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Author(s):  
Jay S. Shavadia ◽  
Wendimagegn Alemayehu ◽  
Christopher deFilippi ◽  
Cynthia M. Westerhout ◽  
Jasper Tromp ◽  
...  

2021 ◽  
Vol 12 ◽  
Author(s):  
Julien Engelhardt ◽  
Emmanuel Cuny ◽  
Dominique Guehl ◽  
Pierre Burbaud ◽  
Nathalie Damon-Perrière ◽  
...  

Background: Deep brain stimulation is an efficacious treatment for refractory essential tremor, though targeting the intra-thalamic nuclei remains challenging.Objectives: We sought to develop an inverse approach to retrieve the position of the leads in a cohort of patients operated on with optimal clinical outcomes from anatomical landmarks identifiable by 1.5 Tesla magnetic resonance imaging.Methods: The learning database included clinical outcomes and post-operative imaging from which the coordinates of the active contacts and those of anatomical landmarks were extracted. We used machine learning regression methods to build three different prediction models. External validation was performed according to a leave-one-out cross-validation.Results: Fifteen patients (29 leads) were included, with a median tremor improvement of 72% on the Fahn–Tolosa–Marin scale. Kernel ridge regression, deep neural networks, and support vector regression (SVR) were used. SVR gave the best results with a mean error of 1.33 ± 1.64 mm between the predicted target and the active contact position.Conclusion: We report an original method for the targeting in deep brain stimulation for essential tremor based on patients' radio-anatomical features. This approach will be tested in a prospective clinical trial.


2021 ◽  
Author(s):  
João Tavares ◽  
◽  
Lígia Passos ◽  
Daniela Figueiredo ◽  
Larissa Pedreira ◽  
...  

Review question / Objective: The review questions of this scoping are: 1) What are the atypical presentations of symptoms of COVID-19 and its prevalence in older adults (60 or more years) that have been reported? 2) What are the demographic and clinical characteristics of older adults (60 or more years) with atypical presentations of symptoms of COVID-19? 3) What are the clinical outcomes for older adults with atypical presentations (60 or more years) of covid-19? The objective of this scoping review is to identify and analyse the atypical presentation of symptoms of COVID-19 in older adults. Eligibility criteria: Participants: This scoping review will consider all studies that included persons with 60 years or over. Concept: This scoping review will include studies that focus on atypical presentations of Covid-19. Atypical presentation was defined as an absence of the typical symptoms of COVID-19 and the presence of unusual symptoms such as, but not limited to, delirium, fall, functional impairment, reduce oral intake, chest pain, etc. Context: This scoping review will consider all contexts, but not limited to, of hospital, long-term care, primary care, community services and home care.


Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-217782
Author(s):  
David P Nichols ◽  
Pradeep K Singh ◽  
Arthur Baines ◽  
Lindsay J Caverly ◽  
James F Chmiel ◽  
...  

RationaleInhaled tobramycin and oral azithromycin are common chronic therapies in people with cystic fibrosis and Pseudomonas aeruginosa airway infection. Some studies have shown that azithromycin can reduce the ability of tobramycin to kill P. aeruginosa. This trial was done to test the effects of combining azithromycin with inhaled tobramycin on clinical and microbiological outcomes in people already using inhaled tobramycin. We theorised that those randomised to placebo (no azithromycin) would have greater improvement in forced expiratory volume in one second (FEV1) and greater reduction in P. aeruginosa sputum in response to tobramycin.MethodsA 6-week prospective, randomised, placebo-controlled, double-blind trial testing oral azithromycin versus placebo combined with clinically prescribed inhaled tobramycin in individuals with cystic fibrosis and P. aeruginosa airway infection.ResultsOver a 6-week period, including 4 weeks of inhaled tobramycin, the relative change in FEV1 did not statistically significantly differ between groups (azithromycin (n=56) minus placebo (n=52) difference: 3.44%; 95% CI: −0.48 to 7.35; p=0.085). Differences in secondary clinical outcomes, including patient-reported symptom scores, weight and need for additional antibiotics, did not significantly differ. Among the 29 azithromycin and 35 placebo participants providing paired sputum samples, the 6-week change in P. aeruginosa density differed in favour of the placebo group (difference: 0.75 log10 CFU/mL; 95% CI: 0.03 to 1.47; p=0.043).ConclusionsDespite having greater reduction in P. aeruginosa density in participants able to provide sputum samples, participants randomised to placebo with inhaled tobramycin did not experience significantly greater improvements in lung function or other clinical outcomes compared with those randomised to azithromycin with tobramycin.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tao Li ◽  
Yan Xiong ◽  
Zhong Zhang ◽  
Xin Tang ◽  
Gang Chen ◽  
...  

