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The American Association of Endodontists (AAE) and the American Academy of Oral and Maxillofacial Radiology (AAOMR) developed guidelines for the prescription of cone-beam computed tomographic (CBCT) imaging. The impact of appropriately prescribed CBCT imaging on endodontic diagnosis and treatment (Tx) decisions was examined. The clinical databases at the School of Dentistry at the University of California, Los Angeles, Los Angeles, California, were queried to identify patients referred for CBCT imaging from the postgraduate endodontic clinic over a consecutive 36-month period. Primary and secondary indications for CBCT imaging were recorded. Pre-CBCT uncertainty in diagnosis, Tx of the teeth in question, and post-CBCT changes to the diagnosis and Tx plan were recorded. CBCT imaging was prescribed for 12% of patients. A total of 442 scans were prescribed to evaluate 526 teeth. Molars accounted for 51% of teeth examined. Overall, CBCT effected a change in periapical diagnosis (21%) and in the Tx plan (69%). The 5 most frequent primary indications for CBCT imaging were, in order, AAE-AAOMR recommendations 7, 9, 2, 12, and 6. The impact of these recommendations on Tx decisions varied from 48% through 93%. This study validates the use of the AAE-AAOMR guidelines for prescribing CBCT imaging for endodontic evaluations. CBCT imaging contributed predominantly to Tx decisions rather than diagnostic determinations. This study validates AAE-AAOMR case selection guidelines for CBCT imaging and shows a positive impact of prescription imaging on endodontic decision making. [ABSTRACT FROM AUTHOR]

Background: Sepsis is a highly heterogeneous syndrome, which has hindered the development of effective therapies. This has prompted investigators to develop a precision medicine approach aimed at identifying biologically homogenous subgroups of patients with septic shock and critical illnesses. Transcriptomic analysis can identify subclasses derived from differences in underlying pathophysiological processes that may provide the basis for new targeted therapies. The goal of this study was to elucidate pathophysiological pathways and identify pediatric septic shock subclasses based on whole blood RNA expression profiles. Methods: The subjects were critically ill children with cardiopulmonary failure who were a part of a prospective randomized insulin titration trial to treat hyperglycemia. Genome-wide expression profiling was conducted using RNA sequencing from whole blood samples obtained from 46 children with septic shock and 52 mechanically ventilated noninfected controls without shock. Patients with septic shock were allocated to subclasses based on hierarchical clustering of gene expression profiles, and we then compared clinical characteristics, plasma inflammatory markers, cell compositions using GEDIT, and immune repertoires using Imrep between the two subclasses. Results: Patients with septic shock depicted alterations in innate and adaptive immune pathways. Among patients with septic shock, we identified two subtypes based on gene expression patterns. Compared with Subclass 2, Subclass 1 was characterized by upregulation of innate immunity pathways and downregulation of adaptive immunity pathways. Subclass 1 had significantly worse clinical outcomes despite the two classes having similar illness severity on initial clinical presentation. Subclass 1 had elevated levels of plasma inflammatory cytokines and endothelial injury biomarkers and demonstrated decreased percentages of CD4 T cells and B cells and less diverse T cell receptor repertoires. Conclusions: Two subclasses of pediatric septic shock patients were discovered through genome-wide expression profiling based on whole blood RNA sequencing with major biological and clinical differences. Trial Registration This is a secondary analysis of data generated as part of the observational CAF-PINT ancillary of the HALF-PINT study (NCT01565941). Registered March 29, 2012. [ABSTRACT FROM AUTHOR]

Bitter taste receptors (Tas2rs in mice) detect bitterness, a warning signal for toxins and poisons, and are expressed in enteroendocrine cells. We tested the hypothesis that Tas2r138 and Tas2r116 mRNAs are modulated by microbiota alterations induced by a long-term high-fat diet (HFD) and antibiotics (ABX) (ampicillin and neomycin) administered in drinking water. Cecum and colon specimens and luminal contents were collected from C57BL/6 female and male mice for qRT-PCR and microbial luminal 16S sequencing. HFD with/without ABX significantly increased body weight and fat mass at 4, 6, and 8 weeks. Tas2r138 and Tas2r116 mRNAs were significantly increased in mice fed HFD for 8 weeks vs. normal diet, and this increase was prevented by ABX. There was a distinct microbiota separation in each experimental group and significant changes in the composition and diversity of microbiome in mice fed a HFD with/without ABX. Tas2r mRNA expression in HFD was associated with several genera, particularly with Akkermansia, a Gram-negative mucus-resident bacterium. These studies indicate that luminal bacterial composition is affected by sex, diet, and ABX and support a microbial dependent upregulation of Tas2rs in HFD-induced obesity, suggesting an adaptive host response to specific diet-induced dysbiosis. [ABSTRACT FROM AUTHOR]

