Showing papers by "Lenox Hill Hospital published in 2022"

Overview of tau PET molecular imaging

Abstract: Purpose of review This article reviews tau PET imaging with an emphasis on first-generation and second-generation tau radiotracers and their application in neurodegenerative disorders, including Alzheimer's disease and non-Alzheimer's disease tauopathies. Recent findings Tau is a critical protein, abundant in neurons within the central nervous system, which plays an important role in maintaining microtubules by binding to tubulin in axons. In its abnormal hyperphosphorylated form, accumulation of tau has been linked to a variety of neurodegenerative disorders, collectively referred to as tauopathies, which include Alzheimer's disease and non-Alzheimer's disease tauopathies [e.g., corticobasal degeneration (CBD), argyrophilic grain disease, progressive supranuclear palsy (PSP), and Pick's disease]. A number of first-generation and second-generation tau PET radiotracers have been developed, including the first FDA-approved agent [18F]-flortaucipir, which allow for in-vivo molecular imaging of underlying histopathology antemortem, ultimately guiding disease staging and development of disease-modifying therapeutics. Summary Tau PET is an emerging imaging modality in the diagnosis and staging of tauopathies.

Clinical results and patient-reported outcomes following robotic-assisted primary total knee arthroplasty

Abstract: Aims The aim of this study was to report patient and clinical outcomes following robotic-assisted total knee arthroplasty (RA-TKA) at multiple institutions with a minimum two-year follow-up. Methods This was a multicentre registry study from October 2016 to June 2021 that included 861 primary RA-TKA patients who completed at least one pre- and postoperative patient-reported outcome measure (PROM) questionnaire, including Forgotten Joint Score (FJS), Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement (KOOS JR), and pain out of 100 points. The mean age was 67 years (35 to 86), 452 were male (53%), mean BMI was 31.5 kg/m 2 (19 to 58), and 553 (64%) cemented and 308 (36%) cementless implants. Results There were significant improvements in PROMs over time between preoperative, one- to two-year, and > two-year follow-up, with a mean FJS of 17.5 (SD 18.2), 70.2 (SD 27.8), and 76.7 (SD 25.8; p < 0.001); mean KOOS JR of 51.6 (SD 11.5), 85.1 (SD 13.8), and 87.9 (SD 13.0; p < 0.001); and mean pain scores of 65.7 (SD 20.4), 13.0 (SD 19.1), and 11.3 (SD 19.9; p < 0.001), respectively. There were eight superficial infections (0.9%) and four revisions (0.5%). Conclusion RA-TKA demonstrated consistent clinical results across multiple institutions with excellent PROMs that continued to improve over time. With the ability to achieve target alignment in the coronal, axial, and sagittal planes and provide intraoperative real-time data to obtain balanced gaps, RA-TKA demonstrated excellent clinical outcomes and PROMs in this patient population. Cite this article: Bone Jt Open 2022;3(7):589–595.

Efficacy of the monocarbonyl curcumin analog C66 in the reduction of diabetes-associated cardiovascular and kidney complications

Abstract: Abstract Curcumin is a polyphenolic compound derived from turmeric that has potential beneficial properties for cardiovascular and renal diseases and is relatively safe and inexpensive. However, the application of curcumin is rather problematic due to its chemical instability and low bioavailability. The experimental results showed improved chemical stability and potent pharmacokinetics of one of its analogs – (2 E ,6 E )-2,6-bis[(2-trifluoromethyl)benzylidene]cyclohexanone (C66). There are several advantages of C66, like its synthetic accessibility, structural simplicity, improved chemical stability (in vitro and in vivo), presence of two reactive electrophilic centers, and good electron-accepting capacity. Considering these characteristics, we reviewed the literature on the application of C66 in resolving diabetes-associated cardiovascular and renal complications in animal models. We also summarized the mechanisms by which C66 is preventing the release of pro-oxidative and pro-inflammatory molecules in the priming and in activation stage of cardiomyopathy, renal fibrosis, and diabetic nephropathy. The cardiovascular protective effect of C66 against diabetes-induced oxidative damage is Nrf2 mediated but mainly dependent on JNK2. In general, C66 causes inhibition of JNK2, which reduces cardiac inflammation, fibrosis, oxidative stress, and apoptosis in the settings of diabetic cardiomyopathy. C66 exerts a powerful antifibrotic effect by reducing inflammation-related factors (MCP-1, NF-κB, TNF-α, IL-1β, COX-2, and CAV-1) and inducing the expression of anti-inflammatory factors (HO-1 and NEDD4), as well as targeting TGF-β/SMADs, MAPK/ERK, and PPAR-γ pathways in animal models of diabetic nephropathy. Based on the available evidence, C66 is becoming a promising drug candidate for improving cardiovascular and renal health.

