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Are the Chicago 3.0 manometric diagnostics consistent with Chicago 4.0?
(2023)
Angélica Tobón
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Albis C Hani
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Cristiam D Pulgarin
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Andres F Ardila
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Oscar M Muñoz
<jats:title>Summary</jats:title> <jats:p>There is little information on the degree of concordance between the results obtained using the Chicago 3.0 (CCv3.0) and Chicago 4.0 (CCv4.0) protocols to interpret high-resolution manometry (HRM) seeking to determine the value provided by the new swallowing maneuvers included in the last protocol. This is a study of diagnostic tests, evaluating concordance by consistency between the results obtained by the CCv3.0 and CCv4.0 protocols, in patients undergoing HRM. Concordance was assessed with the kappa test. Bland–Altman scatter plots, and Lin’s correlation-concordance coefficient (CCC) were used to assess the agreement between IRP measured with swallows in the supine and seated position or with solid swallows. One hundred thirty-two patients were included (65% women, age 53 ± 17 years). The most frequent HRM indication was dysphagia (46.1%). Type I was the most common type of gastroesophageal junction. The most frequent CCv4.0 diagnoses were normal esophageal motility (68.9%), achalasia (15.5%), and ineffective esophageal motility (IEM; 5.3%). The agreement between the results was substantial (Kappa 0.77 ± 0.05), with a total agreement of 87.9%. Diagnostic reclassification occurred in 12.1%, from IEM in CCv3.0 to normal esophageal motility in CCv4.0. Similarly, there was a high level of agreement between the IRP measured in the supine compared to the seated position (CCC0.92) and with solid swallows (CCC0.96). In conclusion, the CCv4.0 protocol presents a high concordance compared to CCv3.0. In the majority of manometric diagnoses there is no reclassification of patients with provocation tests. However, the more restrictive criteria of CCv4.0 achieve a better reclassification of patients with IEM.</jats:p>
10Scopus© Citations 1
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Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS
(2021)
Felipe González-Seguel
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Juan José Pinto-Concha
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Nadine Aranis
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LEPPE ZAMORA, JAIME ESTEBAN
6Scopus© Citations 30
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High-Resolution Manometry Thresholds and Motor Patterns Among Asymptomatic Individuals
(2022)
Arvind Rengarajan
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Benjamin D. Rogers
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Zhiqin Wong
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Salvatore Tolone
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Daniel Sifrim
30 1Scopus© Citations 33
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The double posteromedial portals endoscopy for posterior ankle impingement syndrome in athletes
(2022)
Nicola Maffulli
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Rocco Aicale
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Filippo Migliorini
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WAGNER, EMILIO
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Amol Saxena
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Posterior ankle impingement syndrome (PAIS) may result from flexor hallucis longus tendinopathy, compression of the posterior process of the talus from the presence of an os trigonum, soft-tissue impingement, or a combination of these. Posterior extra-articular endoscopy performed with the patient supine through the double posteromedial portals, with excision of adhesions, excision of the posterior process of the talus or an os trigonum, and decompression of the tendon of the flexor hallucis longus (FHL), can be used in athletes with PAIS.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Thirty-four athletes with PAIS in whom conservative management had failed underwent posterior ankle endoscopy in the supine position using the double posteromedial portals. The patients were assessed pre- and postoperatively using the American Orthopaedic Foot and Ankle Society hindfoot scale score, the Tegner scale, and the simple visual analogue scale. Time of surgery, return to sports, patient satisfaction, and complications were recorded and analysed. The average length of postoperative follow-up was 26.7 ± 12.6 (range 24 to 72) months.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>The mean Tegner activity scale score improved to 9 ± 0.2 postoperatively (<jats:italic>p</jats:italic> < 0.05), while the mean American Orthopaedic Foot and Ankle Society scale score improved to 96 ± 5.1 (range 87 to 100) postoperatively, with 29 of 34 patients (85.3%) achieving a perfect score of 100 (<jats:italic>p</jats:italic> < 0.05). The mean time to return to sports was 8.7 ± 0.7 (range 8 to 10) weeks. The complication rate was low, with no superficial wound infections or venous thromboembolism events; only two patients (5.9%) reported pain and tenderness by 3 months after the index procedure.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Posterior ankle endoscopy for the resection of a posterior process of the talus or an os trigonum and decompression of the tendon of FHL is safe and allows excellent outcomes with low morbidity in athletes with PAIS.</jats:p> </jats:sec>
