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This article, published in the Journal of Neurological Surgery, examines the diagnostic accuracy of beta-2 transferrin gel electrophoresis (B2Tf GE) in detecting cerebrospinal fluid (CSF) rhinorrhea. The study conducted a retrospective review of patients who presented with unilateral thin clear rhinorrhea (UTCR) and underwent B2Tf GE. The results showed that B2Tf GE had a sensitivity of 87.5%, specificity of 76.9%, positive predictive value of 77.8%, and negative predictive value of 87% in detecting CSF rhinorrhea. However, the study also highlighted the potential limitations of B2Tf GE and suggested considering other diagnostic tests in cases where B2Tf GE results deviate from clinical suspicion. [Extracted from the article]

Objectives: Unilateral clear thin rhinorrhea (UCTR) can be concerning for a nasal cerebrospinal fluid (CSF) leak. Beta‐2 transferrin electrophoresis has been the gold standard for initial non‐invasive confirmatory testing for CSF rhinorrhea, but there can be issues with fluid collection and testing errors. Ipratropium bromide nasal spray (IBNS) is highly effective at reducing rhinitis‐related rhinorrhea, and should presumably not resolve CSF rhinorrhea. This study assessed whether different clinical features and IBNS response helped predict presence or absence of CSF rhinorrhea. Methods: A prospective cohort study was conducted where all patients with UCTR had nasal fluid tested for beta‐2 transferrin, and were prescribed 0.06% IBNS. Patients were diagnosed with CSF rhinorrhea or other rhinologic conditions. Clinical variables like IBNS response (rhinorrhea reduction), positional worsening, salty taste, postoperative state, female gender, and body‐mass index were assessed for their ability to predict CSF rhinorrhea. Sensitivity, specificity, and predictive values and odds ratios were calculated for all clinical variables. Results: Twenty patients had CSF rhinorrhea, and 53 had non‐CSF etiologies. Amongst clinical variables assessed for predicting CSF absence or presence, significant associations were shown for IBNS response (OR = 844.66, p = 0.001), positional rhinorrhea worsening (OR = 8.22, p = 0.049), and body‐mass index ≥30 (OR = 2.92, p = 0.048). IBNS response demonstrated 96% sensitivity and 100% specificity, and 100% positive and 91% negative predictive values for predicting CSF rhinorrhea. Conclusions: In patients with UCTR, 0.06% IBNS response is an excellent screening tool for excluding CSF rhinorrhea, and should be considered in the diagnostic workup of CSF rhinorrhea. Level of Evidence: 2 Laryngoscope, 134:56–61, 2024 [ABSTRACT FROM AUTHOR]

Background We observed an increase in the frequency of false-positive (FP) human immunodeficiency virus (HIV) test results that correlated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) prevalence. We measured FP rates of laboratory-based fourth-generation HIV antigen/antibody test among those with polymerase chain reaction (PCR)-confirmed infection with SARS-CoV-2 compared with FP rate of those who tested SARS-CoV-2 PCR-negative. Methods All patients PCR tested for SARS-CoV-2 within 2 weeks of an HIV fourth-generation assay were selected. Positive HIV fourth-generation assays were reviewed and divided into groups of FP, true positive (TP), and presumptive negative (PN). Variables included age, race, ethnicity, gender, pregnancy, and Coronavirus Disease 2019 (COVID-19) immunization status. Associations with positive SARS-CoV-2 tests were assessed using linear logistic regression. Multivariate logistic regression was used to assess sets of variables. Results There were 31 910 medical records that met criteria. The frequency of SARS-CoV-2 positive tests was calculated in groups of HIV TP, FP, and PN. In total, 31 575 patients had PN HIV test result, 248 patients had TP, and 87 patients had FP. Those with HIV FP tests had the highest percentage of COVID-19–positive test results at 19.5%, which was significantly higher than HIV PN (11.3%; P =.016) and HIV TP (7.7%; P =.002). After adjustment for all covariates, only FP HIV was significantly associated with COVID-19 (odds ratio, 4.22; P =.001). Conclusions This study reveals that patients with positive SARS-CoV-2 PCR tests are significantly more likely to have an FP fourth-generation HIV test than those with negative SARS-CoV-2 PCR tests. [ABSTRACT FROM AUTHOR]

