Records

To develop two automated computer algorithms to extract information from clinical notes, and to generate three cohorts of patients (disease improvement, disease progression, and no disease change) to track periodontal disease (PD) change over time using longitudinal electronic dental records (EDR). We conducted a retrospective study of 28,908 patients who received a comprehensive oral evaluation between 1 January 2009, and 31 December 2014, at Indiana University School of Dentistry (IUSD) clinics. We utilized various Python libraries, such as Pandas, TensorFlow, and PyTorch, and a natural language tool kit to develop and test computer algorithms. We tested the performance through a manual review process by generating a confusion matrix. We calculated precision, recall, sensitivity, specificity, and accuracy to evaluate the performances of the algorithms. Finally, we evaluated the density of longitudinal EDR data for the following follow-up times: (1) None; (2) Up to 5 years; (3) > 5 and ≤ 10 years; and (4) >10 and ≤ 15 years. Thirty-four percent (n = 9954) of the study cohort had up to five years of follow-up visits, with an average of 2.78 visits with periodontal charting information. For clinician-documented diagnoses from clinical notes, 42% of patients (n = 5562) had at least two PD diagnoses to determine their disease change. In this cohort, with clinician-documented diagnoses, 72% percent of patients (n = 3919) did not have a disease status change between their first and last visits, 669 (13%) patients' disease status progressed, and 589 (11%) patients' disease improved. This study demonstrated the feasibility of utilizing longitudinal EDR data to track disease changes over 15 years during the observation study period. We provided detailed steps and computer algorithms to clean and preprocess the EDR data and generated three cohorts of patients. This information can now be utilized for studying clinical courses using artificial intelligence and machine learning methods.

Comparison of simultaneous vs sequential pars plana vitrectomy and cataract surgery

BackgroundTo compare the clinical outcomes of patients undergoing sequential pars plana vitrectomy (PPV) followed by cataract extraction surgery (CE) [PPV/CE], simultaneous PPV and CE (PPV + CE), and sequential CE followed by PPV [CE/PPV].MethodsA retrospective observational cohort study of 427 eyes of 404 patients who underwent either sequential or simultaneous PPV and CE surgery between March 2016 and May 2021. Pre-operative and post-operative assessments (up to 2 years of follow-up visits) of uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), spherical equivalent (SEQ), and refractive prediction error (RPE) was done. Main outcome measures were both visual (UCVA, CDVA) and refractive (RPE, SEQ).ResultsThere was a statistically significant difference in CDVA of the PPV/CE, PPV + CE, CE/PPV groups (logMAR 0.34 ± 0.40, 0.65 ± 0.61, and 0.55 ± 0.60, respectively) at one month postoperatively (POM1) (P < 0.001), and at the POM12 visits (logMAR 0.25 ± 0.34, 0.53 ± 0.68, and 0.44 ± 0.48; P = 0.04). In the subgroup analysis of patients with a diagnosis of either epiretinal membrane or vitreous opacities, there was no statistically significant difference in SEQ (P = 0.09) and RPE (P = 0.13) at the combined 1 month and 3 month visits.ConclusionSimultaneous PPV and cataract surgery demonstrated similar improvements in visual acuity and refractive outcomes, as well as comparable intraoperative and postoperative complication profiles to sequential surgery.

Persistent Treatment-Emergent Central Sleep Apnea (TECSA) Following Hypoglossal Nerve Stimulation.

Since 2001, hypoglossal nerve stimulators (HNS) have been used worldwide to treat patients with obstructive sleep apnea (OSA). Recently, a few studies reported treatment-emergent central sleep apnea (TECSA) with spontaneous resolution following HNS. However, the evidence of persistent development of TECSA during long-term care visits was lacking. As a result, this study first report two patients with persistent TECSA and describe their development phenotype during more than two years of follow-up visits to help explore the influencing factors and underlying mechanisms. This retrospective study included twenty-seven patients who underwent HNS implantation from 2016 to 2021. Their demographic data, pre- and postoperative sleep study characteristics, and device use settings were collected. The possible factors associated with post-operative elevated CSA (central apnea index ≥5) were evaluated. Moreover, the development phenotype of the TECSA was observed and followed up with a titration trial study. Among overall 27 patients with OSA, 3 patients with an increased preoperative Epworth Sleepiness Score (ESS) got an elevated CSA (CAI ≥ 5). Two of these 3 patients developed a persistent TECSA with a significant negative correlation between obstructive apnea index (OAI) and central and mixed sleep apnea index (CMAI) (R = -0.745, P = 0.021). These development phenotypes might be associated with different stimulation amplitudes of the HNS device. Furthermore, the following titration trial study also suggested that different amplitudes would influence the development of TECSA following HNS. OSA patients with severe daytime sleepiness are more likely to have elevated CSA following HNS. An inappropriate stimulation amplitude might influence the development course of TECSA in such patients.

