Healthy Young Patients Research Articles

Modified Altemeier Procedure as Management for Incarcerated Rectal Prolapse in a Young Healthy Male Patient: A Case Report and Literature Review

Rectal prolapse (RP) is a rare condition presenting as a partial or complete protrusion of the rectum or as mucosa through the anal canal, and it usually occurs in the elderly or females with multiple risk factors. An initial presentation of incarcerated RP is even rarer. We present a case of a previously healthy 39-year-old man who presented with an incarcerated RP that necessitated urgent perineal proctosigmoidectomy (Altemeier procedure), with diverting sigmoid colostomy, followed by a reversal of the colostomy three months later. This case highlights the importance of surgical management (the modified Altemeier procedure) for a patient with an incarcerated RP. There are no specific guidelines for management of RP; all the recommendations and latest approaches are patients-based approaches according to their presentations, risk factors, age, and gender.

ACUTE RETINAL PIGMENT EPITHELIITIS: CLINICAL CASES

Acute retinal pigment epitheliitis is a rare idiopathic inflammatory disease of the retina that occurs most often in young healthy patients. The article presents three clinical cases with the results of dynamic observations.

Toluene Inhalant Addiction and Cardiac Functions in Young Adults: A Comparison of Electrocardiographic and Echocardiographic Parameters.

Volatile substance (thinner) addiction can cause serious cardiac events, such as malignant ventricular arrhythmias, acute coronary syndromes, sudden death syndrome, and dilated cardiomyopathy, as reported in many case studies. We aimed to find echocardiographic and electrocardiographic parameters that could foresee these adverse outcomes in clinical settings. We enrolled 32 healthy young adult patients with at least 1 year of thinner addiction and no cardiac symptoms. We also recruited a control group of 30 healthy individuals without any medical problems. Both groups received standard echocardiography and ECG tests. We analyzed the following echocardiographic parameters: LVEDd (left ventricular end-diastolic diameter), LVESd (left ventricular end-systolic diameter), mitral valve EF slope, E/A ratio, and aortic and pulmonary valve VTI (velocity time integral). We also measured the corrected (QTc), uncorrected QT intervals, and widest P-wave values in the ECG. We used the SPSS 13 software for statistical analysis. The echocardiographic findings did not differ significantly between the groups. However, the ECG results showed that the thinner addicts had higher values of corrected (QTc), uncorrected QT intervals, and widest P-wave values than the control group, according to Mann-Whitney U and Student's T test. Corrected QT (QTc) and P-wave duration are increased in individuals with a thinner addiction. These findings may suggest a higher risk of sudden cardiac death, atrial, and ventricular dysrhythmias in the future.

Comparative analysis of myoelectric activity and mandibular movement in healthy and nonpainful articular temporomandibular disorder subjects.

Temporomandibular disorders (TMDs) are one of the leading causes of craniofacial pain, and a high incidence of TMDs in young adults has been reported. Previous studies have used surface electromyography (sEMG) and mandibular kinematic analysis for TMDs diagnosis. This study aimed to provide normal reference values of sEMG and mandibular kinematics in Han Chinese adults, compare the sex differences and assess their diagnosis value on pain-free articular TMDs. This observational study recruited healthy young adults with individual normal occlusion and nonpainful articular TMDs patients with disc displacement. The sEMG signals of the anterior temporalis (TA), masseter (MM), and sternocleidomastoid and digastric were recorded in the mandibular postural positions (MPP) and during maximal voluntary clenching (MVC) with K7 electromyograph. Mandibular kinematics, including maximum opening and opening/closing velocities, were assessed by K7 kinesiograph. The sEMG reference values ranged from 3.0 to 4.3 µV in the MPP (n = 90) in healthy subjects. The sEMG values during MVC, maximum opening, and opening velocity were significantly higher in males than in females. Also, these indices showed good diagnostic efficiency for pain-free articular TMDs (n = 26). Reference values and sex differences in sEMG and mandibular kinematics in healthy subjects were determined. Compared with them, articular TMDs patients showed significantly lower myoelectric activity during maximal biting and restricted mouth opening range and velocity, which may assist in TMDs diagnosis. By analyzing sEMG of masticatory muscle and mandibular kinematics data from healthy Han Chinese young adults and TMDs patients with disc displacement, this study evaluated the sex difference and their diagnosis value on nonpainful TMDs with disc displacement. NCT06372769.