Objective: Assess the ongoing impact of COVID-19 on mental well-being of breast radiologists nationwide two years after the start of the pandemic and compared to early in the pandemic. Methods: A 27-question survey was distributed from December 2021 to January 2022 to physician members of the Society of Breast Imaging. Psychological distress and anxiety scores were calculated, and factors associated with them were identified with a multivariate logistic model. Results: A total of 550 surveys were completed (23% response rate); the mean respondent age was 50 +/-- 10 years. Fifty percent (265/526) of respondents reported two or more psychological distress symptoms, down from 58% in 2020 (P = 0.002), whereas 70% (362/526) of respondents reported increased anxiety, down from 82% in 2020 (P < 0.001). As in 2020, reporting financial strain and childcare adversely affecting job ability were associated with worse psychological distress scores (OR 3.6, 95% CI: 1.6--8.3, P = 0.02 and OR 6.0, 95% CI: 2.5--14.4, P = 0.002, respectively). Less time spent consulting, educating, and discussing results with patients was associated with higher psychological distress (OR 5.3, 95% CI: 2.1--13.2, P = 0.036) and anxiety (OR 6.4, 95% CI: 2.3--17.5, P < 0.001). Diminished research collaboration was associated with higher anxiety (OR 1.8, 95% CI: 1.1--2.9, P = 0.019). Conclusion: The COVID-19 pandemic continues to cause mental health symptoms in breast radiologists, especially for those with pandemic-specific childcare needs and financial distress. Pandemic-related decreased opportunities to connect with patients and colleagues negatively impacts radiologists' mental health. [ABSTRACT FROM AUTHOR]

Purpose: To determine hepatocellular carcinoma (HCC) magnetic resonance imaging (MRI) biomarkers that enable the prediction of delisting from tumor progression versus successful transplantation in patients listed for orthotopic liver transplantation (OLT). Methods: With IRB approval and HIPPA compliance, patients with HCC awaiting OLT who were delisted due to HCC progression from 2006 to 2015 were identified. Patients with adequate MR images for review were subsequently matched with a cohort of patients successfully bridged to OLT in the same time period. Matching considered the tumor stage and the dominant treatment strategy adopted to bridge the patient to OLT. Potential MRI features were evaluated by univariable and multivariable analysis using a conditional logistic model. Results: There were 53 patients included in each cohort. On uni‐variable analysis, significant unfavorable MR imaging features included T2 hyperintensity (odds ratio [OR], 19.0), infiltrative border (OR, 7.50), lobulated shape (OR, 4.5), T1 hypointensity (OR, 3.0), heterogeneous arterial enhancement (OR, 7.0), and corona venous enhancement (OR, 4.0). A significant favorable MR imaging feature was the presence of intralesional fat (OR =.36). The best multivariable logistic prediction model derived from the above notable features included only T1 and T2 signal intensity, border definition, and absence of intra‐lesional fat as significant variables, with an area under the receiver operating characteristic curve (AUC) of.86 in the prediction of delisting. Conclusion: Select MR imaging features of HCC at presentation before any treatment are significantly associated with the risk of tumor progression regardless of tumor stage and treatment strategy in patients awaiting liver transplantation. [ABSTRACT FROM AUTHOR]

The presented models do not include NfL The oEV:nEV pS129- -syn ratio increased similarly in the order HC < PD < MSA (Additional file 1: Fig. Consequently, unlike the oEV:nEV total -syn ratio, the oEV:nEV pS129- -syn ratio separated the groups only moderately. Serum/plasma nEV and oEV biomarker measurements for the HC, PD, and MSA groups. [Extracted from the article]

Background: Shock management requires quick and reliable means to monitor the hemodynamic effects of fluid resuscitation. Point-of-care ultrasound (POCUS) is a relatively quick and non-invasive imaging technique capable of capturing cardiac output (CO) variations in acute settings. However, POCUS is plagued by variable operator skill and interpretation. Artificial intelligence may assist healthcare professionals obtain more objective and precise measurements during ultrasound imaging, thus increasing usability among users with varying experience. In this feasibility study, we compared the performance of novice POCUS users in measuring CO with manual techniques to a novel automation-assisted technique that provides real-time feedback to correct image acquisition for optimal aortic outflow velocity measurement. Methods: 28 junior critical care trainees with limited experience in POCUS performed manual and automation-assisted CO measurements on a single healthy volunteer. CO measurements were obtained using left ventricular outflow tract (LVOT) velocity time integral (VTI) and LVOT diameter. Measurements obtained by study subjects were compared to those taken by board-certified echocardiographers. Comparative analyses were performed using Spearman's rank correlation and Bland–Altman matched-pairs analysis. Results: Adequate image acquisition was 100% feasible. The correlation between manual and automated VTI values was not significant (p = 0.11) and means from both groups underestimated the mean values obtained by board-certified echocardiographers. Automated measurements of VTI in the trainee cohort were found to have more reproducibility, narrower measurement range (6.2 vs. 10.3 cm), and reduced standard deviation (1.98 vs. 2.33 cm) compared to manual measurements. The coefficient of variation across raters was 11.5%, 13.6% and 15.4% for board-certified echocardiographers, automated, and manual VTI tracing, respectively. Conclusions: Our study demonstrates that novel automation-assisted VTI is feasible and can decrease variability while increasing precision in CO measurement. These results support the use of artificial intelligence-augmented image acquisition in routine critical care ultrasound and may have a role for evaluating the response of CO to hemodynamic interventions. Further investigations into artificial intelligence-assisted ultrasound systems in clinical settings are warranted. [ABSTRACT FROM AUTHOR]

