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Dastagirzada YM, Eremiev A, Wisoff JH, Kay-Rivest E, Shapiro WH, Unterberger A, Waltzman SB, Roland JT, Golfinos JG, Harter DH. Auditory brainstem implantation: surgical experience and audiometric outcomes in the pediatric population. J Neurosurg Pediatr 2024; 33:496-504. [PMID: 38427998 DOI: 10.3171/2023.12.peds23299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 12/26/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Pediatric data regarding treatment via an auditory brainstem implant (ABI) remains sparse. The authors aimed to describe their experience at their institution and to delineate associated demographic data, audiometric outcomes, and surgical parameters. METHODS An IRB-approved, retrospective chart review was conducted among the authors' pediatric patients who had undergone auditory brainstem implantation between 2012 and 2021. Demographic information including sex, age, race, coexisting syndrome(s), history of cochlear implant placement, average duration of implant use, and follow-up outcomes were collected. Surgical parameters collected included approach, intraoperative findings, number of electrodes activated, and complications. RESULTS A total of 19 pediatric patients had an ABI placed at the authors' institution, with a mean age at surgery of 4.7 years (range 1.5-17.8 years). A total of 17 patients (89.5%) had bilateral cochlear nerve aplasia/dysplasia, 1 (5.3%) had unilateral cochlear nerve aplasia/dysplasia, and 1 (5.3%) had a hypoplastic cochlea with ossification. A total of 11 patients (57.9%) had a history of cochlear implants that were ineffective and required removal. The mean length of implant use was 5.31 years (0.25-10 years). Two patients (10.5%) experienced CSF-related complications requiring further surgical intervention. The most recent audiometric outcomes demonstrated that 15 patients (78.9%) showed improvement in their hearing ability: 5 with sound/speech awareness, 5 able to discriminate among speech and environmental sounds, and 5 able to understand common phrases/conversation without lip reading. Nine patients (47.4%) are in a school for the deaf and 7 (36.8%) are in a mainstream school with support. CONCLUSIONS The authors' surgical experience with a multidisciplinary team demonstrates that the retrosigmoid approach for ABI placement in children with inner ear pathologies and severe sensorineural hearing loss is a safe and effective treatment modality. Audiometric outcome data showed that nearly 79% of these patients had an improvement in their environmental and speech awareness. Further multicenter collaborations are necessary to improve these outcomes and potentially standardize/enhance electrode placement.
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Affiliation(s)
| | | | | | - Emily Kay-Rivest
- 2Otolaryngology, NYU Langone Medical Center, New York, New York; and
| | - William H Shapiro
- 2Otolaryngology, NYU Langone Medical Center, New York, New York; and
| | - Ansley Unterberger
- 3Department of Neurosurgery, UCLA Medical Center, Los Angeles, California
| | - Susan B Waltzman
- 2Otolaryngology, NYU Langone Medical Center, New York, New York; and
| | - J Thomas Roland
- 2Otolaryngology, NYU Langone Medical Center, New York, New York; and
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Dawes K, Simpson G, Lines L, van den Berg M. Interventions to support children after a parental acquired brain injury: a scoping review. Brain Inj 2024:1-14. [PMID: 38687294 DOI: 10.1080/02699052.2024.2347555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE This scoping review aimed to identify manualised programs and practice suggestions to support children's health literacy, behaviors and emotions after a parental acquired brain injury. METHODS A systematic search of five scientific databases (PsychINFO, MEDLINE, ProQuest, Scopus, Cochrane) and gray literature occurred. Inclusion criteria included: studies and gray literature published 1989 to 2023, in English, child populations with relationship to parental acquired brain injury, identifying manualised programs or practice suggestions via content analysis approach. ETHICAL CONSIDERATIONS No data were collected from human participants. All included studies, where relevant, demonstrated consent and/or ethical processes. RESULTS Sixteen relevant studies and three gray literature resources (n = 19) were identified, including two studies that detailed manualised programs, and fifteen studies and two resource packs that included practice suggestions. Five common domains within practice suggestions were identified: systemic commitment (n = 17); family-centered approaches (n = 16); child-centered practices (n = 15); structured programs (n = 9); and peer support (n = 8). CONCLUSIONS More rigorous evaluation is required to test the potential benefits of manualised programs and practice suggestions. A systemic commitment at clinical and organizational levels to provide child and family-centered practices, structured programs, and access to peer support, early and throughout adult-health care settings, may help to meet the support needs of children.
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Affiliation(s)
- Kate Dawes
- South Australian Brain Injury Rehabilitation Service, SA Health, Adelaide, Australia
- Caring Futures Institute, Flinders University of South Australia, Adelaide, Australia
| | - Grahame Simpson
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, Australia
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Lauren Lines
- Caring Futures Institute, Flinders University of South Australia, Adelaide, Australia
| | - Maayken van den Berg
- Caring Futures Institute, Flinders University of South Australia, Adelaide, Australia
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Garcia A, Haleem A, Poe S, Gosh D, Christian Brown M, Herrmann BS, Lee DJ. Auditory Brainstem Implant Outcomes in Tumor and Nontumor Patients: A Systematic Review. Otolaryngol Head Neck Surg 2024. [PMID: 38329219 DOI: 10.1002/ohn.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/03/2023] [Accepted: 01/13/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To elucidate the differences in auditory performance between auditory brainstem implant (ABI) patients with tumor or nontumor etiologies. DATA SOURCES PubMed, Embase, and Web of Science Core Collection from 1990 to 2021. REVIEW METHODS We included published studies with 5 or more pediatric or adult ABI users. Auditory outcomes and side effects were analyzed with weighted means for closed-set, open-set speech, and categories of auditory performance (CAP) scores. Overall performance was compared using an Adult Pediatric Ranked Order Speech Perception (APROSPER) scale created for this study. RESULTS Thirty-six studies were included and underwent full-text review. Data were extracted for 662 tumor and 267 nontumor patients. 83% were postlingually deafened and 17% were prelingually deafened. Studies that included tumor ABI patients had a weighted mean speech recognition of 39.2% (range: 19.6%-83.3%) for closed-set words, 23.4% (range: 17.2%-37.5%) for open-set words, 21.5% (range: 2.7%-48.4%) for open-set sentences, and 3.1 (range: 1.0-3.2) for CAP scores. Studies including nontumor ABI patients had a weighted mean speech recognition of 79.8% (range: 31.7%-84.4%) for closed-set words, 53.0% (range: 14.6%-72.5%) for open-set sentences, and 2.30 (range: 2.0-4.7) for CAP scores. Mean APROSPER results indicate better auditory performance among nontumor versus tumor patients (3.5 vs 3.0, P = .04). Differences in most common side effects were also observed between tumor and nontumor ABI patients. CONCLUSION Auditory performance is similar for tumor and nontumor patients for standardized auditory test scores. However, the APROSPER scale demonstrates better ABI performance for nontumor compared to tumor patients.
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Affiliation(s)
- Alejandro Garcia
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Sonja Poe
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Deborah Gosh
- Howe Library, Massachusetts Eye and Ear, Boston, MA, USA
| | - M Christian Brown
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Barbara S Herrmann
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Audiology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Lee KN, Chen CA, Kuo C, Yang LY. Ankle-brachial index associates with arteriovenous fistula stenosis. J Vasc Access 2024:11297298231226155. [PMID: 38326930 DOI: 10.1177/11297298231226155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Arteriovenous fistula (AVF) stenosis is associated with pre-existing arterial atherosclerosis of AVF and results in significant morbidity and hospitalization for hemodialysis patients. The ankle brachial index (ABI) is a noninvasive method of assessing atherosclerosis. This study was to examine whether ABI is a significant predictor for AVF stenosis. METHODS This was a retrospective, longitudinal cohort study. Patients with hemodialysis between 1 January 2016 and 31 December 2022 were reviewed. ABI was assessed in January 2016. AVF stenosis was diagnosed by fistulography. RESULTS A total of 82 patients were included. Forty-two patients experienced AVF stenosis. The univariate logistic regression analysis showed that AVF stenosis was associated with age (OR: 1.045, p = 0.033), DM status (OR: 5.529, p = 0.013), 7-year averaged cholesterol level (OR: 1.018, p = 0.034), 7-year averaged triglyceride level (OR: 1.007, p = 0.017), and ABI (OR: 0.011, p < 0.001). In multivariate logistic regression analysis, ABI was a strong predictor for AVF stenosis (OR: 0.036, p = 0.023). Then, a cut-off point of ABI with optimal sensitivity and specificity for AVF stenosis was 1.01. An analysis of time to events with adjustment for other variables showed that patients with ABI < 1.01 were significantly associated with AVF stenosis (HR: 3.859, p < 0.001). CONCLUSIONS ABI below 1.01 was associated with AVF stenosis. This finding may be useful in tailoring surveillance programs for monitoring AVF function.
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Affiliation(s)
- Kai-Ni Lee
- Department of Nephrology, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Chien-An Chen
- Department of Nephrology, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Chieh Kuo
- Department of Cardiology, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Li-Yu Yang
- Graduate Institute of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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Razaqyar MS, Osta E, Towne JM, Woolsey MD, Ishaque M, Chiang FL, Fox PT. Long-Term Neurocognitive Outcomes in Pediatric Nonfatal Drowning: Results of a Family Caregiver Survey. Pediatr Neurol 2024; 151:21-28. [PMID: 38091919 DOI: 10.1016/j.pediatrneurol.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/01/2023] [Accepted: 11/03/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Drowning is a leading cause of brain injury in children. Long-term outcome data for drowning survivors are sparse. This study reports neurocognitive outcomes for 154 children hospitalized following drowning. METHODS A survey for parent caregivers was distributed online. Likert scale items assessed 10 outcome variables in four domains: motor (three), perception (three), language (three), and social/emotional (one). Cluster analysis, outcome relative risk, and descriptive statistics were applied. RESULTS Of 208 surveys received, 154 met inclusion criteria. Coma was the most common admission status (n = 137). Cluster analysis identified three outcome groups: Mild (n = 39), Moderate (n = 75), and Severe (n = 40). Motor impairment with cognitive and perceptual sparing (deefferentation) was present in Moderate (P < 1 × 10-26) and Severe (P < 1 × 10-12) but absent in Mild. Locked-in state was endorsed in both Moderate (83%) and Severe (70%). The strongest predictor of good outcome (Mild) was hospitalization with no medical intervention (relative risk [RR] = 6.7). Responsivity on admission (RR = 4.2) or discharge (RR = 12.22) also predicted good outcome. In-hospital prognostication and counseling predicted outcome weakly (RR = 1.3) or not at all. CONCLUSIONS Long-term outcomes in pediatric drowning ranged widely. Overall, motor impairments exceeded perceptual or cognitive (P < 1 × 10-18), with "locked-in state" endorsed in most (93 of 154). The strongest predictors of good outcome were the lack of necessity for interventions and responsivity on admission or discharge. The eponym "Conrad syndrome" is proposed for locked-in state following nonfatal drowning in children.
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Affiliation(s)
- Muslima S Razaqyar
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Eri Osta
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas; School of Data Science, University of Texas at San Antonio, San Antonio, Texas
| | - Jonathan M Towne
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mary D Woolsey
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mariam Ishaque
- Department of Neurosurgery University of Virginia, Charlottesville, Virginia
| | - Florence L Chiang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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Cho SM, Khanduja S, Wilcox C, Dinh K, Kim J, Kang JK, Chinedozi ID, Darby Z, Acton M, Rando H, Briscoe J, Bush E, Sair HI, Pitts J, Arlinghaus LR, Wandji ACN, Moreno E, Torres G, Akkanti B, Gavito-Higuera J, Keller S, Choi HA, Kim BS, Gusdon A, Whitman GJ. Clinical Use of Bedside Portable Low-field Brain Magnetic Resonance Imaging in Patients on ECMO: The Results from Multicenter SAFE MRI ECMO Study. Res Sq 2024:rs.3.rs-3858221. [PMID: 38313271 PMCID: PMC10836091 DOI: 10.21203/rs.3.rs-3858221/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Purpose Early detection of acute brain injury (ABI) is critical for improving survival for patients with extracorporeal membrane oxygenation (ECMO) support. We aimed to evaluate the safety of ultra-low-field portable MRI (ULF-pMRI) and the frequency and types of ABI observed during ECMO support. Methods We conducted a multicenter prospective observational study (NCT05469139) at two academic tertiary centers (August 2022-November 2023). Primary outcomes were safety and validation of ULF-pMRI in ECMO, defined as exam completion without adverse events (AEs); secondary outcomes were ABI frequency and type. Results ULF-pMRI was performed in 50 patients with 34 (68%) on venoarterial (VA)-ECMO (11 central; 23 peripheral) and 16 (32%) with venovenous (VV)-ECMO (9 single lumen; 7 double lumen). All patients were imaged successfully with ULF-pMRI, demonstrating discernible intracranial pathologies with good quality. AEs occurred in 3 (6%) patients (2 minor; 1 serious) without causing significant clinical issues.ABI was observed in ULF-pMRI scans for 22 patients (44%): ischemic stroke (36%), intracranial hemorrhage (6%), and hypoxic-ischemic brain injury (4%). Of 18 patients with both ULF-pMRI and head CT (HCT) within 24 hours, ABI was observed in 9 patients with 10 events: 8 ischemic (8 observed on ULF-oMRI, 4 on HCT) and 2 hemorrhagic (1 observed on ULF-pMRI, 2 on HCT). Conclusions ULF-pMRI was shown to be safe and valid in ECMO patients across different ECMO cannulation strategies. The incidence of ABI was high, and ULF-pMRI may more sensitive to ischemic ABI than HCT. ULF-pMRI may benefit both clinical care and future studies of ECMO-associated ABI.