Association of macular pigment optical density with plasma macular carotenoids levels and serum lipids in South Indian healthy volunteers and patients with early age-related macular degeneration.

Purpose: The objective of the present study was to investigate the relationship between macular pigment optical density (MPOD) and plasma carotenoids [(L) and (Z)] and serum lipids in South Indian young healthy volunteers and patients with early age-related macular degeneration (AMD). Methods: Two hundred and fourteen (N = 214) study participants (Healthy control group (N) = 178; Early AMD group (N) = 36) were enrolled after getting their written informed consent. The MPOD of the study participants was assessed using MPS II (Electron Technology, UK) after completing their routine ocular examination. Serum lipids were measured by the standard technique. Plasma levels of L, Z, lycopene and beta-carotene were estimated by high performance liquid chromatography with photo diode array detector. Statistical analysis used: Correlations among variables in serum, plasma and the MPOD were established using Spearman's rho correlation coefficient. Results: The overall mean MPOD in healthy control group and early AMD group were found to be 0.47 ± 0.16 (N = 178; 317 eyes) and 0.35 ± 0.22 (N = 36; 38 eyes) at 1° eccentricity respectively and were found to be statistically significant (p < 0.001). A strong positive association was found between plasma L, Z and L + Z and MPOD. Serum HDL showed a strong negative association with MPOD and other lipids showed a very weak association. MPOD was unaffected by body mass index. Conclusions: MPOD is positively associated with plasma L,Z and L + Z, adding further evidence that additional intake of L/Z may be beneficial in delaying the risk of AMD in our population.

Effect of Coenzyme Q10 on early wound healing after recession coverage surgery with the modified coronally advanced tunnel technique and a connective tissue graft: A 6-month, triple-blinded, randomized, placebo-controlled pilot trial

ObjectivesCoenzyme Q10 (CoQ10) or ubiquinone is one of a cell’s most important electron carriers during oxidative phosphorylation and many other cellular processes. As a strong anti-oxidant with further anti-inflammatory effects CoQ10 is of potential therapeutical value. The aim of this randomized controlled clinical trial was to investigate the effect of topical CoQ10 on early wound healing after recession coverage surgery using the modified coronally advanced tunnel (MCAT) and palatal connective tissue graft (CTG).Materials and methodsThirty patients with buccal gingival recessions were evaluated after being randomly allocated to: 1) MCAT and CTG with topical application of a coenzyme Q10 spray for 21 days or 2) MCAT and CTG with placebo spray. Wound healing was evaluated by the early wound healing index (EHI). Patient-reported pain was analyzed by a 100-mm visual analogue scale (VAS) at day 2, 7, 14 and 21 post-surgically. Mean recession coverage, gain of keratinized tissue and esthetic outcomes were assessed at 6 months.ResultsEHI and pain scores showed no significant differences. Time to recovery defined as VAS<10 mm was shorter in the test group. Mean root coverage after 6 months was 84.62 ± 26.57% and 72.19 ± 26.30% for test and placebo, p=0.052. Complete root coverage was obtained in 9 (60%) test and in 2 (13.3%) placebo patients. Increase in keratinized tissue width and esthetical outcomes were similar for both groups.ConclusionCoQ10 had no significant effect on early wound healing and on mean root coverage after 6 months.Clinical relevanceEarly wound healing: in young healthy patients with no inflammatory oral conditions topical CoQ10 does not improve early healing.

Concurrent Central Retinal Vein Occlusion and Rhegmatogenous Retinal Detachment in Two Young Healthy Patients

Concurrent Central Retinal Vein Occlusion and Rhegmatogenous Retinal Detachment in Two Young Healthy Patients

Assessment of pulmonary physiological changes caused by aging, cigarette smoking, and COPD with hyperpolarized 129Xe magnetic resonance.