Congenital diseases of the kidney and urinary tract (CAKUT) and glomerulonephritis are the main causes of chronic kidney disease (CKD) in children. Although renal osteodystrophy (ROD) and indices of mineral metabolism have been characterized in dialyzed children, the impact of primary kidney disease on ROD is unknown. We performed a cross‐sectional study of bone biopsies performed in 189 pediatric dialysis patients aged 12.6 ± 5.4 years. Patients were classified into three groups according to primary kidney disease: CAKUT (n = 82), hereditary (n = 22), or glomerular disease (n = 85). Serum concentrations of calcium, phosphate, alkaline phosphatase (ALP), parathyroid hormone (PTH), and 25(OH) vitamin D were measured at the time of biopsy. Fibroblast growth factor 23 (FGF23) levels were measured in a subset of 59 patients. Levels of calcium, phosphate, PTH, and 25(OH) vitamin D were similar across groups. CAKUT patients had higher serum ALP and lower C‐terminal FGF23 levels. Bone turnover and bone volume parameters did not differ across groups. However, osteoid volume (OV/BV), osteoid surface (OS/BS), and osteoid maturation time (OMT) were highest in the CAKUT group and lowest in the hereditary group. Multiple regression analysis revealed that calcium, phosphate, ALP, and PTH were independently associated with OV/BV and osteoid thickness (O.Th). PTH was an independent factor affecting bone formation rate. The relationship between CKD etiology and bone histomorphometric variables was abrogated after adjustment for biochemical parameters in the multivariable models. Overall, bone histology differed according to CKD etiology in the unadjusted analysis; however, this association could not be confirmed independently of biochemical parameters. Although CAKUT patients had a greater mineralization defect with elevated serum ALP levels, longitudinal studies will be needed to elucidate mediation pathways that might be involved in the complex interplay of CKD‐mineral bone disease (MBD). © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

Background: Small airways are known to be affected early in the course of COPD; however, traditional spirometric indices may not accurately identify small airways disease.Research Question: Can forced expiratory volume in 3 s/forced expiratory volume in 6 s (FEV3/FEV6) identify early airflow abnormalities and predict future clinically important respiratory-related outcomes, including development of COPD?Study Design and Methods: The study included 832 current and former smokers with post-bronchodilator FEV1/FVC ≥ 0.7 from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) cohort. Participants were classified as having a reduced pre-bronchodilator FEV3/FEV6 based on lower limit of normal (LLN) values. Repeatability analysis was performed for FEV3 and FEV6. Regression modeling was used to evaluate the relationship between baseline FEV3/FEV6 and outcome measures, including functional small airways disease, on thoracic imaging and respiratory exacerbations. Interval-censored analysis was used to assess progression to COPD.Results: FEV3/FEV6 less than the LLN at baseline, defined as reduced compared with FEV3/FEV6 at or above the LLN, was associated with lower FEV1, poorer health status (St. George's Respiratory Questionnaire score), more emphysema, and more functional small airways disease on quantitative imaging. FEV3 and FEV6 showed excellent agreement between repeat measurements. A reduced FEV3/FEV6 was associated with increased odds of a severe respiratory exacerbation within the first year of follow-up and decreased time to first exacerbation. A low FEV3/FEV6 was also associated with development of COPD according to spirometry results (post-bronchodilator FEV1/FVC < 0.7) during study follow-up.Interpretation: FEV3/FEV6 is a routinely available and repeatable spirometric index that can be useful in the evaluation of early airflow obstruction in current and former smokers without COPD. A reduced FEV3/FEV6 can identify those at risk for future development of COPD and respiratory exacerbations.Clinical Trial Registration: ClinicalTrials.gov; No.: NCT01969344; URL: www.Clinicaltrials: gov: ClinicalTrials.gov. [ABSTRACT FROM AUTHOR]

Objective: Assess the impact of COVID-19 on patient-breast radiologist interactions and evaluate the relationship between safety measure--constrained communication and physician wellbeing. Methods: A 41-question survey on the perceived effect of COVID-19 on patient care was distributed from June 2020 to September 2020 to members of the Society of Breast Imaging and the National Consortium of Breast Centers. Non-radiologists and international members were excluded. Anxiety and psychological distress scores were calculated. A multivariable logistic model was used to identify demographic and mental health factors associated with responses. Results: Five hundred twenty-five surveys met inclusion criteria (23% response rate). Diminished ability to fulfill patients' emotional needs was reported by 46% (221/479), a response associated with younger age (OR, 0.8 per decade; P < 0.01), higher anxiety (OR, 2.3; P < 0.01), and higher psychological distress (OR, 2.2; P = 0.04). Personal protective equipment made patient communication more difficult for 88% (422/478), a response associated with younger age (OR, 0.8 per decade; P = 0.008), female gender (OR, 1.9; P < 0.01), and greater anxiety (OR, 2.6; P = 0.001). The inability to provide the same level of care as prior to COVID-19 was reported by 37% (177/481) and was associated with greater anxiety (OR, 3.4; P < 0.001) and psychological distress (OR, 1.7; P = 0.03). Conclusion: The majority of breast radiologists reported that COVID-19 has had a negative impact on patient care. This perception was more likely among younger radiologists and those with higher levels of anxiety and psychological distress. [ABSTRACT FROM AUTHOR]

