bluuebunny/crossref_metadata_2025 huggingface dataset:
“Early Efficacy and Safety of Unilateral Biportal Endoscopic Lumbar Interbody Fusion Versus Minimal Invasive in the Treatment of Lumbar Degenerative Diseases”
Authors: Yu Qi , Hu Xuqi , Pan Xuekang , Kong Xiangjia , Zhang Jianqiao , Yu Yefeng , Chen Jiayi , Ren Peng , Lu Huigen
Published: July 2023

Study Design:

This was a retrospective cohort study.

Objective:

To compare the early clinical efficacy and radiologic outcomes between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

Summary of Background Data:

Along with the continuous development of endoscopic technology, the early safety and effectiveness of ULIF technology are still unknown.

Materials and Methods:

This retrospective study included 61 patients who underwent fusion surgery through ULIF or MIS-TLIF in 2021. Twenty-nine patients underwent ULIF (group A), and 32 underwent MIS-TLIF (group B). Fusion rate, bone graft volume, hidden blood loss (HBL), C-reactive protein level, operative time, Oswestry Disability Index , Visual Analog Scale score, and MacNab criteria were assessed in both groups.

Results:

The Visual Analog Scale score for back pain in the early postoperative period was significantly lower in group A than in group B (P<0.05). All other clinical scores showed improvement, with no significant difference between the 2 groups (P>0.05). There was no statistically significant difference in postoperative C-reactive protein levels and fusion rates between the 2 groups (P>0.05). However, HBL was higher and operative time was longer in group A than in group B (P<0.05). Most importantly, there were no statistically significant differences between groups A and B in fusion rate, length of stay and bone graft volume (P>0.05). No serious surgical complications occurred in our study.

Conclusions:

ULIF is a new option for lumbar fusion. Despite the drawbacks of longer operation time and higher HBL, ULIF may be a viable alternative to MIS-TLIF as technology advances.
Risk Factors for Postoperative Surgical Site Infection in Patients Undergoing Spinal Tumor Surgery
Authors: Xin Baoquan , Cao Shuang , Bai Guangjian , Huang Xing , Ye Chen , Hu Runlin , Gao Xin , Zou Weiwei , Liu Tielong
Published: July 2023

Study Design:

A retrospective comparative case-control study.

Objective:

The aim of this study was to determine the risk factors for postoperative surgical site infection (SSI) in patients with spinal tumors requiring reoperation during the perioperative period.

Summary of Background Data:

SSI is a common postoperative complication of spinal surgery. The occurrence of SSI not only increases the mortality rate but prolongs the patient’s hospital stay and increases the medical cost.

Methods:

Included in this study were 202 patients with spinal tumors who received surgical treatment between January 2008 and December 2018, of whom 101 patients who developed SSI and underwent secondary surgery were used as the SSI group, and the other 101 patients with no SSI who were matched with the SSI group by age (±10), pathologic diagnosis (malignant/no-malignant), tumor site (C/T/L/S), surgical approach (anterior/posterior/combined), and surgical team were used as the control group. The clinical data of the 202 patients in both groups were analyzed by logistic regression modeling to identify SSI-associated risk factors.

Results:

Multivariate logistic regression analysis showed that the revision status (B=1.430, P=0.028), the number of spinal levels fused ≥4 (B=0.963, P=0.006), and the use of bone cement (B=0.739, P=0.046) were significantly associated with the increased risk of developing postoperative SSI.

Conclusions:

This study identified the revision status, the number of spinal levels fused ≥4, and the use of bone cement as independent risk factors for SSI in patients with spinal tumors who underwent reoperation during the perioperative period.
Efficacy and Safety of Conservative Treatment Compared With Surgical Treatment for Thoracolumbar Fracture With Score 4 Thoracolumbar Injury Classification and Severity (TLICS)
Authors: Li Ting , Yan Jingxin , Liu Xilin , Hu Jiang , Wang Fei
Published: July 2023

Study Design:

This was a systematic review and meta-analysis.

Objective:

The clinical outcomes, radiologic outcome, and complications were compared between surgical treatment and conservative treatment of thoracolumbar fractures with a Thoracolumbar Injury Classification and Severity (TLICS) score of 4.

Summary of Background Data:

The thoracolumbar fracture is the main reason leading to the spinal cord injury. Some studies suggested that the treatment of TLICS=4 is a “gray zone.” Hence, the efficacy and safety of surgical treatment and conservative treatment of thoracolumbar fractures with scores 4 TLICS was still debated.

Materials and Methods:

A comprehensive search of PubMed, Embase, and the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database was performed up to October 2021. Relevant studies were identified using specific eligibility criteria and data was extracted and analyzed based on primary and secondary outcomes.