Delayed purulent infected breast after a large-volume Aquafilling filler injection in an HIV-positive transgender patient: a case report

Known to be chemically inert, Aquafilling filler has been widely used in local aesthetic clinics in South Korea for breast augmentation. However, Aquafilling is only approved as a dermal filler and is not approved as an injectable filler for breast augmentation by the U.S. Food and Drug Administration or the Ministry of Food and Drug Safety. Several reports of complications following large-volume Aquafilling injections in the breast have been published. In this study, an HIV (human immunodeficiency virus)-infected transgender patient presented to the emergency room with a purulent infection of the breast and systemic fever. The patient had a history of large-volume Aquafilling injection in both breasts 3 years earlier to obtain a feminized appearance of the breasts. After using intravenous antibiotics and performing several surgical debridements over 4 weeks, the overall inflammatory response subsided. The skin defect site was covered successfully using an Integra Wound Matrix Dressing and there were no recurrent complications over 2 years of follow-up visits. Before injecting Aquafilling to augment patients’ breasts, a thorough consultation is mandatory, and doctors must notify patients that the risk of complications may be relatively high. Furthermore, any fillers including Aquafilling must not be used for unapproved purposes.

Association between Peri-Implant Soft Tissue Health and Different Prosthetic Emergence Angles in Esthetic Areas: Digital Evaluation after 3 Years' Function.

The aim of the present retrospective study was to assess peri-implant soft tissue health for implants restored with different prosthetic emergence profile angles. Patients were treated with implants supporting fixed dentures and were followed for 3 years. Buccal emergence angle (EA) measured at 3 years of follow-up visits (t1) were calculated for two different groups: Group 1 (153 implants) for restorations with angle between implant axis and prosthetic emergence angle from ≥30°, and Group 2 (67 implants) for those with angle ≤30°, respectively. Image J software was used for the measurements. Moreover, peri-implant soft tissue parameters such as pocket probing depth (PPD), plaque index (PI) and gingival index (GI) were assessed, respectively. A total of 57 patients were included in the analysis and a total of 220 implants were examined. Mean (±SD) EA in Groups 1 and 2 was 46.4 ± 12.2 and 24.5 ± 4.7 degrees, respectively. After 3 years of follow-up, a PPD difference of 0.062 mm (CI95% -0.041 mm; 0.164 mm) was calculated between the two groups and was not statistically significant (p = 0.238). Similar results were found for PI (OR = 0.78, CI95% 0.31; 1.98, p = 0.599). Furthermore, GI scores of 2 and 3 were found for nine implants (5.9%) in Group 1, and for five implants in Group 2 (7.5%). A non-significant difference (p = 0.76) was found. Peri-implant soft-tissue health does not seem to be influenced by EA itself, when a proper emergence profile is provided for implant-supported reconstructions in anterior areas.

Adopting a High-Polyphenolic Diet Is Associated with an Improved Glucose Profile: Prospective Analysis within the PREDIMED-Plus Trial.

Previous studies suggested that dietary polyphenols could reduce the incidence and complications of type-2 diabetes (T2D); although the evidence is still limited and inconsistent. This work analyzes whether changing to a diet with a higher polyphenolic content is associated with an improved glucose profile. At baseline, and at 1 year of follow-up visits, 5921 participants (mean age 65.0 ± 4.9, 48.2% women) who had overweight/obesity and metabolic syndrome filled out a validated 143-item semi-quantitative food frequency questionnaire (FFQ), from which polyphenol intakes were calculated. Energy-adjusted total polyphenols and subclasses were categorized in tertiles of changes. Linear mixed-effect models with random intercepts (the recruitment centers) were used to assess associations between changes in polyphenol subclasses intake and 1-year plasma glucose or glycosylated hemoglobin (HbA1c) levels. Increments in total polyphenol intake and some classes were inversely associated with better glucose levels and HbA1c after one year of follow-up. These associations were modified when the analyses were run considering diabetes status separately. To our knowledge, this is the first study to assess the relationship between changes in the intake of all polyphenolic groups and T2D-related parameters in a senior population with T2D or at high-risk of developing T2D.

