Search

Objective: To perform a systematic review of the utility of exoskeleton robotic therapy on lower extremity recovery in Spinal Cord Injury (SCI) patients., Methods: We used the Embase, Cochrane, and PubMed databases and searched from January 2012 to December 2023 for studies on exoskeleton robotic assist devices used in working with SCI patients. Only articles published in English were evaluated, and the retrieved articles were screened via our inclusion/exclusion criteria. We conducted our meta-analysis with the Cochrane Review Manager 5.4 (RevMan) software. Robotic assisted gait training and conventional gait training methodology were compared using Walking Index for Spinal Cord Injury II (WISCII), Spinal Cord Independence Measure III (SCIM III), and 6 Minute Walk Test (6MWT) as reported outcome measures., Results: Eleven randomized clinical trials (RCTs) involving 552 total participants were included in the meta-analysis. The results of the meta-analysis indicated statistically significant improvement in SCIM III [MD 5.14, 95 % CI = (4.47, 5.810), P < 0.00001], WISCII [MD 2.31, 95 % CI = (2.13, 2.49), P < 0.00001] and 6MWT [MD 37.04, 95 % CI = (32.35, 41.74), P < 0.00001] in patients with SCI as compared to conventional gait training (CGT) therapy. Conclusion : Robotic Therapy could improve ambulation/quality of life in patients with spinal cord injuries compared to the standard treatment only, but future studies should include additional measures addressing quality of life and patient satisfaction., Competing Interests: None., (© 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Background: The anatomic substrate of bicuspid valves may lead to suboptimal TAVR stent expansion and geometry., Aim: We evaluated determinants of stent geometry in bicuspid valves treated with Sapien transcatheter aortic valve replacement (TAVR) valves., Methods: A multicenter retrospective registry of patients (February 2019 to August 2022) who underwent post-TAVR computed tomography to determine stent area (vs. nominal valve area) and stent ellipticity (maximum diameter/minimum diameter). Predictors of relative stent expansion (minimum area/average of inflow + outflow area) and stent ellipticity were evaluated in a multivariable regression model, including valve calcium volume (indexed by annular area), presence of raphe calcium, sinus diameters indexed by area-derived annular diameter, and performance of pre-dilation and post-dilation., Results: The registry enrolled 101 patients from four centers. The minimum stent area (vs. nominal area) was 88.1%, and the maximum ellipticity was 1.10, with both observed near the midframe of the valve in all cases. Relative stent expansion ≥90% was observed in 64/101 patients. The only significant predictor of relative stent expansion ≥90% was the performance of post-dilation (OR: 4.79, p = 0.018). Relative stent expansion ≥90% was seen in 86% of patients with post-dilation compared to 57% without (p < 0.001). The stent ellipticity ≥1.1 was observed in 47/101 patients. The significant predictors of stent ellipticity ≥1.1 were the indexed maximum sinus diameter (OR: 0.582, p = 0.021) and indexed intercommisural diameter at 4 mm (OR: 2.42, p = 0.001). Stent expansion has a weak negative correlation with post-TAVR mean gradient (r = -0.324, p < 0.001)., Conclusion: Relative stent expansion ≥90% was associated with the performance of post-dilation, and stent ellipticity ≥1.1 was associated with indexed intercommisural diameter and indexed maximum sinus diameter. Further studies to determine optimal deployment strategies in bicuspid valves are needed., (© 2024 The Author(s). Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)

With an estimated prevalence of 68% among healthy adults without a previous diagnosis of scoliosis, adult spinal deformities are a growing concern as the population ages. Our understanding of this growing concern has been historically guided by previous studies performed on the pediatric population. Over time, different classifications have been developed with their own respective limitations. The Roussouly classification was the first classification to describe the shapes of an asymptomatic spine. It considers lumbar lordosis, pelvic incidence, and the inflection point from lumbar lordosis to thoracic kyphosis to attempt to stratify the shapes of an asymptomatic spine. This classification aims to guide treatment, provide information regarding prognosis, allow stratification for research, and be highly reproducible. Overall, the Roussouly classification is a novel way to think about sagittal malalignment, considering the patient's individual anatomy, while allowing for communication between surgeons. Additionally, it has proven to be a reliable system that provides prognostic value for clinicians and may minimize complications when a patient's sagittal alignment is optimized using this classification system., Competing Interests: The authors report no funding. Dr. Avramis is a consultant for Acuity Surgical and DePuy Spine. The other authors report no potential conflicts of interest., (Copyright © 2024 Baylor University Medical Center.)

