bluuebunny/crossref_metadata_2025 huggingface dataset:
Ligamentous injuries of the hand and wrist
Authors: Heras-Palou Carlos
Published: September 2021

Ligament injuries in the hand and wrist can lead to instability or dislocation of the joint. Instability is manifest by abnormal joint movement with loading and leads to disability through symptoms of pain, weakness or inability to tolerate load acutely and disruption of joint congruity produces arthritis through excessive contact pressure on the joint surface. The anatomy, mechanisms of injury, diagnosis and treatment of ligament injuries are described according to the joints affected.
Osteoarthritis of the wrist and hand
Authors: Sood Manu
Published: September 2021

Osteoarthritis of the hand is a common and often painful condition with significant implications for hand function. The pathology and commonest clinical presentations of this condition, along with osteoarthritis of the wrist, are described in this chapter together with options for treatment.
Upper limb spasticity
Authors: McArthur Paul
Published: September 2021

Spasticity is an involuntary hypertonic state. Dynamic spasticity produces deformity, impairs function, and may lead to contracture and fibrosis. Assessment and management of spasticity should be undertaken through a multidisciplinary team environment following repeated examination and assessment. Management options include physiotherapy, splintage, botulinum toxin, and surgery. Treatment aims include facilitating skin care and hygiene, and improving hand function.
Avoiding patient dissatisfaction
Authors: Mercer Nigel , Soldin Mark
Published: September 2021

The practice of medicine has always been a balance of the latest scientific advances, and a less well-defined ‘art’ of patient care. Much of this ‘art’ is good communication. In cosmetic surgery, advances in anatomical and scientific knowledge have allowed plastic surgeons to enhance youthful beauty to a level never thought possible in the past. Technical success does not, however, equate with patient satisfaction. All surgeons will have the occasional patient who is unhappy with a result that the surgeon feels is reasonable. It is likely that something was missed in the patient preparation for surgery, possibly a psychological condition that was overlooked. Cosmetic surgery patients are, by definition, dissatisfied with their body image. This dissatisfaction could be understandable and reasonable, or it may be excessive and abnormal. Within the cosmetic surgery patient spectrum there will be patients with body dysmorphic disorder or other problems that will place both patient and surgeon at risk of an unhappy outcome even though there has been a good surgical result. Plastic surgeons must have insight into the psychology of body image dissatisfaction. Subspecialization in modern medicine means that today’s plastic surgeons may need the help of psychologists to assist in the identification of these patients.
Treatment of large and ptotic breasts
Authors: Searle Adam , de Mey Albert , Zirak Christophe
Published: September 2021

The breasts have always been considered a sign of femininity. The correction of breast deformities is therefore important from a physical and psychological point of view, improving greatly the quality of life. Many surgical techniques have been proposed to correct the shape and volume of the breast, and in recent decades techniques have been proposed to preserve the nipple sensitivity and increase the vascular safety of the procedure. Templates (such as the Wise pattern) have been proposed to improve planning and different pedicles for the areola have been described. During the last 20 years, new techniques have been introduced to minimize scars, leaving normal sensitivity in almost all cases, the possibility of lactation, and a pleasing shape. The periareolar scar is, unfortunately, always necessary to reposition the nipple–areolar complex. The vertical scar is necessary to resect the excess of skin of the lower pole of the breast. Effort has been directed to reduce or eliminate the horizontal submammary scar, leading to a vertical scar only, even in large reductions.
Classification of craniofacial anomalies
Authors: Jagadeesan Jagajeevan , Nishikawa Hiroshi
Published: September 2021

Craniofacial anomalies are a rare group of congenital disorders that affect the cranium and the face. Due to the rarity and diverse nature of presentation, classifying them has always posed a challenge. An ideal classification system is meant to be simple, effective, and reproducible. This chapter provides a brief history of the different classification schemes and explains a simple, modified, and descriptive classification system. A brief description of the more common craniofacial conditions and their clinical features is presented. The management of individual conditions is discussed in their respective chapters.
Classification, evaluation, and management of the neonate with a cleft
Authors: Sainsbury David C.G.
Published: September 2021

Numerous classifications, including LAHSAL and Kernahan’s striped Y, aid organizing the heterogeneous nature of typical orofacial clefts. Antenatal diagnosis occurs in approximately 80% of births and is more accurate for diagnosing cleft lip than cleft palate. Most parents find antenatal diagnosis beneficial for psychological adjustment and planning prior to the birth. Airway assessment is vital in neonates with a cleft. Most, even those with severe Robin sequence, can be managed non-surgically with lateral or prone positioning, a nasopharyngeal airway, and supplemental oxygen. Sleep studies are an important means of assessing the airway. Feeding is a major concern in babies with a cleft; early feeding intervention and parental education is important. Other conditions, including Robin sequence, 22q11 deletion syndrome, Stickler syndrome, and van der Woude syndrome, must be identified early in conjunction with the cleft multidisciplinary team. Genetic analysis and counselling should be considered.
Radiology of the head and neck
Authors: Zammit-Maempel Ivan
Published: September 2021

