The Effects of Injury Type on Health-Related Quality of Life in Youth Athletes: A Cross-Sectional Analysis.

OBJECTIVE: The relationship between health-related quality of life (HRQoL) and injury type has not been analyzed for young athletes. We hypothesized that there would be no difference in HRQoL between injured athletes, injured nonathletes, and normative data for healthy youth (NDHY) or among athletes with acute, overuse, or concussion injuries. DESIGN: Cross-sectional clinical cohort. SETTING: Primary care sports medicine clinics at 3 academic institutions. PARTICIPANTS: Patients aged 8 to 18 years presenting with injury. INDEPENDENT VARIABLES: Injury type and athletic participation. MAIN OUTCOME MEASURES: Health-related quality of life measured 1 month after injury through the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric-25 v2.0 assessed pain interference, peer relationships, depression, fatigue, anxiety, and mobility. One-way analysis of variance was performed with P values of <0.05 considered significant. Concussion Learning Assessment and School Survey (CLASS) evaluated academic performance. RESULTS: Three hundred fifty-seven patients (36% male), with average age of 14.2 years, completed HRQoL and CLASS surveys following injury. There were 196 overuse injuries (55%), 119 acute injuries (33%), and 42 concussions (12%). Ninety-four percent were athletes. Six percent were nonathletes; 90.5% of concussed patients reported grades worsening. Concussed athletes reported more fatigue (P = 0.008) compared with other injury types but no worse than NDHY. Athletes with overuse injuries had lower mobility (P = 0.005) than other injury types and NDHY. Patients with lower HRQoL were female, older age, or required surgery. No other domains had significant differences by injury type nor did HRQoL differ between the athletes, nonathletes, and NDHY. CONCLUSIONS: With the exception of injuries requiring surgery, HRQoL of injured young athletes was similar to NDHY in most domains.

Intravascular ultrasound guided transcatheter electrosurgical revascularization of an interrupted aortic arch.

Interrupted aortic arch is a rare (prevalence 1:100000) but malignant cause of secondary hypertension, with late sequela of early myocardial infarction, stroke, and heart failure. We present the case of a 49-year-old male patient with aortic interruption successfully treated by intravascular ultrasound guided transcatheter electrosurgical wire crossing and revascularization using a covered stent. Learning objective: Transcatheter electrosurgical wire techniques utilizing intravascular ultrasound facilitate safe and effective percutaneous revascularization of complex aortic coarctation patients.

An Unusual Tale of Two Appendices in a Case of Acute Appendicitis: One Gangrenous, One Inflamed.

Appendicectomy is one of the most common surgeries performed worldwide. The incidence of acute appendicitis is higher among adolescents and young adults. Though various positions of the appendix, such as retrocecal, pelvic, subcecal, pre- or post-ileal, and their clinical implications have been well established, appendiceal anomalies like duplication or triplication of the appendix are yet to receive attention due to their very low incidence. We report an incidental finding of a duplicated appendix in a 19-year-old girl who presented with features of acute appendicitis. What makes this case report an interesting learning point for young surgeons is the identification of a perforated appendix with gangrene at the tip, along with an inflamed duplicated appendix. This report alerts us to the need for a thorough intraoperative inspection, to look for possible anatomical abnormalities, and to take the right management decisions to avoid unnecessary re-explorations. While operating a patient with features of acute appendicitis, a failure to identify a duplicated appendix is comparable to abandoning an inflamed appendix in-situ. Such instances not only increase the morbidity due to complications like the formation of pelvic abscesses, wound dehiscence, and surgical site infection, but also cause mortality.

Key interactions with deazariboflavin cofactor for light-driven energy transfer in Xenopus (6-4) photolyase.

Photolyases are flavoenzymes responsible for light-driven repair of carcinogenic crosslinks formed in DNA by UV exposure. They possess two non-covalently bound chromophores: flavin adenine dinucleotide (FAD) as a catalytic center and an auxiliary antenna chromophore that harvests photons and transfers solar energy to the catalytic center. Although the energy transfer reaction has been characterized by time-resolved spectroscopy, it is strikingly important to understand how well natural biological systems organize the chromophores for the efficient energy transfer. Here, we comprehensively characterized the binding of 8-hydroxy-7,8-didemethyl-5-deazariboflavin (8-HDF) to Xenopus (6-4) photolyase. In silico simulations indicated that a hydrophobic amino acid residue located at the entrance of the binding site dominates translocation of a loop upon binding of 8-HDF, and a mutation of this residue caused dysfunction of the efficient energy transfer in the DNA repair reaction. Mutational analyses of the protein combined with modification of the chromophore suggested that Coulombic interactions between positively charged residues in the protein and the phenoxide moiety in 8-HDF play a key role in accommodation of 8-HDF in the proper direction. This study provides a clear evidence that Xenopus (6-4) photolyase can utilize 8-HDF as the light-harvesting chromophore. The obtained new insights into binding of the natural antenna molecule will be helpful for the development of artificial light-harvesting chromophores and future characterization of the energy transfer in (6-4) photolyase by spectroscopic studies.

