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Osborn Fulton posted an update 6 months ago
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune nervous system disease that has become increasingly recognized. This retrospective study is aimed to analyze the relations between clinical manifestations and blood brain barrier (BBB) integrity in anti-NMDAR encephalitis patients.
Anti-NMDAR encephalitis patients were admitted to the First Affiliated Hospital of Guangxi Medical University from April 2014 to April 2020. Patients were grouped by the normal BBB and damaged BBB groups according to the cerebrospinal fluid (CSF) albumin/serum albumin (QAlb). Neutrophil-to-lymphocyte ratio (NLR) in peripheral blood was used for estimating the inflammatory status. The modified Rankin Scale (mRS) was used to assess prognosis.
Seventy-three anti-NMDAR encephalitis patients were diagnosed based on the autoimmune encephalitis diagnosis criteria of 2016. Fifty-three (72.6%) patients were in the normal BBB group and twenty (27.4%) were in the BBB damaged group. There were no significant digGIF) and mRS score after 2 months follow-up.
The dysfunction of BBB can be helpful in evaluating its prognosis since QAlb showed associations with ICU admission, NLR, a higher CSF protein, intrathecal IgG synthesis (IgGLoc, IgGIF) and mRS score after 2 months follow-up.
Children’s hospitals frequently care for infants with various life-threatening airway anomalies. Management of these infants can be challenging given unique airway anatomy and potential malformations. Airway emergency management must be immediate and precise, often demanding specialized equipment and/or expertise. We developed a Neonatal-Infant Emergency Airway Program to improve medical responses, communication, equipment usage and outcomes for all infants requiring emergent airway interventions in our neonatal and infant intensive care unit (NICU).
All patients admitted to our quaternary NICU from 2008 to 2019 were included in this study. Our program consisted of a multidisciplinary airway response team, pager system, and emergency equipment cart. Respiratory therapists present at each emergency event recorded specialist response times, equipment utilization, and outcomes. A multidisciplinary oversite committee reviewed each incident.
Since 2008, there were 159 airway emergency events in our NICU (~12es in response to COVID-19 regulations. A similar program could be implemented in other centers.
Type one laryngeal cleft (T1LC) has been implicated as a major contributor to aspiration in non-syndromic pediatric dysphagia. Despite an increasing incidence, there remains controversy in diagnosis and treatment algorithms.
The primary objective of this study was to evaluate the inter-rater reliability (IRR) for the diagnosis and treatment of T1LC.
A retrospective analysis was conducted to identify children evaluated for a T1LC from 2016 to 2017 at a single tertiary care center. The microlaryngoscopy video recordings depicting palpation of the interarytenoid region with a right-angle probe were reviewed. These recordings were shown to blinded pediatric otolaryngologists and each surgeon’s determination of the presence or absence of a T1LC as well as recommended treatment (observation, injection laryngoplasty, or endoscopic cleft repair) was recorded and compared against the other blinded surgeons. Fleiss’s kappa was calculated to evaluate IRR in both diagnosis and treatment.
Eight pediatric otolaryngologists were included in the study with a mean post-training experience of 15 years (range 1-35 years). The inter-rater percent agreement in diagnosis of our patient population was 28.6% (range 3.7-71%) with a kappa value of 0.31 (p<0.0001). In regard to management, the inter-rater percent agreement in treatment was 11.4% (range 0-35%) with a kappa value of 0.14 (p=0.01).
This study highlights the challenges and variation that exists among surgeons in diagnosing and managing potential T1LC. Further standardizing the endoscopic examination and treatment algorithm may reduce diagnostic and treatment discordance.
This study highlights the challenges and variation that exists among surgeons in diagnosing and managing potential T1LC. Further standardizing the endoscopic examination and treatment algorithm may reduce diagnostic and treatment discordance.
Several animal models of subglottic stenosis (SGS) have been described in the literature, however many result in severe stenosis that requires early intervention and carry a high mortality rate. This limits the application of the model and may require the use of additional animals to achieve desired results due to procedural complications. A novel endoscopic method of inducing SGS in a rabbit model was developed as part of a larger investigation on the treatment of this condition. The objective of this study was to develop an animal model for survivable subglottic stenosis.
12 New Zealand white rabbits underwent 2 trials of prolonged intubation that were not successful in inducing SGS. A partially sheathed nylon brush injury technique was then designed and implemented. Airway assessment consisted of rigid bronchoscopy 6 weeks and 8 months after injury.
12 rabbits undergoing subglottic brush injury had focal posteriorly based subglottic stenosis on bronchoscopy at 6 weeks and 8 months post-injury. One rabbit was euthanized after the brush induced subglottic injury but prior to 6 week bronchoscopy due to an unrelated orthopedic injury. This animal was therefore excluded from analysis and replaced. No rabbits required early airway intervention or sacrifice. All survived a period of 8 months.
Inducing subglottic injury with a partially-sheathed nylon brush safely and reliably creates a controlled SGS with zero procedure-related mortality over 8 months. Butyzamide price This model could be the basis for a longer-term evaluation of subglottic scar evolution and intervention.
Inducing subglottic injury with a partially-sheathed nylon brush safely and reliably creates a controlled SGS with zero procedure-related mortality over 8 months. This model could be the basis for a longer-term evaluation of subglottic scar evolution and intervention.