The Association between Cognitive Reserve and Depressive Mood in Older Inpatients: Gender and Age Differences

Abstract: Cognitive Reserve (CR) plays a protective role in neurological and acute/chronic diseases. Its effect on mood, however, is still unclear, although it may be relevant in a hospital setting. We aimed to explore the relationship between CR and depressive mood in older inpatients, evaluating possible gender- and age-related differences. This study involved 86 inpatients aged ≥65 years with an MMSE ≥15. Participants underwent a multidimensional evaluation that included the assessment of CR with the Cognitive Reserve Index questionnaire, divided into three sections (Education, Working Activity, and Leisure Time). Depressive mood was assessed with the 15-item Geriatric Depression Scale (GDS). The relationship between CR and GDS was evaluated by multivariable linear regressions. Significant inverse associations between CR and GDS scores emerged in the total sample (β = −0.03 [SD = 0.02], p = .047), especially in men (β = −0.05 [SD = 0.02], p = .005) and in individuals aged <85 years (β = −0.07 [SD = 0.03], p = .01). Among the single CRI sections, CRI-Leisure Time was significantly associated with GDS in the total sample, in men, and participants <85 years. CR seems to be inversely associated with depressive mood in older inpatients. This relationship is particularly marked for CR related to Leisure Time, which may be modifiable even in older age through social support and interaction.

Assessment of Level of Fear in Adult Patients Undergoing Elective Urogynecologic and Gynecologic Procedures and Surgeries During the COVID-19 Pandemic Using the Validated Surgical Fear Questionnaire

Abstract: This study aimed to assess and trend fears surrounding elective surgery and office procedures in benign gynecologic and urogynecologic patients during the coronavirus disease 2019 (COVID-19) pandemic.This was a multicenter, prospective, observational study. Recruitment occurred from June 23, 2020, to March 23, 2021. Females 18 years or older presenting for elective benign gynecologic or urogynecologic surgery or office procedures were eligible. Patients were excluded if non-English speaking or undergoing an emergent procedure or surgery. Fear was assessed by the Surgical Fear Questionnaire (SFQ), which was also modified to include 2-4 additional questions pertaining to COVID-19 (modified version of the Surgical Fear Questionnaire [mSFQ]). Total SFQ scores and short- and long-term fear scores were compared between procedures and surgery and to historic data.A total of 209 patients undergoing 107 procedures or 102 surgical procedures completed the questionnaire. Participants were separated into subgroups determined by the timing of questionnaire completion related to phases of the pandemic. The most common procedure was urodynamics (n = 59 [55%]). The most common elective surgical procedure was hysterectomy (n = 59 [57.8%]). Furthermore, 72.5% of surgical procedures were for urogynecologic indications.Fear levels were low and not different in patients undergoing procedures versus surgery (12.38 ± 12.44 vs 12.03 ± 16.01, P = 0.958). There was no difference between procedures versus surgery for short- (6.21 ± 8.38 vs 6.81 ± 8.44, P = 0.726) or long-term fear (6.18 ± 8.89 vs 5.22 ± 8.20, P = 0.683). Compared with historic data, our hysterectomy patients had less surgical fear. The mSFQ demonstrated higher fear scores for both procedures and surgery (mSFQ, 20.57 ± 20.55 for procedures; 28.78 ± 28.51 for surgery). There were no significant fluctuations in SFQ score in relation to critical COVID-19 events.Fear of surgery and office procedures was low and consistent throughout the COVID-19 pandemic and lower than historic data.