Results:

A total of 10 studies involving 555 patients were included (3 randomized controlled trials and 7 retrospective studies). There was no significant difference of hospital time (standardized mean difference=0.24, 95% CI: −1.50 to 1.97, P=0.79) and Oswestry Disability Index (mean difference=2.97, 95% CI: −1.07 to 7.01, P=0.15) between surgery and nonsurgery. The length of returning to work was shorter in surgical treatment (standardized mean difference=1.27, 95% CI: 0.07–2.46, P=0.04). Visual Analog Scale in surgical treatment was lower at 1, 3, and 6 months (respectively, P<0.00001, P=0.003, and P=0.02). However, there existed no significant difference between surgical treatment and nonsurgical treatment at 12 and >24 months (respectively, P=0.18 and 0.17). Cobb angle was lower in surgical treatment at postoperative at 6, 12, and >24 months (respectively, P=0.005, P<0.00001, P=0.002, and P=0.0002). Finally, the surgical treatment had a lower incidence of complications (odds ratio=3.89, 95% CI: 1.90–7.94, P=0.0002).

Conclusions:

Current evidence recommended that surgical treatment is superior to conservative treatment of TLICS score of 4 at the early follow-up. Surgical treatment had lower Cobb angle, Visual Analog Scale scores, and complications compared with a nonsurgical TLICS score of 4. However, these findings needed to be verified further by multicenter, double-blind, and large-sample randomized controlled trials.
Gut microbiota and microbiota-derived metabolites in cardiovascular diseases
Authors: Chen Xiaofeng , Zhang Hua , Ren Sichong , Ding Yangnan , Remex Naznin Sultana , Bhuiyan Md. Shenuarin , Qu Jiahua , Tang Xiaoqiang
Published: July 2023

Cardiovascular diseases, including heart failure, coronary artery disease, atherosclerosis, aneurysm, thrombosis, and hypertension, are a great economic burden and threat to human health and are the major cause of death worldwide. Recently, researchers have begun to appreciate the role of microbial ecosystems within the human body in contributing to metabolic and cardiovascular disorders. Accumulating evidence has demonstrated that the gut microbiota is closely associated with the occurrence and development of cardiovascular diseases. The gut microbiota functions as an endocrine organ that secretes bioactive metabolites that participate in the maintenance of cardiovascular homeostasis, and their dysfunction can directly influence the progression of cardiovascular disease. This review summarizes the current literature demonstrating the role of the gut microbiota in the development of cardiovascular diseases. We also highlight the mechanism by which well-documented gut microbiota-derived metabolites, especially trimethylamine N-oxide, short-chain fatty acids, and phenylacetylglutamine, promote or inhibit the pathogenesis of cardiovascular diseases. We also discuss the therapeutic potential of altering the gut microbiota and microbiota-derived metabolites to improve or prevent cardiovascular diseases.
Ceftazidime Plasma Concentrations and Neurotoxicity: The Importance of Therapeutic Drug Monitoring in Patients Undergoing Different Modalities of Renal Replacement Therapy. A Grand Round
Authors: Robosa Roselle S. , Lau Cindy , Stojanova Jana , Chin Cheau Wern , Marriott Deborah J. E.
Published: July 2023

Ceftazidime–avibactam (CTZ-AVM) is a novel cephalosporin/beta-lactamase inhibitor with broad-spectrum activity against multidrug-resistant Pseudomonas aeruginosa. Ceftazidime-induced neurotoxicity is a well-described adverse effect, particularly in patients with renal insufficiency. However, appropriate dosing of ceftazidime–avibactam in patients undergoing renal replacement therapy (RRT) is sparsely investigated, and therapeutic drug monitoring to guide dosing remains lacking. Furthermore, when dose adjustment for impaired renal function is based on CTZ-AVM product information, inferior cure rates have been obtained compared with those with the standard therapy for intra-abdominal infections. Maintaining an effective dose while avoiding toxicity in these patients is challenging. Here, the authors describe the case of a critically ill patient, undergoing 2 modalities of RRT, who developed ceftazidime-induced neurotoxicity as confirmed using ceftazidime therapeutic drug monitoring. This case illustrates a therapeutic drug monitoring–based approach for guiding ceftazidime–avibactam dosing in this context and in diagnosing the cause of neurological symptoms and signs.
Mechanisms of Development of Orbital Fractures: A Review
Authors: Kono Shinjiro , Vaidya Aric , Takahashi Yasuhiro
Published: July 2023

Purpose:

The purpose of this study is to review the mechanisms in the development of orbital fractures.

Methods:

This is a comprehensive literature review that summarizes the mechanisms of developing orbital fractures.

Results:

There are 3 proposed mechanisms in the development of orbital fractures, which include the buckling, hydraulic, and globe-to-wall contact mechanisms. These mechanisms, as well as patient age, causes of injuries, and periorbital anatomy, influence the extent, sites, and patterns of orbital fractures.

Conclusion:

A deeper understanding of these mechanisms helps us to detect and properly manage orbital fractures in the clinical setting.
A Modified Bicanalicular Crawford Placement Method for Congenital Nasolacrimal Duct Obstruction: Reducing Need for Operative Room Removal
Authors: Thompson John P. , Pharo Austin M. , Ingram Ellen E. , Bozner Elizabeth M. , Avdic Armin , Ellis George S.
Published: July 2023

Purpose:

This study introduces a method for Crawford bicanalicular stent placement for congenital nasolacrimal duct obstruction by looping the ends to themselves which are tied together with dissolvable sutures to ease in-office removal.

