PFO closure complications from the AGA registry

Objectives: To evaluate all complications that occurred during or after cardiac catheterizations for Amplatzer PFO device closure of patent foramen ovale (PFO), determine the cause of the complications and recommend techniques to minimize complications in the future. Background: Rare complications were reported to the manufacturer of the Amplatzer PFO occluder since the introduction of the device. Methods: A panel of independent physicians reviewed all complications reported to the manufacturer to determine whether the complication was related to the device or related to the cardiac catheterization procedure. Demographic data, echocardiograms, operative reports, and time to occurrence of complications were reviewed. Results: A total of 11 events were reported. Only two patients had device related complications (erosion), an incidence of 0.018%. Two patients were found to have additional atrial septal defect after PFO closure. Two patients were thought to have an inflammatory reaction without any serious sequelae. Five complications were related to the cardiac catheterization procedure (atrial appendage perforation). Conclusions: Device related complications after Amplatzer PFO occluder placement are extremely rare. Cardiac catheterization related complications appear to be the most common cause of the hemodynamic compromise. Careful manipulation of catheters and wires, recognition of the location of the catheter by fluoroscopy and echocardiography will decrease the risk of such complications. © 2008 Wiley‐Liss, Inc.     

Association of bone marrow fibrosis with inferior survival outcomes in chronic myelomonocytic leukemia

The impact of bone marrow fibrosis grade on the prognosis of patients with chronic myelomonocytic leukemia (CMML) remains controversial. Therefore, we examined the records of 82 patients diagnosed with CMML at our institution and summarized baseline characteristics and molecular profiles by subgroups of absent or mild (grades 0/1) and moderate (grade 2) fibrosis. Cox proportional hazards models were constructed to assess the prognostic significance of fibrosis grade. Grade 2 fibrosis was identified in 63 patients (76.8%), grade 1 in 16 patients (19.5%), and grade 0 in 3 patients (3.7%). Grade 2 fibrosis was associated with reduced hemoglobin levels (median 9.75 vs 11.0 g/dL in grade 0/1; p?=?0.04) and increased percentages of ringed sideroblasts (7.5 vs 0%; p?=?0.008). In multivariable analysis, grade 2 fibrosis was an independent predictor of poor overall survival (OS; 95% CI 1.32–6.35; HR 2.90; p?=?0.008), but not event-free survival (EFS; 95% CI 0.62–2.67; HR 1.28; p?=?0.50). Absolute neutrophil count (ANC) was found to impact OS (95% CI 1.01–1.09; HR 1.05; p?=?0.009), while both ANC (95% CI 1.00–1.07; HR 1.04; p?=?0.04) and peripheral blood blast percentage (95% CI 1.02–1.32; HR 1.16; p?=?0.02) impacted EFS. These results implicate fibrosis grade is an important indicator of prognosis, with high-grade fibrosis predicting inferior survival. Given the prevalence of marrow fibrosis in CMML, fibrosis grading should be incorporated into prognostic assessment and therapeutic decision-making.     

Bottom-up analysis of emergent properties of N-acetylcysteine as an adjuvant therapy for COVID-19

N-acetylcysteine (NAC) is an abundantly available antioxidant with a wide range of antidotal properties currently best studied for its use in treating acetaminophen overdose. It has a robustly established safety profile with easily tolerated side effects and presents the Food and Drug Administration's approval for use in treating acetaminophen overdose patients. It has been proven efficacious in off-label uses, such as in respiratory diseases, heart disease, cancer, human immunodeficiency virus infection, and seasonal influenza. Clinical trials have recently shown that NAC's capacity to replenish glutathione stores may significantly improve coronavirus disease 2019 (COVID-19) outcomes, especially in high risk individuals. Interestingly, individuals with glucose 6-phosphate dehydrogenase deficiency have been shown to experience even greater benefit. The same study has concluded that NAC's ability to mitigate the impact of the cytokine storm and prevent elevation of liver enzymes, C-reactive protein, and ferritin is associated with higher success rates weaning from the ventilator and return to normal function in COVID-19 patients. Considering the background knowledge of biochemistry, current uses of NAC in clinical practice, and newly acquired evidence on its potential efficacy against COVID-19, it is worthwhile to investigate further whether this agent can be used as a treatment or adjuvant for COVID-19.     

Effect of piezocision corticotomy on en-masse retraction:: A randomized controlled trial

ObjectivesTo compare the amount of en-masse retraction with or without piezocision corticotomy, to assess the type of tooth movement, to evaluate root integrity after retraction, and to record reported pain levels.Materials and MethodsThis randomized, controlled clinical trial included 26 orthodontic patients requiring premolar extraction. The patients were divided into two groups: (1) an extraction with piezocision corticotomy group (PCG) and (2) an extraction-only group, which served as the control group (CG). Cone-beam computed tomography images were acquired before and 4 months after the initiation of en-masse retraction utilizing miniscrews. The following variables were assessed: the amount of en-masse retraction, incisor inclination, incisor and canine root resorption, and patient-reported pain.ResultsTwelve and 11 participants completed the entire study in the PCG and CG, respectively. The amount of en-masse retraction was significantly greater in the PCG compared to the CG (mean = 4.8 ± 0.57 mm vs 2.4 ± 0.33 mm, respectively [P < .001]). There was also significantly less tipping and root resorption of incisors in the PCG (P < .05). The reported pain was significantly higher on the first day in the PCG compared to the CG (P < .001); however, it became similar between the groups after 24 hours.ConclusionsPiezocision corticotomy enhanced the amount of en-masse retraction two times more with less root resorption. However, future studies are required to assess the long-term effects of this technique.     

