The natural history of AVM hemorrhage in the posterior fossa: comparison of hematoma volumes and neurological outcomes in patients with ruptured infra- and supratentorial AVMs

Object Patients with posterior fossa arteriovenous malformations (AVMs) are more likely to present with hemorrhage than those with supratentorial AVMs. Observed patients subject to the AVM natural history should be informed of the individualized effects of AVM characteristics on the clinical course following a new, first-time hemorrhage. The authors hypothesize that the debilitating effects of first-time bleeding from an AVM in a previously intact patient with an unruptured AVM are more pronounced when AVMs are located in the posterior fossa. Methods The University of California, San Francisco prospective registry of brain AVMs was searched for patients with a ruptured AVM who had a pre-hemorrhage modified Rankin Scale (mRS) score of 0 and a post-hemorrhage mRS score obtained within 2 days of the hemorrhagic event. A total of 154 patients met the inclusion criteria for this study. Immediate post-hemorrhage presentation mRS scores were dichotomized into nonsevere outcome (mRS ≤ 3) and severe outcome (mRS > 3). There were 77 patients in each group. Univariate and multivariate logistic regression analyses using severe outcome as the binary response were run. The authors also performed a logistic regression analysis to measure the effects of hematoma volume and AVM location on severe outcome. Results Posterior fossa location was a significant predictor of severe outcome (OR 2.60, 95% CI 1.20–5.67, p = 0.016) and the results were strengthened in a multivariate model (OR 4.96, 95% CI 1.73–14.17, p = 0.003). Eloquent location (OR 3.47, 95% CI 1.37–8.80, p = 0.009) and associated arterial aneurysms (OR 2.58, 95% CI 1.09, 6.10; p = 0.031) were also significant predictors of poor outcome. Hematoma volume for patients with a posterior fossa AVM was 10.1 ± 10.1 cm3 compared with 25.6 ±28.0 cm3 in supratentorial locations (p = 0.003). A logistic analysis (based on imputed hemorrhage volume values) found that posterior fossa location was a significant predictor of severe outcome (OR 8.03, 95% CI 1.20–53.77, p = 0.033) and logarithmic hematoma volume showed a positive, but not statistically significant, association in the model (p = 0.079). Conclusions Patients with posterior fossa AVMs are more likely to have severe outcomes than those with supratentorial AVMs based on this natural history study. Age, sex, and ethnicity were not associated with an increased risk of severe outcome after AVM rupture, but posterior fossa location, associated aneurysms, and eloquent location were associated with poor post-hemorrhage mRS scores. Posterior fossa hematomas are poorly tolerated, with severe outcomes observed even with smaller hematoma volumes. These findings support an aggressive surgical posture with respect to posterior fossa AVMs, both before and after rupture.

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An analysis of tumor-related potential spinal column instability (Spine Instability Neoplastic Scores 7–12) eventually requiring surgery with a 1-year follow-up

Neurosurgical FOCUS ◽

10.3171/2021.2.focus201098 ◽

2021 ◽

Vol 50 (5) ◽

pp. E6

Author(s):

Enrique Vargas ◽

Dennis T. Lockney ◽

Praveen V. Mummaneni ◽

Alexander F. Haddad ◽

Joshua Rivera ◽

...

Keyword(s):