Correlation between Levels of Serum Lipoprotein-Associated Phospholipase A2 and Soluble Suppression of Tumorigenicity 2 and Condition of Acute Heart Failure Patients and Their Predictive Value for Prognosis.

Objective To explore the correlation between levels of serum lipoprotein-associated phospholipase A2 (LP-PLA2) and soluble suppression of tumorigenicity 2 (sST2) and condition of acute heart failure (AHF) patients and their predictive value for prognosis. Methods The data of patients who complained of acute dyspnea and were treated in our hospital (January 2018–January 2020) were selected for review analysis, and those diagnosed with AHF by means of chest films, physical examination, cardiogram, and color Doppler ultrasonography (CDS) were selected as the study objects. The patients were split into the mild group (I or II, 55 cases) and the severe group (III or IV, 50 cases) according to the clinical condition grading standard in Guidelines for Diagnosis and Treatment of Acute Heart Failure. In addition, 105 healthy individuals examined in our medical center in the same period were selected as the control group. The serum LP-PLA2 and sST2 levels of all study objects were measured to analyze the correlation between these levels and AHF condition. Readmission due to heart failure and all-cause death were regarded as the endpoint events, and after one year of follow-up visits, the occurrence of the endpoint events in patients of the two groups was recorded, and with the endpoint events as the variable, the patients were divided into the event group and nonevent group to establish a logistic regression analysis model and analyze the merit of serum LP-PLA2 and sST2 in evaluating patient outcome. Results The patients' general information such as age and gender between the severe group and the mild group were not statistically different (P > 0.05), and the levels of high-sensitivity c-reactive protein (CRP), hemoglobin, creatinine, and uric acid of the severe group were greatly different from those of the mild group (P < 0.001), the comparison result of serum LP-PLA2 and sST2 levels was severe group > mild group > control group (P all <0.001), and the serum LP-PLA2 and sST2 levels of the severe group were, respectively, 275.98 ± 50.68 ng/ml and 2,122.65 ± 568.65 ng/ml; among 105 AHF patients, 50 of them had endpoint events (47.6%), including 36 in the severe group (36/50, 72.0%) and 14 in the mild group (14/55, 25.5%), and the event group presented greatly higher serum LP-PLA2 and sST2 levels than in the nonevent group (P < 0.001); according to the logistic regression analysis, serum LP-PLA2 and sST2 had independent predictive value for prognosis of AHF patients, which could be used as the independent predictive factors for 1-year prognosis. Conclusion Serum LP-PLA2 and sST2 have a good diagnosis value for the condition and prognosis of AHF patients, which shall be promoted and applied in practice.

Perceived satisfaction with HIV care and its association with adherence to antiretroviral therapy and viral suppression in the African Cohort Study

