UCHealth Yampa Valley Medical Center

Introduction: Midline Shift (MLS) quantifies mass effect and herniation risk in acute neurological emergencies. Manual MLS measurements are time-consuming and variable, delaying critical intervention. This study evaluated the performance of Rapid MLS (iSchemaView, Inc.), automated software that quantifies MLS and visualizes displacement on non-contrast CT scans. Methods: In this retrospective multicenter-study, patients with intracranial pathology causing MLS were identified from NCCT databases. Automated MLS measurements from Rapid MLS were compared to those by three expert neuroradiologists. The primary outcome assessed non-inferiority of Rapid MLS to the average mean absolute error (MAE) of experts across pairwise comparisons (one-sided α=0.025). Secondary analyses included Passing-Bablok regression and a Bland-Altman plot. Results: Of 157 initial cases, 153 (mean age 68.7 ± 16.3 years; 59 M, 89 F, 5 unknown) were analyzed after four exclusions due to non-axial images, excessive streak artifact, mass at septum pellucidum, and hemicraniectomy. The cases covered a range of pathologies and expected MLS values outlined in Table 1 and Figure 1 respectively. The primary endpoint analysis demonstrated the MAE of Rapid (0.8mm; 95% CI: 0.7-1.0 mm) was non-inferior to the average pairwise MAE of experts (0.9mm; 95% CI: 0.8-1.0mm) (p<0.0001). Passing-Bablok regression analysis showed high agreement (intercept=0.29; slope=0.90) with minimal bias (difference of 0.2; p=0.0516)(Figure 2). We note that Rapid MLS progressively underestimates values above 10mm where clinical concern is already high. Further investigation of the bias with a Bland-Altman analysis determined a small mean difference of 0.2mm (95% CI: 0.0-0.4mm) between Rapid MLS and expert measurements. Conclusion: Rapid MLS provides fast, reproducible MLS measurements on NCCT, with accuracy comparable to expert neuroradiologists. This tool may enhance triage and decision-making in stroke, traumatic brain injury, and other emergencies by reducing time to diagnosis and intervention.

The rs6923761 (Gly168Ser) missense variant in the glucagon-like peptide-1 receptor (GLP-1R) has been associated with favorable anthropometric and metabolic parameters in individuals with obesity but decreased responsiveness to incretin-based therapies. Here, we performed a pre-specified analysis of a randomized-controlled trial in individuals with obesity and pre-diabetes comparing treatment with the GLP-1R agonist liraglutide, the dipeptidyl peptidase 4 inhibitor sitagliptin or hypocaloric diet, and evaluated the effects of the rs6923761 variant on outcomes. We found significantly greater weight loss to liraglutide with each copy of the variant allele present, indicating a gene dose effect. In addition, individuals with the variant allele exhibited a significant reduction in the pro-thrombotic and pro-inflammatory factor plasminogen activator inhibitor-1 after liraglutide treatment. There was no effect of genotype on fasting glucose after liraglutide treatment, yet individuals with the variant allele exhibited decreased responsiveness to liraglutide and hypocaloric diet in measurements of fasting insulin, C-peptide, glucagon, and HOMA-IR. In conclusion, we found that the GLP-1R rs6923761 variant exerts a dual impact on liraglutide efficacy-enhancing weight loss while diminishing metabolic benefits. The observed associations could be consistent with the constitutive activation of the GLP-1R in the presence of this variant with reduced activation/signaling in response to pharmacologic agents, a pattern that has been observed with the rs10305492 variant in animal models. Future studies are needed to investigate the molecular mechanisms of associations with the rs6923761 variant.