Synthesis and Photophysical Properties of Fluorescence Molecular Probe for Turn-ON-Type Detection of Cytosine Bulge DNA.

A fluorescent molecule DANP that binds to cytosine bulge DNA and emits characteristic fluorescence was conjugated to pyrene to give a new fluorescence probe PyDANP. Temperature- and solvent-dependent absorption changes showed that DANP and pyrene chromophores stacked at room temperature in an aqueous buffer solution and quenched fluorescence. Upon binding of DANP moiety in PyDANP to cytosine bulge DNA, the fluorescence from DANP bound to C-bulge increased by ∼12-fold, showing that PyDANP is a turn-ON probe for the detection of C-bulge DNA.

Early repair of large infant ventricular septal defect despite respiratory syncytial virus-induced respiratory failure with postrepair chylous pericardial effusion requiring pleuropericardial window: a case report and review of the literature.

The surgical correction of congenital cardiac lesions that are complicated by intercurrent respiratory syncytial virus (RSV) pneumonitis has traditionally been deferred for at least 6 to 8 weeks. The presumption is that using cardiopulmonary bypass will increase the risk of postoperative pulmonary complications. We present an infant who developed acute respiratory failure related to RSV pneumonitis and required urgent mechanical ventilation. Cardiac evaluation revealed a large nonrestrictive ventricular septal defect (VSD), aortic arch hypoplasia, normally functioning bicuspid aortic valve, and hemodynamic instability associated with markedly increased pulmonary blood flow. Separation from mechanical ventilation was unsuccessful preoperatively. He underwent VSD repair with cardiopulmonary bypass less than 4 weeks after initial RSV infection. He was extubated successfully within 72 hours of VSD repair. Approximately 6 weeks postoperatively, he developed a circumferential chylous pericardial effusion of unclear etiology--an exceedingly rare complication of VSD repair in early infancy in a non-Down syndrome patient. The chylous effusion was initially managed unsuccessfully with Portogen/Monogen and a percutaneously placed pericardial drain. Two weeks later, he underwent creation of a pleuropericardial window with successful resolution of the chylous effusion. It is of interest to pediatricians to be able to correctly time the repair of congenital heart disease lesions after RSV infection to minimize post-bypass pulmonary complications and yet avoid morbidity from undue delays in repair. In addition, chylopericardium can occur in infants after VSD repair, and dietary modification and catheter drainage may not be adequate.

InCl3-driven regioselective synthesis of functionalized/annulated quinolines: scope and limitations.

The efficient, regioselective synthesis of functionalized/annulated quinolines was achieved by the coupling of 2-aminoaryl ketones with alkynes/active methylenes/α-oxoketene dithioacetals promoted by InCl(3) in refluxing acetonitrile as well as under solvent-free conditions in excellent yields. This transformation presumably proceeded through the hydroamination-hydroarylation of alkynes, and the Friedländer annulation of active methylene compounds and α-oxoketene dithioacetals with 2-aminoarylketones. In addition, simple reductive and oxidative cyclization of 2-nitrobenzaldehyde and 2-aminobenzylalcohol, respectively, afforded substituted quinolines. Systematic optimization of the reaction parameters allowed us to identify two-component coupling (2CC) conditions that were tolerant of a wide range of functional groups, thereby providing densely functionalized/annulated quinolines. This approach tolerates the synthesis of various bioactive quinoline frameworks from the same 2-aminoarylketones under mild conditions, thus making this strategy highly useful in diversity-oriented synthesis (DOS). The scope and limitations of the alkyne-, activated methylene-, and α-oxoketene dithioacetal components on the reaction were also investigated.

4-Dimethylamino pyridine-promoted one-pot three-component regioselective synthesis of highly functionalized 4H-thiopyrans via heteroannulation of ß-oxodithioesters.

A highly convergent and regioselective heteroannulation protocol for the synthesis of hitherto unreported highly substituted 2-amino-4-(aryl/alkyl)-5-(aroyl/heteroaroyl)-3-(cyano/carboalkoxy)-6-methylthio-4H-thiopyran derivatives has been developed. This one-pot three-component domino coupling of ß-oxodithioesters, aldehydes, and malononitrile/ethyl or methyl cyanoacetate is promoted by 4-dimethylamino pyridine (DMAP) in solvent (dichloromethane (DCM)) as well as under solvent-free conditions. Systematic optimization of reaction parameters identified that the three-component coupling (3CC) protocol is tolerant to a wide array of functionality providing densely functionalized 4H-thiopyrans in excellent yields. The merit of this cascade Knoevenagel condensation/Michael addition/cyclization sequence is highlighted by its high atom-economy, excellent yields, and efficiency of producing three new bonds (two C-C and one C-S) and one stereocenter in a single operation.

Molecular Docking and in Vitro Antileishmanial Evaluation of Chromene-2-thione Analogues.