Methods:

This is a single institution, retrospective study that evaluates outcomes of patients aged 5 years and under who underwent bicanalicular stenting for congenital nasolacrimal duct obstruction by a single surgeon (G.S.E.) between 2004 and 2020. Only primary surgeries were included in the analysis. Stenting could be accompanied by balloon dilatation and/or turbinate infracture. Age, sex, follow-up time, complications, type of intervention, extrusion, recurrence, and operative room removal were recorded.

Results:

This study included 56 eyes from 54 patients with a mean age of 19.0 ± 9.5 months (range, 8–50 months). There was a 30.3% extrusion rate, a 5.4% rate of recurrence of disease, and a 3.6% rate of operative room removal. The average follow-up time was 25.1 ± 39.8 months (range, 1–132 months). For patients with or without extrusion, there were no significant differences between age, sex, laterality, type of intervention, follow-up time, or rate of recurrence. Each eye that had recurrence (3 total) or needed operative room removal (2 total) underwent only bicanalicular stenting without accompanying procedures, although the difference in rates between procedures was also not statistically significant.

Conclusions:

This method had a low recurrence and operative room removal rate, with similar extrusion and complication rates to other bicanalicular stent and intubation methods for the treatment of congenital nasolacrimal duct obstruction.
National survey of second opinions for hospitalized patients in need of liver transplantation
Authors: Kaplan Alyson , Lee-Riddle Grace S. , Nobel Yael , Dove Lorna , Shenoy Akhil , Rosenblatt Russell , Samstein Benjamin , Emond Jean C. , Brown Robert S.
Published: July 2023

Decisions about patient candidacy for liver transplant (LT) can mean the difference between life and death. We surveyed LT centers across the United States to assess their perceptions of and barriers to second-opinion referrals for inpatients declined for transplant. The medical and surgical directors of 100 unique US LT programs that had done >20 LTs in 2021 were surveyed with a 33-item questionnaire including both multiple-choice and free-response questions. The response rate was 60% (60 LT centers) and included 28 larger-volume ( ≥100 LTs in 2021) and 32 smaller-volume (<100 LTs in 2021) programs. The top 3 reasons for inpatient denial for LT included lack of social support (21%), physical frailty (20%), and inadequate remission duration from alcohol use (11%). Twenty-five percent of the programs reported “frequently” facilitating a second opinion for a declined inpatient, 52% of the programs reported “sometimes” doing so, and 7% of the programs reported never doing so. One hundred percent of the programs reported that they receive referrals for second opinions. Twenty-five percent of the programs reported transplanting these referrals frequently (over 20% of the time). Neither program size nor program location statistically impacted the findings. When asked if centers would be in favor of standardizing the evaluation process, 38% of centers would be in favor, 39% would be opposed, and 23% were unsure. The practices and perceptions of second opinions for hospitalized patients evaluated for LT varied widely across the United States. Opportunities exist to improve equity in LT but must consider maintaining individual program autonomy.
Feasibility of steroid-free tacrolimus-basiliximab immunosuppression in pediatric liver transplantation and predictors for steroid requirement
Authors: Trezeguet Renatti Guido , Riva Natalia , Minetto Julia , Reijenstein Hayellen , Gole Maria , Meza Veronica , Bosaleh Andrea , Licciardone Nieves , Aredes Diego , Lauferman Leandro , Cervio Guillermo , Dip Marcelo , Schaiquevich Paula , Halac Esteban , Imventarza Oscar
Published: July 2023

Avoidance of steroids in pediatric liver transplantation may reduce toxicity and morbidity. The aim of this study was to analyze the feasibility of a steroid-free tacrolimus-basiliximab immunosuppression scheme, the risk factors associated with steroid requirement, and safety parameters. Patients who underwent liver transplantation for biliary atresia between 2011 and 2019 were included and followed for 6 months after transplantation. Immunosuppression consisted of tacrolimus-based treatment with basiliximab induction. Steroid-free survival was estimated, and risk factors for steroid requirement were evaluated using multivariate Cox regression analysis. A total of 76 patients were included, of whom 42 (55.3%) required steroids (>14 d) due to biopsy-proven acute rejection (47.6%, n = 20), instability in liver function tests (35.7%, n = 15), tacrolimus-related adverse drug reactions (14.3%, n = 6), or other reasons (bronchospasm episode, n = 1). Steroid-free survival was 45.9% (95% CI, 35.9–58.8). Independent factors associated with steroid requirement included tortuosity in tacrolimus trough levels (≥1.76 vs. <1.76: HR 5.8, 95% CI, 2.6–12.7; p < 0.001) and mean tacrolimus trough levels (≥ 6.4 ng/mL vs. < 6.4 ng/mL: HR 0.4, 95% CI, 0.2–0.7; p = 0.002). The rate of bacterial and viral infections was comparable between patients with and without steroids, although in the former group, cytomegalovirus infection developed earlier (p = 0.03). Patients receiving steroids had higher total cholesterol, LDL, and HDL levels (p < 0.05) during follow-up, but no changes in the height Z-score were observed 1 year after transplantation. Basiliximab induction in combination with tacrolimus-based treatment avoided steroid requirements in 45% of the patients. Tacrolimus variability and trough levels below 6.4 ng/mL independently increased the risk of steroid requirement. Further efforts should be focused on personalizing immunosuppressive treatment.
Liver transplantation for refractory hepatic hydrothorax is associated with a greater survival benefit compared to other complications of cirrhosis
Authors: Osman Karim T. , Naritsin Anastasia , Amuchi Brenda , Qamar Amir A.
Published: July 2023