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Affiliation(s)
| | | | | | - Kha Dinh
- UTHSC: The University of Texas Health Science Center at Houston
| | - Jiah Kim
- Johns Hopkins Hospital: Johns Hopkins Medicine
| | | | | | | | | | | | | | - Errol Bush
- Johns Hopkins Hospital: Johns Hopkins Medicine
| | | | | | | | | | - Elena Moreno
- UTHSC: The University of Texas Health Science Center at Houston
| | - Glenda Torres
- UTHSC: The University of Texas Health Science Center at Houston
| | - Bindu Akkanti
- UTHSC: The University of Texas Health Science Center at Houston
| | | | | | - HuiMahn A Choi
- UTHSC: The University of Texas Health Science Center at Houston
| | - Bo Soo Kim
- Johns Hopkins Hospital: Johns Hopkins Medicine
| | - Aaron Gusdon
- UTHSC: The University of Texas Health Science Center at Houston
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Mace EH, Maiga AW, Beyene RT, Smith MC, Streams JR, Peetz AB, Dennis BM, Guillamondegui OD, Gondek SP. Vascular imaging immediately after tourniquet removal does not increase vasospasm risk. Injury 2024; 55:110974. [PMID: 37563047 DOI: 10.1016/j.injury.2023.110974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/22/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Prehospital tourniquet use is now standard in trauma patients with diagnosed or suspected extremity vascular injuries. Tourniquet-related vasospasm is an understudied phenomenon that may confound management by causing erroneous arterial pressure indices (APIs) and abnormalities on computed tomography angiography (CTA) that do not reflect true arterial injuries. We hypothesized that shorter intervals between tourniquet removal and CTA imaging and longer total tourniquet times would be correlated with a higher likelihood of false positive CTA. MATERIALS AND METHODS We performed a single-institution retrospective cohort study of patients presenting to a busy, urban Level 1 Trauma Center with prehospital tourniquets from 2019 to 2021. Patients who presented with a tourniquet disengaged upon arrival or who died prior to admission to the Trauma Unit were excluded. Tourniquet duration, time between tourniquet removal and CTA imaging (CTA interval), CTA findings, and management of extremity arterial injuries were extracted. The proportion of false positive injuries on CTA was assessed for correlation with increasing time interval from tourniquet removal to CTA imaging and correlation with increasing total tourniquet time using multivariable logistic regression. RESULTS 251 patients were identified with prehospital tourniquets. 127 underwent CTA of the affected extremity, 96 patients had an abnormal CTA finding, and 57 (45% of total CTA patients) had false positive arterial injuries on imaging. Using multivariable logistic regression, neither the CTA interval nor the tourniquet duration was associated with false positive CTA injuries. Female sex was associated with false positive injuries on CTA (OR 2.91, 95% CI: 1.01 - 8.39). Vasospasm was cited as a possible explanation by radiologists in 40% of false positive CTA reports. CONCLUSIONS Arterial vasospasm is a frequent finding on CTA after tourniquet use for extremity trauma, but concerns regarding tourniquet-related vasospasm should not alter trauma patient management. Neither the duration of tourniquet application nor the time interval since removal is associated with decreased CTA accuracy, and any delay in imaging does not appear to reduce the likelihood of vasospasm. These findings are important for supporting expedited care of trauma patients with severe extremity injuries.
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Affiliation(s)
- Eric H Mace
- Vanderbilt University Medical Center, Department of General Surgery, Nashville, Tennessee, Medical Center North, D-5203, Suite CCC-4312, 1161 21st Avenue South, Nashville, TN 37232-2730, USA
| | - Amelia W Maiga
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, Tennessee, Medical Arts Building, Suite 404, 1211 21st Avenue South, Nashville Tennessee 37212-1750, USA.
| | - Robel T Beyene
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, Tennessee, Medical Arts Building, Suite 404, 1211 21st Avenue South, Nashville Tennessee 37212-1750, USA
| | - Michael C Smith
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, Tennessee, Medical Arts Building, Suite 404, 1211 21st Avenue South, Nashville Tennessee 37212-1750, USA
| | - Jill R Streams
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, Tennessee, Medical Arts Building, Suite 404, 1211 21st Avenue South, Nashville Tennessee 37212-1750, USA
| | - Allan B Peetz
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, Tennessee, Medical Arts Building, Suite 404, 1211 21st Avenue South, Nashville Tennessee 37212-1750, USA
| | - Bradley M Dennis
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, Tennessee, Medical Arts Building, Suite 404, 1211 21st Avenue South, Nashville Tennessee 37212-1750, USA
| | - Oscar D Guillamondegui
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, Tennessee, Medical Arts Building, Suite 404, 1211 21st Avenue South, Nashville Tennessee 37212-1750, USA
| | - Stephen P Gondek
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, Tennessee, Medical Arts Building, Suite 404, 1211 21st Avenue South, Nashville Tennessee 37212-1750, USA
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Cumplido-Trasmonte C, Barquín-Santos E, Gor-García-Fogeda MD, Plaza-Flores A, García-Varela D, Ibáñez-Herrán L, González-Alted C, Díaz-Valles P, López-Pascua C, Castrillo-Calvillo A, Molina-Rueda F, Fernandez R, Garcia-Armada E. STELO: A New Modular Robotic Gait Device for Acquired Brain Injury-Exploring Its Us ability. Sensors (Basel) 2023; 24:198. [PMID: 38203060 PMCID: PMC10781374 DOI: 10.3390/s24010198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
In recent years, the prevalence of acquired brain injury (ABI) has been on the rise, leading to impaired gait functionality in affected individuals. Traditional gait exoskeletons are typically rigid and bilateral and lack adaptability. To address this, the STELO, a pioneering modular gait-assistive device, was developed. This device can be externally configured with joint modules to cater to the diverse impairments of each patient, aiming to enhance adaptability and efficiency. This study aims to assess the safety and usability of the initial functional modular prototype, STELO, in a sample of 14 ABI-diagnosed participants. Adverse events, device adjustment assistance and time, and gait performance were evaluated during three sessions of device use. The results revealed that STELO was safe, with no serious adverse events reported. The need for assistance and time required for device adjustment decreased progressively over the sessions. Although there was no significant improvement in walking speed observed after three sessions of using STELO, participants and therapists reported satisfactory levels of comfort and usability in questionnaires. Overall, this study demonstrates that the STELO modular device offers a safe and adaptable solution for individuals with ABI, with positive user and therapist feedback.
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Affiliation(s)
- Carlos Cumplido-Trasmonte
- International Doctoral School, Rey Juan Carlos University, 28922 Madrid, Spain;
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
| | - Eva Barquín-Santos
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
| | - María Dolores Gor-García-Fogeda
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
- Department of Physical Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain;
| | - Alberto Plaza-Flores
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
| | - David García-Varela
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
| | - Leticia Ibáñez-Herrán
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
| | - Carlos González-Alted
- Spanish National Reference Centre for Brain Injury (CEADAC), 28034 Madrid, Spain; (C.G.-A.); (P.D.-V.)
| | - Paola Díaz-Valles
- Spanish National Reference Centre for Brain Injury (CEADAC), 28034 Madrid, Spain; (C.G.-A.); (P.D.-V.)
| | | | | | - Francisco Molina-Rueda
- Department of Physical Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain;
| | - Roemi Fernandez
- Centre for Automation and Robotics (CAR), CSIC-UPM, Ctra. Campo Real km 0.2–La Poveda-Arganda del Rey, 28500 Madrid, Spain
| | - Elena Garcia-Armada
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
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Uloza V, Pribuišis K, Ulozaite-Staniene N, Petrauskas T, Damaševičius R, Maskeliūnas R. Accuracy Analysis of the Multiparametric Acoustic Voice Indices, the VWI, AVQI, ABI, and DSI Measures, in Differentiating between Normal and Dysphonic Voices. J Clin Med 2023; 13:99. [PMID: 38202106 PMCID: PMC10779457 DOI: 10.3390/jcm13010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
The study aimed to investigate and compare the accuracy and robustness of the multiparametric acoustic voice indices (MAVIs), namely the Dysphonia Severity Index (DSI), Acoustic Voice Quality Index (AVQI), Acoustic Breathiness Index (ABI), and Voice Wellness Index (VWI) measures in differentiating normal and dysphonic voices. The study group consisted of 129 adult individuals including 49 with normal voices and 80 patients with pathological voices. The diagnostic accuracy of the investigated MAVI in differentiating between normal and pathological voices was assessed using receiver operating characteristics (ROC). Moderate to strong positive linear correlations were observed between different MAVIs. The ROC statistical analysis revealed that all used measurements manifested in a high level of accuracy (area under the curve (AUC) of 0.80 and greater) and an acceptable level of sensitivity and specificity in discriminating between normal and pathological voices. However, with AUC 0.99, the VWI demonstrated the highest diagnostic accuracy. The highest Youden index equaled 0.93, revealing that a VWI cut-off of 4.45 corresponds with highly acceptable sensitivity (97.50%) and specificity (95.92%). In conclusion, the VWI was found to be beneficial in describing differences in voice quality status and discriminating between normal and dysphonic voices based on clinical diagnosis, i.e., dysphonia type, implying the VWI's reliable voice screening potential.
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Affiliation(s)
- Virgilijus Uloza
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, 50061 Kaunas, Lithuania; (V.U.); (K.P.); (T.P.)
| | - Kipras Pribuišis
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, 50061 Kaunas, Lithuania; (V.U.); (K.P.); (T.P.)
| | - Nora Ulozaite-Staniene
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, 50061 Kaunas, Lithuania; (V.U.); (K.P.); (T.P.)
| | - Tadas Petrauskas
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, 50061 Kaunas, Lithuania; (V.U.); (K.P.); (T.P.)
| | | | - Rytis Maskeliūnas
- Faculty of Informatics, Kaunas University of Technology, 51368 Kaunas, Lithuania
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10
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Sonderman M, Aday AW, Farber-Eger E, Mai Q, Freiberg MS, Liebovitz DM, Greenland P, McDermott MM, Beckman JA, Wells Q. Identifying Patients With Peripheral Artery Disease Using the Electronic Health Record: A Pragmatic Approach. JACC Adv 2023; 2:100566. [PMID: 37829143 PMCID: PMC10569163 DOI: 10.1016/j.jacadv.2023.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Peripheral artery disease (PAD) is underdiagnosed due to poor patient and clinician awareness. Despite this, no widely accepted PAD screening is recommended. OBJECTIVES The authors used machine learning to develop an automated risk stratification tool for identifying patients with a high likelihood of PAD. METHODS Using data from the electronic health record (EHR), ankle-brachial indices (ABIs) were extracted for 3,298 patients. In addition to ABI, we extracted 60 other patient characteristics and used a random forest model to rank the features by association with ABI. The model identified several features independently correlated with PAD. We then built a logistic regression model to predict PAD status on a validation set of patients (n = 1,089), an external cohort of patients (n = 2,922), and a national database (n = 2,488). The model was compared to an age-based and random forest model. RESULTS The model had an area under the curve (AUC) of 0.68 in the validation set. When evaluated on an external population using EHR data, it performed similarly with an AUC of 0.68. When evaluated on a national database, it had an AUC of 0.72. The model outperformed an age-based model (AUC: 0.62; P < 0.001). A random forest model with inclusion of all 60 features did not perform significantly better (AUC: 0.71; P = 0.31). CONCLUSIONS Statistical techniques can be used to build models which identify individuals at high risk for PAD using information accessible from the EHR. Models such as this may allow large health care systems to efficiently identify patients that would benefit from aggressive preventive strategies or targeted-ABI screening.
