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Hualu Han, Runhua Zhang, Gaifen Liu, Huiyu Qiao, Zhensen Chen, Yang Liu, Xiaoyi Chen, Dongye Li, Yongjun Wang, Xihai Zhao
Reduction in cerebral blood flow (CBF), one of the major metrics for cerebral perfusion, is associated with many brain disorders. Therefore, early characterization of CBF prior to occurrence of symptoms is essential for prevention of cerebral ischemic disorders. We hypothesized that large artery atherosclerosis might be a potential indicator for decline in cerebral perfusion. The aim of this study was to investigate the relationship between large artery atherosclerosis and CBF in asymptomatic adults. A total of 134 asymptomatic subjects (mean age, 56...
December 12, 2018: NeuroImage
Mustafa Iftikhar, Bushra Usmani, Abanti Sanyal, Saleema Kherani, Simrat Sodhi, Saghar Bagheri, Etienne M Schönbach, Nadia Junaid, Hendrik Pn Scholl, Syed Ma Shah
IMPORTANCE: It is important to establish reliable outcome measures to detect progression in retinitis pigmentosa (RP). BACKGROUND: To evaluate progression of RP using multimodal imaging, including spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF) and microperimetry (MP). DESIGN: Retrospective longitudinal study at a tertiary teaching hospital. PARTICIPANTS: 205 eyes of 106 patients with RP with 1-5 years of follow-up...
December 15, 2018: Clinical & Experimental Ophthalmology
Nicolae Done, Dennis H Oh, Martin A Weinstock, John D Whited, George L Jackson, Heather A King, Sara B Peracca, A Rani Elwy, Julia C Prentice
INTRODUCTION: Teledermatology has emerged as an important strategy to enhance access to high-quality skin care. VA Telederm is a provider-facing, web-based mobile app designed to integrate into the existing teledermatology workflow in the US Veterans Health Administration (VHA). In this study, we will conduct a systematic evaluation of VA Telederm on access outcomes in VHA facilities using a pragmatic trial guided by clinical and operational leaders. METHODS AND ANALYSIS: The study is a prospective, stepped-wedge cluster randomised trial with cross-sectional exposure and outcome measurement via retrospective database analysis of administrative records...
December 14, 2018: BMJ Open
Guanli Xie, Changming Song, Xiaomin Lin, Minguang Yang, Xiao Fan, Weilin Liu, Jing Tao, Lidian Chen, Jia Huang
OBJECTIVE: To determine the mechanism(s) involved in electroacupuncture (EA)-mediated improvements in synaptic plasticity in a rat model of middle cerebral artery occlusion and reperfusion (MCAO/R)-induced cognitive deficits. METHODS: Focal cerebral ischemic stroke was induced by (MCAO/R) surgery. Rats were randomly split into 4 groups: control group (sham operation control), MCAO group, Baihui (GV 20) and Shenting (GV 24) acupoint EA group (verum acupuncture, MCAO + VA), and nonacupoint EA group (control acupuncture, MCAO + CA)...
December 11, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Craig S Rosen, Nancy C Bernardy, Kathleen M Chard, Barbara Clothier, Joan M Cook, Jill Crowley, Afsoon Eftekhari, Shannon M Kehle-Forbes, David C Mohr, Siamak Noorbaloochi, Robert J Orazem, Josef I Ruzek, Paula P Schnurr, Brandy N Smith, Nina A Sayer
The United States Department of Veterans Affairs (VA) provides Cognitive Processing Therapy (CPT) and Prolonged Exposure therapy (PE) for PTSD at all of its facilities, but little is known about systematic differences between patients who do and do not initiate these treatments. VA administrative data were analyzed for 6,251 veterans receiving psychotherapy over one year in posttraumatic stress disorder (PTSD) specialty clinics at nine VA medical centers. CPT and PE were initiated by 2,173 (35%) patients. Veterans' probability of initiating either CPT or PE (considered together) was 29% lower (adjusted odds ratio = ...
November 20, 2018: Journal of Anxiety Disorders
Hildi Hagedorn, Marie Kenny, Adam J Gordon, Princess E Ackland, Siamak Noorbaloochi, Wei Yu, Alex H S Harris
BACKGROUND: In the US, emergency room visits and overdoses related to prescription opioids have soared and the rates of illicit opioid use, including heroin and fentanyl, are increasing. Opioid use disorder (OUD) is associated with higher morbidity and mortality, higher HIV and HCV infection rates, and criminal behavior. Opioid agonist therapy (OAT; methadone and buprenorphine) is proven to be effective in treating OUD and decreasing its negative consequences. While the efficacy of OAT has been established, too few providers prescribe OAT to patients with OUD due to patient, provider, or system factors...