BackgroundIncreased availability of HIV care over the past decade has dramatically reduced morbidity and mortality among people living with HIV (PLWH) in sub-Saharan Africa. However, perceived and experienced barriers to care, including dissatisfaction with services, may impact adherence and viral suppression. We examined the associations between satisfaction with HIV care and antiretroviral therapy (ART) adherence and viral load suppression.MethodsThe African Cohort Study (AFRICOS) is a prospective observational study conducted at PEPFAR-supported clinics in four African countries. At enrollment and twice-yearly study visits, participants received a clinical assessment and a socio-behavioral questionnaire was administered. Participants were classified as dissatisfied with care if they reported dissatisfaction with any of the following: waiting time, health care worker skills, health care worker attitudes, quality of clinic building, or overall quality of care received. Robust Poisson regression was used to estimate prevalence ratios and 95% confidence intervals (CIs) for associations between satisfaction with care and ART adherence and between satisfaction with care and viral suppression (viral load < 1000 copies/mL).ResultsAs of 1 March 2020, 2928 PLWH were enrolled and 2311 had a year of follow-up visits. At the first annual follow-up visit, 2309 participants responded to questions regarding satisfaction with quality of care, and 2069 (89.6%) reported satisfaction with care. Dissatisfaction with waiting time was reported by 177 (7.6%), building quality by 59 (2.6%), overall quality of care by 18 (0.8%), health care worker attitudes by 16 (0.7%), and health care worker skills by 15 (0.7%). After adjusting for age and site, there was no significant difference in viral suppression between those who were satisfied with care and those who were dissatisfied (aPR: 1.03, 95% CI 0.97–1.09). Satisfaction with HIV care was moderately associated with ART adherence among AFRICOS participants (aPR: 1.09; 95% CI 1.00–1.16).ConclusionsWhile patient satisfaction in AFRICOS was high and the association between perceived quality of care and adherence to ART was marginal, we did identify potential target areas for HIV care improvement, including reducing clinic waiting times.

Economic burden of comorbid chronic conditions among survivors of stroke in China: 10-year longitudinal study

BackgroundThe coexistence of chronic diseases among people with stroke is common. However, little is known about the extent of incremental healthcare expenditures associated with having physically and psychologically chronic conditions among stroke survivors.MethodsWe used the nationally representative data from the China Health and Nutrition Survey, including 36,076 participants enrolled as our analytic cohort of ten years of follow-up visits (2006, 2009, 2011, 2015). Chronic conditions include hypertension, diabetes, obesity, and impaired cognitive function. Two-part models were used to estimate the effect of comorbid chronic conditions on total annual healthcare expenditure, out-of-pocket (OOP) healthcare expenditure, and incidence of catastrophic healthcare expenditure (CHE).ResultsAmong survivors of stroke during 2006 to 2015, the prevalence rates of hypertension, diabetes, obesity and impaired cognitive function were 75.5, 9.8, 12.7 and 65.1%, significantly higher than those among adults without stroke history (27.9, 2.7, 10.0 and 41.2%). Having hypertension ($794.5, p = 0.004), diabetes ($3978.5, p < 0.001) were associated with the largest incremental total healthcare expenditures. Stroke survivors with diagnosed hypertension and diabetes had additional 5.7 (p < 0.001) and 10.4 (p < 0.001) percentage point of CHE rate, respectively. Total healthcare expenditures were $2413.0 (P < 0.001) and $5151.7 (P < 0.001) higher among patients with 2, and ≥ 3 chronic conditions, respectively, than those individuals with no chronic conditions.ConclusionsExcess expenditures associated with chronic diseases were substantial among stroke survivors. These results highlight the needs for both prevention and better management of multimorbidity among stroke survivors, which in turn may lower the financial burden of treating these concurrent comorbidities.

Balance and cognitive decline in older adults in the cardiovascular health study.

Previous studies have demonstrated an association between gait speed and cognitive function. However, the relationship between balance and cognition remains less well explored. This study examined the cross-sectional and longitudinal relationship of balance and cognitive decline in older adults. A cohort of 4,811 adults, aged ≥65years, participating in the Cardiovascular Health Study was followed for 6years. Modified Mini-Mental State Examination (3MSE) and Digit Symbol Substitution Test (DSST) were used to measure cognition. Tandem balance measures were used to evaluate balance. Regression models were adjusted for demographics, behavioural and disease factors. Worse balance was independently associated with worse cognition in cross-sectional analysis. Longitudinally, participants aged ≥76years with poorer balance had a faster rate of decline after adjustment for co-variates: -0.97 points faster decline in 3MSE per year (95% confidence interval (CI): -1.32, -0.63) compared to the participants with good balance. There was no association of balance and change in 3MSE among adults aged <76years (P value for balance and age interaction < 0.0001). DSST scores reflected -0.21 (95% CI: -0.37, -0.05) points greater decline when adjusted for co-variates. In Cox proportional hazard models, participants with worse balance had a higher risk of being cognitively impaired over the 6 years of follow-up visits (adjusted HR:1.72, 95% CI: 1.30, 2.29). Future studies should evaluate standing balance as a potential screening technique to identify individuals at risk of cognitive decline. Furthermore, a better understanding of the pathophysiological link between balance and cognition may inform strategies to prevent cognitive decline.