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Affiliation(s)
- Mark Sonderman
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Aaron W. Aday
- Division of Cardiovascular Medicine, Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Farber-Eger
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Quan Mai
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew S. Freiberg
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David M. Liebovitz
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Philip Greenland
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary M. McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joshua A. Beckman
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Quinn Wells
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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11
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Ghoreyshi ZS, Al-Thalaya Z, Rajabi Z, Azimian M, Ebrahimipour M. Providing Functional Communication Test for Persian Patients and Determining Its Validity and Reliability. Indian J Otolaryngol Head Neck Surg 2023; 75:241-248. [PMID: 37274965 PMCID: PMC10235240 DOI: 10.1007/s12070-022-03150-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/25/2022] [Indexed: 11/26/2022] Open
Abstract
The International Classification of Impairment, Disabilities and Health by the World Health Organization had a profound influence on assessing and treating people with acquired brain injuries (ABI), which cause a movement from using impairment-based intervention to use therapies that focused on improving the participation and function of the individual's daily life. Although the first step of any therapy plan is to measure the damaged function of the related dimension, no available functional communication test for Persian-speaking people with ABI is available. Our purpose of this study was to provide a Functional Communication Test for Persian-speaking patients to measure the strengths and weakness of communication in dementia-free patients with ABI. In this cross-sectional study, the first version of the Persian Functional Communication Test (P-FUCT) was designed based on the structure of the most common functional communication tests such as ASHA-FACS and CADL. The content validity ratio (CVR) were determined. The final version of P-FUCT was administered on 30 dementia-free patients with ABI completed once by a clinician and once by the caregivers and the correlation between the scores was obtained. Concurrently, the P-WAB-1 was administered to assess the concurrent validity of the P-FUCT. The results indicated that P-FUCT has an acceptable level of internal consistency (alpha = 0.96), inter-rater 0.91 and intra-rater measurements 0.95 p < 0.05 with an adequate CVR of 0.71. The correlation between P-WAB-1 and P-FUCT scores completed by clinicians and the caregivers was r = 0/79 and r = 0/80. The P-FUCT is a valid and reliable assessment tool can be use for measuring the function communication ability of dementia-free patients with ABI.
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Affiliation(s)
- Zahra Sadat Ghoreyshi
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zahra Al-Thalaya
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zahra Rajabi
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mojtaba Azimian
- Department of Clinical Group, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mona Ebrahimipour
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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12
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Mankekar G, Holmes S. Hearing Reh abilitation in Vestibular Schwannoma. Audiol Res 2023; 13:357-366. [PMID: 37218842 DOI: 10.3390/audiolres13030031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/13/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
The most common complaint among patients with vestibular schwannoma (VS) is hearing loss. This significantly affects the quality of life before, during, and after treatment for patients with VS. Untreated hearing loss in VS patients may even lead to depression and feelings of social isolation. A variety of devices are available for hearing rehabilitation for patients with vestibular schwannoma. These include contralateral routing of hearing signals (CROSs), bone-anchored hearing devices, auditory brainstem implants (ABI), and cochlear implants. In the United States, ABI is approved for patients 12 years of age and older with neurofibromatosis type 2. In the past few years, cochlear implantation has been offered simultaneously or sequentially with tumor resection or irradiation, or even to patients whose VS have been monitored with serial imaging. However, determining the functional integrity of the auditory nerve in patients with vestibular schwannoma is a challenge. This review article consists of (1) the pathophysiology of vestibular schwannoma (VS), (2) hearing loss in VS, (3) treatment of VS and associated hearing loss, (4) options for auditory rehabilitation in patients with VS with their individual benefits and limitations, and (5) challenges in hearing rehabilitation in this cohort of patients to determine auditory nerve functionality. (6) Future directions.
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Affiliation(s)
- Gauri Mankekar
- Department of Otolaryngology, Louisiana State Health University Sciences Center, Shreveport, LA 71103, USA
| | - Sean Holmes
- Department of Otolaryngology, Cox Health Medical Group, Springfield, MO 35807, USA
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13
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Bennett E, Fletcher A, Talbot E, Robinson L. Returning to education after childhood acquired brain injury: Learning from lived parental experience. NeuroRehabilitation 2023:NRE220205. [PMID: 37125567 DOI: 10.3233/nre-220205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Returning to education (RtE) after an acquired brain injury (ABI) can be stressful for children/young people (CYP) and families. While much can be done to support RtE, there has been limited exploration of the lived experience of parents/carers about what can both help and hinder the process. OBJECTIVE The aim was to understand more about RtE from parents' perspectives to inform best practice and facilitate improvements in service delivery. METHODS A service evaluation explored parent/carer views about the RtE process and the support received from healthcare professionals at a regional centre in the UK. Questionnaires (n = 59) were sent to parents of patients treated for an ABI in the last two years. RESULTS 31 parents (response rate = 51%) completed the survey. Results highlight the many challenges of RtE. Thematic analysis of responses revealed six key themes: Parental mindset and growth; What do they need know?; Specialist support and information; Talk and share; Challenges of new and hidden needs; and Don't forget them! CONCLUSION Parents offer crucial insight into the challenges of the RtE process. Their feedback highlights important factors for service development and reminds professionals of the key components of an effective return.
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Affiliation(s)
- E Bennett
- Department of Clinical Psychology and Neuropsychology, Nottingham University Hospitals NHS Trust, Nottingham, UK
- BRILL Team, Nottingham Children's Hospital, Nottingham, UK
| | - A Fletcher
- BRILL Team, Nottingham Children's Hospital, Nottingham, UK
- Brain Injury Community Service, The Children's Trust, Tadworth, UK
| | - E Talbot
- Department of Clinical Psychology and Neuropsychology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Robinson
- East Midlands Children and Young Persons' Integrated Cancer Service, Nottingham Children's Hospital, Nottingham, UK
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14
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Menichelli D, Galardo G, Cammisotto V, Bartimoccia S, Carnevale R, Pignatelli P, Pastori D. Association of proprotein convertase subtilisin/kexin type 9 (PCSK9) levels with abnormally high ankle-brachial index in atrial fibrillation. Kardiol Pol 2023; 81:381-387. [PMID: 36929300 DOI: 10.33963/kp.a2023.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/23/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND High ankle-brachial index (ABI) has been associated with increased risk of worse outcomes in the general population. Few data on atrial fibrillation (AF) do exist. Experimental data suggest that proprotein convertase subtilisin/kexin type 9 (PCSK9) contribute to vascular calcification but clinical data on this association are lacking. AIMS We want to investigate the relationship between circulating PCSK9 levels and abnormally high ABI in patients suffering from AF. METHODS We analysed data from 579 patients included in the prospective ATHERO-AF study. An ABI ≥1.4 was considered as high. PCSK9 levels were measured coincidentally with ABI measurement. We used an optimized cut-offs of PCSK9 for both ABI and mortality obtained from ROC curve analysis. All-cause mortality according to the ABI value was also analysed. RESULTS 115 (19.9%) had an ABI ≥1.4. The mean (SD) age was 72.1 (7.6) years and 42.1% of patients were women. Patients with ABI ≥1.4 were older, more frequently male and diabetic. Multivariable logistic regression analysis showed an association between ABI ≥1.4 and serum levels of PCSK9 >1150 pg/ml (odds ratio [OR], 1.649; 95% confidence interval [CI], 1.047-2.598; P = 0.031). During a median follow up of 41 months, 113 deaths occurred. At multivariable Cox regression analysis, ABI ≥1.4 (hazard ratio [HR], 1.626; 95% CI, 1.024-2.582; P = 0.039), CHA₂DS₂-VASc score (HR, 1.249; 95% CI, 1.088-1.434; P = 0.002), antiplatelet drug use (HR, 1.775; 95% CI, 1.153-2.733; P = 0.009), and PCSK9 >2060 pg/ml (HR, 2.200; 95% CI, 1.437-3.369; P <0.001) were associated with all-cause death. CONCLUSIONS In AF patients, PCSK9 levels relate to an abnormally high ABI ≥1.4. Our data suggest a role for PCSK9 in favouring vascular calcification in AF patients.
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Affiliation(s)
- Danilo Menichelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.,Department of General Surgery, Surgical Specialties and Organ Transplantation
| | - Gioacchino Galardo
- Department of General Surgery, Surgical Specialties and Organ Transplantation
| | - Vittoria Cammisotto
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Simona Bartimoccia
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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15
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Lullove E. Use of fetal bovine dermal repair scaffold in diabetic foot ulcers with recidivism: an open-label prospective clinical study. J Wound Care 2023; 32:S10-S16. [PMID: 36744738 DOI: 10.12968/jowc.2023.32.sup2.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed to establish the effectiveness of fetal bovine dermal scaffold (FBDS) application with multilayer offloading (standard of care) over that of traditional therapies in the treatment of diabetic foot ulcers (DFUs). METHOD Patients from a single centre in South Florida, US were recruited for this research. All patients underwent a run-in period of standardised care and vascular testing to determine and control the ability to heal. Patients were placed in multilayer offloading total contact cast (TCC) systems with application of FBDS every four weeks. Wound measurements and efficacy of offloading were monitored weekly. RESULTS In an older population with diabetes and above-normal body mass index (BMI), use of FBDS was successful in wound closure, with average time to closure of 7.85 weeks for the 20 patients in this study. It should be noted that surface wound area was reduced by approximately 40% by week 4 and by almost 83% by week 9. Follow-up at three and six months showed no residual or recurrent ulcerations in this study population for 19/20 patients. CONCLUSION Total wound closure of hard-to-heal DFUs in this patient series study was achieved with local surgical debridement, TCC offloading and application(s) of a FBDS in older patients with above-normal BMI and in wounds of >4 weeks non-progressive healing. Furthermore, at three and six months, 19/20 patients' wounds remained closed and did not re-ulcerate.
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Affiliation(s)
- Eric Lullove
- West Boca Center for Wound Healing, Coconut Creek, FL, US
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16
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Singla A, Chobufo MD, Meesum A, Ali A, Aronow WS, Goldsweig AM, Balla S, Whelton PK. Prevalence and outcomes of low ankle brachial index by atherosclerotic cardiovascular disease risk level: Insights from the National Health and Nutrition Examination Survey (NHANES). Am J Med Sci 2023; 365:121-9. [PMID: 36152814 DOI: 10.1016/j.amjms.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 06/20/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Ankle brachial index (ABI) as a risk-enhancing factor in addition to the pooled cohort equation (PCE) in assessing cardiovascular risk for primary prevention of atherosclerotic cardiovascular disease (ASCVD) is uncertain. METHODS We analyzed data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES), for 5130 participants, aged 40 and older, without known cardiovascular disease or diabetes, with available data on standard ASCVD risk and ABI. Prevalence of low ABI (ABI<0.9) and all-cause mortality in persons with low, borderline and intermediate ASCVD risk categories using PCE was assessed. RESULTS The overall prevalence of low ABI was 3.1%. The participants with low ABI were predominantly clustered in the intermediate (33%) and high (33%) ASCVD risk categories while most participants with a normal ABI were in the low (56%) and intermediate (23%) risk categories. All-cause mortality was higher among participants with low ABI compared to those with a normal ABI in both the intermediate/borderline and high-risk categories, p<0.001 but not in the low-risk ASCVD category, p = 0.323. CONCLUSIONS Using the PCE, two-third of the participants with low ABI were classified as having a low, borderline or intermediate risk of ASCVD. Low ABI was associated with an increased all-cause mortality in the overall cohort and specifically among those with a borderline/intermediate or high risk of ASCVD but not in those with a low risk of ASCVD. Our study supports consideration of ABI as a risk enhancer for primary prevention among patients classified as borderline or intermediate risk of ASCVD.
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17
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Collins A, D'Cruz K, Jackman A, Anderson V, Jenkin T, Scheinberg A, Muscara F, Knight S. Engaging children and adolescents with acquired brain injury and their families in goal setting: The family perspective. Neuropsychol Rehabil 2023; 33:1-23. [PMID: 34538207 DOI: 10.1080/09602011.2021.1977154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study explored the experiences of goal setting in paediatric rehabilitation from the perspectives of children and adolescents with acquired brain injury (ABI) and their parents in paediatric rehabilitation. Using a qualitative research design, 15 semi-structured interviews were conducted with 13 parents and 8 young people with ABI aged between 9 and 18 years who were engaged in outpatient rehabilitation. Interview transcripts were analysed using constructivist grounded theory methods. Two main themes and several sub-themes emerged: Experiences of goal setting: The role of professionals; The role of the young person; and The role of the parents. Working as a team: Understanding each other and building trust; Communicating, sharing knowledge and different perspectives; and Being flexible. These themes reflect parent's and young people's experience of goal setting during paediatric rehabilitation for ABI and suggest clinicians play an important role in educating young people and their families about goal setting in the outpatient rehabilitation context. Young people and their parents also perceive the focus of outpatient rehabilitation as working collaboratively with clinicians to gain knowledge to manage the consequences of ABI. Our findings emphasize the importance of the therapeutic consumer-clinician relationship and the need to actively engage young people in goal setting.