Logistic Regression ◽

San Francisco ◽

Surgical Intervention ◽

Nonoperative Management ◽

Multivariable Analysis ◽

Spinal Instability ◽

Karnofsky Performance Scale ◽

Surgery Group ◽

Increased Risk

OBJECTIVE Within the Spine Instability Neoplastic Score (SINS) classification, tumor-related potential spinal instability (SINS 7–12) may not have a clear treatment approach. The authors aimed to examine the proportion of patients in this indeterminate zone who later required surgical stabilization after initial nonoperative management. By studying this patient population, they sought to determine if a clear SINS cutoff existed whereby the spine is potentially unstable due to a lesion and would be more likely to require stabilization. METHODS Records from patients treated at the University of California, San Francisco, for metastatic spine disease from 2005 to 2019 were retrospectively reviewed. Seventy-five patients with tumor-related potential spinal instability (SINS 7–12) who were initially treated nonoperatively were included. All patients had at least a 1-year follow-up with complete medical records. A univariate chi-square test and Student t-test were used to compare categorical and continuous outcomes, respectively, between patients who ultimately underwent surgery and those who did not. A backward likelihood multivariate binary logistic regression model was used to investigate the relationship between clinical characteristics and surgical intervention. Recursive partitioning analysis (RPA) and single-variable logistic regression were performed as a function of SINS. RESULTS Seventy-five patients with a total of 292 spinal metastatic sites were included in this study; 26 (34.7%) patients underwent surgical intervention, and 49 (65.3%) did not. There was no difference in age, sex, comorbidities, or lesion location between the groups. However, there were more patients with a SINS of 12 in the surgery group (55.2%) than in the no surgery group (44.8%) (p = 0.003). On multivariate analysis, SINS > 11 (OR 8.09, CI 1.96–33.4, p = 0.004) and Karnofsky Performance Scale (KPS) score < 60 (OR 0.94, CI 0.89–0.98, p = 0.008) were associated with an increased risk of surgery. KPS score was not correlated with SINS (p = 0.4). RPA by each spinal lesion identified an optimal cutoff value of SINS > 10, which were associated with an increased risk of surgical intervention. Patients with a surgical intervention had a higher incidence of complications on multivariable analysis (OR 2.96, CI 1.01–8.71, p = 0.048). CONCLUSIONS Patients with a mean SINS of 11 or greater may be at increased risk of mechanical instability requiring surgery after initial nonoperative management. RPA showed that patients with a KPS score of 60 or lower and a SINS of greater than 10 had increased surgery rates.

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New data on the distribution, natural history and morphology of Kunsia tomen-tosus (Lichtenstein, 1830) (Rodentia: Cricetidae: Sigmodontinae)

Zootaxa ◽

10.11646/zootaxa.1505.1.1 ◽

2007 ◽

Vol 1505 (1) ◽

pp. 1-18 ◽

Cited By ~ 5

Author(s):

ALEXANDRA M.R. BEZERRA ◽

ANA PAULA CARMIGNOTTO ◽

ANDREA P. NUNES ◽

FLÁVIO H.G. RODRIGUES

Keyword(s):

Natural History ◽

Posterior Margin ◽

Longitudinal Variation ◽

Habitat Types ◽

Personal Communications ◽

Museum Data ◽

Natural Grasslands ◽

Increased Risk ◽

New Localities ◽

First Time

The distribution, natural history, and morphology of Kunsia tomentosus are updated from museum data, literature and personal communications. Thirty-seven specimens and fossil fragments are now known for the species. Two new localities are added to the previously known distributional range of the species. The very disperse records suggest that K. tomentosus presents a broad and yet fragmentary geographic distribution, and information gathered on habitat use hints that its presence is associated with open formations, mainly with the open grassland formations within Cerrado domain. The specimens analyzed here increased considerably the range of body size and craniodental measurements for species, but patterns of geographic variation of these features remain insufficiently known. Some longitudinal variation was observed in the shape of the posterior margin of the palate. We also describe for the first time the stomach morphology of K. tomentosus, which exhibits a derived unilocular-pouched pattern. The apparent restriction to some habitat types and its natural rarity, allied with the replacement of natural grasslands by agriculture fields in the Cerrado domain, denotes an increased risk for the known populations in Brazil.

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Coenosia wulpi (Pont) (Diptera, Muscidae, Coenosiinae): redescription of male, description of female and terminalia

Revista Brasileira de Zoologia ◽

10.1590/s0101-81752007000200014 ◽

2007 ◽

Vol 24 (2) ◽

pp. 359-361

Author(s):

Márcia S. Couri

Keyword(s):

United Kingdom ◽

Natural History ◽

San Francisco ◽

Museum Collection ◽

Male And Female ◽

History Museum ◽

California Academy ◽

Academy Of Sciences ◽

First Time ◽

Holotype Male

Coenosia wulpi Pont, 1972 (Diptera, Muscidae, Coenosiinae) is the only Coenosia Meigen, 1826 species recorded from Mexico. It is known only from the holotype male deposited at "The Natural History Museum" collection (London, United Kingdom). A series of five males and seven females was found at California Academy of Sciences collection (San Francisco, California), which enabled the redescription of the male, and the description of the female and the male and female terminalia, for the first time.