The Hybrid Latissimus Dorsi Flap in Immediate Breast Reconstruction: A Comparative Study With the Abdominal-Based Flap.

The implant-enhanced latissimus dorsi (LD) flap, or a hybrid LD flap, is widely used in certain indications, even though abdominal-based flaps are now considered the gold standard of autologous breast reconstruction. However, few articles distinguish the hybrid LD flap from traditional LD flaps, and not many articles have compared the surgical outcomes, with the abdominal-based flap procedure, especially in the area of immediate breast reconstruction. In addition, it is often overlooked that the reported esthetic comparisons are based on different populations and contralateral balancing procedures (CBPs). Thus, this study aimed to review the reconstruction outcomes and to compare the variable-matched esthetic outcomes between 2 groups. A retrospective review of patients who underwent immediate breast reconstruction with either a hybrid LD flap or an abdominal-based free flap and had completed at least 2 years of follow-up visits was carried out. The patient demographics, oncologic data, breast parameters, and postoperative outcomes were compared across the entire patient group. The body mass index (BMI)- and CBP-matched cohort was randomly selected and assessed using the Aesthetic Outcome parameter of the Aesthetic Item Scale. Thirty-eight hybrid LD flap and 51 abdominal-based free flap procedures were included. The hybrid LD group showed a shorter operation time (330 ± 260 minutes vs 550 ± 480 minutes, respectively; P < 0.01), and fewer patients in the hybrid LD group underwent additional revision surgeries (7 [18.4%] vs 20 [39.2%], respectively; P < 0.01). Other complication rates were not significantly different between groups. A BMI- and CBP-matched esthetic analysis revealed that the hybrid LD group showed superior results in symmetry (Mann-Whitney U test, P = 0.047). The LD flap in combination with an implant remains a viable option in immediate breast reconstruction and had a similar complication profile while having a shorter operative time compared with the abdominal-based autologous breast reconstruction procedure. If properly used in certain populations, hybrid LD flaps may offer superior results regarding symmetry over the abdominal-based flap procedure.

Unlocked versus dynamic and static distal locked femoral nails in stable and unstable intertrochanteric fractures. A prospective study

IntroductionFew clinical studies have analyzed the utility of distal interlocking screws in stable and unstable intertrochanteric fractures treated with intramedullary devices. We performed a prospective analysis comparing short unlocked versus short dynamic and short static distal locked intramedullary nails. Materials and methodsNine level-II trauma centres were involved in the study. 240 patients over the age of 65 with a stable (AO/OTA 31-A1) or unstable intertrochanteric fracture (AO/OTA 31-A2) were prospectively investigated. The same type of nail was used in every patient. Patients were randomly divided into 3 groups according to the type of distal locking used. Intra-operative variables were examined and patients were followed clinically and radiographically at 1, 3, 6, 12 months postoperatively. All complications were recorded. ResultsA total of 212 patients completed 1 year of follow-up visits. In the Unlocking Group (UG) the operation time, blood loss, fluoroscopy time, total length of incision were significantly decreased compared to both the Dynamic Group (DG) and the Static Group (SG) (p < 0.05). Conversely, no reliable differences in intraoperative variables were noted between the Dynamic Group and the Static Group (p > 0.05). In terms of time of fracture union we found no differences among the three Groups (p > 0.05). Moreover, no cases of limb shortening >1 cm or varus collapse were detected in any group. The 3 Groups were similar in terms of HHS, SF-12 and Barthel index results at 1-year follow-up (p > 0.05). Finally, no significant differences were demonstrated across the three Groups in terms of major complications. ConclusionsThis clinical study further confirms the hypothesis that short intramedullary nails do not need to be locked for stable and unstable intertrochanteric fractures.

An infant illustrating single bubble on his CXR

A male infant presented with choking, post feeding non-bilious vomiting and abdominal distention without meconial defecation. His CXR showed single “bubble,” suggestive for pyloric atresia.After the standard stabilizing measures conducted, the operation room was arranged and he was underwent the corrective surgery via laparotomy. His postoperative period was unremarkable, with a decent outcome during3 years of follow-up visits.