From the Cover: Agriculture,population growth,and statistical analysis of the radiocarbon record

The human population has grown significantly since the onset of the Holocene about 12,000 y ago. Despite decades of research, the factors determining prehistoric population growth remain uncertain. Here, we examine measurements of the rate of growth of the prehistoric human population based on statistical analysis of the radiocarbon record. We find that, during most of the Holocene, human populations worldwide grew at a long-term annual rate of 0.04%. Statistical analysis of the radiocarbon record shows that transitioning farming societies experienced the same rate of growth as contemporaneous foraging societies. The same rate of growth measured for populations dwelling in a range of environments and practicing a variety of subsistence strategies suggests that the global climate and/or endogenous biological factors, not adaptability to local environment or subsistence practices, regulated the long-term growth of the human population during most of the Holocene. Our results demonstrate that statistical analyses of large ensembles of radiocarbon dates are robust and valuable for quantitatively investigating the demography of prehistoric human populations worldwide.The population is currently growing at an average rate of 1% per year with some countries exhibiting growth rates as large as a few percent or more (1). Such high growth rates are a phenomenon associated with modern industrial human societies and far exceed the average growth rates of prehistoric populations (2). The current rapid growth of the human species belies a humble beginning. Fossil evidence suggests that anatomically modern humans evolved some 200,000 y ago (3). Based on genetic studies of mitochondrial DNA, it appears that, for the first 100,000 y, humans inhabited Africa in relatively small, isolated groups existing on the brink of extinction (4). Perhaps driven by unstable environmental conditions, humans migrated 60,000–80,000 y ago (5) into Europe, Asia, and Australia (6, 7). At the dawn of the Holocene 12,000 y ago, humans had already arrived to the Americas (8), successfully populating virtually the whole planet.The onset of the Holocene marked the transition to an epoch of significantly warmer temperatures, higher CO₂ content, and a relatively stable climate (9, 10). These environmental conditions are conducive to agriculture (11), which may have increased food productivity, thus accelerating population growth. Accelerated population growth associated with agriculture is sometimes referred to as the Agricultural or Neolithic Demographic Transition (12). The causal link between agriculture and accelerated population growth remains controversial (13–15).Studies of prehistoric skeletal remains and genetic coalescent analysis are some of the most rigorous attempts to investigate a potential causal link between agriculture and accelerated population growth. Cemetery data show that fertility increased during the transition to agriculture (12, 16–18). However, mortality cannot be measured from these data, and thus the population growth rate is unknown (18). Accelerated growth also may be inferred from genetic diversity among modern populations. However, the conversion of genetic diversity into a growth rate is subject to several systematic uncertainties and thus far has yielded contradictory results regarding the impact of the agricultural transition on population growth (19–24).Radiocarbon dates provide a direct record of prehistoric human activity, and large samples have been used for quantitative demographic analysis (25–30). Larger populations produce more datable material; thus, the temporal frequency of the radiocarbon record reflects the size of the population. Here, we use the summed probability distribution (SPD) of an ensemble of calibrated radiocarbon measurements, corrected for taphonomic loss (31), as a proxy for the relative size of a population as a function of time (Materials and Methods). The SPD provides a proxy measurement of the size of a prehistoric population with a level of precision and time resolution not currently attainable by any other technique. Using the SPD approach, we compare measurements of long-term population growth rates worldwide to investigate the impact of agriculture on the growth of prehistoric societies.     

Health and wellbeing of Victorian adults with intellectual disability compared to the general Victorian population

Multiple measures of health and wellbeing of people with intellectual disability (ID) and the general Victorian population were compared using representative population level data. The sample consisted of adults with ID (N = 897) and the general Victorian population (N = 34,168) living in the state of Victoria in Australia. Proxy respondents were interviewed on behalf of people with ID, while respondents from the general Victorian population were interviewed directly. The data were weighted to reflect the age/sex/geographic distribution of the population. Results revealed that adults with ID reported higher prevalence of poor social determinants of health, behavioural risk factors, depression, diabetes, poor or fair health. A higher proportion of people with ID reported blood pressure and blood glucose checks, while a lower proportion reported cervical and breast cancer screening, compared with the general Victorian population. The survey identified areas where targeted approaches may be undertaken to improve the health outcomes of people with ID and provide an important understanding of the health and wellbeing of these Victorians.     

ASO Visual Abstract: Practice Patterns of Antibiotic Prophylaxis in Patients Undergoing Mastectomy—A Survey of Members of the American Society of Breast Surgeons

Annals of Surgical Oncology -