Leishmaniases are an epidemic in various countries, and the parasite is developing resistance against available drugs. Thus, development of new drugs against Leishmania is an open area of investigation for synthetic organic chemists. To meet this challenge, a series of chromene-2-thione derivatives have been synthesized and docked into the active site of trypanothione reductase (TryR) enzyme required for redox balance of the parasite. These were screened on promastigote, axenic amastigote, and intracellular amastigote stages of Leishmania donovani and found to show high levels of antileishmanial activity together with minimal toxicity to human peripheral blood mononuclear cells. Compounds 3b and 3k were found to be the most active among the tested compounds. Although the compounds show moderate antileishmanial activity, they identify a chemical space to design and develop drugs based on these chromene-2-thione derivatives against the Leishmania parasite.

Asymptomatic complete atrioventricular block in a 13-year-old girl.

Atrioventricular (AV) block is a delay or an interruption in the transmission of an impulse from atria to ventricles due to an anatomic or a functional impairment in the conduction system. Atrioventricular block may be congenital or acquired. Electrocardiographic screening of asymptomatic school-aged children (median, 12.4 years) in Japan found the prevalence of a third-degree AV block to be 2 per 100,000. We report a case of asymptomatic complete AV block of unknown etiology in a 13-year-old child who did not require pacemaker placement. The importance of recognizing an asymptomatic complete AV block in the pediatric population, the classification and controversies of pacemaker placement, and the complications of pacemaker placement are discussed.

Enteroviral sepsis and ischemic cardiomyopathy in a neonate: case report and review of literature.

Neonatal entero-viral sepsis is a rare but fulminant infection with multisystem involvement, often presenting with hepatitis, meningo-encephalitis, disseminated intravascular coagulation (DIC), and myocarditis. Neonatal myocarditis often proves fatal. We report here a case of neonatal enteroviral myocarditis with multisystem organ failure and ischemic cardiomyopathy that was managed medically.

How should we select health professionals for studies?

The investigation of healthcare professionals' practice patterns has increased sharply, in part driven by the development of practice guidelines; however, the optimal way to select providers is not known. We evaluated three distinct sources of physician specialists for completeness and potential biases. Professional society directories, which are frequently used to identify providers, provided biased populations. A national registry, the American Medical Association master file, produced the most comprehensive, least-biased single source.

Protective association of aspirin/NSAIDs and esophageal cancer: a systematic review and meta-analysis.

BACKGROUND & AIMS: Esophageal carcinomas have high fatality rates, making chemoprevention agents desirable. We performed a systematic review with meta-analysis of observational studies evaluating the association of aspirin/nonsteroidal anti-inflammatory drug (NSAID) use and esophageal cancer. METHODS: We evaluated the MEDLINE, BIOSIS, and Web of Science electronic databases (1980-2001); manually reviewed the literature; and consulted with experts. Studies were included if they: (1) evaluated exposure to NSAIDs, aspirin, or both; (2) evaluated esophageal cancer; and (3) reported relative risks or odds ratios or provided data for their calculation. Data were independently abstracted by 2 investigators. The primary and sensitivity analyses used both fixed and random-effects models. RESULTS: Nine studies (2 cohort, 7 case control) containing 1813 cancer cases were identified. All primary summary estimates were homogeneous. Statistical pooling showed a protective association between any use of aspirin/NSAID and esophageal cancer (odds ratio [OR] = 0.57; 95% confidence interval [CI], 0.47-0.71). Both intermittent (OR = 0.82; CI, 0.67-0.99) and frequent medication use were protective (OR = 0.54; CI, 0.43-0.67), with greater protection with more frequent use. Stratified by medication type, aspirin use was protective (OR = 0.5; CI, 0.38-0.66), and NSAIDs had a borderline protective association (OR = 0.75; CI, 0.54-1.0). Any use was protective against both esophageal adenocarcinoma (OR = 0.67; CI, 0.51-0.87) and squamous cell carcinoma (OR = 0.58; CI, 0.43-0.78). CONCLUSIONS: Pooled results support a protective association between aspirin and NSAIDs and esophageal cancer (of both histological types) and provide evidence for a dose effect. These findings support evaluating these agents in clinical trials of high-risk patients.

Ventricular arrhythmia: role of the implantable cardioverter defibrillator and radiofrequency ablation in addition to drugs.

The control of life-threatening arrhythmias in the prevention of sudden cardiac death has been a long-standing challenge to clinicians. Large-scale, randomized, controlled trials have contributed immensely to our understanding of the management of life-threatening arrhythmias. There are many causes of life-threatening ventricular arrhythmias, which they occur mostly in the setting of healed myocardial infarction. Available treatments for the management of ventricular arrhythmias include antiarrhythmic drugs, implantable cardioverter defibrillators and catheter ablation. Each therapy provides unique advantages for selected patients with life-threatening arrhythmias. Because the goal of arrhythmia management is not only to provide the single best therapy but to provide the greatest assurance of symptomatic arrhythmia control, the use of combined therapy has become a standard treatment strategy for patients with sustained ventricular arrhythmias. This review will discuss the different modes of treatment available for the treatment of life-threatening ventricular arrhythmias, and their potential risks and benefits. The rationale for using hybrid or combination therapy will be presented. Finally, some of the better-known primary and secondary prevention trials for treatment of ventricular tachycardias will be reviewed.