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OBJECTIVE: To evaluate the proximal effects of hypertensive disorders of pregnancy (HDP) on a validated measure of brain abnormalities in infants born at ≤32 weeks' gestational age (GA) using magnetic resonance imaging at term-equivalent age. STUDY DESIGN: In a multisite prospective cohort study, 395 infants born at ≤32 weeks' GA, underwent 3T magnetic resonance imaging scan between 39 and 44 weeks' postmenstrual age. A single neuroradiologist, blinded to clinical history, evaluated the standardized Kidokoro global brain abnormality score as the primary outcome. We classified infants as HDP-exposed by maternal diagnosis of chronic hypertension, gestational hypertension, pre-eclampsia, or eclampsia. Linear regression analysis identified the independent effects of HDP on infant brain abnormalities, adjusting for histologic chorioamnionitis, maternal smoking, antenatal steroids, magnesium sulfate, and infant sex. Mediation analyses quantified the indirect effect of HDP mediated via impaired intrauterine growth and prematurity and remaining direct effects on brain abnormalities. RESULTS: A total of 170/395 infants (43%) were HDP-exposed. Adjusted multivariable analyses revealed HDP-exposed infants had 27% (95% CI 5%-53%) higher brain abnormality scores than those without HDP exposure (P = .02), primarily driven by increased white matter injury/abnormality scores (P = .01). Mediation analyses showed HDP-induced impaired intrauterine growth significantly (P = .02) contributed to brain abnormality scores (22% of the total effect). CONCLUSIONS: Maternal hypertension independently increased the risk for early brain injury and/or maturational delays in infants born at ≤32 weeks' GA with an indirect effect of 22% resulting from impaired intrauterine growth. Enhanced prevention/treatment of maternal hypertension may mitigate the risk of infant brain abnormalities and potential neurodevelopmental impairments.
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OBJECTIVE: To describe racial inequities in pediatric inflammatory bowel disease care and explore potential drivers. METHODS: We undertook a single-center, comparative cohort study of newly diagnosed Black and non-Hispanic White patients with inflammatory bowel disease, aged <21 years, from January 2013 through 2020. Primary outcome was corticosteroid-free remission (CSFR) at 1 year. Other longitudinal outcomes included sustained CSFR, time to anti-tumor necrosis factor therapy, and evaluation of health service utilization. RESULTS: Among 519 children (89% White, 11% Black), 73% presented with Crohn's disease and 27% with ulcerative colitis. Disease phenotype did not differ by race. More patients from Black families had public insurance (58% vs 30%, P < .001). Black patients were less likely to achieve CSFR 1-year post diagnosis (OR: 0.52, 95% CI:0.3-0.9) and less likely to achieve sustained CSFR (OR: 0.48, 95% CI: 0.25-0.92). When adjusted by insurance type, differences by race to 1-year CSFR were no longer significant (aOR: 0.58; 95% CI: 0.33, 1.04; P = .07). Black patients were more likely to transition from remission to a worsened state, and less likely to transition to remission. We found no differences in biologic therapy utilization or surgical outcomes by race. Black patients had fewer gastroenterology clinic visits and 2-fold increased odds for emergency department visits. CONCLUSIONS: We observed no differences by race in phenotypic presentation and medication usage. Black patients had half the odds of achieving clinical remission, but a degree of this was mediated by insurance status. Understanding the cause of such differences will require further exploration of social determinants of health.
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Disparidades em Assistência à Saúde , Doenças Inflamatórias Intestinais , Humanos , Estudos de Coortes , Serviços de Saúde , Doenças Inflamatórias Intestinais/terapia , Negro ou Afro-Americano , Brancos , CriançaRESUMO
OBJECTIVE: To examine the incidence of postoperative neonatal acute kidney injury (AKI) following general surgical procedures and to test the hypothesis that postoperative urine neutrophil gelatinase-associated lipocalin (uNGAL) concentrations predict AKI. The secondary objective was to evaluate for an association between AKI and hospital mortality. STUDY DESIGN: Prospective observational study of infants undergoing abdominal and thoracic surgical procedures in the neonatal intensive care unit from October 2018 to March 2020. The primary outcome was incidence of neonatal AKI (defined by the neonatal modified Kidney Diseases Improving Global Outcomes criteria) following each procedure to postoperative day 5. Severe AKI was defined as stage 2 or 3 AKI. Urine samples were obtained pre- and postoperatively at 6 time points to evaluate for levels of uNGAL. Secondary outcomes were in-hospital mortality and length of stay. RESULTS: Subjects (n = 141) underwent a total of 192 general surgical procedures during the study period. Neonatal AKI and severe AKI occurred following 36 (18%) and 15 (8%) procedures (n = 33 subjects). Percent change of uNGAL from 24 hours preoperatively to 24 hours postoperatively was greater in subjects with neonatal AKI (190.2% [IQR 0.0, 1666.7%] vs 0.7% [IQR -31.2%,140.2%], P = .0374). The strongest association of uNGAL and AKI occurred at 24 hours postoperatively (area under the receiver operator curves of 0.81, 95% CI 0.72, 0.89). Increased mortality risk was observed in subjects with any postoperative AKI (aOR 11.1 95% CI 2.0, 62.8, P = .0063) and severe AKI (aOR 13.8; 95% CI 3.0, 63.1, P = .0007). CONCLUSION: Elevation in uNGAL 24 hours postoperative was associated with AKI. Neonates with postoperative AKI had increased mortality.