Compared with conventional coagulation tests and factor-specific assays, viscoelastic hemostatic assays (VHAs) can provide a more thorough evaluation of clot formation and lysis but have several limitations including clot deformation. In this proof-of-concept study, we test a noncontact technique, termed resonant acoustic rheometry (RAR), for measuring the kinetics of human plasma coagulation. Specifically, RAR utilizes a dual-mode ultrasound technique to induce and detect surface oscillation of blood samples without direct physical contact and measures the resonant frequency of the surface oscillation over time, which is reflective of the viscoelasticity of the sample. Analysis of RAR results of normal plasma allowed defining a set of parameters for quantifying coagulation. RAR detected a flat-line tracing of resonant frequency in hemophilia A plasma that was corrected with the addition of tissue factor. Our RAR results captured the kinetics of plasma coagulation and the newly defined RAR parameters correlated with increasing tissue factor concentration in both healthy and hemophilia A plasma. These findings demonstrate the feasibility of RAR as a novel approach for VHA, providing the foundation for future studies to compare RAR parameters to conventional coagulation tests, factor-specific assays, and VHA parameters. [ABSTRACT FROM AUTHOR]

This article profiles the violence that occurs in the films that compose the most popular (top-grossing) genres of 1994: comedy, drama, and action. The critical features used to describe film violence are intentionality, frequency, seriousness, consequences, explicitness, and severity (damage to the body of the recipient). Scales for seriousness, explicitness, and severity were systematically applied to the films using frame-by-frame analysis. Although the initiators of violence in American films employ lethal violence in nearly half the violent events, depiction of any consequences to the recipient's body occurs in 1 out of 10 cases. Throughout, the effects of violence on the victim's body are mystified by a form of narrative that occults and minimizes consequences arising from clearly depicted intentional assaults. So far as violence is concerned, the Hollywood body is an impossible one, merely a dramaturgical figure.

To compare 30-day major adverse cardiac events (MACE) and resource utilization between a traditional protocol and a new 0/1-hour, high sensitivity cardiac troponin I (hs-cTnI) rapid protocol for exclusion of acute myocardial infarction (AMI). Data on the impact of new, rapid rule-out protocols using hs-cTnI in the US healthcare system are lacking. While validated in European cohorts, the impact of such protocols on US emergency care is unclear. We performed a stepped wedge, cluster randomized trial of patients evaluated for possible AMI in 9 EDs (urban and suburban) in an integrated health system from 7/2020-3/2021. The trial arms included a new 0/1-hour rapid protocol and standard care. Randomization occurred by ED site. We included all adult ED patients for whom the treating clinician ordered an ECG and cardiac troponin. We excluded patients with STEMI, a hs-cTnI >18 ng/L in the ED, or a traumatic cause of symptoms. In the rapid protocol, MI was excluded, and ED discharge advised if hs-cTnI <4 ng/L at time 0, or =4 ng/L at time 0 with 1 hour <8 ng/L. In standard care, troponin was measured at 0 and 3 hours, clinicians were blinded to values =18 ng/L, and =18 ng/L was used to exclude AMI and guide ED discharge. Outcomes included MACE at 30-days (death or AMI), ED discharge rates, length of stay, and cardiac testing. Analysis included a mixed effect model adjusting for ED site, time, sex, age, and race. We report adjusted odds ratios (aOR). The trial included 32,609 patients, of whom 13,505 were in the standard care and 19,104 in the rapid protocol arms. At 30-days, MACE occurred in 32 (0.25%) patients in the rapid protocol vs. 18 (0.19%) patients in the standard care arm (aOR 0.82, 95% CI 0.30 – 2.26). The ED discharge rates were lower under the rapid protocol (58.0%) vs. standard care (59.8%). The proportion of patients receiving cardiac stress testing (4.0% vs. 3.4%) and coronary catheterization (1.3% vs. 1.0%) fell under the rapid protocol. In adjusted analysis, there was no statistically significant difference in rates of ED discharge (aOR 1.03, 95% CI 0.94-1.13) with the rapid protocol. There was a reduction in the odds of observation placement (aOR 0.90, 95% CI 0.82-0.99) as well as a reduced overall length of stay for patients discharged from the ED or observation unit (aOR 0.95, 95% CI 0.91–0.99) under the rapid protocol. The difference in the odds of coronary catheterization was not statistically significant (aOR 0.83, 95% CI 0.36 – 1.86), but there was reduced odds of cardiac stress testing under the rapid protocol (aOR 0.71, 95% CI 0.53 – 0.95). Implementation of a rapid 0/1-hour protocol to evaluate for AMI in the ED was safe and associated with modest reductions in healthcare resource utilization. [ABSTRACT FROM AUTHOR]