Objective: Suicide is the second leading cause of death in Canadian adolescents. The Interpersonal Theory of Suicide attempts to explain suicide etiology and proposes that feelings of perceived burdensomeness or thwarted belongingness lead to suicide ideation, but this has not been extensively studied in adolescents. This study aimed to use the Interpersonal Theory of Suicide to examine factors that may be associated with suicide ideation in adolescents. The factors of interest were school connectedness, perceived availability of support, self-esteem, feelings of worthlessness, feelings of hopelessness, bullying and cyberbullying victimization, substance use, and social media use., Methods: Data were from the 2017 Ontario Student Drug Use and Health Survey, a survey of 7th to 12th graders enrolled in a publicly funded school in Ontario. Weighted multivariate logistic regression of suicide ideation on all exposure variables was conducted., Results: 13.6% of students in the sample endorsed having suicidal ideation in the preceding 12 months. Not knowing where to turn to for support, feeling worthless, endorsing low self-esteem, being bullied, and using cannabis were each associated with greater odds of suicide ideation. Feeling hopeless, social media use, using alcohol and tobacco , and being cyberbullied were not associated with suicide ideation in the weighted multivariate logistic regression model., Conclusions: This study is consistent with the Interpersonal Theory of Suicide as low self-esteem and feelings of worthlessness, two indicators of perceived burdensomeness, and not knowing where to turn to for support, an indicator of thwarted belongingness, were associated with greater odds of suicide ideation. These findings can help guide interventions aimed at reducing the burden of suicidality during adolescence and demonstrate the need to provide accessible mental health support for youth.

Objective: Cefazolin is a heat-labile antibiotic that is not usually added to polymethylmethacrylate (PMMA) cement spacers because it is believed to be inactivated by the high polymerization temperatures. The purpose of this study was to compare cefazolin versus vancomycin high-dose antibiotic cement spacers., Methods: High-dose antibiotic PMMA spacers with either cefazolin or vancomycin were fabricated. Setting time, compressive strength, and compression modulus of spacers were measured. Spacers were emerged in saline, and the eluent was tested on days 1, 2, 3, 7, 14, and 30 to determine the zone of inhibition of methicillin-sensitive Staphylococcus aureus and estimate the cumulative antibiotic released., Results: Cefazolin, compared with vancomycin-loaded spacers, had significantly shorter setting time [mean difference (MD) -1.8 minutes, 95% confidence interval (CI), -0.6 to -3.0], greater compressive strength (MD 20.1 megapascal, CI, 15.8 to 24.5), and compression modulus (MD 0.15 megapascal, CI, 0.06 to 0.23). The zone of inhibition of eluent from PMMA-C spacers was significantly greater than PMMA-V spacers at all time points, an average of 11.7 ± 0.8 mm greater across time points. The estimated cumulative antibiotic released from cefazolin spacers was significantly greater at all time points ( P < 0.0001)., Conclusions: Cefazolin was not inactivated by PMMA polymerization and resulted in spacers with superior antimicrobial and biomechanical properties than those made with vancomycin, suggesting that cefazolin could play a role in the treatment of infected bone defects with high-dose antibiotic PMMA spacers., Competing Interests: The authors report no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: While nicotine replacement therapy (NRT) is a frontline tobacco treatment that doubles smoking quit rates, only about 18% of Black adults who smoke cigarettes report lifetime use of NRT. A promising approach for increasing NRT use is in-session (in-vivo) NRT sampling within cessation interventions. The present pilot study examined the effectiveness of an in-vivo NRT sampling intervention within a single-session, culturally-targeted motivational intervention trial in Black adults who smoke cigarettes., Methods: Non-treatment-seeking disadvantaged Black adults (N = 60) were offered the choice to sample nicotine lozenge, patch, or both in-session with the counselor present. Regardless of their choice, they were offered a one-week starter kit of both products. Data were analyzed at baseline and 1-month follow-up. Primary outcomes were 1) differences in motivation to quit smoking among NRT samplers versus non-samplers, 2) in-vivo NRT sampling preferences, and 3) in-vivo sampling's association with NRT use and improved smoking outcomes at follow up., Results: Almost all participants accepted a take-home NRT starter kit, and approximately half of those offered in-vivo sampling agreed to sample. Participants preferred sampling lozenges in session (75.8% lozenge only vs. 12.1% nicotine patch only or 12.1% both; p < .001). Motivation to quit smoking was not related to likelihood of in-vivo NRT sampling (p > .05). At 1-month follow-up, in-vivo samplers were more likely to use NRT (94% vs. 35%, respectively; p < .001) and report a quit attempt (81.8% vs. 53.9%, p < .05) compared to non-samplers., Conclusion: In-vivo NRT sampling is a promising strategy to improve NRT uptake among Black adults who smoke cigarettes, regardless of motivation to quit smoking., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Annular and left ventricular outflow tract (LVOT) calcification increase the risk of annular rupture following transcatheter aortic valve replacement (TAVR). The outcomes of a strategy of routine use of a balloon-expandable valve (BEV) for all patients irrespective of annular or LVOT calcium is unknown., Objectives: We evaluated the impact of bespoke sizing on annular rupture in patients treated with a BEV., Methods: All consecutive patients undergoing TAVR at a single centre (February 2020-February 2022) were treated only with a BEV. No other valve design was used. Annular/LVOT calcification was assessed using a standardized grading system. For each annular area, we determined the percentage valve oversizing with nominal deployment. The balloon deployment volume was then adjusted when required (over-/underfilled) to achieve over-sizing of approximately 5% in the presence of annular/LVOT calcium and 5%-10% in the absence of annular/LVOT calcium. Adjusted valve areas were assumed to change proportionately to the change in balloon deployment volume., Results: Among 533 TAVR treated patients, annular/LVOT calcification was present in 166 (31.1%) and moderate or severe in 90 (16.9%). In patients with annular/LVOT calcification, the adjusted oversizing was 3.5 ± 3.6% and in patients without annular/LVOT calcification, the adjusted oversizing was 6.8 ± 4.7% (p &lt; 0.001). There were no cases of annular rupture and no cases with more than mild paravalvular leak (PVL). Mild PVL was more frequent in patients with annular/LVOT calcium (10.8% vs 4.6%, p = 0.01)., Conclusion: Bespoke BEV sizing by adjustment of balloon deployment volume avoided annular rupture in patients undergoing TAVR., (© 2022 Wiley Periodicals LLC.)