Context: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women, affecting approximately 5% to 20% of women of reproductive age. The economic burden of PCOS was previously estimated at approximately $3.7 billion annually in 2020 USD when considering only the costs of the initial diagnosis and of reproductive endocrine morbidities, without considering the costs of pregnancyrelated and long-term morbidities. Objective: This study aimed to estimate the excess prevalence and economic burden of pregnancy-related and long-term health morbidities attributable to PCOS. Methods: PubMed, EmBase, and Cochrane Library were searched, and studies were selected in which the diagnosis of PCOS was consistent with the Rotterdam, National Institutes of Health, or Androgen Excess and PCOS Society criteria, or that used electronic medical record diagnosis codes, or diagnosis based on histopathologic sampling. Studies that included an outcome of interest and a control group of non-PCOS patients who were matched or controlled for body mass index were included. Two investigators working independently extracted data on study characteristics and outcomes. Data were pooled using random effects meta-analysis. The I² statistic was used to assess inter-study heterogeneity. The quality of selected studies was assessed using the Newcastle-Ottawa Scale. Results: The additional total healthcare-related economic burden of PCOS due to pregnancy-related and long-term morbidities in the United States is estimated to be $4.3 billion annually in 2020 USD. Conclusion: Together with our prior analysis, the economic burden of PCOS is estimated at $8 billion annually in 2020 USD. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia has gained momentum as a potential risk‐stratification tool in liver transplantation (LT). While LT recipients recently have more advanced end‐stage liver disease, the impact of sarcopenia in high acuity recipients with a high model for end‐stage liver disease (MELD) score remains unclear. Methods: We retrospectively assessed sarcopenia by calculating skeletal muscle index (SMI) from cross‐sectional area at third lumbar vertebra (cm2) and height (m2) in 296 patients with a CT ≤ 30 days prior to LT. Sex‐specific SMI cut‐offs were developed, and its impact was assessed in patients with MELD ≥ 35. Results: In patients with MELD ≥ 35 (n = 217), men with a SMI < 30 cm2/m2 had significantly higher rates of bacteremia (P =.021) and a longer hospital stay (P <.001). Women with a SMI < 34 cm2/m2 had a longer hospital stay (P =.032). There were no relationships between SMI and survival in men and women with MELD ≥ 35. Conclusions: This series examined sarcopenia with a focus on high MELD patients. Although decreased SMI contributed to higher post‐LT hospital stay, it did not impact patient survival, suggesting that while SMI alone may not aid in patient selection for LT, it certainly may guide perioperative care‐planning in this challenging patient population. [ABSTRACT FROM AUTHOR]

Objectives: Since 2000, medical treatment for epilepsy and cardiovascular risk‐reduction strategies have advanced significantly in the United States (US). However, seizure‐free rates remain unchanged, and people with epilepsy are at higher risk than the general population for heart disease and stroke. The purpose of this study is to determine how cardiovascular, epilepsy‐related, and other causes of death are changing in epilepsy in comparison with the US population. Materials & Methods: Changes in the 15 underlying causes of death in epilepsy (ICD‐10 G40‐G40.9) and the US population were analyzed and compared from 2000 to 2018. The CDC multiple cause‐of‐death database was utilized as the primary data source. Changes in the relative proportions for each cause‐of‐death over were evaluated using logistic regression. Results: The proportions of deaths in epilepsy due to heart disease declined 34.4% (p <.001), a rate similar to the general population (39.9%). Epilepsy‐related deaths declined 25% as a percentage of all epilepsy deaths (p <.001). The proportions of deaths due to stroke and neoplasms increased significantly in epilepsy versus the US population (p <.001 linear trend). Conclusions: The reduction in ischemic heart disease in epilepsy is a novel and highly significant finding, which reflects widespread implementation of cardiovascular risk‐factor reduction and treatment in the United States. Reductions in epilepsy‐related deaths are an exciting development which requires further investigation into causality. The increase in deaths due to neoplasms and stroke relative to the US population is concerning, warranting vigilance and increased efforts at recognition, prevention, and treatment. [ABSTRACT FROM AUTHOR]