To comprehensively assess the impact of aging, cigarette smoking, and chronic obstructive pulmonary disease (COPD) on pulmonary physiology using 129Xe MR. A total of 90 subjects were categorized into four groups, including healthy young (HY, n = 20), age-matched control (AMC, n = 20), asymptomatic smokers (AS, n = 28), and COPD patients (n = 22). 129Xe MR was utilized to obtain pulmonary physiological parameters, including ventilation defect percent (VDP), alveolar sleeve depth (h), apparent diffusion coefficient (ADC), total septal wall thickness (d), and ratio of xenon signal from red blood cells and interstitial tissue/plasma (RBC/TP). Significant differences were found in the measured VDP (p = 0.035), h (p = 0.003), and RBC/TP (p = 0.003) between the HY and AMC groups. Compared with the AMC group, higher VDP (p = 0.020) and d (p = 0.048) were found in the AS group; higher VDP (p < 0.001), d (p < 0.001) and ADC (p < 0.001), and lower h (p < 0.001) and RBC/TP (p < 0.001) were found in the COPD group. Moreover, significant differences were also found in the measured VDP (p < 0.001), h (p < 0.001), ADC (p < 0.001), d (p = 0.008), and RBC/TP (p = 0.032) between the AS and COPD groups. Our findings indicate that pulmonary structure and functional changes caused by aging, cigarette smoking, and COPD are various, and show a progressive deterioration with the accumulation of these risk factors, including cigarette smoking and COPD. Pathophysiological changes can be difficult to comprehensively understand due to limitations in common techniques and multifactorial etiologies. 129Xe MRI can demonstrate structural and functional changes caused by several common factors and can be used to better understand patients' underlying pathology. Standard techniques for assessing pathophysiological lung function changes, spirometry, and chest CT come with limitations. 129Xe MR demonstrated progressive deterioration with accumulation of the investigated risk factors, without these limitations. 129Xe MR can assess lung changes related to these risk factors to stage and evaluate the etiology of the disease.

Change in the Spatial Position of Mini-implants During Distal Movement of the Entire Maxillary Dentition: An Observational CBCT Study.

To determine the change in the sagittal and vertical position of mini-implants placed in the maxilla during distal movement of the entire maxillary dentition. Overall, 28 mini-implants (1 placed on each side in 14 patients) were evaluated in healthy patients aged 15 to 25 years old. CBCTs were taken immediately after leveling and aligning prior to distalization (T1) and after 6 months (T2) to evaluate the distal movement of the maxillary teeth and position of the mini-implants. The vertical and sagittal angulation of each mini-implant was measured at T1 and T2. The linear distance between the mini-implant and the alveolar crest, the maxillary sinus, the maxillary second premolar, and the maxillary first permanent molar were measured. The change in angulation and the linear displacement of the miniimplant were evaluated in the vertical and sagittal plane. Wilcoxon signed rank test was performed to determine if there was a statistically significant change in the position of the mini-implant. Vertically, there was a significant change in the linear distance between the mini-implant and the alveolar crest on the right side (P ≤ .006) as well as the miniimplant and the maxillary sinus on the left side (P ≤ .003). Sagittally, there was a statistically significant rotation of the miniimplant occlusally (left side P ≤ .004 and right side P ≤ .002). The head and tip of the mini-implant were displaced toward the maxillary second premolar and away from the maxillary first permanent molar, respectively. There was a significant relative displacement of the mini-implant anteriorly away from the maxillary first permanent molar (left side P ≤ .026 and right side P ≤ .041) and closer to the maxillary second premolar (left side: P ≤ .011 and right side: P ≤ .002). There was a statistically and clinically significant rotation of the mini-implant in the vertical and sagittal direction during distal movement of the entire maxillary arch. The linear displacement of the mini-implant was more pronounced in the sagittal direction than the vertical direction.

Optical coherence tomography angiography suggests choriocapillaris perfusion deficit as etiology of acute macular neuroretinopathy

PurposeAcute macular neuroretinopathy (AMN) can cause sudden-onset and permanent scotoma in healthy young patients. Analysis of optical coherence tomography (OCT) and OCT angiography (OCTA) of AMN patients may provide insights into disease mechanism.MethodsWe conducted a retrospective study of consecutive SARS-Cov-2-related AMN patients that presented in our clinic between Jan 1st, 2022, and April 30th, 2023, within 30 days of symptom onset. Retinal vessel area density (VAD) of AMN lesions in OCTA was quantified and compared to an adjacent tissue control (ATC). This quantification was performed for the superficial vascular plexus (SVP), the intermediate capillary plexus (ICP), the deep capillary plexus (DCP), the choriocapillaris (CC), and choroid. Furthermore, en face OCT images were analyzed.ResultsNine AMN patients were identified, 6 of these (4 female, 2 male, average age 25 years) fulfilled the inclusion criteria and were included into this study. Average time from symptom onset to OCTA was 14.3 days. No VAD differences between AMN and adjacent tissue were found in either retinal layer (SVP, ICP, DCP). In contrast, VAD in CC was reduced by 27% against the ATC (p = 0.007) and choroidal VAD was reduced by 41% (p = 0.017). Further analysis of en face OCT could show that the pathognomonic infrared hyporeflectivity in AMN is caused by photoreceptor alterations rather than changes in the inner retinal layers.ConclusionsOur data suggests that a perfusion deficit in the choroidal layers is responsible for AMN rather than in the DCP, which is the predominant hypothesis in current literature.