Hepatic hydrothorax (HH) is a significant complication of cirrhosis associated with increased mortality. Liver transplantation (LT) remains the best treatment modality. We aim to assess predictors of mortality and the survival benefit of LT in patients with HH. A prospectively maintained cohort of adult patients with cirrhosis, being evaluated for LT at our institution, was retrospectively reviewed from 2015 to 2020. The primary outcome was death or LT. Cox proportional hazard regression identified associations between covariates and death. We calculated the years saved due to LT by comparing patients who were on the waiting list with patients who received an LT. This was done by calculating the area under the Kaplan-Meier curve. Censoring occurred at the time of the last follow-up or death. Patients with refractory HH had the lowest median survival of only 0.26 years. Within the HH group, having a refractory HH group was significantly associated with an increased risk of mortality (HR 1.73; 95% CI 1.06–2.81; p-value 0.03). Refractory HH was also significantly associated with mortality when evaluated in the entire cohort and after adjusting for other covariates (HR 1.48, 95% CI 1.03–2.11; p-value 0.03). Patients with refractory HH had the highest 1-year survival benefit with LT (0.48 y), followed by patients with non-refractory HH (0.28 y), then patients with other complications of cirrhosis (0.19 y). In this large study evaluating the prognostic impact of HH on patients with cirrhosis, refractory HH was an independent predictor of mortality. LT provides an additional survival benefit to patients with HH compared with those without HH.
Liver transplantation with uncontrolled versus controlled DCD donors using normothermic regional perfusion and ex-situ machine perfusion
Authors: Ghinolfi Davide , Patrono Damiano , De Carlis Riccardo , Melandro Fabio , Buscemi Vincenzo , Farnesi Francesca , Torri Francesco , Lauterio Andrea , Di Salvo Maria , Cerchione Raffaele , Zanierato Marinella , Morganti Riccardo , Romagnoli Renato , De Simone Paolo , De Carlis Luciano
Published: July 2023

In Italy, 20 minutes of continuous, flat-line electrocardiogram are required for death declaration, which significantly increases the risks of donation after circulatory death (DCD) LT. Despite prolonged warm ischemia time, Italian centers reported good outcomes in controlled donation after circulatory death LT by combining normothermic regional and end-ischemic machine perfusion. However, data on uncontrolled DCD (uDCD) LT performed by this approach are lacking. This was a multicenter, retrospective study performed at 3 large-volume centers comparing clinical outcomes of uncontrolled versus controlled DCD LT. The aim of the study was to assess outcomes of sequential normothermic regional perfusion and end-ischemic machine perfusion in uncontrolled DCD liver transplantation (LT). Of 153 DCD donors evaluated during the study period, 40 uDCD and 59 donation after circulatory death grafts were transplanted (utilization rate 52% vs. 78%, p = 0.004). Recipients of uDCD grafts had higher MEAF (4.9 vs. 3.5, p < 0.001) and CCI scores at discharge (24.4 vs. 8.7, p = 0.026), longer ICU stay (5 vs. 4 d, p = 0.047), and a trend toward more severe AKI. At multivariate analysis, 90-day graft loss was associated with recipient BMI and lactate downtrend during normothermic regional perfusion. One-year graft survival was lower in uDCD (75% vs. 90%, p = 0.007) but became comparable when non-liver–related graft losses were treated as censors (77% vs. 90%, p = 0.100). The incidence of ischemic cholangiopathy was 10% in uDCD versus 3% in donation after circulatory death, p = 0.356. uDCD LT with prolonged warm ischemia is feasible by the sequential use of normothermic regional perfusion and end-ischemic machine perfusion. Proper donor and recipient selection are key to achieving good outcomes in this setting.
3-D-Printed Models for Temporal Bone Training: A Validity Study
Authors: Frithioff Andreas , Frendø Martin , Weiss Kenneth , Foghsgaard Søren , Mikkelsen Peter Trier , Frederiksen Thomas Winther , Pedersen David Bue , Sørensen Mads Sølvsten , Andersen Steven Arild Wuyts
Published: July 2023

Objective

3-D printing offers convenient and low-cost mastoidectomy training; nonetheless, training benefits using 3-D-printed temporal bones remain largely unexplored. In this study, we have collected validity evidence for a low-cost, 3-D-printed temporal bone for mastoidectomy training and established a credible pass/fail score for performance on the model.

Study design

A prospective educational study gathering validity evidence using Messick's validity framework.

Setting

Seven Danish otorhinolaryngology training institutions.

Participants

Eighteen otorhinolaryngology residents (novices) and 11 experienced otosurgeons (experts).

Intervention

Residents and experienced otosurgeons each performed two to three anatomical mastoidectomies on a low-cost, 3-D-printed temporal bone model produced in-house. After drilling, mastoidectomy performances were rated by three blinded experts using a 25-item modified Welling scale (WS).