Evolution of Proximal Junctional Kyphosis and Proximal Junctional Failure Rates Over 10 Years of Enrollment in a Prospective Multicenter Adult Spinal Deformity Database

Abstract: Retrospective cohort study.The aim of this study was to investigate the evolution of proximal junctional kyphosis (PJK) rate over 10-year enrollment period within a prospective database.PJK is a common complication following adult spinal deformity (ASD) surgery and has been intensively studied over the last decade.Patients with instrumentation extended to the pelvis and minimum 2-year follow-up were included. To investigate evolution of PJK/proximal junctional failure (PJF) rate, a moving average of 321 patients was calculated across the enrollment period. Logistic regression was used to investigate the association between the date of surgery (DOS) and PJK and/or PJF. Comparison of PJK/PJF rates, demographics, and surgical strategies was performed between the first and second half of the cohort.A total of 641 patients met inclusion criteria (age: 64±10 years, 78.2% female, body mass index: 28.3±5.7). The overall rate of radiographic PJK at 2 years was 47.9%; 12.9% of the patients developed PJF, with 31.3% being revised within 2-year follow-up. Stratification by DOS produced two halves. Between these two periods, rate of PJK and PJF demonstrated nonsignificant decrease (50.3%-45.5%, P =0.22) and (15.0%-10.9%, P =0.12), respectively. Linear interpolation suggested a decrease of 1.2% PJK per year and 1.0% for PJF. Patients enrolled later in the study were older and more likely to be classified as pure sagittal deformity ( P <0.001). There was a significant reduction in the use of three-column osteotomies ( P <0.001), an increase in anterior longitudinal ligament release ( P <0.001), and an increase in the use of PJK prophylaxis (31.3% vs 55.1%). Logistical regression demonstrated no significant association between DOS and radiographic PJK ( P =0.19) or PJF ( P =0.39).Despite extensive research examining risk factors for PJK/PJF and increasing utilization of intraoperative PJK prophylaxis techniques, the rate of radiographic PJK and/or PJF did not significantly decrease across the 10-year enrollment period of this ASD database.

Upper versus Lower Lumbar Lordosis Corrections in Relation to Pelvic Tilt – An Essential Element in Surgical Planning for Sagittal Plane Deformity

Abstract: Retrospective study of a multicenter Adult Spinal Deformity (ASD) Database.To investigate the change in Pelvic tilt (PT) imparted by regional changes in lumbar lordosis at 2-year minimum follow up.The distribution of lumbar lordosis between L1-4 and L4-S1 is known to vary based on pelvic incidence (PI). However, the extent to which regional changes effect PT is not clearly elucidated. This information can be useful for ASD surgical planning.Operative patients from a multicenter ASD database were included with Lowest Instrumented Vertebrae (LIV) S1/Ilium, >5 levels of fusion, Proximal Junction Kyphosis (PJK) angle < 20, and >5 degrees of change in lumbar lordosis from L4-S1 and L1-4. Radiographic analysis was performed evaluating Thoracic Kyphosis (TK), T10-L2 kyphosis (TL), L1-S1 lordosis (LL), L4-S1 lordosis, L1-4 lordosis, sagittal vertical axis (SVA) and PI-LL from preoperative to postoperative, and change at 2-years follow-up. Stepwise regression analysis was performed in order to determine the relationship between PT and the above radiographic parameters. Health-related quality of life (HRQOL) outcomes were also compared between preoperative and postoperative timepoints at 2 years.103 patients met inclusion for the study. There was improvement in all the radiographic parameters and HRQOLs at 2 years follow-up (p < 0.01). Stepwise regression model showed an inverse relationship between PT and LL change (r = 0.71, p < 0.01). Regionally, an increase in 10 degrees from L4-S1 correlated with a 2.4 degree decrease in PT (p < 0.01), while an increase in 10 degrees from L1-4 resulted in a 1.6 degree decrease in PT (p < 0.01).In the surgical planning for ASD, our data demonstrated significant correlational difference between corrections in the upper (L1-4) and lower (L4-S1) lumbar spine and PT changes. These calculations can be useful in planning sagittal plane corrections for ASD.