Cyclophosphamide or Rituximab Treatment of Scleritis and Uveitis for Patients with Granulomatosis with Polyangiitis

Purpose: Vision-threatening ocular inflammation can be a devastating complication of granulomatosis with polyangiitis (GPA). Here we performed a retrospective observational study to describe the safety and efficacy of treating scleritis and uveitis with either cyclophosphamide or rituximab in GPA. Methods: A chart review of patients diagnosed with GPA-associated scleritis or uveitis, treated with either cyclophosphamide or rituximab as the final therapy at our clinic, was conducted. A total of 1 year of follow-up visits was required for inclusion in the study. Results: Thirteen patients (19 eyes) suffering from GPA-associated scleritis and/or uveitis were identified. As the final therapy, rituximab was administered to 9 patients and cyclophosphamide to 4. Mean duration of follow-up was 55 months (range 16–23 months). Remission was observed in all patients. Three patients had a flare of scleritis after the completion of therapy, and they were restarted on their respective agents. One patient had a flare of retinal vasculitis during rituximab therapy. One patient on cyclophosphamide experienced transient leukopenia. No adverse side effects of rituximab were noted throughout the course of treatment. Conclusions: Cyclophosphamide and rituximab are safe and effective agents for controlling scleritis and uveitis associated with GPA, with eventual progression towards steroid-sparing remission.

Hearing Loss and Ethnicity in Age-related Cognitive Decline

Hearing Loss and Ethnicity in Age-related Cognitive Decline

A patient with diplopia and upper eyelid edema: a case report

Idiopathic orbital inflammatory disease, previously referred to as orbital pseudotumor, is a nonneoplastic, non-infective disease. The inflammatory process can involve one or more orbital sof tissues; extraocular muscles, tear gland, scleralorepiscleral tissue or orbital fat. Orbital myositis typically presents itself with a sudden onset of restricted ocular motility, diplopia, congestive proptosis, eyelid ptosis, periocular swelling and conjunctival hyperemia. A thorough workup is essential for ruling out other entities.This report presents a case of a 47-year old man with a sudden onset of right upper eyelid swelling and diplopia. Until then he had no health problems. Afer initial ophthalmologic workup and ultrasound an orbital mass was suspected. Te MRI and a biopsy of the mass confirmed an isolated superior oblique muscle myositis. We treated him with systemic steroids. A good response and fast regression were observed. In two years of follow-up visits no recurrence was noted.Isolated superior oblique muscle myositis is extremely rare. This is one of eleven cases documented between 1988 and 2015. This case report presents a 47-year old man with a sudden onset of right upper eyelid swelling and diplopia. Until then he had no health problems. After initial ophthalmologic workup and ultrasound an orbital mass was suspected. The MRI and a biopsy of the mass confirmed an isolated superior oblique muscle myositis. We treated him with systemic steroids. A good response and fast regression was observed. In two years of follow-up visits no recurrence was noted.Isolated superior oblique muscle myositis is extremely rare. This is one of eleven documented cases between 1988 and 2015.

Sustained Improvement Following Arthroscopic Repair Massive Rotator Cuff Tears

To determine the longer term outcomes of arthroscopic repair of massive rotator cuff tears. A retrospective review of patients who underwent arthroscopic repairs of massive rotator cuff tears by a single surgeon was conducted. Criteria for inclusion were age greater than 18, history of arthroscopic repair of a massive rotator cuff tear (>5cm or >two tendons), no prior history of tear, and at least three years of follow-up visits following surgery. Once a list of patients meeting these criteria was collated, patients were contacted and informed consent was obtained. The main study variables consisted of the Penn Shoulder Score and ASES Shoulder Score; as such, these standard surveys were administered by research personnel following consent. . An average score for each survey was calculated and surgical notes were reviewed to determine strength on external rotation prior to surgery and whether full or partial coverage was achieved arthroscopically. 50 patients were deemed eligible for the study. 8 were excluded due to lack of clinical follow up and an additional 6 became deceased. Of 36 patients 5 patients declined participation and 6 were unable to be contacted leaving a response rate of 69%. The average participant age was 64.6, with 40% female and 60% male. 76% of participants were white, 20% African American, and 4% Asian. The average ASES survey score was 77.73, and the average Penn Shoulder Score was 78.08. Partial Repair (n=12) Full Repair (n=13) All Patients (n=25) Average ASES Score 68.19 86.92 77.73. Average Penn Shoulder Score 69.58 85.92 78.08. Arthroscopic repair of massive rotator cuff tears yields sustained improvement. Complete coverage yielded slightly superior outcomes but partial repairs were still deemed satisfactory.

