Persistent hemifacial spasm after microvascular decompression: a risk assessment model

<p><b>Objective:</b> Microvascular decompression (MVD) for hemifacial spasm (HFS) provides resolution of disabling symptoms such as eyelid twitching and muscle contractions of the entire hemiface. The primary aim of this study was to evaluate the predictive value of patient demographics and spasm characteristics on long-term outcomes, with or without intraoperative lateral spread response (LSR) as an additional variable in a risk assessment model.</p> <p><b>Methods:</b> A retrospective study was undertaken to evaluate the associations of pre-operative patient characteristics, as well as intraoperative LSR and need for a staged procedure on the presence of persistent or recurrent HFS at the time of hospital discharge and at follow-up. A risk assessment model was constructed with the inclusion of six clinically or statistically significant variables from the univariate analyses. A receiving operator characteristic curve was generated, and area under the curve was calculated to determine the strength of the predictive model.</p> <p><b>Results:</b> A risk assessment model was first created consisting of significant pre-operative variables (Model 1) (age >50, female gender, history of botulinum toxin use, platysma muscle involvement). This model demonstrated borderline predictive value for persistent spasm at discharge (AUC .60; <i>p</i>=.045) and fair predictive value at follow-up (AUC .75; <i>p</i>=.001). Intraoperative variables (e.g. LSR persistence) demonstrated little additive value (Model 2) (AUC .67). Patients with a higher risk score (three or greater) demonstrated greater odds of persistent HFS at the time of discharge (OR 1.5 [95%CI 1.16–1.97]; <i>p</i>=.035), as well as greater odds of persistent or recurrent spasm at the time of follow-up (OR 3.0 [95%CI 1.52–5.95]; <i>p</i>=.002)</p> <p><b>Conclusions:</b> A risk assessment model consisting of pre-operative clinical characteristics is useful in prognosticating HFS persistence at follow-up.</p

Validation of <i>S. mediterranea</i> transcript assemblies.

<p>Transcript assembly for <i>Smed-Smad-1 (CUFF.118389.0)</i>. <i>Smed-Smad-1</i> encodes 4 exons which are supported by RNA-Seq reads (maroon) and an <i>S. mediterranea</i> mRNA sequence.</p

Number of genes and transcripts enriched in <i>S.mediterranea</i> and Human cell populations.

<p><i>S. mediterranea</i> adult cells include the X1, X2 and Xins populations and human cells include embryonic stem cells (hESCs) and day-6 embryoid bodies (hEBs). <i>S. mediterranea</i> X1 neoblasts and hESCs are both pluripotent, irradiation-sensitive cell populations.</p

Strain-specific transcript expression.

<p>(A) Scatterplot of log₂(1+FPKM) values for transcripts expressed in non-irradiated asexual (x-axis) and sexual (y-axis) animals. Biases in expression are categorized as follows: sexual-specific (red), sexual-biased (orange), unbiased (green), asexual-biased (blue) and asexual-specific (purple). The piechart (inset) shows the fraction of transcripts that fall into each category. (B) RT-PCR validation of strain-biased expression in sexual and asexual non-irradiated (−) and irradiated (+) samples; results are shown for 13 samples (<i>Smed-actin</i> used as a control).</p

Strain-specific patterns of GO category enrichment.

<p>GO category counts were obtained from Pfam domain annotations. Enrichment was determined by comparing category counts between transcripts. Enrichment in sexual animals was determined by comparing category counts between the sexual-specific/sexual-biased and unbiased categories; enrichment in asexual animals was determined by comparing the asexual-specific/asexual-biased and unbiased categories (transcripts that showed unbiased expression were used as the control set). The test for significance was performed using the Chi-square test. P-values were adjusted using the Bonferroni correction.</p

Classification of alternative splicing events.

<p>(A) Number of splicing events and genes detected for 5 classes of alternative splicing events: cassette exons, alternative 5′ splice sites, alternative 3′ splice sites, mutually exclusive exons and retained introns. (B) Percentage of each class of alternative splicing event shown in piechart. (C) Frame preservation in constitutively and alternatively spliced cassette exons; phase 2 and phase 1 exons are out-of-frame; phase 0 exons are in-frame. (D) RT-PCR validation of strain-specific alternative splicing events in non-irradiated (−) and irradiated (+) sexual and asexual animals. A cassette exon (<i>CUFF.250649</i>) is shown in top gel, while a retained intron (<i>CUFF.62385</i>) is shown in the bottom gel.</p

Summary of RNA-seq based genome annotation for <i>S. mediterranea</i>.

<p>Summary of RNA-seq based genome annotation for <i>S. mediterranea</i>.</p

Additional file 2: of Stress hyperglycaemia in critically ill patients and the subsequent risk of diabetes: a systematic review and meta-analysis

Search strategies. (DOCX 17 kb

The relationship between the rate of gastric emptying, as assessed by the gastric emptying coefficient (GEC), and baseline plasma concentrations of cholecystokinin (CCK) and peptide YY (PYY)

<p><b>Copyright information:</b></p><p>Taken from "The relationship between gastric emptying, plasma cholecystokinin, and peptide YY in critically ill patients"</p><p>http://ccforum.com/content/11/6/R132</p><p>Critical Care 2007;11(6):R132-R132.</p><p>Published online 21 Dec 2007</p><p>PMCID:PMC2246231.</p><p></p

Plasma cholecystokinin (CCK) and peptide YY (PYY) concentrations at baseline and after intragastric Ensure (100 mL, 106 kcal with 21% lipid) in 39 critically ill patients (mean ± standard error of the mean)

<p><b>Copyright information:</b></p><p>Taken from "The relationship between gastric emptying, plasma cholecystokinin, and peptide YY in critically ill patients"</p><p>http://ccforum.com/content/11/6/R132</p><p>Critical Care 2007;11(6):R132-R132.</p><p>Published online 21 Dec 2007</p><p>PMCID:PMC2246231.</p><p></p> *< 0.05 versus baseline