Complete remission with histamine blocker in a patient with intractable hyperadrenergic postural orthostatic tachycardia syndrome secondary to long coronavirus disease syndrome.

The COVID-19 pandemic caused by the novel severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), has emerged as a global public health concern and its sequels have barely started to outcrop. A good percentage of patients who suffered from COVID-19 are prone to develop long-COVID or post-COVID condition (PCC), a multisystemic, heterogeneous, chronic disorder. Patients with PCC may experience diverse manifestations, of which cardiovascular and neurological symptoms are among the most frequently reported. Indeed, dysautonomia presented as orthostatic intolerance has gained room following recent reports linking postural orthostatic tachycardia syndrome (POTS) with PCC. Disturbances in heart rate (HR) and blood pressure (BP) during postural changes are the cornerstones of orthostatic intolerance seen in patients suffering from PCC. A subtype of POTS, hyperadrenergic POTS, has been widely studied because of its association with mast cell activation syndrome (MCAS). Although a causative relationship between PCC, hyperadrenergic POTS, and MCAS remains unrevealed, these syndromes can overlap. We want to propose here a correlation produced by a close-loop mechanism with positive feedback established after SARS-CoV-2 infection in a previously healthy young patient.

Reversing immunosuppression in the tumor microenvironment of fibrolamellar carcinoma via PD-1 and IL-10 blockade

Fibrolamellar carcinoma (FLC) is a rare liver tumor driven by the DNAJ-PKAc fusion protein that affects healthy young patients. Little is known about the immune response to FLC, limiting rational design of immunotherapy. Multiplex immunohistochemistry and gene expression profiling were performed to characterize the FLC tumor immune microenvironment and adjacent non-tumor liver (NTL). Flow cytometry and T cell receptor (TCR) sequencing were performed to determine the phenotype of tumor-infiltrating immune cells and the extent of T cell clonal expansion. Fresh human FLC tumor slice cultures (TSCs) were treated with antibodies blocking programmed cell death protein-1 (PD-1) and interleukin-10 (IL-10), with results measured by cleaved caspase-3 immunohistochemistry. Immune cells were concentrated in fibrous stromal bands, rather than in the carcinoma cell compartment. In FLC, T cells demonstrated decreased activation and regulatory T cells in FLC had more frequent expression of PD-1 and CTLA-4 than in NTL. Furthermore, T cells had relatively low levels of clonal expansion despite high TCR conservation across individuals. Combination PD-1 and IL-10 blockade signficantly increased cell death in human FLC TSCs. Immunosuppresion in the FLC tumor microenvironment is characterized by T cell exclusion and exhaustion, which may be reversible with combination immunotherapy.

Statistical Investigations on Relationship of Intraocular Pressure with Environmental Factors