The diagnosis of Parkinson's disease (PD) and atypical parkinsonian syndromes is difficult due to the lack of reliable, easily accessible biomarkers. Multiple system atrophy (MSA) is a synucleinopathy whose symptoms often overlap with PD. Exosomes isolated from blood by immunoprecipitation using CNS markers provide a window into the brain's biochemistry and may assist in distinguishing between PD and MSA. Thus, we asked whether α-synuclein (α-syn) in such exosomes could distinguish among healthy individuals, patients with PD, and patients with MSA. We isolated exosomes from the serum or plasma of these three groups by immunoprecipitation using neuronal and oligodendroglial markers in two independent cohorts and measured α-syn in these exosomes using an electrochemiluminescence ELISA. In both cohorts, α-syn concentrations were significantly lower in the control group and significantly higher in the MSA group compared to the PD group. The ratio between α-syn concentrations in putative oligodendroglial exosomes compared to putative neuronal exosomes was a particularly sensitive biomarker for distinguishing between PD and MSA. Combining this ratio with the α-syn concentration itself and the total exosome concentration, a multinomial logistic model trained on the discovery cohort separated PD from MSA with an AUC = 0.902, corresponding to 89.8% sensitivity and 86.0% specificity when applied to the independent validation cohort. The data demonstrate that a minimally invasive blood test measuring α-syn in blood exosomes immunoprecipitated using CNS markers can distinguish between patients with PD and patients with MSA with high sensitivity and specificity. Future optimization and validation of the data by other groups would allow this strategy to become a viable diagnostic test for synucleinopathies. [ABSTRACT FROM AUTHOR]

Introduction: Increased societal prevalence of marijuana continues to challenge liver transplant (LT) programs. This study aimed to examine the potential effects of marijuana use on outcomes. Methods: This retrospective study included recipients who underwent LT between 1/2012 and 6/2018. According to pre‐LT marijuana use, patients were classified into recent (≤6 months of LT), former (chronic use but not ≤6 months), or non‐users. Additionally, the impact of post‐LT marijuana use on survival was assessed. Results: Of 926 eligible patients, 184 were pre‐LT marijuana users (42 recent; 142 former) (median follow‐up: 30.3 months). Pre‐users were more likely to be male, White, and have histories of tobacco, alcohol, and illicit drug use. Additionally, recent users were of higher acuity, with higher MELD and requiring ICU admission. Patient survival at 1‐year was 89% in non‐users, 94% (HR: 0.494, 95% CI: 0.239–1.022 vs. non‐users) in former users, and 83% (HR: 1.516, 95% CI: 0.701–3.282) in recent users. Post‐operative complications in pre‐LT users and the survival analysis for post‐LT marijuana users vs. non‐users did not show significance. Conclusions: Our results demonstrated that marijuana use did not have an adverse impact on post‐LT outcomes; however, further studies utilizing larger cohorts are warranted. [ABSTRACT FROM AUTHOR]

Introduction: Trapped lung, characterized by atelectatic lung unable to reexpand and fill the thoracic cavity due to a restricting fibrous visceral pleural peel, is occasionally seen in patients with end-stage liver disease complicated by hepatic hydrothorax. Limited data suggest that trapped lung prior to orthotopic liver transplantation may be associated with poor outcomes. Research Question: What is the clinical significance of trapped lung in patients receiving orthotopic liver transplantation? Design: We performed a retrospective analysis of patients who underwent liver transplantation over an 8-year period. Baseline clinical characteristics and postoperative outcomes of adult patients with trapped lung were analyzed and compared to the overall cohort of liver transplant recipients and controls matched 3:1 based on age, sex, Model for End-Stage Liver Disease (MELD) score, and presence of pleural effusion. Results: Of the 1193 patients who underwent liver transplantation, we identified 20 patients (1.68%) with trapped lung. The probability of 1 and 2-year survival were 75.0% and 57.1%, compared to 85.6% and 80.4% (p = 0.02) in all liver transplant recipients and 87.9% and 81.1% (p = 0.03) in matched controls respectively. Patients with trapped lung had a longer hospital length of stay compared to the total liver transplant population (geometric mean 54.9 ± 8.4 vs. 27.2 ± 0.7 days, p ≤ 0.001), when adjusted for age and MELD score. Discussion: Patients with trapped prior to orthotopic liver transplantation have increased probability of mortality as well as increased health care utilization. This is a small retrospective analysis, and further prospective investigation is warranted. [ABSTRACT FROM AUTHOR]

Purpose: Passive leg raise (PLR), in combination with technologies capable of capturing stroke volume changes, has been widely adopted in the management of shock. However, dedicated evaluation of safety, feasibility, and receptiveness of patients and nursing staff to PLR maneuver is missing. Methods: A noninterventional, prospective trial recruited adult patients with onset of undifferentiated shock within 24 hours with persistent vasopressor requirements despite fluid resuscitation. A standardized PLR maneuver was used to compare two noninvasive hemodynamic monitoring systems, each without significant impact on the performance of the maneuver. Safety and efficacy of the PLR were evaluated via subjective and objective measures. Objective measures of patient comfort and tolerance were evaluated through changes in vital signs, sedation, and analgesia requirements. Nurses and awake patients completed surveys on their experience. Results: Seventy-nine patients were enrolled. Testing was aborted in 2 cases for medical reasons (one patient developed rapid atrial fibrillation, second had profound desaturation). Of all, 5.4% of patients required additional vasopressor support after completion of the PLR maneuver due to persistent hypotension and 4.1% of patients required additional sedation. Among awake patients (N = 35), 6% reported pain and 29% reported discomfort. A total of 11% of nurses reported minor technical difficulties with the maneuver. Conclusion: Passive leg raise maneuver leads to a few serious but reversible complications in a selected population of hemodynamically unstable patients. Although it provides relevant diagnostic information, it may impact patient care. Treating physician should be aware of infrequent but possible complications and appreciate the impact of the maneuver on patients' comfort and nursing workload. [ABSTRACT FROM AUTHOR]