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Affiliation(s)
- Alana Collins
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | | | - Angie Jackman
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Taylor Jenkin
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Adam Scheinberg
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
| | - Frank Muscara
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, Australia
| | - Sarah Knight
- Department of Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
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18
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Racca F, Geraci C, Cremascoli L, Ruvolo D, Piccolella F, Romenskaya T, Longhitano Y, Martuscelli E, Saviano A, Savioli G, Zanza C. Invasive Mechanical Ventilation in Traumatic Brain Injured Patients with Acute Respiratory Failure. Rev Recent Clin Trials 2023; 18:3-11. [PMID: 36043786 DOI: 10.2174/1574887117666220826164723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022]
Abstract
Patients with severe traumatic brain injury (TBI) need to be admitted to intensive care (ICU) because they require invasive mechanical ventilation (IMV) due to reduced consciousness resulting in loss of protective airway reflexes, reduced ability to cough and altered breathing control. In addition, these patients can be complicated by pneumonia and acute distress syndrome (ARDS). IMV allows these patients to be sedated, decreasing intracranial pressure and ensuring an adequate oxygen delivery and tight control of arterial carbon dioxide tension. However, IMV can also cause dangerous effects on the brain due to its interaction with intrathoracic and intracranial compartments. Moreover, when TBI is complicated by ARDS, the setting of mechanical ventilation can be very difficult as ventilator goals are often different and in conflict with each other. Consequently, close brain and respiratory monitoring is essential to reduce morbidity and mortality in mechanically ventilated patients with severe TBI and ARDS. Recently, recommendations for the setting of mechanical ventilation in patients with acute brain injury (ABI) were issued by the European Society of Intensive Care Medicine (ESICM). However, there is insufficient evidence regarding ventilation strategies for patients with ARDS associated with ABI. The purpose of this paper is to analyze in detail respiratory strategies and targets in patients with TBI associated with ARDS.
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Affiliation(s)
- Fabrizio Racca
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Cristina Geraci
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Luca Cremascoli
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Domenico Ruvolo
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Piccolella
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Tatsiana Romenskaya
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Yaroslava Longhitano
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Foundation of "Ospedale Alba-Bra", Department of Emergency Medicine, Anaesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno, Italy
| | - Ermelinda Martuscelli
- Department of Emergency Medicine and Anesthesia and Critical Care, San Giacomo Hospital, Novi Ligure (AL), Italy
| | - Angela Saviano
- Department Of Emergency Medicine - Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Gabriele Savioli
- Clinical Echocardiography and Urgency Ultrasound, Emergency Medicine, Fondazione IRCCS San Matteo, 27100 Pavia, Italy
| | - Christian Zanza
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Foundation of "Ospedale Alba-Bra", Department of Emergency Medicine, Anaesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno, Italy
- Department Of Emergency Medicine - Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
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19
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Ciardullo S, Bianconi E, Cannistraci R, Parmeggiani P, Marone EM, Perseghin G. Peripheral artery disease and all-cause and cardiovascular mortality in patients with NAFLD. J Endocrinol Invest 2022; 45:1547-1553. [PMID: 35364761 PMCID: PMC9270293 DOI: 10.1007/s40618-022-01792-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/21/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE Cardiovascular disease (CVD) is the first cause of death in patients with non-alcoholic fatty liver disease (NAFLD) and risk stratification is recommended by current guidelines. The aim of this study is to assess the prevalence of peripheral arterial disease (PAD) in patients with NAFLD and its association with all-cause and cardiovascular disease (CVD) mortality. METHODS 9145 participants 40 years or older attended a mobile examination center visit in the 1999-2004 cycles of the National Health and Nutrition Examination Survey. PAD was defined as an ankle-brachial index (ABI) < 0.90 in either of the legs and mortality data through December 2015 were obtained from the National Death Index. NAFLD was defined by a fatty liver index ≥ 60 in the absence of other liver conditions, leading to a final sample of 3094 subjects. RESULTS The overall prevalence of PAD was 5.9% (95% CI 5.0-6.9). Over a median follow-up of 13 years, 876 participants died, 208 of cardiovascular causes. Incidence rates of all-cause mortality (for 1000 person-years) were 20.2 (95% CI 18.7-21.7) and 70.0 (95% CI 60.1-81.6) for participants without and with PAD, respectively. Multivariable-adjusted Cox proportional hazard models showed that PAD was associated with a higher risk of all-cause (1.8, 95% CI 1.4-2.4) and cardiovascular mortality (HR 2.5, 95% CI 1.5-4.3) after adjustment for potential confounders including prevalent CVD. CONCLUSION Current guidelines strongly encourage the screening of CVD in patients with NAFLD and the use of the simple and inexpensive measurement of ABI in routine clinical practice may find indication.
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Affiliation(s)
- S Ciardullo
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Università degli Studi di Milano Bicocca, Milan, Italy
| | - E Bianconi
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - R Cannistraci
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Università degli Studi di Milano Bicocca, Milan, Italy
| | - P Parmeggiani
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - E M Marone
- Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Vascular Surgery, Policlinico di Monza, Monza, Italy
| | - G Perseghin
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy.
- Department of Medicine and Surgery, University of Milano Bicocca, Università degli Studi di Milano Bicocca, Milan, Italy.
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Lee TL, Chang YM, Liu CH, Su HC, Sung PS, Lin SH, Chen CH. Ankle-Brachial Index Predicts Long-Term Renal Outcomes in Acute Stroke Patients. Healthcare (Basel) 2022; 10. [PMID: 35628050 DOI: 10.3390/healthcare10050913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/29/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023] Open
Abstract
Renal dysfunction is common after stroke. We aimed to investigate the clinical predictability of the ankle−brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) on poststroke renal deterioration. A total of 956 consecutive participants with acute ischemic stroke between 1 July 2016, and 31 December 2017 were enrolled and a final of 637 patients were recruited for final analysis. By using the group-based trajectory model (GBTM), the patients’ renal function trajectories were grouped into the low, intermediate, and high categories (LC, IC, and HC). Significant deterioration in the slope was noted in the IC (p < 0.001) and LC (p = 0.002) groups but was nonsignificant in the HC (p = 0.998) group. Abnormal ABI (ABI ≤ 0.9) was independently related to LC (adjusted odds ratio: 2.40; 95% CI, 1.16−4.95; p = 0.019) and was also independently associated with increased risks of a ≥30% decline in eGFR (adjusted hazard ratio [aHR], 2.28; 95% CI, 1.29−4.05; p = 0.005), a doubling of serum creatinine (aHR, 3.60; 95% CI, 1.93−8.34; p < 0.001) and ESRD (HR, 3.28; 95% CI, 1.23−8.74; p = 0.018). However, baPWV did not have a significant relationship with any of the renal outcomes. Patients with a lower ABI during acute stroke should receive regular renal function tests and should be closely monitored to improve poststroke renal care.
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Lehnert B, Herold J, Blaurock M, Busch CJ. Reli ability of the Acoustic Voice Quality Index AVQI and the Acoustic Breathiness Index (ABI) when wearing CoViD-19 protective masks. Eur Arch Otorhinolaryngol 2022. [PMID: 35522325 DOI: 10.1007/s00405-022-07417-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/20/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Investigating whether the Acoustic Voice Quality Index (AVQI) and the Acoustic Breathiness Index (ABI) are valid and comparable to previous unmasked measurements if the speaker wears a surgical mask or a FFP-2 mask to reduce the risk of transmitting air-borne viruses such as SARS-CoV-2. METHODS A convenience sample of 31 subjectively healthy participants was subjected to AVQI and ABI voice examination four times: Twice wearing no mask, once with a surgical mask and once with a FFP-2 mask as used regularly in our hospital. The order of the four mask conditions was randomized. The difference in the results between the two recordings without a mask was then compared to the differences between the recordings with each mask and one recording without a mask. RESULTS Sixty-two percent of the AVQI readings without a mask represented perfectly healthy voices, the largest AVQI without a mask value was 4.0. The mean absolute difference in AVQI was 0.45 between the measurements without masks, 0.48 between no mask and surgical mask and 0.51 between no mask and FFP-2 mask. The results were neither clinically nor statistically significant. For the ABI the resulting absolute differences (in the same order) were 0.48, 0.69 and 0.56, again neither clinically nor statistically different. CONCLUSION Based on a convenience sample of healthy or only mildly impaired voices wearing CoViD-19 protective masks does not substantially impair the results of either AVQI or ABI results.
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Peltonen E, Laivuori M, Vakhitov D, Korhonen P, Venermo M, Hakovirta H. The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle-Brachial Index ( ABI). J Cardiovasc Dev Dis 2022; 9. [PMID: 35621858 DOI: 10.3390/jcdd9050147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The ankle−brachial index (ABI) is a first-line examination in cardiovascular risk evaluation. Since cut-off values for normal ABI vary, the aim of the present study was to identify the cardiovascular-mortality-based estimate for the normal range of the ABI. After determining the reference range for the ABI, the corresponding toe−brachial index (TBI) and toe pressure for normal ABI were analyzed. Methods: All consecutive non-invasive pressure measurements in the vascular laboratory of a large university hospital 2011−2013 inclusive were collected and combined with patient characteristics and official dates and causes of death. Patients with an ABI range of 0.8−1.4 on both lower limbs were included in this study. Results: From 2751 patients, 868 had bilateral ABI values within the inclusion. Both ABI category ranges 0.80−0.89 and 0.90−0.99 had poorer survival compared to ABI categories 1.00−1.29 (p < 0.05). The 1-, 3-, and 5-year cardiovascular-death-free survival for respective ABI categories 0.80−0.99 vs. 1.00−1.29 were 90% vs. 96%, 84% vs. 92%, and 60% vs. 87%. The 1-, 3-, and 5-year overall survival for ABI categories 0.80−0.99 vs. 1.00−1.29 were 85% vs. 92%, 75% vs. 83%, and 42% vs. 74%. Conclusions: Borderline ABI (0.90−0.99) associates with higher overall and cardiovascular mortality compared to ABI values 1.00−1.29.
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Buso G, Darioli R, Calanca L, Depairon M, Schwitter J, Mazzolai L, Alatri A. In postmenopausal women, lower limb peripheral arterial disease, assessed by ankle-brachial index, may be a strong predictor of cardiovascular risk. Eur J Intern Med 2022; 99:63-69. [PMID: 35135705 DOI: 10.1016/j.ejim.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lower limb peripheral arterial disease (PAD) is a leading atherosclerotic disease in the elderly. However, awareness of the disease is poor, particularly in women. METHODS In this retrospective, cross-sectional study, postmenopausal women referred to our Angiology Division were tested for PAD, defined as an "ankle-brachial index" (ABI) ≤0.9 or ≥1.4 (in the latter case with a "toe-brachial index" <0.7), or a history of lower limb arterial revascularization. Aim of our study was to assess cardiovascular (CV) risk profile in postmenopausal women with and without PAD, and to evaluate the role of PAD and six classic CV risk factors (CVRFs), namely age, current smoking, hypertension, dyslipidaemia, severe chronic renal failure, and diabetes in predicting CV disease (CVD), defined as coronary artery disease and/or cerebrovascular disease. RESULTS Overall, 850 patients were included, 39.4% of whom with PAD. Compared with women without PAD, those with PAD were older (75.2 vs 66 years, respectively; p <0.001), and displayed higher rates of other CVRFs (p <0.001 for each). A personal history of CVD was reported in 18.8% of women with PAD and in 6.1% of those without PAD (p <0.001). At multivariate regression analysis, PAD (odds ratio [OR]: 2.15; 95% confidence interval [CI]: 1.33-3.47), and hypertension (OR: 2.20; 95%CI: 1.24-3.88) were the strongest factors associated with CVD presence. CONCLUSIONS PAD is a strong marker of CVD in this selected series of postmenopausal women. If confirmed in the general population, PAD screening through ABI calculation may be considered for CV risk assessment in postmenopausal women.
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Affiliation(s)
- Giacomo Buso
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | - Luca Calanca
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Michèle Depairon
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Jürg Schwitter
- Division of Cardiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Adriano Alatri
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland..
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Andring N, Olszewski C, Strickland L, Beck E, Bang K, Pilson H, Carroll E, Halvorson J. No false elevation in ankle brachial index in patients with tibial plateau fractures and vascular risk factors. J Orthop 2022; 30:115-119. [PMID: 35264825 PMCID: PMC8899118 DOI: 10.1016/j.jor.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The ankle brachial index (ABI) is a useful tool in detection of lower extremity vascular injury. However, diabetes mellitus (DM), chronic kidney disease (CKD), and peripheral vascular disease (PVD) may affect extremity perfusion leading to possible false elevation of the ABI value. If true in trauma patients, this can affect initial evaluation, diagnostics, and management. We therefore explored mean ABI values in tibial plateau fractures of patients with vascular risk factors to help determine whether there is a difference. Design This is a retrospective chart review of patients sustaining tibial plateau fractures with a specific ABI value recorded in the medical record. Patients were identified as either having vascular risk factors or not and data analysis performed to determine if their ABI differed and whether they were more likely to have a vascular injury. Results 282 acute tibial plateau injuries with specific ABI values were identified, 46 of which carried the risk factors in question. The average risk factor group ABI was 0.95 ± 0.15 versus those without risk factors 1.0 ± 0.15 (p = 0.057). No patient with risk factors required a vascular intervention or four-compartment fasciotomy. Conclusions This study shows no statistical significance between the presenting ABI of patients with risk factors such as DM, CKD, or PVD and those without those risk factors who sustained acute tibial plateau fractures. Therefore, in general the ABI still holds as a useful screening tool for evaluation of vascular insult in the setting of acute lower extremity trauma.