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Edward Heron-Allen FRS (1861–1943): a review of his scientific career, with an annotated bibliography of his foraminiferal publications

Archives of Natural History ◽

10.3366/anh.2004.31.1.6 ◽

2004 ◽

Vol 31 (1) ◽

pp. 6-29 ◽

Cited By ~ 3

Author(s):

Richard L. Hodgkinson ◽

John E. Whittaker

Keyword(s):

Natural History ◽

Royal Society ◽

Annotated Bibliography ◽

Natural History Museum ◽

Scientific Career ◽

History Museum ◽

First Time

ABSTRACT: In spite of his many other interests, Edward Heron-Allen also worked for nearly 50 years as a scientist on minute shelled protists, called foraminifera, much of it in an unpaid, unofficial capacity at The Natural History Museum, London, and notably in collaboration with Arthur Earland. During this career he published more than 70 papers and obtained several fellowships, culminating in 1919 in his election to the Royal Society. Subsequently, he bequeathed his foraminiferal collections and fine library to the Museum, and both are housed today in a room named in his honour. In this paper, for the first time, an assessment of his scientific accomplishments is given, together with a full annotated bibliography of his publications held in the Heron-Allen Library. This is part of a project to produce a bibliography of his complete publications, recently initiated by the Heron-Allen Society.

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First Records of Bufo luchunnicus (Yang et Rao, 2008) and Amolops wenshanensis Yuan, Jin, Li, Stuart et Wu, 2018 (Anura: Bufonidae, Ranidae) from Vietnam

Russian Journal of Herpetology ◽

10.30906/1026-2296-2020-27-2-81-86 ◽

2020 ◽

Vol 27 (2) ◽

pp. 81-86

Author(s):

Cuong The Pham ◽

Minh Duc Le ◽

Chung Van Hoang ◽

Anh Van Pham ◽

Thomas Ziegler ◽

...

Keyword(s):

Natural History ◽

Genetic Divergence ◽

Morphological Data ◽

Type Series ◽

Lao Cai ◽

First Time ◽

Nd2 Gene ◽

Quang Ninh

We record two species of amphibians for the first time from Vietnam: Bufo luchunnicus from Lao Cai and Son La provinces and Amolops wenshanensis from Quang Ninh Province. Morphologically, the Vietnamese representatives of B. luchunnicus resemble the type series from China. The specimen of A. wenshanensis from Vietnam slightly differs from the type series from China by having a smaller size (SVL 33.2 mm vs. 35.7 – 39.9 mm in males) and the presence of distinct transverse bands on the dorsal surfaces of limbs. Genetic divergence between the sequence of the Vietnamese specimen and those of A. wenshanensis from China available from GenBank is 1.2 – 1.6% (ND2 gene). In addition, morphological data and natural history notes of aforementioned species are provided from Vietnam.

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22. Description of Hospitalized Patients with Influenza Vaccine Failure

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.067 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S35-S35

Author(s):

Joanna Kimball ◽

Yuwei Zhu ◽

Dayna Wyatt ◽

Helen Talbot

Keyword(s):

Logistic Regression ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Older Patients ◽