Medical Professionalism and Physician Dignity: Are We at Risk of Losing It?

Abstract: A vast literature that includes the paradigm of dignity-in-care has repeatedly underlined the need for a patient-centered approach in medicine. The medical system is obligated to relate to patients in all the appropriate humanistic dimensions (i.e., biological, psychological, social, and spiritual) to provide quality healthcare. However, many healthcare systems across the globe are changing due to the despotism of bureaucracy, budgeting, and downsizing of resources. A transformation of the doctor-patient relationship has occurred to accommodate a sort of commercial trade between producers and consumers. The reduction of medicine to a technological evidence-based paradigm (e.g., rigid clinical methods with only objective perspectives and quantitative measurement searching for one absolute quantifiable objective “truth”) stands in opposition to a person-oriented value-based medicine (e.g., with flexible methods and subjective perspectives gained through qualitative approaches and awareness of the relativity of “truths”) and has undermined the long-standing and venerated humanistic approach in medicine. “Dignity” within the dyadic doctor-patient relationship means to recuperate the personhood of the physician as a human being. The nuances of person-centered medicine require the presence of the integrated, well-adjusted physician, capable of flexibility and fortitude. Therefore, the literature regarding burnout (as an occupational syndrome recognized by the WHO ICD-11) and the inter-related concepts of compassion fatigue, moral distress, and vicarious traumatization (or secondary traumatic stress) among physicians and healthcare professionals should be taken into careful consideration. The significant negative consequences of these conditions impact not only patient satisfaction and health outcomes but also the biopsychosocial health and quality of life of physicians. The corporatization and concomitant technological advances of medicine threaten its humanistic underpinnings as respect for patients and the physician is compromised.

Full-Length Spine—Clinical Correlations With Specific Phenotypes and Measurements With Classification Systems

Abstract: Full-length spine imaging is indicated in several clinical scenarios in the daily practice of a spine surgeon. A detailed understanding of spinal anatomy and imaging parameters allows the surgeon to make the best clinical judgment in the care of their patients. This chapter briefly highlights specific radiographic parameters and common measurements in full-length spinal radiographs. Indications for advanced imaging techniques, including CT scans, MRI imaging, and 3-dimensional models, will also be addressed. And lastly, how these imaging parameters form the basis of widely accepted classification systems that are critical to routine clinical practice and research methodology.

Excess activity of 3-hydroxykynurenine, quinolinic acid, and other toxic tryptophan metabolites in neurogenerative diseases and other protein misfolding diseases

Abstract: Many diseases, particularly diseases caused by neural degeneration, have important similarities in that cell death is associated with abnormal deposition of protein aggregates within neuronal cells. These diseases tend to occur predominantly in older individuals and to be slowly progressive. Notable examples include Parkinson's disease (PD), Alzheimer's disease (ALZ), amyotrophic lateral sclerosis (ALS) and Huntington's disease (HD). These neurodegenerative diseases are all proteopathies, diseases of protein misfolding, and misfolded proteins tend to aggregate and cause damage within neurons. Abnormal protein folding is also a prominent feature of other diseases, including diseases as different as sickle cell anemia, type 2 diabetes, cystic fibrosis, autism spectrum disorder, cataracts of the eye, schizophrenia, multiple sclerosis, and even of aging itself. Abnormal tryptophan (TRY) metabolism appears to play a crucial role in the causation of each of these diseases, through numerous mechanisms. Importantly, excess production of neurotoxic kynurenines, such as 3-hydroxykynurenine (3-HK), quinolinic acid (pyridine-2,3-dicarboxylate, QUIN) and xanthurenic acid, potentiate the protein misfolding and aggregation that characterize these diseases. Optical spectroscopy of TRY and its toxic metabolites provides further evidence for the role of the KYN pathway in these diseases.