Main outcome measure

Validity evidence using Messick's framework including reliability assessment applying both classical test theory and Generalizability theory.

Results

Novices achieved a mean score of 13.9 points; experienced otosurgeons achieved 23.2 points. Using the contrasting groups method, we established a 21/25-point pass/fail level. The Generalizability coefficient was 0.91, and 75% of the score variance was attributable to participant performance, indicating a high level of assessment reliability. Subsequent D studies revealed that two raters rating one performance or one rater rating two performances were sufficiently reliable for high-stakes assessment.

Conclusion

Validity evidence supports using a low-cost, 3-D-printed model for mastoidectomy training. The model can be printed in-house using consumer-grade 3-D printers and serves as an additional training tool in the temporal bone curriculum. For competency-based training, we established a cut-off score of 21 of 25 WS points using the contrasting groups method.
Perceived Value of Holistic Needs Assessment in Supporting the Needs of Women With Breast Cancer
Authors: Briggs Lydia , Corner Jessica , Blake Holly
Published: July 2023

Background

Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly.

Objective

The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.

Methods

A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.

Results

The contribution of HNA to women’s experiences of support was complex and dependent on various influences: (1) how the woman’s own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.

Conclusion

Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women’s views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful “in principle” but reported little benefit of the assessment, and some reported negative outcomes.

Implications for Practice

Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.
Creating an Organizational Culture and Climate of Meaningful Recognition for Nurse Managers
Authors: Joseph M. Lindell , Kelly Lesly , Hovda Davis Mary Beth , Zimmermann Deb , Ward Dani
Published: July 2023

OBJECTIVES

To examine the current nurse manager (NM) recognition culture and climate in organizations and to develop a theoretical foundation for meaningful recognition.

BACKGROUND

Nurse managers call for wider recognition, but the theoretical conceptualization and underpinnings of meaningful recognition are sparse in the literature.

METHODS

A qualitative descriptive design was used utilizing individual interviews. The study participants included 30 individuals consisting of NMs, chief nursing officers, and chief nursing executives. Content analysis was conducted.

RESULTS

A theoretical model with super-categories and supportive quotes was created to operationalize a culture and climate of meaningful recognition in the organizations represented by the sample.

CONCLUSION

This qualitative descriptive study highlights the importance of recognizing the value of NMs for their contributions to nursing leadership and patient care. Implications of recognizing NMs are counteracting the feeling of being invisible and mitigating issues within the work environment.
Building a Nurse-Led Collaborative Care Delivery Model for Behavioral Health Patients Boarding on a Pediatric Medical Unit
Authors: Shannon M. Teresa , Green MaryEllen , Pires-Serisser Ana Maria , King Elizabeth-Anne
Published: July 2023

With the current global mental health crisis, hospitals have experienced an exponential increase in behavioral health patients boarding on medical and surgical units. Nursing leaders are challenged with adapting existing infrastructure to deliver safe high-quality care to this patient population. This article describes 1 medical center's nurse-led effort to improve safety and quality care experiences for pediatric behavioral health patients boarding on a medical unit and for the staff providing care.
The Impact of DNP Scholarly Projects on Healthcare Organizations
Authors: Hlebichuk Jeanne , Lancaster Rachelle J. , Vizgirda Vida
Published: July 2023

Many DNP scholarly projects occur in healthcare organizations, often taking various forms based on specific academic requirements. Projects require site mentorship, project facilitation, and institutional review board resources. This article highlights the impact of DNP scholarly projects on healthcare organizations and provides a road map for success for healthcare leaders and site mentors.
Development of smart infusion pumps: State of the art and future perspectives
Authors: Xu Weiran , Hou Luoya , Zhu Disha , Jin Xiaoyan , Shang Shaomei , Wang Xuefeng , Han Hongbin
Published: July 2023

This review discusses the working principle, design advantages and limitations of intelligent infusion pumps, and points out the research prospects of intelligent infusion pumps in personalized closed-loop management and prospective medication decision-making.
Argument-based Ethics and Mandatory Reporting Laws for Trafficked Persons
Authors: Chen Rebecca , Robitz Rachel , Nichols Beatrice , Coverdale John , Nguyen Phuong , Gordon Mollie
Published: July 2023

Human trafficking, which includes sex and labor trafficking, is a pressing issue that needs to be more adequately addressed. Health care professionals have a unique opportunity to assist people who are experiencing human trafficking. However, no consensus exists concerning the involvement of law enforcement through mandatory reporting of trafficked adults. This column uses argument-based ethics to analyze existing literature on ethical justification for mandatory reporting laws. It also recommends areas of growth for health care professionals and ethicists concerned about the use of mandatory reporting for human trafficking.
Country of birth is associated with discrepancies in the prescription of two-drug regimens in successfully treated people with HIV in France
Authors: Palich Romain , Hentzien Maxime , Hocqueloux Laurent , Duvivier Claudine , Allavena Clotilde , Huleux Thomas , Makinson Alain , Rey David , Delobel Pierre , Cuzin Lise ,   for the Dat’AIDS Study Group
Published: July 2023

Objectives:

We aimed to examine the association of the country of birth and the other patients’ characteristics with the prescription of two-drug regimens (2DRs) in virally suppressed people with HIV (PWH) in France.