Scopus© Citations 4 1
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Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile
(2022)
Rodrigo A. Cornejo
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Jorge Montoya
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Abraham I. J. Gajardo
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GRAF SANTOS, JERÓNIMO
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Leyla Alegría
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Prone positioning is currently applied in time-limited daily sessions up to 24 h which determines that most patients require several sessions. Although longer prone sessions have been reported, there is scarce evidence about the feasibility and safety of such approach. We analyzed feasibility and safety of a continuous prolonged prone positioning strategy implemented nationwide, in a large cohort of COVID-19 patients in Chile.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Retrospective cohort study of mechanically ventilated COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS), conducted in 15 Intensive Care Units, which adhered to a national protocol of continuous prone sessions ≥ 48 h and until PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> increased above 200 mm Hg. The number and extension of prone sessions were registered, along with relevant physiologic data and adverse events related to prone positioning. The cohort was stratified according to the first prone session duration: Group A, 2–3 days; Group B, 4–5 days; and Group C, > 5 days. Multivariable regression analyses were performed to assess whether the duration of prone sessions could impact safety.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>We included 417 patients who required a first prone session of 4 (3–5) days, of whom 318 (76.3%) received only one session. During the first prone session the main adverse event was grade 1–2 pressure sores in 97 (23.9%) patients; severe adverse events were infrequent with 17 non-scheduled extubations (4.2%). 90-day mortality was 36.2%. Ninety-eight patients (24%) were classified as group C; they exhibited a more severe ARDS at baseline, as reflected by lower PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> ratio and higher ventilatory ratio, and had a higher rate of pressure sores (44%) and higher 90-day mortality (48%). However, after adjustment for severity and several relevant confounders, prone session duration was not associated with mortality or pressure sores.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Nationwide implementation of a continuous prolonged prone positioning strategy for COVID-19 ARDS patients was feasible. Minor pressure sores were frequent but within the ranges previously described, while severe adverse events were infrequent. The duration of prone session did not have an adverse effect on safety.</jats:p> </jats:sec>
Scopus© Citations 17 1
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Critical care echocardiography in prone position patients during COVID-19 pandemic: a feasibility study
(2022)
Diego Ugalde
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Juan Nicolas Medel
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Pablo Mercado
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Ronald Pairumani
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Daniela Eisen
Scopus© Citations 5 1
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Response to “Synucleinopathy: Treatment of Supine Hypertension”
(2021)
IDIAQUEZ RIOS, JUAN FRANCISCO
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IDIAQUEZ, JUAN
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Juan Carlos Casar
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Italo Biaggioni
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Influence of Including Patients with Premorbid Disability in Acute Stroke Trials: The HeadPoST Experience
(2021)
Xia Wang
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Tom J. Moullaali
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Menglu Ouyang
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Laurent Billot
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Else Charlotte Sandset