Introduction Epilepsy mortality rates are rising. It is unknown whether rates are rising due to an increase in epilepsy prevalence, changes in epilepsy causes of death, increase in the lethality or epilepsy or failures of treatment. To address these questions, we compare epilepsy mortality rates in the USA with all-cause and all-neurological mortality for the years 1999 to 2017. Objectives To determine changes in US epilepsy mortality rates versus all-cause mortality, and to evaluate changes in the leading causes of death in people with epilepsy. Design Retrospective population-based multiple causeof-death study. Primary outcome Change in age-adjusted epilepsy mortality rates compared with mortality rates for all-cause and all-neurological mortality. Secondary outcome Changes in the leading causes of death in epilepsy. Results From 1999 to 2017, epilepsy mortality rates in the USA increased 98.8%, from 5.83 per million in 1999 to 11.59 per million (95%CI 88.2%–110.0%), while allcause mortality declined 16.4% from 8756.34 per million to 7319.17 per million (95%CI 16.3% to 16.6%). For the same period, all-neurological mortality increased 80.8% from 309.21 to 558.97 per million (95%CI 79.4%–82.1%). The proportion of people with epilepsy who died due to neoplasms, vascular dementia and Alzheimer’s increased by 52.3%, 210.1% and 216.8%, respectively. During the same period, the proportion who died due to epilepsy declined 27.1%, while ischaemic heart disease as a cause of death fell 42.6% (p<0.001). Conclusions Epilepsy mortality rates in the USA increased significantly from 1999 to 2017. Likely causes include increases in all-neurological mortality, increased epilepsy prevalence and changes in the underlying causes of death in epilepsy, led by increases in vascular dementia and Alzheimer’s. An important finding is that ischaemic heart disease and epilepsy itself are declining as underlying causes of death in people with epilepsy. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the role of qualitative and quantitative DCE-MRI parameters in prostate cancer (PCa) stratified by whole-mount histopathology (WMHP) Gleason score (GS) and PI-RADSv2. Methods: This retrospective study included 323 PCa tumors in 254 men, who underwent 3T MRI prior to prostatectomy, 7/2009-12/2016. Qualitative DCE curve types included type 1 (progressive), type 2 (plateau) and type 3 (washout). Quantitative DCE-MRI pharmacokinetic (PK) parameters included Ktrans (influx volume transfer coefficient), Kep (efflux reflux rate constant) and iAUC (initial area under the curve). DCE-MRI features of true positive lesions were evaluated for overall, index, transition zone (TZ) and peripheral zone (PZ), based on GS grade (low = 6, high > 6) and PI-RADSv2 score using SPSSv24. Results: There were 57 (17.6%) low-grade and 266 (82.4%) high-grade PCa lesions. PI-RADSv2 3, 4 and 5 included 106, 120 and 97 lesions, respectively. 251 (77.7%) and 72 (22.3%) lesions were located in PZ and TZ, respectively. High-grade lesions had significantly higher proportion of Type 3 curves compared to low-grade lesions in overall (70.3% vs. 54.4%) and TZ (73.5% vs. 43.5%). As PI-RADSv2 increased, the proportion of type 3 curve significantly increased for overall (80.4–51.9%), index (80.4–54.7%) and PZ (78.7–52.1%) lesions. Among PK parameters, Ktrans (0.43 vs 0.32) and iAUC (8.99 vs 6.9) for overall PCa, Ktrans (0.43 vs 0.31) and iAUC (9 vs 6.67) for PZ PCa, and iAUC (8.94 vs 7.42) for index PCa were significantly higher for high-grade versus low-grade lesions. Also, Ktrans (0.51–0.34), Kep (1.75–1.29) and iAUC (9.79–7.6) for overall PCa, Ktrans (0.53–0.32), Kep (1.81–1.26) and iAUC (9.83–7.34) for PZ PCa; and Kep (1.79–1.17) and iAUC (11.3–8.45) for index PCa increased significantly with a higher PI-RADSv2 score. Conclusions: The results of study show the possible utility of qualitative and quantitative DCE-MRI parameters for assessment of PCa GS and PI-RADSv2 categorization. [ABSTRACT FROM AUTHOR]

Background: Sudden unexpected death in epilepsy (SUDEP) is rare in well-controlled epilepsy. However, SUDEP is a common cause of death in drug-resistant epilepsy. Over the last 30 years, multiple cohort and population studies have identified clinical risk factors associated with an increased risk for SUDEP. Objective: To identify and rank the leading SUDEP risk factors from major cohort and population-based studies. The incidence of SUDEP is also evaluated in special clinical situations, including antiepileptic drug treatment, epilepsy surgery, devices, and assignment to placebo in clinical trials. Methods: A PubMed search for English language human cohort studies for the terms Sudden, Death, and Epilepsy was performed for the years 1987-2017. Risk factors for SUDEP were identified and ranked by the weighted log adjusted odds ratio (OR)/relative risk ratio (RR). Findings: The top 10 leading risk factors ranked from highest to lowest log adjusted OR/RR are the following: ≥3 GTC seizures per year; ≥13 seizures in the last year; No Antiepileptic Drug (AED) treatment; ≥3 AEDs; ≥3 GTCs in the past year; 11-20 GTC seizures in the last 3 months; age of onset 0-15 years old; IQ < 70; 3-5 AED changes in the last year; ≥3 AEDs. Two risk factors from separate sources (≥3 GTC seizures and ≥3 AEDs) occur twice in the top 10 risk factors. Conclusion: The top 10 risk factors for SUDEP are identified and ranked. A ranking of the top risk factors could help clinicians identify patients at highest risk for SUDEP. [ABSTRACT FROM AUTHOR]