Design:

Observational study conducted from the national Dat’AIDS prospectively collected database.

Methods:

We included all adults who were actively in care on 31 December 2020 in 26 French centers, with an HIV plasma viral load (pVL) <50 copies/ml for at least 6 months while on antiretroviral therapy (ART). Patients with chronic hepatitis B were excluded because they are not eligible to 2DRs. Univariate and multivariate logistic regressions were built to analyze relationships between patients’ characteristics and receiving a 2DR.

Results:

We analyzed data from 28 395 PWH: 41.7% men who have sex with men, 31.7% women and 26.5% heterosexual men; 35% born abroad. Median age was 53 years [interquartile range (IQR) 44–60]; ART duration 14 years (8–23); duration of virological suppression 87 months (42–142). 2DRs (mainly dolutegravir/rilpivirine, 53.8%, or dolutegravir/lamivudine, 41.7%) were prescribed in 16.3% of the patients and were less common in the ‘born abroad’ group (18.9% versus 11.5%). The multivariate model showed that individuals born in France were more likely to receive a 2DR [adjusted odds ratio (aOR): 1.62 [1.50–1.74]], independently of other characteristics. Older PLWH and those with higher CD4+T-cell counts were also more likely to receive a 2DR.

Conclusion:

Despite unrestricted access to ART in France, independently from HIV disease parameters, PWH born abroad were less likely to receive 2DRs as a maintenance regimen than those born in France. Qualitative data are needed to better understand physicians’ prescribing practices.
A Cost Analysis of Mohs and Total Surgical Excision
Authors: Liu Sophia , Mathew Prakash , Al Bayati Mahmood , Remer Hallie , Verling Samantha , Spector Seth , Thaller Seth
Published: July 2023

Purpose

Skin cancer risk is elevated in veterans, Whites, and males older than 50 years, who comprise the majority of patients at the Miami VA healthcare system.

Treatments include total surgical excision (TSE) with frozen section or permanent pathology, and Mohs surgery. Our protocol consists of Mohs procedures performed offsite followed by reconstruction at the VA. This retrospective study examines the cost difference between TSE and Mohs surgery.

Methods

A retrospective chart review was performed of VA patients who underwent TSE or Mohs surgery between 2017 and 2019. Patients younger than 18 or those without malignancy on final pathology were excluded. Patients were subdivided into TSE versus Mohs. Cost per operating room minute was determined using published data for similar institutions. Pathology costs were estimated using institution specific Medicare data. T test was performed using SPSS.

Results

Of 130 patients identified, 82 underwent TSE and 48 underwent Mohs with reconstruction. Cost per operating room minute for inpatient government-owned facilities was $37.94. A flat fee of $1400 for the Mohs surgery was the contracted rate with the offsite institution. Average cost of Mohs surgery with reconstruction was $3534.12. Average cost of TSE with pathology was $2643.85. Total surgical excision was significantly more cost efficient than Mohs with reconstruction (P < 0.01).

Conclusions

At our institution, TSE seems more cost effective than Mohs with subsequent reconstruction. While these are generalized costs, and data specific to our institution, cost efficiency is an important consideration in improving the value of care for VA patients.
Treatment of Pseudoangiomatous Stromal Hyperplasia of the Breast
Authors: Yturralde Kylee J. , Friedman Harold I.
Published: July 2023

Pseudoangiomatous stromal hyperplasia is an uncommon benign condition of mesenchymal proliferation. Fewer than 1500 cases have been reported in previous literature. It is observed most commonly in postmenopausal and perimenopausal women and is extremely rare to present in children. Recommended treatment in severe cases is often mastectomy due to high incidence of recurrence. However, a careful review of the literature suggests that treatment of this benign disease should be tailored to the mode in which it presents. This case report describes a 16-year-old girl with a severe case of bilateral pseudoangiomatous stromal hyperplasia that was managed with reduction mammoplasty, along with a 10-year case follow-up. Based on a literature review of more than 2800 cases and the current case report, a conservative management strategy is suggested, depending on disease presentation.
Autologous Reconstruction After Failed Implant-Based Breast Reconstruction
Authors: von Glinski Maxi , Holler Nikla , Kümmel Sherko , Reinisch Mattea , Wallner Christoph , Wagner Johannes Maximilian , Dadras Mehran , Sogorski Alexander , Lehnhardt Marcus , Behr Björn
Published: July 2023

Introduction

Failure of an implant-based breast reconstruction often requires a change to an autologous procedure (salvage autologous breast reconstruction [Salv-ABR]). The aim of this study was to compare surgical and patient-reported outcomes of Salv-ABR to immediate or delayed-immediate ABR (I/DI-ABR), which has hardly been addressed in the existing literature.

Methods

All patients undergoing Salv- or I/DI-ABR between January 2014 and December 2020 were asked to participate in this study. Complication rates, the aesthetic outcome (5-point Likert scale), and quality of life (EORTC QLQ-C30 and -BR23, Breast-Q, Center for Epidemiology Studies Depression Scale) were compared between both procedures.