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Affiliation(s)
- Nicholas Andring
- Corresponding author. Wake Forest University School of Medicine Medical Center Blvd, Winston-Salem, NC, 27157, USA.
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Aguirre A, Sharma K, Arora A, Humphries MD. Early ABI Testing May Decrease Risk of Amputation for Patients With Lower Extremity Ulcers. Ann Vasc Surg 2022; 79:65-71. [PMID: 34656726 PMCID: PMC9889134 DOI: 10.1016/j.avsg.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with lower extremity wounds from diabetes mellitus or peripheral artery disease (PAD) have a risk of amputation as high as 25%. In patients with arterial disease, revascularization decreases the risk of amputation. We aimed to determine if the early assessment of arterial perfusion correlates with the risk of amputation. METHODS We retrospectively reviewed patients referred to the vascular clinic over 18 months with Rutherford Grade 5 and 6 chronic limb-threatening ischemia to determine if patients had a pulse exam done at the time the wound was identified and when ankle brachial index (ABI) testing to evaluate perfusion was performed. Kaplan Meier analysis was used to determine if the timing of ABI testing affected the time to revascularization, wound healing, and risk of amputation. RESULTS Ninety-three patients with lower extremity wounds were identified. Of these, 59 patients (63%) did not have a pulse exam performed by their primary care provider when the wound was identified. Patients were classified by when they underwent ankle brachial index testing to assess arterial perfusion. Twenty-four had early ABI (<30 days) testing, with the remaining 69 patients having late ABI testing. Patients in the early ABI group were more likely to have a pulse exam done by their PCP than those in the late group, 12 (50%) vs. 22 (32%), P = 0.03. Early ABI patients had a quicker time to vascular referral (13 days vs. 91 days, P < 0.001). Early ABI patients also had quicker times to wound healing than those in the late group (117 days vs. 287 days, P < 0.001). Finally, patients that underwent early ABI were less likely to require amputation (Fig. 1), although this did not reach statistical significance (P = 0.07). CONCLUSIONS Early ABI testing expedites specialty referral and time to revascularization. It can decrease the time to wound healing. Larger cohort studies are needed to determine the overall effect of early ABI testing to decrease amputation rates.
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Affiliation(s)
- Angela Aguirre
- Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA
| | - Kritika Sharma
- Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA
| | - Aman Arora
- Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA
| | - Misty D Humphries
- Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA.
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Griffin SM, Kinsella EL, Bradshaw D, McMahon G, Nightingale A, Fortune DG, Muldoon OT. New group memberships formed after an acquired brain injury and posttraumatic growth: A prospective study. Neuropsychol Rehabil 2022; 32:2054-2076. [PMID: 35048777 DOI: 10.1080/09602011.2021.2021950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Predicting positive psychosocial outcomes following an Acquired Brain Injury (ABI) remains a challenge. Considerable research demonstrates that social group memberships can have positive effects on psychological well-being, particularly during life transitions. Social group memberships are argued to help people derive a sense of self. This prospective study examined if social group memberships (number of groups and connectedness with groups) could predict posttraumatic growth (PTG) in those affected by ABI. Thirty-six participants (10 females, Mage = 46.56, SD = 11.46) engaged in community rehabilitation services completed measures at two time-points. Mediation analyses demonstrated that the number of new group memberships (groups formed post-injury) predicted greater PTG at time 2, via stronger connectedness with these new group memberships (controlling for initial PTG). The observed results suggest that a focus on developing and strengthening connections with new group memberships may promote positive adjustment after brain injury.
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Affiliation(s)
- Siobhán M Griffin
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
| | - Elaine L Kinsella
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland.,RISE Lab, Department of Psychology, University of Limerick, Limerick, Ireland
| | - Daragh Bradshaw
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
| | - Grace McMahon
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
| | - Alastair Nightingale
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
| | - Donal G Fortune
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland.,HSE Mid-West Region, Limerick, Ireland
| | - Orla T Muldoon
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
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Królczyk J, Piotrowicz K, Skalska A, Mossakowska M, Grodzicki T, Gąsowski J. Mortality of older persons with and without abnormalities in the physical examination of arterial system. Aging Clin Exp Res 2022; 34:2897-904. [PMID: 35995914 DOI: 10.1007/s40520-022-02232-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/13/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Ankle-brachial index (ABI) is a screening tool for peripheral arterial disease (PAD). However, persons with normal ABI may still exhibit abnormalities in the physical examination of arterial system (PHEA). OBJECTIVE In older persons from the PolSenior study, we aimed to assess the risk of total mortality associated with abnormalities in PHEA in the context of dichotomised ABI. METHODS We used data from the PolSenior survey and matched them with mortality information from the Polish Census Bureau. We obtained sociodemographic, medical history, and lifestyle data. The PHEA by a geriatrician included carotid, femoral, popliteal, posterior tibial and the dorsalis pedis arterial pulses, and auscultation of aorta, carotid, femoral, and renal arteries. Ankle-brachial index was tibial to brachial SBP ratio. We plotted the stratified Kaplan-Meier curves and used Cox's regression to assess the unadjusted and adjusted influence of PHEA result on time to death. RESULTS The mean (standard deviation, SD) age of 852 persons (46.7% women) was 74.7 (10.6) years. In the ABI < 0.9 group, the PHEA was not associated with mortality. However, in the ABI ≥ 0.9 group, both in unadjusted and adjusted (RHR; 95% CI: 1.08; 1.02-1.16, p = 0.01) Cox regression, PHEA greater by 1 score was associated with mortality. Presence of 4 or more PHEA abnormalities was raising the risk in the ABI ≥ 0.9 group to the level associated with ABI < 0.9. CONCLUSIONS In the older persons with normal ABI, the greater number of abnormalities during physical examination of arteries may be indicative of higher risk of death.
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Twomey DM, Allen N, Agan MLF, Hayes AM, Higgins A, Carton S, Roche R, Hevey D, Bramham J, Brady N, O'Keeffe F. Self-reported outcomes and patterns of service engagement after an acquired brain injury: a long-term follow-up study. Brain Inj 2021; 35:1649-1657. [PMID: 34898342 DOI: 10.1080/02699052.2021.2004617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PRIMARY OBJECTIVE To describe the clinical characteristics, self-reported outcomes in domains relating to activities of daily living and patterns of service engagement in the survivors of a moderate-to-severe acquired brain injury over seven years. RESEARCH DESIGN A longitudinal research design was used. METHODS AND PROCEDURES Thirty-two individuals who sustained a moderate-to-severe acquired brain injury completed a Sociodemographic and Support Questionnaire at one (t1) and seven years (t2) after completing a publicly funded inpatient neurorehabilitation program. MAIN OUTCOMES AND RESULTS There were minimal changes in independent living, mobility, ability to maintain key relationships and in return to work in the interval between t1 and t2. Sixty-nine percent of participants engaged with two or more allied health professional services and 75% engaged with support services in the community over the seven years. CONCLUSIONS There were minimal additional gains in outcomes relating to activities of daily-living and there was a high level of service need in the first decade postinjury. Young and middle-aged individuals who sustain an ABI may continue to live in the community for decades with some level of disability and may require ongoing access to services.
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Affiliation(s)
- Deirdre M Twomey
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Niamh Allen
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | | | - Aoife M Hayes
- Psychology and Clinical Neuropsychology Services, National Rehabilitation Hospital, Dun Laoghaire, Ireland
| | - Andrea Higgins
- Psychology and Clinical Neuropsychology Services, National Rehabilitation Hospital, Dun Laoghaire, Ireland
| | - Simone Carton
- Psychology and Clinical Neuropsychology Services, National Rehabilitation Hospital, Dun Laoghaire, Ireland
| | - Richard Roche
- Department of Psychology, Maynooth University, Ireland
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Jessica Bramham
- School of Psychology, University College Dublin, Dublin, Ireland.,Psychology and Clinical Neuropsychology Services, National Rehabilitation Hospital, Dun Laoghaire, Ireland
| | - Nuala Brady
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Fiadhnait O'Keeffe
- School of Psychology, University College Dublin, Dublin, Ireland.,School of Psychology, Trinity College Dublin, Dublin, Ireland.,Psychology and Clinical Neuropsychology Services, National Rehabilitation Hospital, Dun Laoghaire, Ireland.,Psychology Department St. Vincent's University Hospital, Dublin, Ireland
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Abstract
BACKGROUND: The ReWork-Stroke program was developed to meet the need for a person-centered rehabilitation program addressing return to work after stroke and was provided by occupational therapists (OTs). OBJECTIVE: To gain knowledge on the implementation process of the ReWork-Stroke program, the mechanisms of impact, and the contextual factors that might have affected the process. METHODS: A case study design was used. Data were collected by interviews with two ReWork-Stroke providers and their logbooks of 13 clients. Content analysis was applied. RESULTS: The ReWork-Stroke program varied in duration (12–48 weeks) and was largely implemented according to plan regarding components and how they were provided. It was mostly delivered at the workplace. Mechanisms of impact were building alliances with clients, providing intervention at the workplace, informing about stroke, assigning co-workers as tutors for clients, and collaboration between stakeholders. CONCLUSIONS: The ReWork-Stroke program can be implemented according to plan and is a flexible person-centered program in which stakeholders, coordinated by an OT, plan and take actions, mostly at the workplace, for the client’s return to work. A key factor was recognizing the current work ability after stroke. Further program development includes a more structured evaluation and technical solutions for supporting stakeholders.
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Affiliation(s)
- Ulla Johansson
- Centre for Research & Development, Uppsala University, Gävle, Sweden
| | - Annika Öst Nilsson
- Centre for Research & Development, Uppsala University, Gävle, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Annie Hansen Falkdal
- Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden
| | - Lena von Koch
- Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Therese Hellman
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
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Karcz K, Trezzini B, Escorpizo R, Schwegler U, Finger M. Factors associated with sustaining work after an acquired brain injury: a scoping review. Disabil Rehabil 2021; 44:6510-6530. [PMID: 34590966 DOI: 10.1080/09638288.2021.1960439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Maintaining work in the long term represents a major challenge for people with acquired brain injury (ABI) as evidenced by a high rate of premature labour market dropouts. The present study aimed to compile factors associated with working in the long term after sustaining an ABI. MATERIALS AND METHODS We carried out a scoping review synthesizing quantitative and qualitative research conducted between 2000 and 2021. Databases searched comprised PubMed, CINAHL Complete, PsycINFO, Scopus, and Web of Science. RESULTS Ten quantitative and nine qualitative studies were included, all but one from high-resource countries. Quantitative research predominantly comprised longitudinal follow-ups on individuals' work status several years post ABI onset, showing an effect of injury-related and sociodemographic factors. Qualitative studies mostly dealt with work maintenance and revealed a key role of cognitive difficulties, psychological personal factors (e.g., adequate coping strategies) and environmental factors (e.g., flexible work schedules, supportive colleagues). CONCLUSIONS The factors identified in our review should receive particular attention in vocational integration and job retention programs to support work participation of people with ABI in the long term. There is a need for measures that regularly monitor and promote a good match between individuals and their work environment.Implications for RehabilitationPeople with acquired brain injury (ABI) often have long-lasting and invisible injury-related difficulties that hamper their labour market participation.Factors identified as positively associated with working in the long term, such as coping strategies and self-awareness, should be strengthened.Future interventions should educate affected persons, employers and health care professionals about long-lasting injury-related difficulties and promote a supportive work environment for people with ABI.Prolonged availability of vocational services could be beneficial for supporting work maintenance of people with ABI.
