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Abstract In Costa Rica there is little information about asthma admissions. In this report the monthly asthma admissions and weather data for a seven year period were reviewed. The hospital [...]

The San Andreas Fault Observatory at Depth pilot hole is located on the southwestern side of the Parkfield San Andreas fault. This observatory includes a vertical seismic profiling (VSP) array. VSP seismograms from nearby microearthquakes contain signals between the P and S waves. These signals may be P and S waves scattered by the local geologic structure. The collected scattering points form planar surfaces that we interpret as the San Andreas fault and four other secondary faults. The scattering process includes conversions between P and S waves, the strengths of which suggest large contrasts in material properties, possibly indicating the presence of cracks or fluids. [ABSTRACT FROM AUTHOR]

Research is limited on the effects of regular substance use on mental health-related outcomes. We used a large nationally representative survey to examine current and future quality of life and risk of psychiatric disorders among past-year regular (weekly) users of alcohol, nicotine, and cannabis. Data on psychiatric disorders and quality of life from two waves (Wave 1 N = 43,093, Wave 2 N = 34,653) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were used to test study aims. In cross-sectional analyses, regular nicotine and cannabis use were associated with higher rates of psychiatric disorder, though regular alcohol use was associated with lower rates of disorders. Prospective analyses found that regular nicotine use predicted onset of anxiety, depressive, and bipolar disorders. Regular alcohol use predicted lower risk of these disorders. Regular cannabis use uniquely predicted the development of bipolar disorder, panic disorder with agoraphobia, and social phobia. Lastly, regular alcohol use predicted improvements in physical and mental health-related quality of life, whereas nicotine predicted deterioration in these outcomes. Regular cannabis use predicted declines in mental, but not physical health. These data add to the literature on the relations between substance use and mental and physical health and suggest increased risk of mental health problems among regular nicotine and cannabis users and better mental and physical health among regular alcohol users. Examination of mechanisms underlying these relationships is needed. [ABSTRACT FROM AUTHOR]

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.)