<jats:p>Background: Patients with premorbid functional impairment are generally excluded from acute stroke trials. We aimed to determine the impact of including such patients in the Head Positioning in acute Stroke Trial (HeadPoST) and early additional impairment on outcomes. Methods: Post hoc analyses of HeadPoST, an international, cluster-randomized crossover trial of lying-flat versus sitting-up head positioning in acute stroke. Associations of early additional impairment, defined as change in modified Rankin scale (mRS) scores from premorbid levels (estimated at baseline) to Day 7 (“early ΔmRS”), and poor outcome (mRS score 3–6) at Day 90 were determined with generalized linear mixed model. Heterogeneity of the trial treatment effect was tested according to premorbid mRS scores 0–1 versus 2–5. Results: Of 8,285 patients (38.9% female, mean age 68 ± 13 years) with complete data, there were 1,984 (23.9%) with premorbid functional impairment (mRS 2–5). A significant linear association was evident for early ∆mRS and poor outcome (per 1-point increase in ΔmRS, adjusted odds ratio 1.20, 95% confidence interval 1.14–1.27; p &#x3c; 0.0001). Patients with greater premorbid functional impairment were less likely to develop additional impairment, but their risk of poor 90-day outcome significantly increased with increasing (worse) premorbid mRS scores (linear trend p &#x3c; 0.0001). There was no heterogeneity of the trial treatment effect by level of premorbid function. Conclusions: Early poststroke functional impairment that exceeded premorbid levels was associated with worse 90-day outcome, and this association increased with greater premorbid functional impairment. Yet, including premorbid impaired patients in the HeadPoST did not materially affect the subsequent treatment effect. Clinical Trial Registration: HeadPoST is registered at http://www.ClinicalTrials.gov (NCT02162017). </jats:p>
1Scopus© Citations 2
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Novedades acerca de los trastornos motores del esófago tras la reciente clasificación de chicago 4.0
(2021)
Claudia Córdoba
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Agustina Rodil
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CISTERNAS, DANIEL
<jats:p>The Chicago Classification includes esophageal motor disorders diagnosed by high-resolution manometry. Of the manometric patterns, some are always clinically relevant and require treatment (eg, the achalasia), while others may be incidental findings requiring no intervention in which aggressive management would be counterproductive. One of the goals of the new version of the recently published Chicago Classification (CCv4.0) was to distinguish between clinically relevant and non-clinically relevant disorders. With this in mind, the study protocol was modified to include liquid swallows in the supine and sitting positions and provocation tests were standardized. Diagnostic criteria were modified, incorporating the presence of symptoms and the support of complementary studies other than manometry. In this review, we will comment the diagnosis and treatment of esophagogastric junction outlet obstruction and hypomotility disorders based on CCv4.0.</jats:p>
Scopus© Citations 3 3
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No benefit of flat head positioning in early moderate–severe acute ischaemic stroke: a HeadPoST study subgroup analysis
(2020)
BRUNSER, ALEJANDRO
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Menglu Ouyang
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Hisatomi Arima
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Pablo M Lavados
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Thompson Robinson
<jats:sec><jats:title>Background</jats:title><jats:p>Although the Head Positioning in acute Stroke Trial (HeadPoST) showed no effect of the flat head position (FP; vs sitting up head position (SUP)) on functional outcome, we hypothesised that it could still offer benefits if commenced early in those with acute ischaemic stroke (AIS) of at least moderate severity.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Subgroup analysis of HeadPoST in participants with National Institutes of Health Stroke Scale (NIHSS) scores ≥7, ≥10 and ≥14, randomised to FP or SUP <4.5 hours of AIS onset on functional outcomes defined by a shift in scores on the modified Rankin scale (mRS) and death/disability (mRS scores 3–6), and any cardiovascular serious adverse event. Logistic regression analyses were undertaken adjusted for study design and baseline risk factors.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>There was no significant differential treatment effect in patient subgroups defined by increasing baseline NIHSS scores: adjusted OR and 95% CI for ordinal shift and binary (3–6) mRS scores: for NIHSS ≥7 (n=867) 0.92 (0.67 to 1.25) and 0.74 (0.52 to 1.04); NIHSS ≥ 10 (n=606) 0.80 (0.58 to 1.10) and 0.77 (0.49 to 1.19); NIHSS ≥14 (n=378) 0.82 (0.54 to 1.24) and 1.22 (0.69 to 2.14).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Early FP had no significant effect in patients with moderate–severe AIS.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="clintrialgov" xlink:href="NCT02162017">NCT02162017</jats:ext-link>.</jats:p></jats:sec>
Scopus© Citations 3 1

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