Abstract Background There is still a lack of clinical data in arthroscopic treatment for treating multiple ligament injuries. This study aims to evaluate the clinical outcomes of patients with multiple ligament injuries undergoing treatment based on the classification stage and type of injury. Methods A prospective, clinical trial on multiple ligament injuries was planned, which included 95 patients (58 men and 37 women; age: 42.8 ± 11.9 [range, 18–63] years) from October 2017 to June 2018. Injuries were classified into three stages (emergency stage < 24 h; acute stage: 24 h to 3 weeks, and chronic stage: > 3 weeks) and six types (KD I–VI) based on injuries time and structures, which indicated appropriate treatments. The clinical outcomes were evaluated at 2, 4, 6, 8, and 12 weeks and at 6, 9, 12 months and 24 months after surgery. The final choices in efficacy index included International Knee Documentation Committee (IKDC) score, Lysholm score, visual analog scale (VAS) score, and range of motion. Results During the follow-up, all patients exhibited statistically significant functional improvement in the injured limb compared with their preoperative situation. The mean postoperative scores of acute stage patients at 2-year follow-up were IKDC subjective score, 77.54 ± 11.53; Lysholm score, 85.96 ± 9.39; Tegner score, 4.13 ± 1.08; and VAS score, 1.21 ± 0.76. The mean postoperative scores of chronic stage patents at 2-year follow-up were IKDC subjective score, 74.61 ± 12.38; Lysholm score, 81.71 ± 10.80; Tegner score, 3.96 ± 1.14; and VAS score, 1.71 ± 0.60. The IKDC subjective score, Lysholm score, and Tegner score were significantly improved (P < 0.01) and the VAS score was significantly decreased (P < 0.01) at 2-year follow-up. Regarding the multiple ligament injuries classification, patients with more structural damage in stages V and VI showed less progress in functional recovery than those in stages I–IV. Conclusions This new classification with three stages and six types helps to identify the severity of injury and plan the management effectively. The outcomes were encouraging and the subjective functional results showed significant improvement at 2-year follow-up. Study design Prospective clinical trial. Level of evidence II


2021 ◽  
Vol 8 ◽  
Author(s):  
Zhe-yu Jin ◽  
Yun Teng ◽  
Hua-zheng Wang ◽  
Hui-lin Yang ◽  
Ying-jie Lu ◽  
...  

Background: Anterior cervical discectomy and fusion (ACDF) has been widely performed to treat cervical generative diseases. Cage subsidence is a complication after ACDF. Although it is known that segmental kyphosis, acceleration of adjacent segmental disease, and restenosis may occur due to cages subsidence; however detailed research comparing zero-profile cages (ROI-C) and conventional plate and cage construct (CPC) on cage subsidence has been lacking.Objective: The objectives of this study was to compare the rate of postoperative cage subsidence between zero profile anchored spacer (ROI-C) and conventional cage and plate construct (CPC) and investigate the risk factors associated with cage subsidence following ACDF.Methods: Seventy-four patients with ACDF who received either ROI-C or CPC treatment from October 2013 to August 2018 were included in this retrospective cohort study. Clinical and radiological outcomes and the incidence of cage subsidence at final follow up-were compared between groups. All patients were further categorized into the cage subsidence (CS) and non-cage subsidence (NCS) groups for subgroup analysis.Results: The overall subsidence rate was higher in the ROI-C group than in the CPC group (66.67 vs. 38.46%, P = 0.006). The incidence of cage subsidence was significantly different between groups for multiple-segment surgeries (75 vs. 34.6%, P = 0.003), but not for single-segment surgeries (54.55 vs. 42.30%, P = 0.563). Male sex, operation in multiple segments, using an ROI-C, and over-distraction increased the risk of subsidence. Clinical outcomes and fusion rates were not affected by cage subsidence.Conclusion: ROI-C use resulted in a higher subsidence rate than CPC use in multi-segment ACDF procedures. The male sex, the use of ROI-C, operation in multiple segments, and over-distraction were the most significant factors associated with an increase in the risk of cage subsidence.


2021 ◽  
Author(s):  
Marc D Ruben ◽  
Lauren J Francey ◽  
Gang Wu ◽  
David F Smith ◽  
Garret A Fitzgerald ◽  
...  

Importance Clinical evidence suggests that the time of day of treatment can affect outcomes in many different diseases, but this information is dispersed, imprecise, and heterogeneous. Consequently, practice guidelines and clinical care recommendations seldom specify intervention time. Objective To understand the sources of variability and summarize clinical findings on the time of day effects of medicine. Data Sources A systematic search of Pubmed, Google Scholar, and ClinicalTrials.gov for chronotherapy OR time of administration. Study Selection Any clinical study since 2000, randomized or observational, that compared the effects of treatment at different times of day. We included pharmacologic or surgical interventions having at least one continuous outcome. Data Extraction and Synthesis For selected studies, we extracted the mean and variance of each time-of-day treatment group. From these, we computed the standardized mean difference (SMD) as the measure of timing effect. Where a study reported multiple outcomes, we selected a single outcome based on a defined order of priority. Main Outcomes and Measures We estimated overall pooled effect size and heterogeneity by a random effects model, followed by outlier detection and subgroup analyses to evaluate how study factors, including drug, design, outcome, and source, associate with timing effect. Results 78 studies met the inclusion criteria, comprising 48 distinct interventions over many therapeutic areas. We found an overall effect of time on clinical outcomes but with substantial heterogeneity between studies. Predicted effects range from none to large depending on the study context. Study size, registration status, and source are associated with the magnitude of effect. Larger trials and those that were pre-registered have markedly smaller effects, suggesting that the published record overstates the effects of the timing of medicine on clinical outcomes. In particular, the notion that antihypertensives are more effective if taken at bedtime draws disproportionately from one source in the field, which consistently detects larger effects than the community average. Lastly, among the most highly studied drug timing relationships, the aspirin anti-clotting effect stands out, consistently favoring evening over morning dosing. Conclusions and Relevance While accounts of drug timing effects have focused on yes/no, appreciating the range of probable effects may help clarify where circadian medicine meets the threshold for clinical benefit.


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