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Injúria Renal Aguda/diagnóstico , Lipocalina-2/urina , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Injúria Renal Aguda/urina , Biomarcadores/urina , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Masculino , Período Pós-Operatório , Estudos Prospectivos , Fatores de RiscoRESUMO
ABSTRACT Introduction: The main clinical feature of chronic nonspecific low back pain (CNLBP) is lower back pain, and suspension sports therapy has a specific effect in this case. Objective: To investigate the changes of flexion-relaxation phenomenon in patients with lower back pain after core control training of suspension exercise therapy (SET). Methods: 84 subjects who met the inclusion and exclusion criteria of chronic low back pain in this experiment were randomly divided into an experimental group and a control group. The experimental group was treated with suspension training. The control group only received acupuncture. We then determined the muscle fascia tension and core stability of the lower lumbar region. Results: The visual analog scale (VAS) and Oswestry dysfunction index (ODI) evaluations of the two groups of patients were different. Conclusion: Suspended core stabilization training has a significant long-term effect in reducing lower back pain and improving waist function in patients with chronic nonspecific low back pain. Level of evidence II; Therapeutic studies - investigation of treatment results.
RESUMO Introdução: A característica clínica principal da dor lombar crônica não especifica (CNLBP) é dor na região lombar. A terapia esportiva por suspensão tem um efeito específico neste caso. Objetivo: Investigar as mudanças do fenômeno flexão- relaxamento em pacientes com dor lombar após treinamento de controle core com terapia de exercícios de suspensão (SET). Métodos: 84 indivíduos que preencheram os critérios de inclusão e exclusão para dor lombar crônica neste experimento foram aleatoriamente divididos em um grupo experimental e um grupo de controle. O grupo experimental foi tratado com treinamento de suspensão. O grupo de controle recebeu apenas acupuntura. Determinamos então a tensão da fáscia muscular e a estabilidade core da região lombar. Resultados: Avaliações da escala visual analógica (EVA) e do índice de incapacidade Owestry (ODI) dos dois grupos de pacientes tiveram resultados diferentes. Conclusão: O treinamento de estabilização do core por suspensão tem efeito de longo prazo considerável na redução de dor lombar e a recuperação da função da cintura em pacientes com dor lombar não especifica crônica. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.
Resumen Introducción: La característica clínica principal del dolor lumbar crónico inespecífico (CNLBP) es dolor en la región lumbar. La terapia deportiva en suspensión tiene un efecto específico en este caso. Objetivo: Investigar los cambios del fenómeno flexión-relajamiento en pacientes con dolor lumbar tras el entrenamiento de control de core con terapia de ejercicios en suspensión (SET). Métodos: Se dividió aleatoriamente los 84 individuos que rellenaron los criterios de inclusión y exclusión para dolor lumbar crónico en este experimento en un grupo experimental y un grupo de control. El grupo experimental fue tratado con entrenamiento en suspensión. El grupo de control recibió apenas acupuntura. Determinamos, entonces, la tensión de la fascia muscular y la estabilidad core de la región lumbar. Resultados: Evaluaciones de escala visual analógica (EVA) y del índice de discapacidad Owestry (ODI) de los dos grupos tuvieron resultados diferentes. Conclusión: El entrenamiento de estabilización del core por suspensión tiene efecto de largo plazo considerable en la reducción de dolor lumbar y la recuperación de la función de la cintura en pacientes con dolor lumbar inespecífico crónico. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.