Objective The objective of the analysis was to examine the association between sociodemographic and dental understanding and utilization characteristics and lower oral health literacy ( HL) and knowledge. Methods The cross-sectional Multicenter Oral Health Literacy Research Study ( MOHLRS) recruited and interviewed 923 English-speaking, initial care-seeking adults. The questionnaire included participant sociodemographic characteristics, measures of the participant's understanding and utilization of dentistry, and two oral HL measures, the Rapid Estimate of Adult Literacy in Medicine and Dentistry ( REALM-D) and the Comprehensive Measure of Oral Health Knowledge ( CMOHK), which were combined into a new composite HL and knowledge measure, the MOHLR-K. Results In adjusted multivariable analysis, persons who reported more understanding of dentist instructions had higher mean scores for all HL measures. Subjects reporting the highest level of understanding had greater scores by an average of 1.6 points for the MOHLR-K (95% CI: 0.85-2.40, P<.01), 2.11 points for REALMD-20 (95% CI: 0.75-3.48, P<.01) and 2.20 points for CMOHK (95% CI: 1.01-3.40, P<.01) after controlling for demographic and other dental understanding and utilization factors. Persons who reported history of tooth decay had higher MOHLR-K scores by an average of about 0.77 points (95% CI: 0.49-1.04, P<.01), higher REALMD-20 scores by 0.54 points (95% CI: 0.12-0.95, P=.01) and higher CMOHK scores by 1.22 points (95% CI: 0.82-1.63, P<.01) as compared to persons without tooth decay history after controlling for the other factors. Persons who had support all of the time for travel to the dentist had higher scores by an average of about 0.5 points for the MOHLR-K (95% CI: 0.04-0.96, P=.03) and about 0.89 points for the REALMD-20 (95% CI: 0-1.79, P=.05) as compared to subjects with no support after controlling for other factors. Report of periodontal history, financial challenges to delay a dental visit and dental utilization were not significantly associated with any of the HL measures once the other factors were adjusted for in the model. Conclusion The analysis confirmed that pronunciation of medical and dental terms may not fully reflect comprehension and revealed that understanding both patients' sociodemographic and dental understanding and utilization factors, such as transportation to the dental office associated with lower oral HL and knowledge, could help the profession develop appropriate clear language programmes to improve access to dental care for vulnerable populations. [ABSTRACT FROM AUTHOR]

Background: Existing evidence demonstrating a relationship between health literacy (HL) and periodontal health is insufficient to identify how providers can help patients manage periodontal disease. This study assesses associations between HL measures (word recognition, numeracy, and conceptual knowledge) and signs of periodontal disease.Methods: This study included 325 new patients at a dental school clinic and employed an oral HL (OHL) survey, full-mouth radiographs, and clinical examination. Evaluations included the relationship between each HL measure versus number of teeth, bleeding score, plaque score, and periodontal severity with linear and ordinal logistic regression models before and after adjusting for covariates.Results: Among HL measures, the Newest Vital Sign demonstrated a significant relationship with number of teeth and the Short Test of Functional Health Literacy in Adults showed a significant association with plaque score. The short Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALMD-20) showed participants who performed in the highest quartile had nearly two additional teeth, over 5.5% fewer bleeding sites, and nearly 9% fewer teeth with plaque after adjustment for demographic variables, smoking, and diabetes mellitus (DM). Participants who scored in the highest quartile of the Comprehensive Measure of Oral Health Knowledge (CMOHK) had nearly 9% less plaque.Conclusions: Two OHL instruments (REAMLD-20 and CMOHK) provided statistical associations with clinical measures of periodontal health at a level that could be considered of moderate clinical relevancy. Findings suggest dentists may wish to assess familiarity of their patients with dental terminology and knowledge of periodontal disease to provide education on oral hygiene, smoking, and DM. [ABSTRACT FROM AUTHOR]

The effects of gestational diabetes mellitus (GDM) were determined on urinary excretion of putative components of insulin signaling. Random urine samples were collected from 375 gravidas at 6 to 14 weeks’ gestation, 22 to 32 weeks’ gestation, and ∼6 weeks’ postpartum. Gestational diabetes mellitus developed in 35 women who were matched with 59 normal gravidas. Urinary concentrations of myo-inositol (MI) and D-chiro-inositol (DCI) were measured by gas chromatography/mass spectrometry and normalized to creatinine levels. Compared to postpartum values, urinary excretion of MI and DCI was increased 2.9-fold and 2-fold, respectively, in early pregnancy, and 5.5-fold and 4.5-fold, respectively, in later gestation. Gravidas with GDM had significantly greater MI and DCI excretion than controls in the first trimester but not subsequently. The results suggest that gravidas destined to develop GDM have altered synthesis, metabolism, and/or renal excretion of MI and DCI in early pregnancy. [ABSTRACT FROM AUTHOR]