Excessive variability in systolic blood pressure that is self-measured at home exacerbates the progression of brain white matter lesions and cognitive impairment in the oldest old

To investigate the effects of variability in self-measured systolic blood pressure at home on the progression of cognitive impairment and white matter lesions in the oldest old. Between April 2009 and October 2009, 248 oldest old aged 80 years or older were eligibly enrolled from geriatric practices and community-dwelling areas of Shandong, China. Self-measured blood pressure at home (HBP) was measured for 7 consecutive days at the baseline, and the Mini-Mental State Examination (MMSE) score and brain white matter hyperintensities (WMH) were assessed at the baseline and during the final follow-up visit. Variability in systolic HBP was evaluated using coefficient of variation (CV) in serial daily systolic HBP measurements of the last 6 consecutive days. After an average of 2.3 years of follow-up visits, 232 oldest old were included in and 16 were excluded from the analysis. The MMSE score declined -4.76 (interquartile ranges: -10.71, -0.83) %, the periventricular WMH, deep WMH, total WMH and WMH fraction increased 16.46 (s.d.: 6.72)%, 10.05 (s.d.: 6.40)%, 14.69 (s.d.: 6.07)% and 15.95 (s.d.: 6.32)%, respectively, in the total oldest old. A declined percentage of the MMSE score and increased percentages of the periventricular WMH, deep WMH, total WMH and WMH fraction in the high group divided by tertile of the CV of the systolic HBP at baseline were greater than those in the low group (P<0.05). The significant differences were retained after adjusting for covariates, including the MMSE score, periventricular WMH, deep WMH and WMH fraction at the baseline (P<0.05). Excessive variability in self-measured systolic HBP exacerbates the progression of cognitive impairment and brain white matter lesions in the oldest old.

Extracorporeal shock wave lithotripsy is a safe and effective treatment for pancreatic stones coexisting with pancreatic pseudocysts

We aimed to investigate outcomes of pancreatic extracorporeal shock wave lithotripsy (P-ESWL) for the removal of large pancreatic stones coexisting with pancreatic pseudocysts (PPCs) in chronic pancreatitis (CP). This is a prospective study performed in CP patients with at least 1 stone (≥5mm). Patients were divided into the PPC group (stones coexisting with PPCs) or the control group (stones alone). Patients were initially subjected to successive P-ESWL treatments, followed by ERCP. Primary outcomes were P-ESWL adverse events, and secondary outcomes were stone clearance, long-term pain relief, improved quality-of-life scores, and PPC regression. A total of 849 patients (59 in the PPC group and 790 in the control group) was subjected to P-ESWL between March 2011 and October 2013. Occurrences of P-ESWL adverse events were similar between the PPCgroup and the control group (11.86% vs 12.41%, P= .940). After the treatment of initial P-ESWL combined with ERCP, the complete, partial, and nonclearance of stones occurred in 67.24%, 20.69%, and 12.07%, respectively, of patients in PPC group, with no significant difference from the control group (complete, partial, and nonclearance: 83.17%, 10.40%, and 11.39%, respectively; P= .106). Fifty-five of 59 patients (93.22%) with PPCs were followed for a median period of 21.9 months (range, 12.0-45.1). PPCs disappeared in 56.36% (31/55) and 76.36% (42/55) of patients after 3 months and 1 year of follow-up visits, respectively. Moreover, complete and partial pain relief were achieved in 63.64% (35/55) and 25.45% (14/55) of patients, respectively. The scores for quality of life (P< .001), physical health (P< .001), and weight loss (P< .001) improved. In our multispecialty tertiary center, initial P-ESWL followed by ERCP was safe in patients with coexisting pancreatic stones and PPCs and effective for stone clearance, main pancreatic duct drainage, and pain relief.