Results

Seventy patients participated in the study (Salv-ABR: n = 23; mean ± SD age, 53.5 ± 9.1 years; follow-up, 28.6 ± 18.5 month; I/DI-ABR: n = 45, mean ± SD age: 50.2 ± 7.3 years; follow-up, 32.8 ± 18.5 month). Main indication for Salv-ABR was a major capsular contracture (n = 14 [60.1%]). Early unplanned reoperation rates were significantly increased in the Salv-ABR (56.5% vs 14.9%; P < 0.01). Patients with I/DI-ABR showed a significantly improved overall aesthetic outcome (2.7 ± 0.9 vs 3.3 ± 0.7; P < 0.01) and scored significantly higher in several subscales of EORTC QLQ-C30/BR23 (Global Health Status, Role Functioning, Body Image; P < 0.05) and the Breast-Q (Psychosocial Well-being, Satisfaction with Breast; P < 0.05) compared with patients with Salv-ABR.

Conclusions

Salvage ABR is associated with a higher complication rate, compromised aesthetic outcome, and quality of life compared with I/DI-ABR. This should be considered and discussed with the patient when planning any kind of reconstructive breast surgery.
Skin Popping for the Hand Surgeon
Authors: Shih Sabrina , Francoisse Caitlin A. , Xu Kyle Y. , Tadisina Kashyap Komarraju
Published: July 2023

Introduction

Subcutaneous injection of illicit drugs, colloquially known as skin popping, is associated with skin and soft tissue infections of the upper extremity. Sequelae of these infections often present to hand surgeons in the late stages of disease, are associated with challenging clinical scenarios, and are a significant burden to both patients and providers. The authors present an illustrative case and review the literature regarding this growing phenomenon in upper extremity surgery.

Methods

A case report detailing the surgical reconstruction of a large forearm wound in the setting of intravenous heroin use and skin popping is presented. Search terms related to upper extremity subcutaneous drug injection were used to find relevant articles in PubMed and EMBASE. A total of 488 articles were found, with 22 studies meeting the inclusion criteria.

Results

In this case report, the patient had a long history of skin popping to the forearm and presented with a chronic wound with exposed bone. The patient was treated with serial debridement, bony fixation, intravenous antibiotics, and soft tissue coverage using an arteriovenous loop and a muscle-only latissimus flap. Literature review yielded 22 studies comprising 38 patients with 55% (11/20) women and age range of 23 to 58 years. Heroin was the most commonly used drug (50.0%). The most common presentation was soft tissue infection (6/20 patients), manifestations of noninfected wounds (5/20), and wound botulism (4/20 of patients). Seventy percent of patients presented with multiple injection sites. Surgical management was described in 18% of cases, with all but one case describing drainage and debridement techniques. Only one case of formal reconstruction using a dermal template was described.

Conclusions

Skin popping infections have unique pathogenesis, presentation, and management patterns that hand surgeons must be aware of when treating these patients. A literature review revealed a relative paucity of reports regarding risk factors and surgical management of “skin popping” sequelae. If patients are reconstructive candidates, complex reconstruction requiring free tissue transfer may be warranted.
How Does Reduction Mammaplasty Surgical Technique Impact Clinical, Aesthetic, and Patient-Reported Outcomes?
Authors: Cunning Jessica R. , Mookerjee Vikram G. , Alper David P. , Rios-Diaz Arturo J. , Bauder Andrew R. , Kimia Rotem , Broach Robyn B. , Barrette Louis-Xavier , Fischer John P. , Butler Paris D.
Published: July 2023

Background

A comprehensive comparison of surgical, aesthetic, and quality of life outcomes by reduction mammaplasty technique does not exist. We sought to ascertain the effect of technique on clinical, aesthetic, and patient-reported outcomes.

Methods

Patients with symptomatic macromastia undergoing a superomedial or inferior pedicle reduction mammoplasty by a single surgeon were identified. BREAST-Q surveys were administered. Postoperative breast aesthetics were assessed in 50 matched-patients. Patient characteristics, complications, quality of life, and aesthetic scores were analyzed.

Results

Overall, 101 patients underwent reductions; 60.3% had a superomedial pedicle. Superomedial pedicle patients were more likely to have grade 3 ptosis (P < 0.01) and had significantly shorter procedure time (P < 0.01). Only the inferior pedicle technique resulted in wound dehiscence (P = 0.03) and reoperations from complications (P < 0.01). Those who underwent an inferior pedicle reduction were 4.3 times more likely to experience a postoperative complication (P = 0.03). No differences in quality of life existed between cohorts (P > 0.05). Superomedial pedicle patients received significantly better scarring scores (P = 0.03).

Conclusions

The superomedial pedicle reduction mammoplasty technique provides clinical and aesthetic benefits compared with the inferior pedicle technique.
Implant-Based Breast Reconstruction in the Elderly
Authors: Danko Dora , Ash Makenna E. , Brown Owen H. , Losken Albert , Thompson Peter W.
Published: July 2023

Background

Advanced age is considered by many to be a relative contraindication to breast reconstruction. However, despite increased medical comorbidities and a perception that elderly patients are less concerned with body image, more women older than 70 years are choosing to undergo breast reconstruction. There is a paucity of data to guide reconstructive decision-making and counseling in this population.