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Affiliation(s)
- Katarzyna Karcz
- Work and Integration Group, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Bruno Trezzini
- Work and Integration Group, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Reuben Escorpizo
- Work and Integration Group, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Rehabilitation and Movement Science, The University of Vermont, USA
| | - Urban Schwegler
- Work and Integration Group, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Monika Finger
- Work and Integration Group, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Milasinovic DZ, Sekulic DB, Nikolic DD, Vukicevic AM, Tomic AP, Miladinovic UM, Paunovic DS, Filipovic ND. Virtual ABI: A computationally derived ABI index for noninvasive assessment of femoro-popliteal bypass surgery outcome. Comput Methods Programs Biomed 2021; 208:106242. [PMID: 34175534 DOI: 10.1016/j.cmpb.2021.106242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/11/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Peripheral arterial disease of the lower limbs, which affects 12-14% of the population, is often treated by bypassing a blocked portion of the vessel. Due to the limited ability of clinicians to predict the outcome of a selected bypass strategy, the five-year graft occlusion ranges from 50% to 90%, with a 20% risk of amputation in the first 5 years after the surgery. The aim of this study was to develop a computational procedure that could enable surgeons to reduce negative effects by assessing patient-specific response to the available surgical strategies. METHODS The Virtual ABI assumes patient-specific finite element modeling of patients' hemodynamics from routinely acquired medical scans of lower limbs. The key contribution of this study is a novel approach for prescribing boundary conditions, which combines noninvasive preoperative measurements and results of numerical simulations. RESULTS The validation performed on six follow-up cases indicated high reliability of the Virtual ABI, since the correlation with the experimentally measured values of ankle-brachial index was R² = 0.9485. CONCLUSION The initial validation showed that the proposed Virtual ABI is a noninvasive procedure that could assist clinicians to find an optimal strategy for treating a particular patient by varying bypass length, choosing adequate diameter, position and shape.
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Affiliation(s)
- Danko Z Milasinovic
- University of Kragujevac, Faculty of Hotel Management and Tourism in Vrnjačka Banja, Vojvođanska bb, 36210 Vrnjačka Banja, Serbia.
| | - Dragan B Sekulic
- Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia
| | - Dalibor D Nikolic
- University of Kragujevac, Institute of Information Technologies, Jovana Cvijića bb, 34000 Kragujevac, Serbia
| | - Arso M Vukicevic
- University of Kragujevac, Faculty of Engineering, Sestre Janjić 6, 34000 Kragujevac, Serbia.
| | | | | | | | - Nenad D Filipovic
- University of Kragujevac, Faculty of Engineering, Sestre Janjić 6, 34000 Kragujevac, Serbia
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Suryani M, Samekto W, Susanto H, Dwiantoro L. Effect of foot-ankle flexibility and resistance exercise in the secondary prevention of plantar foot diabetic ulcer. J Diabetes Complications 2021; 35:107968. [PMID: 34187716 DOI: 10.1016/j.jdiacomp.2021.107968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
AIMS The study aimed to evaluate the effects of foot-ankle flexibility and resistance exercises on the recurrence rate of plantar foot diabetic ulcers, HbA1c levels, diabetic neuropathy examination (DNE) scores, ankle brachial index (ABI), and walking speed within 12 and 24weeks. METHODS We conducted a double-blind randomized clinical trial. Fifty patients with recently healed plantar foot diabetic ulcers were randomized to an intervention group that performed foot-ankle flexibility and resistance exercise three times a week in their home (n=25) or a control group (n=25). Both groups were given foot care education. Outcomes were assessed at plantar foot diabetic ulcer recurrence or at 12 and 24weeks whichever came first. Outcome measures included plantar foot diabetic ulcer recurrence, changes of HbA1c levels, DNE scores, ankle brachial index ABI, and walking speed. RESULTS There were significant difference between groups in ulcer recurrence at either 12weeks (intervention 8%, control 68%, RR 0.288; 95% CI 0.156-0.534, P=0.000) within 12weeks. or 24weeks (intervention 16%, control 72%, RR 0.222; 95% CI 0.088-0.564, P=0.000).). There were significant differences in the DNE score delta (P=0.000) and walking speed delta (P=0.000), but there were no significant differences in the HbA1c delta and ABI delta between groups at either 12 or 24weeks. CONCLUSIONS Foot-ankle flexibility and resistance exercises can reduce the recurrence of plantar foot diabetic ulcer incidence and improve diabetic neuropathy and walking speed. Clinical trial number: NCT04624516.
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Affiliation(s)
- Maria Suryani
- Nursing Study Program, St. Elisabeth School Health Science (STIKES St.Elisabeth), Semarang, Indonesia; Medicine Faculty, Diponegoro University, Semarang, Indonesia.
| | - Widiastuti Samekto
- Medicine Faculty, Diponegoro University, Semarang, Indonesia; St. Elisabeth Hospital, Semarang, Indonesia
| | | | - Luky Dwiantoro
- Medicine Faculty, Diponegoro University, Semarang, Indonesia
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Varshney V, Majee M. JA Shakes Hands with ABA to Delay Seed Germination. Trends Plant Sci 2021; 26:764-766. [PMID: 34053891 DOI: 10.1016/j.tplants.2021.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/09/2021] [Accepted: 05/17/2021] [Indexed: 05/06/2023]
Abstract
Seed germination is a multifaceted process, controlled by many cues, wherein phytohormones play a central role. Despite extensive studies, it remains obscure how hormonal balance and crosstalk between hormones regulate seed germination. Here we highlight new findings showing that crosstalk between jasmonates (JA) and abscisic acid (ABA) delays seed germination.
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Affiliation(s)
- Vishal Varshney
- National Institute of Plant Genome Research (NIPGR), Aruna Asaf Ali Marg, New Delhi 110067, India
| | - Manoj Majee
- National Institute of Plant Genome Research (NIPGR), Aruna Asaf Ali Marg, New Delhi 110067, India.
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Abstract
BACKGROUND The purpose of this study was with a simple clinical setting to compare skin temperature changes in the feet before and after revascularization and to identify possible correlation between ankle brachial index (ABI) and toe pressure (TP) values and foot skin temperature patient with and without diabetes. METHODS Forty outpatient clinic patients were measured ABI, TP, and the skin temperature using infrared thermography (IRT) at the foot before and after revascularization. Patients in the revascularization group were divided into subgroups depending on whether they had diabetes or not and a wound or not. RESULTS There were clear correlation between increase of ABI and TP and increase of the mean skin temperature on the feet after revascularization. The temperature was higher and the temperature change was greater among patients with diabetes. Side-to-side temperature difference between the revascularized feet and contralateral feet decreased after treatment. The mean temperature was higher in the feet with wound whether patient had diabetes mellitus or not. CONCLUSION The simple, prompt, and noninvasive IRT procedure showed its potential as a follow-up tool among patients with diabetes or peripheral arterial disease and previous lower limb revascularization.
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Affiliation(s)
- Arjaleena Ilo
- Department of Vascular Surgery, Oulu University Hospital and Oulu University, Finland
- Arjaleena Ilo, MD, Department of Vascular Surgery, Oulu University Hospital, PO Box 21, 90029 Oulu, Finland.
| | - Pekka Romsi
- Department of Vascular Surgery, Oulu University Hospital and Oulu University, Finland
| | - Matti Pokela
- Department of Vascular Surgery, Oulu University Hospital and Oulu University, Finland
| | - Jussi Mäkelä
- Department of Cardiothoracic Surgery, Oulu University Hospital and Oulu University, Finland
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Shetty KR, Ridge SE, Kanumuri V, Zhu A, Brown MC, Lee DJ. Clinical and scientific innovations in auditory brainstem implants. World J Otorhinolaryngol Head Neck Surg 2021; 7:109-115. [PMID: 33997720 PMCID: PMC8103538 DOI: 10.1016/j.wjorl.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/27/2020] [Accepted: 02/10/2021] [Indexed: 12/03/2022] Open
Abstract
The auditory brainstem implant (ABI) was originally developed to provide rehabilitation of retrocochlear deafness caused by neurofibromatosis type 2 (NF2). Recent studies of the ABI have investigated outcomes in non-NF2 cohorts, such as patients with cochlear nerve aplasia or cochlear ossification and more recently, intractable tinnitus. New technologies that improve the ABI-neural tissue interface are being explored as means to improve performance and decrease side effects. Innovative discoveries in optogenetics and bioengineering present opportunities to continually evolve this technology into the future, enhancing spatial selectivity of neuronal activation in the cochlear nucleus and preventing side effects through reduction in activation of non-target neuronal circuitry. These advances will improve surgical planning and ultimately improve patients’ audiological capabilities. ABI research has rapidly increased in the 21st century and applications of this technology are likely to continually evolve. Herein, we aim to characterize ongoing clinical, basic science, and bioengineering advances in ABIs and discuss future directions of this technology.
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Affiliation(s)
- Kunal R Shetty
- Department of Otorhinolaryngology Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.,Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Sarah E Ridge
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Vivek Kanumuri
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Angela Zhu
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - M Christian Brown
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Daniel J Lee
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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36
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Wu J, Liu M, Huang H. Risk Factors Associated With Diabetic Foot Ulcers and Its Relationship With ABI and Brachial-Ankle Pulse Wave Velocity. INT J LOW EXTR WOUND 2021; 21:609-616. [PMID: 33686903 DOI: 10.1177/1534734620982233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To evaluate the risk factors associated with diabetic foot ulcers (DFUs) and to analyze the relationship of DFUs and the value of Ankle-Brachial Index (ABI) and brachial-ankle pulse wave velocity (baPWV). In this retrospective study, the risk factors associated with DFUs were analyzed, and the value of ABI and baPWV were measured to find its relationship with DFUs. Binary logistic regression analysis indicated that neuropathy and ABI were independent risk factors for DFUs. The patients were divided into 2 groups according to the value of ABI. For patients with DFUs, the value of baPWV decreased with the decrease of ABI. In normal or high ABI group, about a quarter of patients who suffered from DFUs had a higher value of baPWV than the others without DFUs. The pathogenesis of DFUs was multifactorial. Regarding the occurrence and development of foot ulcers, the action of vascular occlusion was more important than vascular sclerosis. ABI measurements should be taken more seriously in patients with DFUs. baPWV should be taken with care in the follow-up of the patients without DFUs. However, in patients with a normal value of ABI, the degree of vascular sclerosis of patients with DFUs may be greater than those without ulceration.
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Affiliation(s)
- Jialu Wu
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Min Liu
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Hui Huang
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, People's Republic of China
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Fisher A, Bellon M, Lawn S, Lennon S. Family perspectives on the accept ability and usefulness of the FAB Positive Behaviour Support program: A pilot study. Brain Inj 2021; 35:609-619. [PMID: 33678101 DOI: 10.1080/02699052.2021.1894479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: This pilot feasibility study aimed to gain preliminary insight into the acceptability and usefulness of the FAB-PBS program for providing behavior support to families following acquired brain injury (ABI) in community settings. The FAB-PBS program is based on a Positive Behavior Support (PBS) framework and principles of Family-Centered Care and Family-Directed Intervention. It consists of an education phase followed by individualized sessions during which the family is supported to develop and implement a PBS plan.Methods: A mixed-methods design was utilized, with feedback obtained from family members via short questionnaires and semi-structured interviews post education phase and individualized sessions, and at three-month follow up.Results: Two family members completed the full FAB-PBS program and reported high satisfaction with the program and increased confidence in providing behavior support. Findings also suggested an increase in desired behaviors and a decrease in challenging behaviors presented by family members with ABI.Conclusions: The FAB-PBS program may be an acceptable and feasible approach to increasing the capability of family caregivers in providing behavior support following ABI. Further pilot testing is required to inform the development of a larger feasibility study.
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Affiliation(s)
- Alinka Fisher
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Michelle Bellon
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- Department of Psychiatry, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Sheila Lennon
- Discipline of Physiotherapy, Repatriation General Hospital, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Jiménez PA, McCandless T. Exploring the Potential of Statistical Modeling to Retrieve the Cloud Base Height from Geostationary Satellites: Applications to the ABI Sensor on Board of the GOES-R Satellite Series. Remote Sens (Basel) 2021; 13:375. [PMID: 34158974 PMCID: PMC8216211 DOI: 10.3390/rs13030375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although cloud base height is a relevant variable for many applications, including aviation, it is not routinely monitored by current geostationary satellites. This is probably a consequence of the difficulty of providing reliable estimations of the cloud base height from visible and infrared radiances from current imagers. We hypothesize that existing algorithms suffer from the accumulation of errors from upstream retrievals necessary to estimate the cloud base height, and that this hampers higher predictability in the retrievals to be achieved. To test this hypothesis, we trained a statistical model based on the random forest algorithm to retrieve the cloud base height, using as predictors the radiances from Geostationary Operational Environmental Satellites (GOES-16) and variables from a numerical weather prediction model. The predictand data consisted of cloud base height observations recorded at meteorological aerodrome report (METAR) stations over an extended region covering the contiguous USA. Our results indicate the potential of the proposed methodology. In particular, the performance of the cloud base height retrievals appears to be superior to the state-of-the-science algorithms, which suffer from the accumulation of errors from upstream retrievals. We also find a direct relationship between the errors and the mean cloud base height predicted over the region, which allowed us to obtain estimations of both the cloud base height and its error.