Aims: The optimal strategy of monitoring for conduction disturbances in patients undergoing transcatheter aortic valve implantation (TAVI) is uncertain. We evaluated a pre- and post-TAVI remote ambulatory cardiac monitoring (rACM) strategy for identification of conduction disturbances and to reduce unplanned pre-discharge post-TAVI permanent pacemaker implantation (PPMI)., Methods and Results: REdireCT TAVI (NCT0381820) was a prospective cohort study of patients referred for outpatient TAVI. Patients with prior PPMI were excluded. Remote ambulatory cardiac monitoring consisted of 2 weeks of continuous electrocardiogram (ECG) monitoring (Pocket-ECGTM) both before and after TAVI. Compliance to monitoring, frequency of notifications, unplanned PPMI post-TAVI, and length of hospitalization were measured. Between June 2018 and March 2020, in 192 undergoing TAVI (mean age: 81.8 years; female sex 46%; balloon-expandable valve 95.3%), compliance to rACM was 91.7% pre-TAVI (mean duration: 12.8 days), and 87.5% post-TAVI (mean duration: 12.9 days). There were 24 (12.5%) rACM notifications (13 pre-TAVI; 11 post-TAVI) resulting in 14 (7.3%) planned PPMI: seven pre-TAVI [due to sinus pauses n = 2 or atrio-ventricular block (AVB) n = 5] and seven post-TAVI [due to sinus pauses n = 1 or AVB n = 5 or ventricular tachycardia (VT) n = 1]. In addition, nine (4.7%) patients received pre-TAVI PPMI due to high-risk baseline ECG (right bundle branch block with hemi-block or prolonged PR interval). Unplanned PPMI post-TAVI during index hospitalization occurred in six (3.1%) patients due to AVB and in one patient readmitted with AVB. The median length of stay post-TAVI was 1 day., Conclusion: A strategy of routine rACM was feasible and frequently led to PPMI. Our approach of 2-week rACM both pre- and post-TAVI achieves both high patient compliance and sufficient surveillance., Clinical Trial Registration: Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03810820., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background/purpose: Acute subjective alcohol effects appear to play an important role in predicting alcohol hangover. However, no studies have used a laboratory-based alcohol challenge to examine the concurrent or longitudinal effects of subjective alcohol responses on hangover frequency. As such, we investigated the direct and indirect effects of alcohol stimulation, sedation, liking and wanting, as measured in a controlled setting, on hangover frequency over five years., Method: Participants were 294 young adult light-to-heavy social drinkers (aged 21-35 years, 42% female) enrolled in the Chicago Social Drinking Project. The study utilized a placebo-controlled, double blind, laboratory alcohol challenge and a battery of measures including the Biphasic Alcohol Effects Scale, Drug Effects Questionnaire, Hangover Symptom Scale, and alcohol use Quantity-Frequency Interview, with the latter two re-administered after five years., Results: Through the use of a path analysis, the present study found significant direct effects from alcohol liking to hangover frequency at initial testing. In addition, there were multiple significant indirect effects from greater alcohol liking and wanting to greater alcohol use quantity-frequency and, in turn, greater hangover frequency at initial testing and 5-year follow-up. Last, there were significant indirect effects from greater alcohol sedation to less alcohol use quantity-frequency and, in turn, less hangover frequency at initial testing and 5-year follow-up., Conclusion: This study highlights the role of the hedonic reward and motivational salience of alcohol as potential mechanisms of alcohol-related consequences (i.e., hangover) among light-to-heavy social drinking young adults., (Copyright © 2022 Elsevier Ltd. All rights reserved.)