December 13, 2018: Addiction Science & Clinical Practice
Frederik Trinkmann, Joshua Gawlitza, Monique Künstler, Julia Schäfer, Michele Schroeter, Julia D Michels, Ksenija Stach, Christina Dösch, Joachim Saur, Martin Borggrefe, Ibrahim Akin
Airways obstruction is frequent in patients with pulmonary hypertension (PH). Small airway disease (SAD) was identified as a major contributor to resistance and symptoms. However, it is easily missed using current diagnostic approaches. We aimed to evaluate more elaborate diagnostic tests such as impulse oscillometry (IOS) and SF₆-multiple-breath-washout (MBW) for the assessment of SAD in PH. Twenty-five PH patients undergoing body-plethysmography, IOS and MBW testing were prospectively included and equally matched to pulmonary healthy and non-healthy controls...
December 9, 2018: Journal of Clinical Medicine
Mingliang Sui, Weibing Tang, Changjiang Wu
RATIONALE: The Epstein-Barr (EB) virus has rarely been reported as a cause of fulminant myocarditis. To our knowledge, the present case is the first report on myocardial calcification in EB viral myocarditis and rhabdomyolysis. PATIENT CONCERNS: A 17-year-old man was admitted to the department with fever, chest tightness, and tachypnea that had been present for 2 days. DIAGNOSES: The initial investigation showed elevated liver enzyme levels, creatine kinase levels, creatine kinase isoenzyme levels, and elevated serum myoglobin...
December 2018: Medicine (Baltimore)
(no author information available yet)
OBJECTIVEThis article is a preliminary evaluation of the efficacy of volume-staged Gamma Knife radiosurgery (GKRS) in the treatment of patients with orbital venous malformations (OVMs).METHODSTwenty patients with moderate to large OVMs were treated with volume-staged GKRS between March 2005 and October 2015. The series included 8 male and 12 female patients with an average age of 22.5 years (range 9-45 years). The diagnoses were confirmed intraoperatively and at pathological examination in 14 cases and presumed in accordance with clinical and imaging findings in 6 cases...
December 1, 2018: Journal of Neurosurgery
Rodrigo Velezmoro
The Veterans Administration (VA)'s Patient Aligned Care Team (PACT) model has been a cornerstone of primary care in the VA healthcare system and has indicated the need for an organizational cultural shift towards interdisciplinary care. Most of the focus in PACT has been on the traditional providers of the medical model, with little attention focused on the role of the psychologist. This paper examines how psychologists can assist in the PACT model and, in particular, within the team VA huddle. Literature on the PACT model, mental health in PACT, and the advantages of the huddle are reviewed...
May 8, 2018: Health Psychology Research
Chelsey R Wilks, Leslie A Morland, Kirsten H Dillon, Margaret-Anne Mackintosh, Shannon M Blakey, H Ryan Wagner, Eric B Elbogen
There have been considerable efforts to understand, predict, and reduce suicide among U.S. military veterans. Studies have shown that posttraumatic stress disorder (PTSD), major depression (MDD), and traumatic brain injury (TBI) increase risk of suicidal behavior in veterans. Limited research has examined anger and social support as factors linked to suicidal ideation, which if demonstrated could lead to new, effective strategies for suicide risk assessment and prevention. Iraq/Afghanistan era veterans (N = 2467) were evaluated in the ongoing Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) multi-site Study of Post-Deployment Mental Health on demographic and psychological variables...
December 4, 2018: Journal of Psychiatric Research
Catherine J Lumley, Thomas M Kaffenberger, Sameer Desale, Eshetu Tefera, Chihun Jim Han, Hind Rafei, Jessica H Maxwell
BACKGROUND: Our objective was to determine the effect of post-diagnosis aspirin use on survival in veterans with head and neck squamous cell carcinoma. METHODS: Retrospective cohort study of 584 veterans with head and neck squamous cell carcinoma treated at the Washington DC VA Medical Center between 1995 and 2015. Charts were queried for clinical-pathologic data, aspirin prescriptions, and outcome. The Kaplan-Meier method was used to determine overall survival (OS) and disease-specific survival (DSS) among aspirin users and nonusers...
December 11, 2018: Head & Neck
Shangfeng Yang, Yajuan Liu, Pengfei Gao, Taiming Zhang, Xianjun Zhu, Mengmeng Zhang, Muqing Chen, Pingwu Du, Guan-Wu Wang, Hengxing Ji, Jinlong Yang
Two-dimensional (2D) black phosphorus (BP) has been attracting ever-growing interest due to its unique band structure, but suffers from low ambient stability owing to its high reactivity to oxygen. Covalent functionalization has been demonstrated to passivate the reactive BP effectively, however the reported covalent functionalization methods are quite limited to aryl diazonium and nucleophilic additions affording P-C and P-O-C single bonds, for which the retaining of one unpaired electron in the Group-VA phosphorus atom hampers the passivation effect...