Clinical relevance: Intraocular pressure (IOP) has a significant role in glaucoma pathophysiology. There are factors that influence in the IOP value, such as central corneal thickness or the biomechanical properties of the cornea. However, other less studied factors may influence the IOP, such as environmental pollution.&#x0D; Background: The increase in air pollution is related to acute respiratory pathologies. Regarding the eyes, is related to conjunctivitis or dry eye disease. The purpose was to analyse the correlation of environmental factors (atmospheric pressure, temperature, O3, NO2, PM10 and PM2.5 concentrations) with intraocular pressure in young healthy patients.&#x0D; Methods: A cross-sectional study was carried out on patients treated at General Optica centres in Spain and Portugal in collaboration with the University of Valladolid. This study included healthy patients (between 18 and 40 years old). IOP measurements were taken with different air tonometers (CT-80, CT-800, NCT-200, NT-510 and NT-530) for one week and correlated with environmental factors (atmospheric pressure, temperature, O3, NO2, PM10 and PM2.5 concentrations). Correlation (Spearman’s Rho) analyses were performed between IOP and the different environmental parameters. Moreover, groupings were performed as a function of the values for healthy exposure levels recommended by the WHO. Different comparisons were performed using the Mann‒Whitney U test.&#x0D; Results: Statistically significant correlations were found (p &lt; .04) between IOP and temperature (r = 0.37), atmospheric pressure (r = 0.20), NO2 (r = 0.14), PM10 (r = 0.21), O3 (r = 0.16) and PM2.5 concentrations (r = 0.16). Regarding the IOP values of people who were exposed to unhealthy concentrations (AQI &gt; 20) versus those who were not, higher IOP values were only found in people exposed to PM2.5.&#x0D; Conclusion: Slight correlations were found between higher temperature, atmospheric pressure and concentrations of pollutant gases and increased IOP. More clinical studies are needed to understand the role that these environmental factors play in the aqueous humour flow and the value of IOP to know if and to what extent these factors may be risk of glaucoma.

Age-related changes in human skeletal muscle transcriptome and proteome are more affected by chronic inflammation and physical inactivity than primary aging.

Evaluation of the influence of primary and secondary aging on the manifestation of molecular and cellular hallmarks of aging is a challenging and currently unresolved issue. Our study represents the first demonstration of the distinct role of primary aging and chronic inflammation/physical inactivity - the most important drivers of secondary aging, in the regulation of transcriptomic and proteomic profiles in human skeletal muscle. To achieve this purpose, young healthy people (n = 15), young (n = 8) and older (n = 37) patients with knee/hip osteoarthritis, a model to study the effect of long-term inactivity and chronic inflammation on the vastus lateralis muscle, were included in the study. It was revealed that widespread and substantial age-related changes in gene expression in older patients relative to young healthy people (~4000 genes regulating mitochondrial function, proteostasis, cell membrane, secretory and immune response) were related to the long-term physical inactivity and chronic inflammation rather than primary aging. Primary aging contributed mainly to the regulation of genes (~200) encoding nuclear proteins (regulators of DNA repair, RNA processing, and transcription), mitochondrial proteins (genes encoding respiratory enzymes, mitochondrial complex assembly factors, regulators of cristae formation and mitochondrial reactive oxygen species production), as well as regulators of proteostasis. It was found that proteins associated with aging were regulated mainly at the post-transcriptional level. The set of putative primary aging genes and their potential transcriptional regulators can be used as a resource for further targeted studies investigating the role of individual genes and related transcription factors in the emergence of a senescent cell phenotype.

Age-Dependent Changes in the Production of Mitochondrial Reactive Oxygen Species in Human Skeletal Muscle.

A decrease in muscle mass and its functionality (strength, endurance, and insulin sensitivity) is one of the integral signs of aging. One of the triggers of aging is an increase in the production of mitochondrial reactive oxygen species. Our study was the first to examine age-dependent changes in the production of mitochondrial reactive oxygen species related to a decrease in the proportion of mitochondria-associated hexokinase-2 in human skeletal muscle. For this purpose, a biopsy was taken from m. vastus lateralis in 10 young healthy volunteers and 70 patients (26-85 years old) with long-term primary arthrosis of the knee/hip joint. It turned out that aging (comparing different groups of patients), in contrast to inactivity/chronic inflammation (comparing young healthy people and young patients), causes a pronounced increase in peroxide production by isolated mitochondria. This correlated with the age-dependent distribution of hexokinase-2 between mitochondrial and cytosolic fractions, a decrease in the rate of coupled respiration of isolated mitochondria and respiration when stimulated with glucose (a hexokinase substrate). It is discussed that these changes may be caused by an age-dependent decrease in the content of cardiolipin, a potential regulator of the mitochondrial microcompartment containing hexokinase. The results obtained contribute to a deeper understanding of age-related pathogenetic processes in skeletal muscles and open prospects for the search for pharmacological/physiological approaches to the correction of these pathologies.