Introduction There is no clear guidance for the optimal setting for dilation and curettage (D&C) for the management of first-trimester pregnancy failure. Identifying patients at risk of clinically significant blood loss at the time of D&C may inform a provider's decision regarding the setting for the procedure. We aimed to identify risk factors predictive for blood loss of 200mL or greater at the time of D&C. Methods This is a retrospective cohort study of patients diagnosed with first-trimester pregnancy failure at gestational age less than 11 weeks who underwent surgical management with D&C at a single safety net academic institution between 4/2016 and 4/2021. Patient characteristics and procedural outcomes were abstracted. Women with less than 200mL versus greater than or equal to 200mL blood loss were compared using descriptive statistics, chi-square for categorical variables, and Satterthwaite t-tests for continuous variables. Results A total of 350 patients were identified; 233 met inclusion criteria, and 228 had non-missing outcome data. Mean gestational age was 55 days (SD 9.4). Thirty-one percent (n=70) had estimated blood loss (EBL) ≥200mL. Younger patients (mean 28.7 years vs. 30.9, p=0.038), Latina patients (67.1% vs. 51.9%, p=0.006), patients with higher body mass index (BMI, mean 30.6 vs. 27.3 kg/m2, p=0.006), and patients with pregnancies at greater gestational age (59.5 days vs. 53.6 days, p<0.001) were more likely to have EBL ≥200mL. Additionally, patients with pregnancies dated by ultrasound (34.3% vs. 18.4%, p=0.007), those who underwent D&C in the operating room (81.4% vs. 48.7%, p<0.001), and those who underwent general anesthesia (81.4% vs. 44.3%, p<0.001) were more likely to have EBL ≥200mL. Discussion In this study, patients with EBL ≥200mL at the time of D&C differed significantly from those with EBL<200mL. This information can assist providers in planning the best setting for their patients' procedures.

Metabolic benefits of glucagon-like peptide 1 (GLP-1) receptor agonists are confounded by weight loss and are not fully achieved by increasing endogenous GLP-1 through dipeptidyl peptidase 4 (DPP-4) inhibition. We investigated weight loss-independent, GLP-1 receptor (GLP-1R)-dependent metabolic effects of liraglutide versus a hypocaloric diet or the DPP-4 inhibitor sitagliptin. GLP-1R antagonism with exendin(9-39) was used to assess GLP-1R-dependent effects during mixed meals. Liraglutide improved insulin sensitivity and decreased fasting and postprandial glucose prior to weight loss, and these benefits were reversed by exendin(9-39). GLP-1R agonists exert rapid, weight loss-independent, GLP-1R-dependent effects on insulin sensitivity not achieved by increasing endogenous GLP-1.

Fractional carbon dioxide (CO2 ) laser resurfacing is used successfully for facial rejuvenation. Post procedure skincare is a variable that influences downtime caused by pain/tenderness, erythema, crusting, and bruising. The primary objective of this pilot study was to demonstrate the benefits of human platelet extract (HPE) (plated)™ CALM Serum, a new topical cosmetic product, following fractionated CO2 ablative laser resurfacing treatment to the entire face versus standard of care. In a single-center, randomized, evaluator-blinded pilot study, a total of 18 subjects were randomized into two groups, CO2 facial resurfacing followed by post-procedural standard of care (Stratacel silicone gel) or CO2 facial resurfacing with the addition of HPE renewosomes in the CALM Serum. CALM Serum demonstrated statistically significant less crusting at Day 10 compared to the control group (p = 0.0193) with less downtime in the first 14 days (p = 0.03). Subjects treated with CALM Serum had statistically significant brighter appearing skin at 14 days (p = 0.007) and more youthful looking skin on Days 14 and 30 (p = 0.003 and 0.04, respectively). This study demonstrates that Renewosome™ technology provides statistically significant post-laser clinical recovery over silicone gel for reducing crusting, and downtime. Subjects reported less diary days of symptoms of pain/tenderness, redness, crusting/flaking, bruising, and itching in the first 14 days compared to the control group. CALM also demonstrated statistically significant improvements in brighter and more youthful appearing skin. CALM is safe and well tolerated.

Letters1 September 1998Guidelines for the Clinical Diagnosis of Lyme DiseaseMark E. McCaulley, MDMark E. McCaulley, MDSteamboat Medical Group; Steamboat Springs, CO 80487Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-129-5-199809010-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The position paper on laboratory diagnosis of Lyme disease [1] is based on a widely accepted paradigm that is inconsistent with a growing body of medical literature. According to this paradigm, cases of Lyme disease are overwhelmingly seropositive and are unlikely to be associated with persistent symptoms after presumed adequate therapy. In addition, any patients remaining persistently symptomatic are presumed to no longer have Lyme disease at all but rather to have such conditions as fibromyalgia, depression, or the chronic fatigue syndrome and, as a result, to be unlikely to respond to additional antibiotic therapy [2]. Such ...

This report summarizes the geology, concentrating on the Proterozoic rocks, of a 1,280-square-mile (3,300-square-kilometer) area comprising the northern Park Range of northernmost Colorado. Techniques are developed that are applicable to crystalline rocks of many kinds in other areas. The summary is supported by study of more than 2,300 thin sections collected during some 20 man-seasons of field work between 1965 and 1976, by 66 new rock and 10 new mineral chemical analyses, and by 36 other published analyses of Park Range rocks.