A Rare Cancer in an Elderly Man with Cervical Radiculopathy: A case report

Abstract: Abstract Chordomas are low-grade, locally invasive, frequently recurring, malignant bone tumor with poor prognosis. Cervical chordoma in adults is rare and often missed when patients present with cervical radiculopathy. They can mimic other malignant tumors and, hence require histologic distinction for prognostic risk stratification and optimal treatment. We present a 61-year-old male with chronic neck pain and sensory neuropathy in bilateral upper limbs. The patient underwent cervical discectomy and fusion which revealed a cystic mass arising from the right neural foramina at C5-C6 level. Histopathological examination of the mass was consistent with chordoma. Elderly patients with cervical radiculopathy should be evaluated for neoplasia including chordoma and differentiated from other etiologies. Early diagnosis and treatment can reduce morbidity and mortality from chordoma.

Guidance and Assessment of Preconception Risk

Abstract: Preconception care is a wide term which refers to the process of meeting with a woman and her partner, identifying risks to a woman’s health, fertility, and pregnancy outcome as they relate to a woman becoming pregnant. The goals of preconception care are to identify potential the risks to the mother, fetus, and pregnancy; educate women about these risks; provide options for intervention and management for risk reduction; advise on reproductive alternatives, and initiate interventions to provide optimum maternal, fetal, and pregnancy outcomes. The goals of preconception health care are to provide guidance; identify, address, and reduce potential risks; and provide an informed consent process to understand their risks prior to pregnancy. In addition, preconception care allows for counseling about delaying pregnancy until risks have been reduced.

<i>The Collected Works of Anna Letitia Barbauld: The Poems, Revised</i>. Edited by William McCarthy. Oxford: Oxford University Press, 2019. 512 pp. $175.00. ISBN 978-0-1987-0434-8.

Abstract: Previous articleNext article No AccessBook ReviewsThe Collected Works of Anna Letitia Barbauld: The Poems, Revised. Edited by William McCarthy. Oxford: Oxford University Press, 2019. 512 pp. $175.00. ISBN 978-0-1987-0434-8.Jessica LimJessica LimUniversity of Cambridge Search for more articles by this author PDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Early Modern Women: An Interdisciplinary Journal Volume 16, Number 2Spring 2022 Published for the Society for the Study of Early Modern Women and Gender Article DOIhttps://doi.org/10.1086/717621 Views: 6Total views on this site For permission to reuse, please contact [email protected]PDF download Crossref reports no articles citing this article.

The Harvard Vanguard Kenmore Practice experience: a focus on human development and relationship building

Abstract: This narrative describes the beginning stages of the transformation of an Internal Medicine department within Harvard Vanguard Medical Associates (Harvard Vanguard). This initial effort laid the foundation for the subsequent beginning of a transformational journey for the larger organization, a 600-physician multi-specialty group practice.

Radiographic Characteristics of Cervical Deformity (CD) Using a Discriminant Analysis