An individualized tractography pipeline for the nucleus basalis of Meynert lateral tract

Abstract Background: At the center of the cortical cholinergic network, the nucleus basalis of Meynert (NBM) is crucial for the cognitive domains most vulnerable in Parkinson’s disease (PD). Preclinical evidence has demonstrated the positive impact of NBM deep brain stimulation (DBS) on cognition but early human trials have had mixed results. It is possible that DBS of the lateral NBM efferent white matter fiber bundle may be more effective at improving cognitive-motor function. However, precise tractography modelling is required to identify the optimal target for neurosurgical planning. Individualized tractography approaches have been shown to be highly effective for accurately identifying DBS targets but have yet to be developed for the NBM. Methods: Using structural and diffusion-weighted imaging, we developed a tractography pipeline using manually segmented regions of interest for precise individualized identification of the lateral NBM target tract. Using dice similarity coefficients, the reliability of the tractography outputs was assessed across three cohorts to investigate: 1) whether this manual segmentation pipeline is more reliable than an existing automatic segmentation pipeline currently used in the literature; 2) the inter- and intra-rater reliability of our pipeline in research scans of patients with PD; and 3) the reliability and practicality of this pipeline in clinical scans of DBS patients. Results: The individualized manual pipeline was found to be significantly more reliable than the existing automated pipeline for both the segmentation of the NBM region itself (p &amp;lt; 0.001) and the reconstruction of the target lateral tract (p = 0.002). There was also no significant difference between the reliability of two different raters in the PD cohort (p = 0.25), which showed high inter- (mean Dice coefficient &amp;gt;0.6) and intra-rater (mean Dice coefficient &amp;gt;0.7) reliability across runs. Finally, the pipeline was shown to be highly reliable within the clinical scans (mean Dice coefficient = 0.77). However, accurate reconstruction was only evident in 7/10 tracts. Conclusion: We have developed a reliable tractography pipeline for the identification and analysis of the NBM lateral tract in research and clinical-grade imaging of healthy young adult and PD patient scans.

Effect of Induced Hypotensive Anesthesia and Normotensive Anesthesia on Intraoperative Blood Loss During Orthognathic Surgery: A Systematic Review.

Orthognathic surgery involves significant bleeding from both soft tissues and bones due to rich blood supply to areas involved. In addition, limited access along with poor visibility and difficulty to isolate or ligate adds to the problem of bleeding during surgery. As a result, to counter drawbacks of intraoperative bleeding, method of induced hypotension stands out. Hypotensive anesthesia is a method through which blood pressure is decreased in a controlled manner. Various studies have been conducted that compared multiple methods to reduce intraoperative blood loss and improve visibility of surgical field. Hence, need for a systematic review to study the effects of hypotensive anesthesia on intraoperative blood loss, duration of the surgery and quality of surgical field. An electronic search was conducted to cumulate data from PubMed, Google scholar and institutional library from 2000 to 2020. In addition, bibliographies of included studies were hand searched to identify potentially eligible studies to append to the data and reach a conclusion. Comparative study of the data available indicates that controlled hypotension during general anesthesia is safe for young healthy patients undergoing orthognathic surgeries. This information could be of key importance to aid in reducing intraoperative blood loss and which improves the observability of the surgical field; lessen the chances of need for blood transfusion; and eventually shorten the length of stay in hospital.

Early risk factors for prolonged mechanical ventilation in patients with severe blunt thoracic trauma: A retrospective cohort study

BackgroundA significant proportion of patients with severe chest trauma require mechanical ventilation (MV). Early prediction of the duration of MV may influence clinical decisions. We aimed to determine early risk factors for prolonged MV among adults suffering from severe blunt thoracic trauma. MethodsThis retrospective, single-center, cohort study included all patients admitted between January 2014 and December 2020 due to severe blunt chest trauma. The primary outcome was prolonged MV, defined as invasive MV lasting more than 14 days. Multivariable logistic regression was performed to identify independent risk factors for prolonged MV. ResultsThe final analysis included 378 patients. The median duration of MV was 9.7 (IQR 3.0–18.0) days. 221 (58.5 %) patients required MV for more than 7 days and 143 (37.8 %) for more than 14 days. Male gender (aOR 3.01, 95 % CI 1.63–5.58, p < 0.001), age (aOR 1.40, 95 % CI 1.21–1.63, p < 0.001, for each category above 30 years), presence of severe head trauma (aOR 3.77, 95 % CI 2.23–6.38, p < 0.001), and transfusion of >5 blood units on admission (aOR 2.85, 95 % CI 1.62–5.02, p < 0.001) were independently associated with prolonged MV. The number of fractured ribs and the extent of lung contusions were associated with MV for more than 7 days, but not for 14 days. In the subgroup of 134 patients without concomitant head trauma, age (aOR 1.63, 95 % CI 1.18–2.27, p = 0.004, for each category above 30 years), respiratory comorbidities (aOR 9.70, 95 % CI 1.49–63.01, p = 0.017), worse p/f ratio during the first 24 h (aOR 1.55, 95 % CI 1.15–2.09, p = 0.004), and transfusion of >5 blood units on admission (aOR 5.71 95 % CI 1.84–17.68, p = 0.003) were independently associated with MV for more than 14 days. ConclusionsSeveral predictors have been identified as independently associated with prolonged MV. Patients who meet these criteria are at high risk for prolonged MV and should be considered for interventions that could potentially shorten MV duration and reduce associated complications. Hemodynamically stable, healthy young patients suffering from severe thoracic trauma but no head injury, including those with extensive lung contusions and rib fractures, have a low risk of prolonged MV.