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Affiliation(s)
- Pedro A. Jiménez
- National Center for Atmospheric Research, Boulder, CO 80301, USA
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McGowan VJ, Akhter N, Halliday E, Popay J, Kasim A, Bambra C. Collective control, social cohesion and health and well-being: baseline survey results from the communities in control study in England. J Public Health (Oxf) 2021; 44:378-386. [PMID: 33423066 DOI: 10.1093/pubmed/fdaa227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/16/2020] [Accepted: 11/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Area-based initiatives (ABIs) are receiving renewed interest as a part of the 'place-based public health' approaches to reducing health inequalities. PURPOSE Examine associations between collective control, social cohesion and health amongst residents involved in the Big Local (BL) ABI. METHODS Survey data on general health, mental well-being, perceptions of individual and collective control and social cohesion was obtained in 2016 for 1600 residents involved in the 150 BL ABI areas in England, and 862 responded-a response rate of >50%. Adjusted mean differences and adjusted odds ratios (ORs) were calculated using random effect linear and generalized estimating equation models. Subgroup analysis by gender and educational level was conducted. RESULTS Mental well-being was positively associated with collective control (mean difference: 3.06 units, 1.23-4.90) and some measures of social cohesion ('people in the area are willing to help each other' [mean difference: 1.77 units, 0.75-2.78]). General health was positively associated with other measures of social cohesion (area-belonging [OR: 4.25, 2.26-7.97]). CONCLUSIONS Collective control and some aspects of social cohesion were positively associated with better mental well-being and self-rated health amongst residents involved with BL. These positive associations were often greater amongst women and participants with a lower education. Increasing the collective control residents have in ABIs could improve the health effects of ABIs.
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Affiliation(s)
- V J McGowan
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.,Fuse-UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne NE2 4HH, UK
| | - N Akhter
- Fuse-UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne NE2 4HH, UK.,Department of Anthropology, Durham University, Durham DH1 3LE, UK
| | - E Halliday
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster LA1 4YG, UK
| | - J Popay
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster LA1 4YG, UK
| | - A Kasim
- Fuse-UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne NE2 4HH, UK.,Department of Anthropology, Durham University, Durham DH1 3LE, UK
| | - C Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.,Fuse-UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne NE2 4HH, UK
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Exell R, Hilari K, Behn N. Interventions that support adults with brain injuries, learning dis abilities and autistic spectrum disorders in dating or romantic relationships: a systematic review. Disabil Rehabil 2020; 44:2567-2580. [PMID: 33181032 DOI: 10.1080/09638288.2020.1845824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the current evidence on dating interventions, their theoretical underpinnings and effectiveness for adult neuro-atypical populations. METHODS A literature search was completed using CINAHL, Communication Source, PsycARTICLES, PsycINFO, SocINDEX, MEDLINE, Embase, AMED and EMB Reviews (all), for English-language, peer-reviewed studies into interventions for relationships or dating among adults with acquired brain injuries (ABI), learning disabilities or autistic spectrum disorder (ASD). Demographic data and intervention details were extracted for all included studies. Standard checklists were used for methodological quality and intervention description. Narrative synthesis for studies rating above poor quality. RESULTS A total of 11 studies (13 articles) were eligible, ABI (n = 6), learning disability (n = 4), ASD (n = 1). These comprised five comparison or control group studies, two pre-post studies and four case studies. The methodological quality was varied, but intervention descriptions were generally poor. While all studies reported positive outcomes, firm conclusions on their effectiveness are difficult due to the high number of before-after analyses and variation in content and outcome measures used. CONCLUSIONS More high-quality studies are needed to assess the effectiveness of interventions. Also, greater consensus is needed on the key behaviors for dating and relationships and the measures to assess these.IMPLICATIONS FOR REHABILITATIONIntimate relationships are important to quality of life, but challenging for many people in neuro-atypical populations.There are a small number of researched interventions to support dating or marital relationships among adults with ABI, ASD or learning disabilities.Rehabilitation professionals should ask about dating and relationships and support people if this area is identified as important.Rehabilitation professionals should consider different interventions for dating skills and marital relationships.
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Affiliation(s)
- Roseanne Exell
- School of Health Sciences, City University of London, London, UK
| | - Katerina Hilari
- School of Health Sciences, City University of London, London, UK
| | - Nicholas Behn
- School of Health Sciences, City University of London, London, UK
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Nakanishi S, Iwamoto M, Shinohara H, Iwamoto H, Kaneto H. Impact of sarcopenia on glycemic control and atherosclerosis in Japanese patients with type 2 diabetes: Cross-sectional study using outpatient clinical data. Geriatr Gerontol Int 2020; 20:1196-1201. [PMID: 33084163 DOI: 10.1111/ggi.14063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/09/2020] [Accepted: 10/01/2020] [Indexed: 01/20/2023]
Abstract
AIM This study examined the association among sarcopenia and various surrogate markers of atherosclerosis in Japanese patients with type 2 diabetes (T2D). METHODS Patients with T2D who visited the outpatient clinic comprised the study's participants. Handgrip strength (Grip), usual gait speed (GS) and skeletal muscle index, in addition to glycated hemoglobin, ankle-brachial index (ABI) and intima-media thickening (IMT), were measured in 1030 patients for the diagnosis of sarcopenia. From these results were obtained three categorical data (without sarcopenia [NS], sarcopenia with two factors [Sw2], sarcopenia with three factors [Sw3]), and continuous data for atherosclerosis. RESULTS Glycated hemoglobin was significantly high among patients in the Sw3 category, as well as among all patients with sarcopenia, compared with those in the NS group, after adjustment was made for age, gender, duration of diabetes, and medications for hypertension and dyslipidemia. ABI was significantly low among the Sw2 and Sw3 patients, as well as among all patients with sarcopenia, but mean and maximum IMT were not when compared with the NS category of patients after the adjustment described above. However, skeletal muscle index, Grip and GS were positively associated with ABI after the adjustment. Grip and GS were negatively associated with maximum IMT after the adjustment. CONCLUSIONS These results imply that measurements to diagnose sarcopenia could play an important role for early detection of preclinical atherosclerosis, specifically peripheral artery disease, among Japanese patients with T2D. Geriatr Gerontol Int 2020; 20: 1196-1201.
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Affiliation(s)
- Shuhei Nakanishi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Okayama, Japan
| | | | | | - Hideyuki Iwamoto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Okayama, Japan
| | - Hideaki Kaneto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Okayama, Japan
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Kawatkar SP, Barlaam B, Kemmitt P, Simpson I, Watson D, Wang P, Lamont S, Su Q, Boiko S, Ikeda T, Patel J, Pike A, Pollard H, Read J, Sarkar U, Wang H, Wen Q, Yan Z, Dowling JE, Dry H, Edmondson SD. Identification of a novel series of azabenzimidazole-derived inhibitors of spleen tyrosine kinase. Bioorg Med Chem Lett 2020; 30:127393. [PMID: 32721854 DOI: 10.1016/j.bmcl.2020.127393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022]
Abstract
Spleen Tyrosine Kinase (SYK) is a well-studied enzyme with therapeutic applications in oncology and autoimmune diseases. We identified an azabenzimidazole (ABI) series of SYK inhibitors by mining activity data of 86,000 compounds from legacy biochemical assays with SYK and other homologous kinases as target enzymes. A structure-based design and hybridization approach was then used to improve the potency and kinase selectivity of the hits. Lead compound 23 from this novel ABI series has a SYK IC50 = 0.21 nM in a biochemical assay and inhibits growth of SUDHL-4 cells at a GI50 = 210 nM.
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Affiliation(s)
| | | | - Paul Kemmitt
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Iain Simpson
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - David Watson
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Peng Wang
- Pharmaron Beijing Co., Ltd., Taihe Road BDA, Beijing, 100176, PR China
| | - Scott Lamont
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Qibin Su
- R&D Oncology, AstraZeneca, Boston, MA, United States
| | - Scott Boiko
- R&D Oncology, AstraZeneca, Boston, MA, United States
| | - Timothy Ikeda
- R&D Oncology, Discovery Sciences, AstraZeneca, Cambridge, United Kingdom
| | - Joe Patel
- R&D Oncology, AstraZeneca, Boston, MA, United States
| | - Andy Pike
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Hannah Pollard
- R&D Oncology, Discovery Sciences, AstraZeneca, Cambridge, United Kingdom
| | - Jon Read
- R&D Oncology, Discovery Sciences, AstraZeneca, Cambridge, United Kingdom
| | - Ujjal Sarkar
- R&D Oncology, AstraZeneca, Boston, MA, United States
| | - Haiyun Wang
- R&D Oncology, AstraZeneca, Boston, MA, United States
| | - Quanshan Wen
- Pharmaron Beijing Co., Ltd., Taihe Road BDA, Beijing, 100176, PR China
| | - Zhiyuan Yan
- Pharmaron Beijing Co., Ltd., Taihe Road BDA, Beijing, 100176, PR China
| | | | - Hannah Dry
- R&D Oncology, AstraZeneca, Boston, MA, United States
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Jenkin T, Anderson V, D'Cruz K, Collins A, Muscara F, Scheinberg A, Knight S. Engaging children and adolescents with acquired brain injury and their families in goal setting: The clinician perspective. Neuropsychol Rehabil 2020; 32:104-130. [PMID: 32811301 DOI: 10.1080/09602011.2020.1801470] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper explored clinicians' experiences of the goal setting process with children and adolescents with acquired brain injuries (ABI) and their families in paediatric neurorehabilitation. Semi-structured interviews were conducted with 13 clinicians, all members of an interdisciplinary paediatric rehabilitation service, who work with children and adolescents with ABI and their families. Interview transcripts and additional data were analysed using constructivist grounded theory methods. Three main themes and sub-themes were developed: (1) Seeing the bigger picture: Goals change over time; Families set bigger picture goals; Need-to-dos: Goals that the child/adolescent needs to achieve; and Want-to-dos: Goals that the child/adolescent wants to achieve; (2) Collaborating as a team: Everyone needs to be on the same page; Hearing the child's/adolescent's voice; and Parents as advocates; and (3) Recognizing and navigating challenges: Child-/adolescent- and family-related challenges and Time as a service-related challenge. Participants perceived the clinician's role during goal setting as that of an active collaborator, enabling children and adolescents with ABI and their families to generate meaningful goals. These findings demonstrate insights into goal setting in paediatric ABI neurorehabilitation from clinicians' perspectives, and highlight the importance of collaboration, flexibility and anticipation of challenges in facilitating children's, adolescents' and families' involvement in this process.
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Affiliation(s)
- Taylor Jenkin
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | | | - Alana Collins
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Frank Muscara
- Murdoch Children's Research Institute, Melbourne, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, Australia
| | - Adam Scheinberg
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
| | - Sarah Knight
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
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Manu CA, Freedman B, Rashid H, Winkley K, Edmonds ME. Peripheral Arterial Disease Located in the Feet of Patients With Diabetes and Foot Ulceration Demands a New Approach to the Assessment of Ischemia. Int J Low Extrem Wounds 2020; 21:397-404. [PMID: 32806976 DOI: 10.1177/1534734620947979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Peripheral arterial disease (PAD) is common below the knee in diabetes but arteries in the foot are controversially said to be spared of occlusive disease. This is relevant to the convenient site of vascular assessment that is recommended in guidelines. Should assessment be distal at toe/forefoot to detect foot disease or only proximal to detect disease at ankle level? The objective was to determine frequency of PAD at foot and ankle level. This was a cross-sectional observational study, evaluating arterial disease proximally by palpation of pedal pulses and Ankle Brachial Index (ABI), and distally by Toe Brachial Index (TBI), and forefoot transcutaneous oxygen tension (tcpO2), in consecutive patients presenting with foot ulceration. We assessed 301 limbs in 154 patients: 59% of limbs were ulcerated. PAD in the foot was detected in 70% and 74% of limbs by TBI and forefoot tcpO2, respectively, but PAD at ankle level only in 51% and 34% by pulse palpation and ABI, respectively. In limbs with "normal" ABI, PAD was present in the foot in 70% as indicated by low TBI, and in 73% by low tcpO2, with 70% to 64% having associated ulceration, respectively. When compared with arterial waveforms, as a measure of PAD, TBI gave an excellent AUC (area under the curve of the receiver operating characteristic curve) of 0.81 (95% confidence interval: 0.73-0.89), but ABI gave a poor AUC of 0.65 (95% confidence interval: 0.55-0.76). In conclusion, arterial disease is important in the foot and can be detected by TBI, which should be performed even when ABI is normal. Guidelines that recommend TBI only if ABI is artificially raised need updating.