Background: Retrospective analyses of randomized controlled trials suggest that antiplatelet therapy may modify the potential cerebrovascular benefits of lowering homocysteine with B-vitamins among individuals with cardiovascular disease. We evaluated the effects of B-vitamin supplementation on risk of subsequent stroke among high cardiovascular risk individuals who are not taking antiplatelet medications. Methods: We systematically searched the Cochrane Central Register of controlled trials, PubMed, the Internet Stroke Center stroke trials, and the clinical trials.gov website from 1966 to April 2015. Inclusion criteria included: randomized controlled trials of homocysteine-lowering therapy with B-vitamins; high cardiovascular risk population and follow-up 2:1 year. We considered stroke as the primary outcome. Among 11 randomized controlled trials meeting inclusion criteria, three studies assessed stroke as an outcome and reported event rates according to whether or not individuals were taking antiplatelets: Vitamin Intervention for Stroke Prevention (VISP), VITAmins TO Prevent Stroke (VITATOPS), and Heart Outcomes Prevention Evaluation 2 (HOPE-2). Results: A total of 4643 high vascular risk subjects not taking antiplatelets were evaluated. The overall effect size across studies was summarized using the fixed effects model after confirming there was no significant heterogeneity. Heterogeneity was assessed using the Cochran's Q and I2 statistics. Compared with the control group, those taking B-vitamin supplementation had a lower risk of recurrent stroke (HR 0.86, 95% CI 0.62 to 1.19 for VISP; 0.65, 0.46 to 0.91 for VITATOPS; and 0.60, 0.39 to 0.92 for HOPE-2; overall HR 0.71, 0.58 to 0.88). Conclusion: Homocysteine lowering with B-vitamins among high vascular risk patients who are not taking antiplatelet therapy is related to a significant reduction (29%) in overall stroke risk. A clinical trial of B-vitamins in this group may be warranted. [ABSTRACT FROM AUTHOR]

Background: Sudden unexpected death in epilepsy (SUDEP) is a major cause of death in those with drug-resistant epilepsy (DRE). There is a need for inventories and biomarkers associated with the risk for SUDEP. Objective: To explore the revised SUDEP Risk Inventory (SUDEP-7) in a cohort with DRE and determine the association with Heart Rate and other covariates. Methods: Twenty-five subjects with severe DRE were enrolled in a clinical trial for epilepsy. Baseline demographics, duration of epilepsy, seizure types, seizure frequency, seizure severity, AEDs, and vital signs were collected. Heart rate variability (HRV) was calculated from 1-h recordings of ECG. A SUDEP Risk Inventory (SUDEP-7) was administered, which included seven validated and weighted risk factors initially identified by Walczak et al. as factors associated with SUDEP risk. Results: The total score on the revised SUDEP-7 ranged from 1 to 7, mean=3.4 (SD 1.8). The SUDEP Risk Inventory score was inversely correlated with RMSSD (Pearson r =??0.45, p=0.027). The following variables were significantly associated with RMSSD: epilepsy duration (p=0.02), age (p=0.03), and developmental intellectual disability (p<0.001). The correlation between RMSSD and SUDEP-7 tended to persist also after the adjustment for patient age (r =??0.40, p=0.05). Two subjects died of SUDEP: their SUDEP-7 scores were above average and in the upper twenty-fifth and fiftieth percentiles, respectively (6 and 4, mean=3.4). Conclusion: RMSSD, a measure of low frequency HRV, was significantly associated with SUDEP Risk Inventory (SUDEP-7) scores. Using a multivariate model, the covariates of developmental intellectual disability, age, and duration of epilepsy were also significantly associated with decreased HRV. The correlation between decreased HRV and a higher SUDEP-7 score remained unchanged even after the adjustment for patient age. The results suggest that older age, greater duration of epilepsy, and the presence of developmental intellectual disability may increase the risk of SUDEP through their direct influence on decreasing the vagus nerve-mediated HRV. Further validation of the SUDEP-7 inventory is indicated. Trial Registration: ClinicalTrials.gov, NCT00871377. [ABSTRACT FROM AUTHOR]

Therefore, although the SUDEP-3 may be more targeted to the sample of Tarighati Rasekhi and colleagues, we believe the SUDEP-7 may be more applicable to a broader pediatric and adult population, which is under-represented in this study. It is with great interest that we read the report by Tarighati Rasekhi and colleagues: "Improving prediction of sudden unexpected death in epilepsy: From SUDEP-7 to SUDEP-3"1 This study provides the first external validation of the sudden unexpected death in epilepsy (SUDEP)-7 inventory in a matched-cohort study. Dr. DeGiorgio and Ms. Markovic were involved in the development of the SUDEP-7 and have no commercial incentive for its use. [Extracted from the article]