Right Atrial Enlargement on Electrocardiogram in Previously Healthy Young Patients

ObjectivesTo assess whether right atrial enlargement (RAE) on electrocardiogram (ECG) correlates with true RAE on echocardiogram in previously healthy young patients and to understand which patients with RAE on ECG may warrant additional testing. Study DesignA single-center, retrospective review of previously healthy young patients with 1) ECGs that were read as RAE by a pediatric cardiologist and 2) echocardiograms obtained within 90 days of the ECG. ECGs were reviewed to confirm RAE and determine which leads met criteria. The echocardiograms were then reviewed and RA measurements with Z-scores obtained. A Z-score >2 was considered positive for RAE on echocardiogram. Results162 patients with median age 10.8 years were included in the study. A total of 23 patients had true RAE on echocardiogram, giving a positive predictive value (PPV) of 14%. In patients <1 year of age, the PPV increased to 35%. In patients older than 1 year, the PPV was low at 7%. Patients with true RAE were more likely to meet criteria for RAE in the anterior precordial leads (V1-V3) (48% vs 5%, p< 0.001) and meet criteria for right ventricular hypertrophy (RVH) (22% vs 6%, p=0.023). ConclusionOur findings show that RAE on ECG has a low PPV for RAE on echocardiogram in previously healthy young patients. The highest yield for RAE on echocardiogram was observed in patients who were <1 year of age, had RAE in the anterior precordial leads, or displayed RVH on ECG.

Generation of Human Regulatory Dendritic Cells from Cryopreserved Healthy Donor Cells and Hematopoietic Stem Cell Transplant Recipients.

Acute graft versus host disease (GVHD) remains a significant complication following hematopoietic stem cell transplant (HSCT), despite improved human leukocyte antigen (HLA) matching and advances in prophylactic treatment regimens. Previous studies have shown promising results for future regulatory dendritic cell (DCreg) therapies in the amelioration of GVHD. This study evaluates the effects of cryopreservation on the generation of DCreg, the generation of young and older DCreg in serum-free media, and the feasibility of generating DCreg from young and older HSCT patient monocytes. DCregs were generated in X-vivo 15 serum-free media from donor or patient monocytes. This study includes the use of monocytes from young and older healthy, donor, and HSCT patients with varying hematological diseases. Phenotypic differences in cell populations were assessed via flow cytometry while pro-inflammatory and anti-inflammatory cytokine production was evaluated in culture medium. The number of DCreg generated from cryopreserved monocytes of healthy donors was not significantly different from freshly isolated monocytes. DCreg generated from cryopreserved monocytes had comparable levels of co-stimulatory molecule expression, inhibitory molecule expression, and cytokine production as freshly isolated monocytes. Young and older healthy donor monocytes generated similar numbers of DCreg with similar cytokine production and phenotype. Although monocytes from older HSCT patients generated significantly fewer DCreg, DCreg from young and older HSCT patients had comparable phenotypes and cytokine production. Monocytes from young and older myelodysplastic syndrome (MDS) patients generated reduced numbers of DCreg compared to non-MDS-derived DCreg. We demonstrate that the cryopreservation of monocytes from HSCT patients of varying hematological diseases allows for the cost-effective generation of DCreg on an as-needed basis. Although the generation of DCreg from MDS patients requires further assessment, these data support the possibility of in vitro-generated DCreg as a therapy to reduce GVHD-associated morbidity and mortality in young and older HSCT recipients.