Influenza A ◽

Influenza Season ◽

Hospitalized Patients ◽

Vaccine Failure ◽

Increased Risk ◽

Immunosuppressed Patients

Abstract Background Despite influenza vaccination, some patients develop illness and require hospitalization. Many factors contribute to vaccine failure, including mismatch of the vaccine and circulating strains, waning immunity, timing of influenza season, age and patient comorbidities such as immune function. This study compared vaccinated, hospitalized patients with and without influenza. Methods This study used 2015–2019 Tennessee data from the US Hospitalized Adult Influenza Vaccine Effectiveness Network database. Enrolled patients were ≥ 18 years vaccinated for the current influenza season and admitted with an acute respiratory illness. Patient or surrogate interviews and medical chart abstractions were performed, and influenza vaccinations were confirmed by vaccine providers. Influenza PCR testing was performed in a research lab. Statistical analyses were performed with STATA and R using Pearson’s chi-squared, Kruskal-Wallis and Wilcoxon rank-sum tests and multivariate logistic regression. Results 1236 patients met study criteria, and 235 (19%) tested positive for influenza. Demographics, vaccines and comorbidities were similar between the two groups (Table 1) except for morbid obesity, which was more common in influenza negative patients (13% vs 8%, p = 0.04), and immunosuppression, which was more common in the influenza positive (63% vs 54%, p = 0.01). Logistic regression analysis demonstrated older patients (OR 1.47, 95% CI 1.03–2.10) and immunosuppressed patients (OR 1.56, 1.15–2.12) were at increased risk for influenza (Table 2 and Figure 1). Immunosuppression also increased the risk for influenza A/H3N2 (OR 1.86, 95% CI 1.25–2.75). A sensitivity analysis was performed on patients who self-reported influenza vaccination for the current season without vaccine verification and demonstrated increased risk of influenza in older adults (OR 1.66, 95% CI 1.16–2.39). Table 1: Demographics of influenza positive versus influenza negative patients in influenza vaccinated, hospitalized patients. Table 2: Logistic regression analyses of vaccinated, hospitalized influenza positive patients; vaccinated, hospitalized patients with influenza A subtypes and self-reported vaccinated, hospitalized influenza positive patients. Figure 1: Predicted Probability of Hospitalization with Influenza, Influenza A/H1N1 and Influenza A/H3N2 in Vaccinated Patients by Age. Conclusion Our study demonstrated an increased risk of influenza vaccine failure in older patients and immunosuppressed patients. These groups are also at increased risk for influenza complications. To improve protection of these patients against future influenza illnesses, more effective vaccines are needed, and more research on ring vaccination should be pursued. Disclosures All Authors: No reported disclosures

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Prior Admissions as a Risk Factor for Readmission in Patients Surgically Treated for Femur Fractures: Implications for a Potential Hip Fracture Bundle

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459321996169 ◽

2021 ◽

Vol 12 ◽

pp. 215145932199616

Author(s):

Robert Erlichman ◽

Nicholas Kolodychuk ◽

Joseph N. Gabra ◽

Harshitha Dudipala ◽

Brook Maxhimer ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Hip Fracture ◽

Logistic Regression Analysis ◽

Hip Fractures ◽

Surgical Procedure ◽

Hospital Admissions ◽

Fracture Care ◽

Increased Risk ◽

Payment Models

Introduction: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost. Methods: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed. Results: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9). Discussion: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients. Conclusions: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.

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LINC01414/LINC00824 genetic polymorphisms in association with the susceptibility of chronic obstructive pulmonary disease

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01579-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaoman Zhou ◽

Yunjun Zhang ◽

Yutian Zhang ◽

Quanni Li ◽

Mei Lin ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Genetic Polymorphisms ◽

Chronic Obstructive ◽

Nucleotide Polymorphisms ◽

Obstructive Pulmonary Disease ◽

Logistic Analysis ◽

Copd Patients ◽

Increased Risk ◽

And Gender

Abstract Objective Chronic obstructive pulmonary disease (COPD) is a complicated multi-factor, multi-gene disease. Here, we aimed to assess the association of genetic polymorphisms in LINC01414/ LINC00824 and interactions with COPD susceptibility. Methods Three single nucleotide polymorphisms (SNPs) in LINC01414/LINC00824 was genotyped by Agena MassARRAY platform among 315 COPD patients and 314 controls. Logistic analysis adjusted by age and gender were applied to estimate the genetic contribution of selected SNPs to COPD susceptibility. Results LINC01414 rs699467 (OR = 0.73, 95% CI 0.56–0.94, p = 0.015) and LINC00824 rs7815944 (OR = 0.56, 95% CI 0.31–0.99, p = 0.046) might be protective factors for COPD occurrence, while LINC01414 rs298207 (OR = 2.88, 95% CI 1.31–6.31, p = 0.008) risk-allele was related to the increased risk of COPD in the whole population. Rs7815944 was associated with the reduced risk of COPD in the subjects aged > 70 years (OR = 0.29, p = 0.005). Rs6994670 (OR = 0.57, p = 0.007) contribute to a reduced COPD risk, while rs298207 (OR = 7.94, p = 0.009) was related to a higher susceptibility to COPD at age ≤ 70 years. Rs298207 (OR = 2.54, p = 0.043) and rs7815944 (OR = 0.43, p = 0.028) variants was associated COPD risk among males. Rs7815944 (OR = 0.16, p = 0.031) was related to the reduced susceptibility of COPD in former smokers. Moreover, the association between rs298207 genotype and COPD patients with dyspnea was found (OR = 0.50, p = 0.016), and rs7815944 was related to COPD patients with wheezing (OR = 0.22, p = 0.008). Conclusion Our finding provided further insights into LINC01414/LINC00824 polymorphisms at risk of COPD occurrence and accumulated evidence for the genetic susceptibility of COPD.