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Visonà A, De Paoli A, Fedeli U, Tonello D, Zalunardo B, Zanatta N, Martini R, Pesavento R, Cuppini S, Prior M, Benazzi S, Cimminiello C, Avossa F. Abnormal ankle-brachial index ( ABI) predicts primary and secondary cardiovascular risk and cancer mortality. Eur J Intern Med 2020; 77:79-85. [PMID: 32151490 DOI: 10.1016/j.ejim.2020.02.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/08/2020] [Accepted: 02/29/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND An abnormal ankle-brachial pressure index (ABI) is a marker of the risk for increased total and cardiovascular (CV) mortality. However, it is not clear whether it is associated with an even worse prognosis in patients with previous CV events or with cancer mortality. MATERIALS AND METHODS Consecutive subjects undergoing ABI assessment for suspected peripheral artery disease or for stratification of CV risk in ten centers in the Veneto Region (northeast Italy), between 2011 and 2014 were enrolled. The ABI was expressed as normal ≥0.9 to ≤1.3, and abnormal <0.9 or >1.3. All-cause mortality and CV or cancer mortality and hospitalizations for CV disease were collected from administrative databases up to December 2018. RESULTS The study enrolled 1,177 patients. ABI was abnormal in 57.2%. Median follow-up was 61.6 months (53.4-70.1). All-cause, CV and cancer mortality were higher in patients with abnormal than normal ABI, with hazard ratios (HR) respectively 2.0 (95% CI 1.48-2.69), 1.98 (95% CI 1.24-3.17) and 1.85 (95% CI 1.09-3.15). Among subjects with abnormal ABI, the risk of overall mortality, HR 1.57 (95% CI 1.17-2.12), and CV mortality, HR 2.39 (95% CI 1.43-3.99), was higher in those with previous CV events. These latter also had a higher risk of hospitalization for myocardial infarction and stroke: HR 1.85 (95% CI 1.023.37) and 2.17 (95% CI 1.10-4.28). CONCLUSIONS The co-existence of abnormal ABI and a history of CV events identifies subjects at higher risk, who call for a more aggressive approach. Abnormal ABI is also a predictor of cancer mortality.
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Affiliation(s)
- A Visonà
- Angiology Unit, Azienda ULSS 2 Marca Trevigiana, Castelfranco Veneto, Italy
| | - A De Paoli
- Epidemiological Department, Azienda Zero, Via J. Avanzo, 35 - 35132 Padua, Italy
| | - U Fedeli
- Epidemiological Department, Azienda Zero, Via J. Avanzo, 35 - 35132 Padua, Italy
| | - D Tonello
- Angiology Unit, Azienda ULSS 2 Marca Trevigiana, Castelfranco Veneto, Italy
| | - B Zalunardo
- Angiology Unit, Azienda ULSS 2 Marca Trevigiana, Castelfranco Veneto, Italy; Research and Study Center of the Italian Society for Angiology and Vascular Pathology (Società Italiana di Angiologia e Patologia Vascolare, SIAPAV), Milan, Italy
| | - N Zanatta
- Unità Operativa Semplice a valenza dipartimentale for outpatient activities management, Internal Medicine Department, Azienda ULSS 2 Marca Trevigiana, Conegliano Veneto, Italy
| | - R Martini
- Angiology Unit, University Hospital of Padua, Padua, Italy
| | - R Pesavento
- University Medical Clinic Unit, University Hospital of Padua, Padua, Italy
| | - S Cuppini
- Internal Medicine Unit, Azienda ULSS 5 Polesana, Rovigo, Italy
| | - M Prior
- Angiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - S Benazzi
- Vascular Surgery Unit, Azienda ULSS 9 Scaligera, Verona, Italy
| | - C Cimminiello
- Research and Study Center of the Italian Society for Angiology and Vascular Pathology (Società Italiana di Angiologia e Patologia Vascolare, SIAPAV), Milan, Italy.
| | - F Avossa
- Epidemiological Department, Azienda Zero, Via J. Avanzo, 35 - 35132 Padua, Italy
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Domaszewski P, Konieczny M, Pakosz P, Bączkowicz D, Sadowska-Krępa E. Effect of a Six-Week Intermittent Fasting Intervention Program on the Composition of the Human Body in Women over 60 Years of Age. Int J Environ Res Public Health 2020; 17:E4138. [PMID: 32531956 DOI: 10.3390/ijerph17114138] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 12/18/2022]
Abstract
The objective of this research was to determine the effectiveness of intermittent fasting (IF) in reducing body fat and lowering body mass index. An additional objective was to determine the feasibility of applying IF in overweight women over 60 years of age, which was assessed by the ratio of subjects who resigned from the diet plan. This study included a group of 45 women over 60 years of age. The intervention in the experimental group involved complete abstinence from food intake for 16 h per day, from 20:00 p.m. to 12:00 a.m. (the next day). The results demonstrated that the body weight in the subjects in the experimental group (EXP) group decreased by almost 2 kg and this decrease was visible in the remaining parameters related to body fat mass. The skeletal muscle mass did not change significantly, which indicates an actual decrease in the fat mass. The proportion of subjects who did not succeed in following the prescribed diet plan was 12%. The application of intermittent fasting in female subjects over 60 years of age resulted in positive changes in body composition. Time-restricted feeding (TRF) was characterized by a lower resignation rate compared to other diets involving intermittent fasting.
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Forster SD, Gauggel S, Petershofer A, Völzke V, Mainz V. Ecological Momentary Assessment in Patients With an Acquired Brain Injury: A Pilot Study on Compliance and Fluctuations. Front Neurol 2020; 11:115. [PMID: 32194494 PMCID: PMC7066314 DOI: 10.3389/fneur.2020.00115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/31/2020] [Indexed: 11/18/2022] Open
Abstract
Ecological Momentary Assessment (EMA) promises to be a suitable method for capturing the dynamics in self-assessments through repeated measurements in naturalistic environments using common mobile devices. Therefore, EMA could increase the power of neuropsychological assessment by obtaining a more fine-grained picture of symptoms, limitations, and strengths in patients with an acquired brain injury (ABI) in real-life situations. The present study examined 15 patients with an ABI with cognitive and motor impairments. Following a semirandomized high-frequency sampling plan to assess EMA's feasibility and applicability, data were collected across 7 days. At eight prompts per day, patients were asked about their current activities, the social context they were in, their current mood, performance judgments of their own functional status, and the frequency of self-reflections. The average compliance rate was 71.6%. The fluctuations in patients' responses were measured in terms of variance distributions within simple (intercept only) three-level models and root mean square of successive difference values. They were sufficient, as shown, for example, by the mean within-person variability of 44.9% across all of the items studied. There were no significant correlations between patients' age, severity of depressive symptoms, or their level of functioning and their compliance with study participation or the variability of their responses. The results support the feasibility and applicability of EMA as an assessment technique in patients with an ABI. There are, however, limitations that should be considered when planning an assessment of brain-injured patients using EMA.
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Affiliation(s)
- Saskia D Forster
- Institute of Medical Psychology and Medical Sociology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Siegfried Gauggel
- Institute of Medical Psychology and Medical Sociology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Axel Petershofer
- VAMED Klinik Hattingen GmbH, Rehabilitation Centre for Neurology, Neurosurgery, Neuropaediatrics, Hattingen, Germany
| | - Volker Völzke
- VAMED Klinik Hattingen GmbH, Rehabilitation Centre for Neurology, Neurosurgery, Neuropaediatrics, Hattingen, Germany
| | - Verena Mainz
- Institute of Medical Psychology and Medical Sociology, University Hospital of the RWTH Aachen, Aachen, Germany
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Tulip C, Fisher Z, Bankhead H, Wilkie L, Pridmore J, Gracey F, Tree J, Kemp AH. Building Wellbeing in People With Chronic Conditions: A Qualitative Evaluation of an 8-Week Positive Psychotherapy Intervention for People Living With an Acquired Brain Injury. Front Psychol 2020; 11:66. [PMID: 32082221 PMCID: PMC7006056 DOI: 10.3389/fpsyg.2020.00066] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 01/10/2020] [Indexed: 12/17/2022] Open
Abstract
Research indicates that Acquired Brain Injury (ABI) is associated with significant and chronic impairment across multiple areas of functioning including physical, cognitive, emotional and behavioral domains. Whilst impairments associated with ABI can be ameliorated, cure is seldom possible. The emergence of positive psychology reflects a paradigm shift in health and wellbeing research, highlighting the role of character strengths, positive emotions, meaning, and resilience. Positive psychology interventions have been demonstrated to improve wellbeing in a variety of populations, although research investigating the impact of positive psychotherapy for people living with ABI are sparse. Here we characterize the experience of an 8-week positive psychotherapy intervention for 13 people living with ABI including four mentors and nine participants using thematic analysis of transcripts collected during mini-groups and one-to-one interviews. Six main themes were identified including empowerment, social opportunity, coping, cultivation of positive emotion, consolidation of skills and barriers. Results indicated that wellbeing can be promoted and improved in individuals with ABI. Recent theoretical developments in wellbeing science highlight scope to improve the intervention by connecting individuals to their communities and spending time in nature.
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Affiliation(s)
- Chloe Tulip
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
| | - Zoe Fisher
- Health and Wellbeing Academy, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom.,Community Brain Injury Service, Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Helen Bankhead
- Community Brain Injury Service, Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Lowri Wilkie
- Community Brain Injury Service, Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom.,School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Julia Pridmore
- Health and Wellbeing Academy, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
| | - Fergus Gracey
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Jeremy Tree
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
| | - Andrew H Kemp
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
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Abstract
AIM Diabetes mellitus (DM) and related foot complications constitute a growing healthcare burden. Diabetes mellitus is associated with lower-limb amputation, but diabetic foot assessment is challenging. Here, we evaluated a novel noninvasive diagnostic method-infrared thermography (IRT) -assessing its diagnostic potential compared to conventional noninvasive measurements. METHODS This study included patients with DM (n = 118) and healthy controls (n = 93). All participants underwent ankle brachial index and toe pressure (TP) measurements, and IRT using a standardized protocol with temperature measurement at five foot areas. RESULTS Compared to controls, patients with DM generally had warmer feet and exhibited a significantly greater temperature difference between feet (P < .001). Mean temperatures were highest in patients with DM with neuroischemia, followed by neuropathy. Patients with DM with angiopathy showed the lowest mean temperature-similar to controls and noncomplicated diabetics. Mean temperatures at all measurement sites were significantly higher with abnormal TP (<50 mmHg) than normal TP (≥50 mmHg) (P < .001). Infrared thermography revealed differences between angiosome areas, subclinical infections, and plantar high-pressure areas. CONCLUSION Infrared thermography revealed local temperature differences in high-risk diabetic feet. Normal skin surface temperature varies between individuals, but in combination with other tools, IRT might be useful in clinical screening. CLINICALTRIALS ID 14212016.
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Affiliation(s)
- Arjaleena Ilo
- Department of Vascular Surgery, Oulu
University Hospital and Oulu University, Finland
- Arjaleena Ilo, MD, Department of Vascular
Surgery, Oulu University Hospital and Oulu University, P.O. Box 21, Oulu 90029,
Finland.
| | - Pekka Romsi
- Department of Vascular Surgery, Oulu
University Hospital and Oulu University, Finland
| | - Jussi Mäkelä
- Department of Cardiothoracic Surgery,
Oulu University Hospital and Oulu University, Finland
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Stundl A, Margariti V, Schaefer C, Tiyerili V, Werner N, Grube E, Nickenig G, Sinning JM, Schahab N. Peripheral perfusion of lower limb after transcatheter aortic valve implantation (TAVI) in patients with peripheral artery disease. Int J Cardiol 2019; 297:36-42. [PMID: 31521438 DOI: 10.1016/j.ijcard.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/21/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND In TAVI patients, peripheral arterial disease (PAD) is a common concomitant disease. Given the fact that calcified severe aortic stenosis (AS) limits the blood flow that reaches the periphery, it is conceivable that the treatment of AS may positively influence the peripheral perfusion. AIM To evaluate whether, and if so, how the peripheral perfusion changes after TAVI in patients with PAD comparing with patients without PAD. METHODS On the basis of objective vascular tests, peripheral perfusion in the lower extremities were studied in 108 TAVI patients with or without concomitant PAD. RESULTS 108 consecutive patients with a median logistic EuroSCORE of 12.7 (IQR: 8.5 to 22.0) % underwent TAVI with an extensive pre- and post-procedural assessment of the peripheral perfusion. In patients without PAD, the time to peak flow (tPF) did not differ before (6.45 ± 5.24 s) and after (6.45 ± 5.91 s) TAVI (p = 1.000). In PAD patients, however, the tPF was significantly shortened following TAVI (9.51 ± 9.45 s vs. 8.33 ± 8.16 s, p < 0.001), thereby reflecting an improvement in peripheral blood flow. The resting arterial blood flow before and after TAVI showed the highest level at the beginning (0 s) and constantly decreased afterwards. No improvement in the peak flow was achieved. CONCLUSIONS In PAD patients, TAVI led to improved peripheral blood flow as reflected by shortened time to peak flow measurements.
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Affiliation(s)
- Anja Stundl
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
| | - Vasiliki Margariti
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Christian Schaefer
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Vedat Tiyerili
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nikos Werner
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nadjib Schahab
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
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