Effectiveness and safety of VTE chemoprophylaxis differed between patient subgroups, defined by Caprini risk score and by procedure. Effectiveness was most evident in patients with high Caprini risk scores and microvascular free tissue reconstruction. Bleeding complications were associated with VTE chemoprophylaxis administered in close proximity to potent antiplatelet therapy. The Caprini risk assessment model appears to be an effective tool to stratify otolaryngology patients by risk for VTE. Patients undergoing free tissue reconstruction merit further study before developing recommendations for VTE prophylaxis because of their higher risk of both VTE and bleeding.
Objective The consequences of perioperative venous thromboembolism (VTE) are devastating; identifying patients at risk is an essential step in reducing morbidity and mortality. The utility of perioperative VTE risk assessment in otolaryngology is unknown. This study was designed to risk-stratify a diverse population of otolaryngology patients for VTE events. Study Design Retrospective cohort study. Setting Single-institution academic tertiary care medical center. Subjects and Methods Adult patients presenting for otolaryngologic surgery requiring hospital admission from 2003 to 2010 who did not receive VTE chemoprophylaxis were included. The Caprini risk assessment was retrospectively scored via a validated method of electronic chart abstraction. Primary study variables were Caprini risk scores and the incidence of perioperative venous thromboembolic outcomes. Results A total of 2016 patients were identified. The overall 30-day rate of VTE was 1.3%. The incidence of VTE in patients with a Caprini risk score of 6 or less was 0.5%. For patients with scores of 7 or 8, the incidence was 2.4%. Patients with a Caprini risk score greater than 8 had an 18.3% incidence of VTE and were significantly more likely to develop a VTE when compared to patients with a Caprini risk score less than 8 (P <.001). The mean risk score for patients with VTE (7.4) was significantly higher than the risk score for patients without VTE (4.8) (P <.001). Conclusion The Caprini risk assessment model effectively risk-stratifies otolaryngology patients for 30-day VTE events and allows otolaryngologists to identify patient subgroups who have a higher risk of VTE in the absence of chemoprophylaxis.
Summary We examined the effect of stabling on upper and lower airway inflammation in 14 yearling Arabian horses that had been at pasture since birth. Horses were divided into 2 groups of 7. One group was stabled for 3 months and the other remained at pasture. The groups were then switched over for another 3 months. The nasopharynx, guttural pouches and trachea were examined endoscopically and bronchoalveolar lavage performed every month. An upper airway inflammation score was devised based on the magnitude of pharyngeal lymphoid hyperplasia and guttural pouch inflammation. During stabling this score remained constant, whereas it decreased during the 3 months at pasture. Stabling was also associated with a higher number and percentage of neutrophils in bronchoalveolar lavage fluid and with a smaller percentage of lymphocytes. There was no correlation between upper airway inflammation score and bronchoalveolar lavage cytology. During a nasal occlusion test, dorsal displacement of the soft palate occurred more times in stabled than in pastured horses, but this was heavily biased by the results from one animal. We conclude that stabling is associated with inflammation of both the upper and lower airway of young horses.
A growing number of brain-machine interfaces have now been developed that allow movements of an external device to be controlled using recordings from the brain. This work has been undertaken with a number of different animal models, as well as several human patients with quadriplegia. The resulting movements, whether of computer cursors or robotic limbs, remain quite slow and unstable compared to normal limb movements. It is an open question, how much of this instability is the result of the limited forward control path, and how much has to do with the total lack of normal proprioceptive feedback. We have begun preliminary studies of the effectiveness of electrical stimulation in the proprioceptive area of the primary somatosensory cortex (area 3a) as a potential means to deliver an artificial sense of proprioception to a monkey. We have demonstrated that it is possible for the monkey to detect brief stimulus trains at relatively low current levels, and to discriminate between trains of different frequencies. These observations need to be expanded to include more complex, time-varying waveforms that could potentially convey information about the state of the limb.
Contrast sensitivity as a function of target luminance for four spatial frequencies (0.5, 2, 4, and 8 cycles/deg) was measured in younger (n = 12; age range, 19-35 years) and older (n = 11; age range, 68-79 years) adults in order to examine the feasibility of optical and neural explanations for the impairment of contrast sensitivity in older adults. All subjects were free from identifiable ocular disease and had good acuity. Sensitivity for each spatial frequency was measured at eight luminance levels spanning 3.5 log units in the photopic-mesopic range. When gratings were flickered at 0.5 Hz, functions for older adults were displaced downward on the sensitivity axis across all luminance levels, and the slopes of these functions were steeper than those for younger adults, suggesting that optical mechanisms alone cannot account for the vision loss in older adults. Further measurements, in which spatial targets were flickered at 7.5 Hz, indicated that this faster temporal modulation affected sensitivity as a function of luminance differentially in younger and older adults. These data imply that the neural mechanisms subserving human spatial vision undergo significant changes during adulthood.
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