What have we learned from C5 palsy - A short communication

A study group on C5 palsy retrospectively reviewed 1001 cervical operations at their institutions in order to understand the incidence, prognosticators, pathogenesis, and outcome of C5 palsy after cervical operations. Three studies are summarized. C5 palsy was higher after posterior versus anterior operations. C4-C5 foraminotomy and age were the strongest predictors of C5 palsy after posterior surgeries and anterior cervical decompression-fusion, respectively. Among patients undergoing C4-C5 posterior laminoforaminotomy with instrumented fusion, cord shift on postoperative imaging was thought to be implicated in the pathogenesis of C5 palsy. Among affected patients, 81.4% recovered. Median time to resolution of C5 palsy was between 6 months to 1 year

Summarizing Dialogic Arguments from Social Media

Online argumentative dialog is a rich source of information on popular beliefs and opinions that could be useful to companies as well as governmental or public policy agencies. Compact, easy to read, summaries of these dialogues would thus be highly valuable. A priori, it is not even clear what form such a summary should take. Previous work on summarization has primarily focused on summarizing written texts, where the notion of an abstract of the text is well defined. We collect gold standard training data consisting of five human summaries for each of 161 dialogues on the topics of Gay Marriage, Gun Control and Abortion. We present several different computational models aimed at identifying segments of the dialogues whose content should be used for the summary, using linguistic features and Word2vec features with both SVMs and Bidirectional LSTMs. We show that we can identify the most important arguments by using the dialog context with a best F-measure of 0.74 for gun control, 0.71 for gay marriage, and 0.67 for abortion.Comment: Proceedings of the 21th Workshop on the Semantics and Pragmatics of Dialogue (SemDial 2017

Characteristics of rheumatoid arthritis patients at first presentation to a specialized rheumatology department

Background: Rheumatoid arthritis (RA) is a chronic, progressive, debilitating, systemic, autoimmune disease that mainly affects the diarthrodial joints. It is the most common form of inflammatory arthritis that occurs in approximately 1% of adults. The main objective is to study the characteristics of patients with Rheumatoid Arthritis (RA) at first presentation to a specialized rheumatology department.Methods: The study included 122 consecutive patients with RA, fulfilling 1987 American College of Rheumatology (ACR) criteria for RA at ‘Joint Disease Clinic’ of rheumatology department, at ISIC, New Delhi.Results: The mean age was 45.3 ± 12.4 years, F:M ratio, 8.4:1; maximum patients (31.1%) belonging to age group 30-40 years. Mean age at onset of symptoms was 38.1 ± 12.9 years and disease duration mode 5 years. 88% patients were literate and 59% referred by other patients. 14.8% patients had family history of RA, 7.38% (all males) were smokers. 16.4% female patients developed symptoms of arthritis within one year after delivery. 44.3% patients had severe, 50.8% moderate, 3.3% mild and 1.6% inactive disease (DAS 28[ESR] scoring system). 28.7% patients were taking treatment from alternative systems, 25.4% from orthopaedicians, 15.6% from internists and 8.2% from rheumatologists. Methotrexate and glucocorticoids were the most prescribed drugs (50.8% each) but in inappropriate doses. 23.8% patients had co-morbidities, hypothyroidism (9%) being the commonest.Conclusions: RA affects middle aged women. Hypothyroidism is the mostly associated autoimmune disease. The majority receive suboptimal / inappropriate treatment before visiting a rheumatologist. Most patients consult a rheumatologist at late stage in the disease often with deformities. Hence, increased awareness is needed about this disease among patients and doctors so that patients get timely referral to a rheumatologist for the proper management of this disease.

Penile Lymphangioma: review of the literature with a case presentation.

Background: Penile lymphangiomas are rare manifestations of lymphangiomas or lymphatic malformations which are more commonly found in the head or neck region of the body. Lymphangiomas are further categorized as lymphangioma circumscriptum, cavernous lymphangioma, cystic hygroma, or acquired lymphangiomas (also known as lymphangiectasia), based on their depth and etiology. Results: A literature review revealed only 30 cases of penile lymphangioma between 1947 and March 30, 2018. Several causes were attributed to the acquired penile lymphangiomas, including trauma, phimosis, and infection. While penile lymphangiomas can be initially mistaken for an infection, a thorough history and physical examination is sufficient to clinically diagnose a lymphangioma of the penis. Historically, surgical excision has been the gold standard of treatment for this condition. When asymptomatic, patients may opt for conservative management with avoidance of mechanical trauma alone. Other physicians have revealed novel treatment plans to rid patients of their penile lymphangioma such as a staged laser procedure. Conclusion: In this article, we elucidate the causes, symptoms, treatments, and outcomes associated with penile lymphangiomas found in the literature while also presenting the case of a 30-year-old African-American man diagnosed with acquired penile lymphangioma

