Longitudinal Trends in 30-Day Mortality Between Multi-Site and Single-Site Surgeons

alexandrossfakianakis shared this article with you from Inoreader Longitudinal Trends in 30-Day Mortality Between Multi-Site and Single-Site Surgeons via Annals of Surgery - Most Popular Articles Background: Quality leaders are concerned that creation of multi-hospital health systems may lead to surgeons traveling to and from distant hospitals and thus to more fragmented surgical care and worse outcomes for their patients. Despite this concern, little empirical data exist on outcomes of multi-site versus single-site surgeons. Methods: Using national Medicare data, we assessed trends in the number of multi-site vs. single-site surgeons from 2011 to 2016. We performed a multivariable regression analysis to compare overall 30-day mortality differences, stratified by system and rural status, and examined trends over time. Results: The number of multi-site surgeons and the percentage of multi-site surgeons per hospital decreased over time (24.2%–19.0%; 44.3%–41.8%). Overall, multi-site surgeons had lower 30-day mortality than single-site surgeons (2.24% vs 2.50%, P View on Web

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18F-FDG PET/CT Imaging Post Heart Transplantation Depicts High Accumulation at Sites of Previous Ventricular Assist Device Insertion

alexandrossfakianakis shared this article with you from Inoreader 18F-FDG PET/CT Imaging Post Heart Transplantation Depicts High Accumulation at Sites of Previous Ventricular Assist Device Insertion via Clinical Nuclear Medicine - Published Ahead-of-Print A 37-year-old man with previous heart transplantation for dilated cardiomyopathy underwent screening for malignancy under posttransplantation immunosuppression. 18F-FDG PET/CT revealed uptake in 2 peritoneal sites of the pericardium that corresponded to the insertion sites of a left ventricular assist device that was used before transplantation. Additional abnormal uptake in the right axillary artery, aortic arch, and left femoral artery corresponded to the insertion sites for arterial inflow during cardiopulmonary bypass. Knowledge that FDG accumulation may occur at the insertion sites of an extracorporeal-circulatio n device enables unnecessary tests to be avoided. View on Web

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Differentiation of Bolus Texture During Deglutition via High‐Density Surface Electromyography: A Pilot Study

alexandrossfakianakis shared this article with you from Inoreader Differentiation of Bolus Texture During Deglutition via High‐Density Surface Electromyography: A Pilot Study via The Laryngoscope This pilot study evaluated high-density surface electromyography (HDsEMG) during pharyngeal swallows of five different bolus textures from eight healthy human subjects. Results indicate HDsEMG can differentiate swallows of varying consistencies through analysis of EMG signal features such as power and peak counts while maintaining a spatial orientation. This may prove useful in both future diagnostic and behavioral swallow applications. Objective Swallowing is a complex neuromuscular task. There is limited spatiotemporal data on normative surface electromyographic signal during swallow, particularly across standard textures. We hypothesize the pattern of electromyographic signal of the anterior neck varies cranio-caudally, that laterality can be evaluated, and categorization of bolus texture can be differentiated by high-density surface electromyography (HDsEMG) through signal analysis. Methods An HDsEMG grid of 20 electrodes captured electromyographic activity in eight healthy adult subjects across 240 total swallows. Participants swallowed five standard textures: saliva, thin liquid, puree, mixed consistency, and dry solid. Data were bandpass filtered, underwent functional alignment of signal, and then placed into binary classifier receiver operating characteristic (ROC) curves. Muscular activity was visualized by creating two-dimensional EMG heat maps. Results Signal analysis results demonstrated a positive correlation between signal amplitude and bolus texture. Greater differences of amplitude in the cranial most region of the array when compared to the caudal most region were noted in all subjects. Lateral comparison of the array revealed symmetric power levels across all subjects and textures. ROC curves demonstrated the ability to correctly classify textures within subjects in 6 of 10 texture comparisons. Conclusion This pilot study suggests that utilizing HDsEMG during deglutition can noninvasively differentiate swallows of varying texture noninvasively. This may prove useful in future diagnostic and behavioral swallow applications. Level of Evidence Level 4 Laryngoscope, 2023 View on Web

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Differences in morphology of temporomandibular joint ankylosis of traumatic and infective origin

alexandrossfakianakis shared this article with you from Inoreader Differences in morphology of temporomandibular joint ankylosis of traumatic and infective origin via International Journal of Oral and Maxillofacial Surgery via MedWorm.com The aim of this study was to determine whether there are any differences in morphology between temporomandibular joint ankylosis (TMJA) of traumatic and infective origin. Cone beam computed tomography (CBCT) scans of 25 patients (28 joints) with TMJA of traumatic origin (trauma group) and 15 patients (15 joints) with TMJA of infectious origin (infection group) were included. The following morphological parameters were evaluated on multiple sections of the CBCT scans: lateral juxta-articular bone growth, residual condyle, residual glenoid fossa, ramus thickening, ankylotic mass fusion line, sclerosis of the ankylosed condyle and spongiosa of the glenoid fossa, and mastoid and glenoid fossa air cell obliteration. (Source: International Journal of Oral and Maxillofacial Surgery) View on Web

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A new glutamine synthetase index to evaluate hepatic lobular restoration in advanced fibrosis during anti‐HBV therapy

alexandrossfakianakis shared this article with you from Inoreader A new glutamine synthetase index to evaluate hepatic lobular restoration in advanced fibrosis during anti‐HBV therapy via Journal of Medical Virology Abstract Hepatic lobular architecture distortion is a deleterious turning point and a crucial histological feature of advanced liver fibrosis in chronic liver diseases. Regression of fibrosis has been documented in chronic hepatitis B (CHB) patients. However, whether lobular architecture could be restored following fibrosis regression after antiviral therapy is still unclear. Glutamine synthetase (GS) is generally expressed by perivenular hepatocytes around hepatic veins (HV). In this study, we defined abnormal lobular architecture (GSPT) as GS expressing in the vicinity of portal tracts (PT), which denotes parenchymal extinction and lobular collapse. We defined normal lobular architecture (GSHV) as GS positivity area not approximating PTs. Therefore, we propose a new GS-index, defined as the percentage of GSHV/(GSHV+GSPT), to evaluate the extent of architectural disruption and restoration. We evaluated 43 CHB patients with advanced fi brosis (Ishak stage ≥ 4). Post-treatment liver biopsy was performed after 78 weeks of anti-HBV therapy. The median GS-index improved from 7% (IQR: 0%-23%) at baseline to 36% (IQR: 20%-57%) at week 78 (P < 0.001). Totals of 22 patients (51%) had significant GS-index improvement from 0% (IQR: 0%-13%) to 55% (IQR: 44%-81%), while the other half had almost no change between 17% (IQR: 0%-33%) to 20% (IQR: 12%-31%). When GS-index78w ≥ 50% was used to define hepatic lobular restoration, 37% of patients (16/43) achieved lobular restoration, with much improvement in ALT and AST levels (median value of ∆/Baseline in ALT: restored vs. non-restored was 79.1% vs. 48.8%, P = 0.018; median value of ∆/Baseline in AST: restored vs. non-restored was 69.1% vs. 32.5%, P = 0.005). More importantly, lobular restoration correlated with fibrosis regression (median value of ∆/Baseline in Ishak stage: restored vs. non-restored was 25.0% vs. 0%, P = 0.008). Therefore, in the era of antiviral therapy for CHB, restoration of hepatic lobular architecture is achievable in patients with advanced fibrosis. GS-index provides additional insight into fibrosis regression that goes beyond collagen degradation. This article is protected by copyright. All rights reserved. View on Web

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