Abstract: This was a retrospective review of a prospectively collected database.The aim of this study was to delineate radiographic parameters that distinguish severe cervical spine deformity (CSD).Our objective was to define parameters that distinguish severe CSD using a consensus approach combined with discriminant analysis as no system currently exists in the literature.Twelve CSD surgeons reviewed preoperative x-rays from a CSD database. A consensus was reached for categorizing patients into a severe cervical deformity (sCD), non-severe cervical deformity (non-sCD), or an indeterminate cohort. Radiographic parameters were found including classic cervical and spinopelvic parameters in neutral/flexion/extension alignment. To perform our discriminant analysis, we selected for parameters that had a significant difference between the sCD and non-sCD groups using the Student t test. A discriminant function analysis was used to determine which variables discriminate between the sCD versus non-sCD. A stepwise analysis was performed to build a model of parameters to delineate sCD.A total of 146 patients with cervical deformity were reviewed (60.5±10.5 y; body mass index: 29.8 kg/m2; 61.3% female). There were 83 (56.8%) classified as sCD and 51 (34.9%) as non-sCD. The comparison analysis led to 16 radiographic parameters that were different between cohorts, and 5 parameters discriminated sCD and non-sCD. These parameters were cervical sagittal vertical axis, T1 slope, maximum focal kyphosis in extension, C2 slope in extension, and number of kyphotic levels in extension. The canonical coefficient of correlation was 0.689, demonstrating a strong association between our model and cervical deformity classification. The accuracy of classification was 87.0%, and cross-validation was 85.2% successful.More than one third of a series of CSD patients were not considered to have a sCD. Analysis of an initial 17 parameters showed that a subset of 5 parameters can discriminate between sCD versus non-sCD with 85% accuracy. Our study demonstrates that flexion/extension images are critical for defining severe CD.

Professional Ethics in the Clinical Practice of Perinatal Medicine

Abstract: This chapter provides clinically applicable, ethical sound guidance to ethical challenges in the clinical practice of perinatal medicine. The chapter describes the professional ethics of perinatal medicine as combining professional ethics in obstetrics with professional ethics in pediatrics. The roles of the ethical principles of beneficence and respect for autonomy are described, as well as the best interests of the child standard from professional ethics in pediatrics. The chapter shows how professional ethics in perinatal medicine provides clinically applicable guidance for counseling pregnant women about intrapartum obstetric management, counseling prospective parents about neonatal management, and counseling parents about ethically justified limits on neonatal critical care.

Prostate Artery Embolization

Abstract: Over the past decade, prostate artery embolization (PAE) has emerged as a minimally invasive treatment option for patients suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Literature over that time has moved from discussion of technique and technical feasibility of the procedure to comparisons of PAE with traditional surgical therapies such as transurethral resection of the prostate (TURP). In most studies of patients undergoing PAE, transfemoral arterial access was obtained to catheterize the prostatic arteries. More recently, the use of transradial access to perform PAE has been described. While technically challenging, the transradial technique offers several potential advantages in appropriately selected patients, which may improve the benefit-risk profile of PAE and improve patient satisfaction. We describe the history and applications of PAE, list the equipment needed to perform PAE, review the procedural steps and technical considerations, and provide a case example, all in the context of transradial access.

A New Test for Trigger Finger: The Lenox Independent Flexion Test

Abstract: Background: The diagnosis of trigger finger (TF) in patients who do not demonstrate triggering at presentation can be challenging. We have been using a new test for TF - the Lenox Independent Flexion Test (LIFT). The aim of this study is to determine the sensitivity of LIFT in diagnosing TF. We hypothesise that LIFT will be more sensitive compared to the classic physical exam finding of triggering or locking with active range of motion (AROM). Methods: This is a prospective study of consecutive patients with TF over a 5-month period. Patients with the onset of trigger following trauma and trigger of the thumb were excluded. Patients were examined for tenderness over the first annular (A1) pulley, triggering or locking with AROM, and the LIFT was performed. A two-proportion test was used to determine whether the LIFT was more sensitive than triggering with AROM. Results: The study included 85 patients with 118 TFs. The average age of patients was 63 years and the study included 49 women. There were 69, 49, 0 and 0 grade I, II, III and IV TF, respectively. 108 fingers (92%) had a history of catching or locking of the affected digit, 110 (93%) had tenderness over the A1 pulley, 49 (44%) had triggering or locking with AROM and 102 (91%) had a positive LIFT. The LIFT was found to be more sensitive when compared to triggering with AROM (p < .001). Conclusion: The LIFT is more sensitive than triggering with AROM in the diagnosis of trigger digits. This test is especially useful in the diagnosis of TF in patients who do not have triggering at presentation. Level of Evidence: Level III (Diagnostic).