Restoration of Neonatal Retinal Images

Retinopathy of prematurity (ROP) is an eye disorder primarily affecting premature neonates. Specialists use a number of neonatal retinal images acquired by a wide field of view camera for diagnosis and the subsequent follow up. However, the premature infants’ retinal images are generally of lower visibility compared to adult retinal images, affecting the quality of diagnosis. We study some image dehazing methods from general outdoor scenes and propose an image restoration scheme for neonatal retinal images, based on the physical model of light propagation in a medium. The results from our restoration algorithm is useful for analysis by human experts as well as computer aided diagnosis and specifically we show that our method enhances vessel segmentation significantly compared to traditional methods like adaptive histogram equalization

A Survey of Chemoprophylaxis Techniques in Spine Surgery Among American Neurosurgery Training Programs

The North American Spine Section (NASS) published the Evidence-Based Clinical Guide for the use of antithrombotics in spine surgery. Many of the 14 clinical questions lacked clinical studies to establish evidence-based recommendations, as such expert consensuses were arrived at via a modified nominal group technique. On the clinical inquiry of chemoprophylaxis, the study published that “Unfortunately, scientific scrutiny of chemoprophylaxis in elective spinal surgery has been limited to case series involving discectomy and decompression…safety and efficacy have not been thoroughly studied. This knowledge gap in the optimal prevention of VTE events may be approximated with higher levels of evidence in spine surgery research, which should begin in first understanding chemoprophylaxis techniques across a wide geographical array of neurosurgical training programs. Of the 107 ACGME-approved residencies, contact information for 96 programs were available from ACGME, and responses from 69 unique neurosurgery residencies were collected. Thus, this survey study achieved a 64% respondent rate. Responses appeared equally distributed across the country. The first dose of chemoprophylaxis among patients undergoing surgery for degenerative/ deformity spinal disease started most commonly on postoperative day 1 in 75.3% of neurosurgery programs (n = 52) followed by postoperative day 2 in 10.1% of programs (n = 7), postoperative day 0 – same day of surgery in 8.7% of programs (n = 6), postoperative day 3 in 1.4% of programs (n = 1), and morning of surgery in 1.4% of programs (n = 1). Lastly, 2.9% of programs (n = 2) do not utilize any chemoprophylaxis. Among two of the three indications for spinal surgery, choice of postoperative chemoprophylaxis did not statistically significantly differ between prophylactic UFH versus prophylactic LMWH: 56.5% versus 50.7% in degenerative/ deformity pathologies (p=0.080) and 36.2% versus 43.4% in traumatic pathologies (p-0.535). However, neoplastic pathologies saw a statistically significantly higher proportion of prophylactic UFH (60.8%) compared to prophylactic LMWH (36.2%) (p=0.037). Of those neurosurgeons who documented “other”, one explained that the choice of chemoprophylaxis depends on comorbidities. Similarly, the other mentioned creatinine clearance and “risk factors” as determinants.https://scholarlycommons.henryford.com/merf2019qi/1012/thumbnail.jp

Trends in the Abscopal Effect After Radiation to Spinal Metastases: A Systematic Review

While the abscopal effect has been previously described, the phenomenon has been poorly defined with spinal metastases. This article is unique in that we present the first systematic review of the abscopal effect after radiation therapy to metastatic spinal cancer, especially since the spinal column represents one of the most common metastatic locations. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) resources, a systematic review identified relevant studies via a computer-aided search of MEDLINE and Embase. Ten publications that met the inclusion and exclusion criteria from the PRISMA flow diagram described a total of thirteen patients. Important findings in this review of spinal metastases include (1) abscopal effect is more commonly observed when systemic therapy includes immunomodulators; (2) abscopal effect has a higher likelihood of success when immunomodulators are administered in conjunction with or after radiation therapy to the spine; (3) higher doses of radiation in a smaller number of fractions likely increase the abscopal success; and (4) ionizing radiation to the bone marrow of the spinal column may increase circulating lymphocytes that attack cancerous lesions elsewhere in the body. These trends, however, still require further investigation with experimental and clinical studies.https://scholarlycommons.henryford.com/merf2019clinres/1038/thumbnail.jp

Trends in the Abscopal Effect After Radiation to Spinal Metastases: A Systematic Review

Introduction: While the abscopal effect has been previously described, the phenomenon has been poorly defined with spinal metastases. This article presents the first systematic review of the abscopal effect after radiation therapy to metastatic spinal cancer, especially since the spinal column represents one of the most common metastatic locations. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [Figure 1] in the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) resources, a systematic review identified relevant studies via a computer-aided search of MEDLINE and Embase. Ten publications that met the inclusion and exclusion criteria from the PRISMA flow diagram described a total of thirteen patients. Results: Two patients in two separate articles observed the abscopal effect following radiation therapy alone to the spine. The remaining eight articles commented on the abscopal effect in the setting of both systemic and radiation therapy. Conclusion: Important findings in this review of spinal metastases include (1) abscopal effect is more commonly observed when systemic therapy includes immunomodulators; (2) abscopal effect has a higher likelihood of success when immunomodulators are administered in conjunction with or after radiation therapy to the spine; (3) higher doses of radiation in a smaller number of fractions likely increase the abscopal success; and (4) ionizing radiation to the bone marrow of the spinal column may increase circulating lymphocytes that attack cancerous lesions elsewhere in the body. These trends, however, still require further investigation with experimental and clinical studies