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A nomogram prediction model for lymph node metastasis in endometrial cancer patients

BMC Cancer ◽

10.1186/s12885-021-08466-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhiling Wang ◽

Shuo Zhang ◽

Yifei Ma ◽

Wenhui Li ◽

Jiguang Tian ◽

...

Keyword(s):

Logistic Regression ◽

Endometrial Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

External Validation ◽

Clinicopathological Parameters ◽

Bootstrap Sample ◽

Multivariate Logistic Regression ◽

Node Metastasis ◽

Increased Risk

Abstract Background This study aimed to explore the risk factors for lymph node metastasis (LNM) in patients with endometrial cancer (EC) and develop a clinically useful nomogram based on clinicopathological parameters to predict it. Methods Clinical information of patients who underwent staging surgery for EC was abstracted from Qilu Hospital of Shandong University from January 1st, 2005 to June 31st, 2019. Parameters including patient-related, tumor-related, and preoperative hematologic examination-related were analyzed by univariate and multivariate logistic regression to determine the correlation with LNM. A nomogram based on the multivariate results was constructed and underwent internal and external validation to predict the probability of LNM. Results The overall data from the 1517 patients who met the inclusion criteria were analyzed. 105(6.29%) patients had LNM. According the univariate analysis and multivariate logistic regression analysis, LVSI is the most predictive factor for LNM, patients with positive LVSI had 13.156-fold increased risk for LNM (95%CI:6.834–25.324; P < 0.001). The nomogram was constructed and incorporated valuable parameters including histological type, histological grade, depth of myometrial invasion, LVSI, cervical involvement, parametrial involvement, and HGB levels from training set. The nomogram was cross-validated internally by the 1000 bootstrap sample and showed good discrimination accuracy. The c-index for internal and external validation of the nomogram are 0.916(95%CI:0.849–0.982) and 0.873(95%CI:0.776–0.970), respectively. Conclusions We developed and validated a 7-variable nomogram with a high concordance probability to predict the risk of LNM in patients with EC.

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Facility of Origin Predicts Mortality After Colonic Perforation

The American Surgeon ◽

10.1177/0003134820971623 ◽

2020 ◽

pp. 000313482097162

Author(s):

Samuel D. Butensky ◽

Emma Gazzara ◽

Gainosuke Sugiyama ◽

Gene F. Coppa ◽

Antonio Alfonso ◽

...

Keyword(s):

Logistic Regression ◽

Chronic Care ◽

Care Facility ◽

Colonic Perforation ◽

Risk Of Death ◽

Increased Risk ◽

Chronic Care Facility ◽

Partial Colectomy ◽

Emergent Surgery ◽

Perforated Viscus

Introduction Colonic perforation often requires emergent intervention and carries high morbidity and mortality. The objective of this study was to determine whether nonclinical factors, such as transition of care from outpatient facilities to inpatient settings, are associated with increased risk of mortality in patients who underwent emergent surgical intervention for colonic perforation. Materials and Methods Using the 2006-2015 ACS National Surgical Quality Improvement Program database, we identified adult patients who underwent emergent partial colectomy with primary anastomosis ± protecting ostomy or partial colectomy with ostomy with intraoperative finding of wound class III or IV for a diagnosis of perforated viscus. The outcome of interest was 30-day postoperative mortality. Univariate and multivariate analyses using logistic regression were performed. Results 4705 patients met criteria, of which 841 (17.9%) died. Univariate analysis showed that patients who died after emergent surgery for perforated viscus were more likely to present from a chronic care facility (13.4% vs. 4.4%, P < .0001) and had longer time from admission to undergoing surgery (mean 4.1 vs. 2.0 days, P < .0001. Logistic regression demonstrated that septic shock vs. none (OR 3.60, P < .0001), sepsis vs. none (OR 1.57, P = .00045), transfer from chronic care facility vs. home (OR 1.87, P < .0001), and increased time from admission vs. operation (OR 1.01, P = .0055) were independently associated with increased risk of death. Discussion Transfer from a chronic care facility was independently associated with increased mortality in patients undergoing emergent surgery for perforated viscus.

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