December 10, 2018: Angewandte Chemie
Goran Spasojević, Siniša Vujmilović, Nenad Ponorac, Slobodan Malobabić, Saša Vujinović, Nataša Đukić Macut
We investigated diameters of prevertebral -V1, and atlantic -V3 parts of extradural segment of vertebral artery (VA). Variable results from the literature about VA diameters reflect variety of diagnostic and imaging methods, various sample sizes, different levels of measurements, and lack of possible specific ethnic, regional or genetic data. Additionally, the data are often without distinctions of left- right or of sex. For this CT angiographic study were selected 91 adult person (182 vertebral arteries) of both sexes (47 males and 44 females) and of age between 33 and 75 years...
December 11, 2018: Folia Morphologica (Warsz)
Nicholas A Rattray, Mindy E Flanagan, Laura G Militello, Paul Barach, Zamal Franks, Patricia Ebright, Shakaib U Rehman, Howard S Gordon, Richard M Frankel
BACKGROUND: Poor communication during end-of-shift transfers of care (handoffs) is associated with safety risks and patient harm. Despite the common perception that handoffs are largely a one-way transfer of information, researchers have documented that they are complex interactions, guided by implicit social norms and mental frameworks. OBJECTIVES: We investigated communication strategies that resident physicians report deploying to tailor information during face-to-face handoffs that are often based on their implicit inferences about the perceived information needs and potential harm to patients...
December 10, 2018: Journal of General Internal Medicine
Anuj Desai, Matthew Hudnall, Adam B Weiner, Mehul Patel, Jason Cohen, Pooja Gogana, Roohallah Sharifi, Joshua J Meeks
Introduction: Among veterans, prostate cancer is the most common malignancy and has a higher incidence compared to the rest of the nation. No study has compared the effectiveness of Robotic-assisted-laparoscopic radical prostatectomy (RALP) vs. open radical prostatectomy (ORP) in the Veteran's Affairs (VA) hospital setting during the adoption of RALP. Methods: Institutional Review Board approval was obtained. Retrospective review was completed on Veterans with prostate cancer who underwent ORP or RALP from March 2011 to January 2017 during the introduction of RALP at one VA hospital...
December 7, 2018: Military Medicine
Salla Jäämaa-Holmberg, Birgitta Salmela, Raili Suojaranta, Janne J Jokinen, Karl B Lemström, Jyri Lommi
OBJECTIVES: Our goal was to study the outcome of patients with cardiogenic shock who were treated with venoarterial extracorporeal membrane oxygenation (VA ECMO), including the subsequent long-term health-related quality of life (HRQoL). METHODS: We conducted a retrospective study of 133 consecutive patients treated in a single centre from 2007 to 2016. The HRQoL was studied using the EuroQuol-5 dimensions-3 level questionnaire and the RAND 36-Item Short Form Health Survey at a minimum of 1 year after VA ECMO...
December 10, 2018: European Journal of Cardio-thoracic Surgery
Horia Tudor Stanca, Mihnea Munteanu, Dragoş Cătălin Jianu, Andrei Gheorghe Marius Motoc, Bogdana Tăbăcaru, Simona Stanca, Emil Ungureanu, Veronica Mădălina Boruga, Maria Alexandra Preda
PURPOSE: The paper intends to present the results of using new methods of a new generation diode laser transscleral cyclophotocoagulation (TSCPC) in patients with different types of glaucoma. PATIENTS, MATERIALS AND METHODS: There have been treated 53 eyes from 59 patients with glaucoma refractory to medical, laser or surgical treatment. We have used the newest generation of 810 nm wavelength diode laser. There have been used two protocols of continuous-wave diode laser emitting radiation for cyclophotocoagulation...
2018: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
Stephanie Douglas, Erik Geiger, Andrew McGregor, Amanda Norwich, Deena Abbate, Henry Hsia, Deepak Narayan
Background: Telemedicine is a rapidly growing tool since its invention in the 1950s. Recently, it has expanded to the field of plastic surgery. In the Connecticut VA System, there is 1 plastic surgeon at a central location for the state of Connecticut and southern Massachusetts. Our aim was to pilot a telehealth program for plastic surgery consultation within the VA to improve access to subspecialty care. We intend to discuss the value of telehealth as part of consultation services, and assess patient attitudes toward telemedicine...
October 2018: Plastic and Reconstructive Surgery. Global Open
Imad Khan, Mehboob Rehan, Gunjan Parikh, Christopher Zammit, Neeraj Badjatia, Daniel Herr, Zachary Kon, Charles Hogue, Michael Mazzeffi
Background: Regional cerebral oxygen saturation (rScO2) measured by near-infrared spectroscopy (NIRS) can be used to monitor brain oxygenation in extracorporeal membrane oxygenation (ECMO). ECMO patients that develop acute brain injuries (ABIs) are observed to have worse outcomes. We evaluated the association between rScO2 and ABI in venoarterial (VA) ECMO patients. Methods: We retrospectively reviewed prospectively-collected NIRS data from patients undergoing VA ECMO from April 2016 to October 2016. Baseline demographics, ECMO and clinical characteristics, cerebral oximetry data, neuroradiographic images, and functional outcomes were reviewed for each patient...
2018: Frontiers in Neurology
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