Objectives

The aim of this study was to evaluate patient satisfaction, complication rates, and long-term outcomes in women older than 70 years undergoing implant-based breast reconstruction.

Methods

A total of 400 patients were identified at the authors' institution and divided into 2 groups: ≥70 and <70 years old. Medical comorbidities, surgical outcomes, and patient-reported outcomes as defined by the BREAST-Q were compared using the χ
2 tests for categorical variables and t tests for continuous variables.

Results

The cohort of patients older than 70 years was made up of 25 women, with a mean age of 73 years, and the cohort of patients younger than 70 years was made up of 375 women, with a mean age of 50 years. There was no significant difference in body mass index (P = 0.373), smoking status (P = 0.360), or history of prior ipsilateral radiation (P = 0.508) between the 2 cohorts; however, the elderly cohort was significantly more likely to have diabetes (P = 0.026). Although elderly patients were less likely to undergo bilateral mastectomy (P < 0.001), there was no significant difference in the type of mastectomy, pathological diagnosis, or method of reconstruction. There was no significant difference in complication rates when looking at minor infection (P = 0.553) or major infection (P = 0.553). The 2 groups were equally likely to undergo secondary procedures (P = 0.192). Overall satisfaction rates were high in all BREAST-Q categories in the elderly group and not significantly different when compared with the group of patients younger than 70 years. Matched-pair analysis showed a significant difference with the group of patients older than 70 years having higher levels physical well-being (P < 0.001).

Conclusions

Immediate breast reconstruction can be performed safely and with similar high satisfaction rates in the elderly population as their younger counterparts. Age alone should not be used as a reason for excluding women from these life-changing operations.
Temporal Facelift: A New Method for Temporal and Mid-face Lifting
Authors: Şirinoğlu Hakan , Güvercin Emre
Published: July 2023

Lifting the temporal and mid-face areas creates a very dynamic change in the facial appearance and different planes of dissection were described before. In this article, a new plane of dissection is described which allows the surgeon to perform a very quick and safe dissection in both the temporal and mid-face regions. Patients were operated on using the presented technique and brow lift, cantopexy, and mid-facelift were performed. The outcome of the surgery was analyzed by the authors from standardized photos before and 6 months after the surgery with measurements of the brow and lateral canthus. The plane of dissection is just over the subgaleal fascia which is actually the sub–superficial musculoaponeurotic system layer in the mid-face. This plane of dissection is easy and quick and creates a very mobile mid-face and temporal flap. Forty female patients were operated using the presented technique with a mean follow-up period of 15 months, the longest follow-up was 26 months. No major complication was encountered in these patients. In 5 patients, transient unilateral frontal branch palsy was encountered. In 1 patient, bilateral temporal area depression was observed 8 months after the surgery and treated with a fat injection under local anesthesia. One patient had alopecia in the temporal suture line which can be covered with hair. Temporal facelift is a versatile method with long-lasting results due to its important features; creating a very mobile flap for suspension dissection area, a large surface for adherence, and numerous sutures sharing the tension on the key sutures. Despite its slightly difficult early healing period, the technique should be kept in mind for the rejuvenation of the periorbital area and mid-face.

Level of Evidence: Level I.
A Retrospective and Prospective Cohort Study Comparing Pediatric Patients With Cleft Lip and Palate From the United States and Guatemala
Authors: Card Elizabeth B. , Morales Carrie E. , Kimia Rotem , Ramirez Juan M. , Billingslea Marce , Marroquín Ariel , Masaya Irina , Arteaga Vilma , Marazita Mary L. , Friedland Leonard R. , Low David W. , Schwartz Alan Jay , Scott Michelle , Jackson Oksana A.
Published: July 2023

Orofacial clefts (OFC) remain among the most prevalent congenital abnormalities worldwide. In the United States in 2010 to 2014, 16.2 of 10,000 live births are born with OFC compared with 23.6 of 10,000 in Alta Verapaz, Guatemala in 2012. Demographics and cleft severity scores were retrospectively gathered from 514 patients with isolated OFC at the Children’s Hospital of Philadelphia scheduled for surgery from 2012 to 2019 and from 115 patients seen during surgical mission trips to Guatemala City from 2017 to 2020. Risk factors were also gathered prospectively from Guatemalan families. The Guatemalan cohort had a significantly lower prevalence of cleft palate only compared with the US cohort, which may be a result of greater cleft severity in the population or poor screening and subsequent increased mortality of untreated cleft palate. Of those with lip involvement, Guatemalan patients were significantly more likely to have complete cleft lip, associated cleft palate, and right-sided and bilateral clefts, demonstrating an increased severity of Guatemalan cleft phenotype. Primary palate and lip repair for the Guatemalan cohort occurred at a significantly older age than that of the US cohort, placing Guatemalan patients at increased risk for long-term complications such as communication difficulties. Potential OFC risk factors identified in the Guatemalan cohort included maternal cooking-fire and agricultural chemical exposure, poor prenatal vitamin intake, poverty, and risk factors related to primarily corn-based diets. OFC patients who primarily rely on surgical missions for cleft care would likely benefit from more comprehensive screening and investigation into risk factors for more severe OFC phenotypes.