Various imaging techniques are used in the staging and follow-up of head and neck cancer and evaluating patients presenting with a neck mass. The workhorses in imaging the neck are ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) with positron emission tomography CT (PET-CT) increasingly being requested. Plain radiographs, contrast studies, video fluoroscopy, angiography, and cone beam CT have limited but important roles. This chapter discusses the role of some of these modalities.
Adult thermal burns
Authors: Rawlins Jeremy , Jones Isabel
Published: September 2021

Adult burn injuries are heterogeneous in their aetiology and in their severity, and in the many ways in which they affect the burns patient. Treatment should be initiated promptly, ensuring that other life-threatening injuries are dealt with, and that expert burn care is delivered to the patient. First aid followed by emergency management of the patient, fluid resuscitation, and specialist wound care ensures the patient is given the very best opportunity for full recovery and survival. The burn wound may be managed non-surgically, but for deeper and more severe injuries, surgical debridement and wound cover with grafts, cell suspensions, dermal matrices, or flaps is required. Areas of special attention include the face, hands, and perineum—all functionally and aesthetically important, and each with specific dressing needs and surgical techniques that optimize good outcomes. Scar management and physiotherapy are crucial components of adult burn care, with many therapies applied concurrently to ensure good functional and aesthetic recovery. For those patients with ongoing scar and contracture difficulties, scar therapies and reconstructive burns surgery offer the chance of better function and appearance even many years after the original burn. The journey to recovery would not be complete, however, without important psychosocial input for the burns patient, as the psychological scars are often just as painful as the physical ones.
Semiquantitative assessed proteinuria and risk of heart failure: analysis of a nationwide epidemiological database
Authors: Fukui Akira , Kaneko Hidehiro , Okada Akira , Yano Yuichiro , Itoh Hidetaka , Matsuoka Satoshi , Morita Kojiro , Kiriyama Hiroyuki , Kamon Tatsuya , Fujiu Katsuhito , Michihata Nobuaki , Jo Taisuke , Takeda Norifumi , Morita Hiroyuki , Nakamura Sunao , Nishiyama Akira , Node Koichi , Yokoo Takashi , Nangaku Masaomi , Yasunaga Hideo , Komuro Issei
Published: September 2021

Background

Heart failure (HF) is increasing in prevalence worldwide. We explored whether adults with trace and positive proteinuria were at a high risk for incident HF compared with those with negative proteinuria using a nationwide epidemiological database.

Methods

This is an observational cohort study using the JMDC Claims Database collected between 2005 and 2020. This is a population-based sample [n = 1 021 943; median age 44 years (interquartile range 37–52); 54.8% men]. No participants had a known history of cardiovascular disease (CVD). Each participant was categorized into three groups according to the urine dipstick test results: negative proteinuria (n = 902 273), trace proteinuria (n = 89 599) and positive proteinuria (≥1+; n = 30 071). The primary outcome was HF. The secondary outcomes were myocardial infarction (MI), stroke and atrial fibrillation (AF). We performed multivariable Cox regression analyses to identify the association between the proteinuria category and incident HF and other CVD events.

Results

Over a mean follow-up of 1150 ± 920 days, 17 182 incident HF events occurred. After multivariable adjustment, hazard ratios for HF events were 1.09 [95% confidence interval (CI) 1.03–1.15] and 1.59 (95% CI 1.49–1.70) for trace proteinuria and positive proteinuria versus negative proteinuria, respectively. This association was present irrespective of clinical characteristics. A stepwise increase in the risk of MI, stroke and AF with proteinuria category was also observed. Our primary results were confirmed in participants after multiple imputations for missing values and in those having no medications for hypertension, diabetes mellitus and dyslipidemia. The discriminative predictive value for HF events improved by adding the results of urine dipstick tests to traditional risk factors [net reclassification improvement 0.0497 (95% CI 0.0346–0.0648); P < 0.001].

Conclusions

Not only positive proteinuria, but also trace proteinuria was associated with a greater incidence of HF in the general population. Semiquantitative assessment of proteinuria would be informative for the risk stratification of HF.
A High Frequency of Candida auris Blood Stream Infections in Coronavirus Disease 2019 Patients Admitted to Intensive Care Units, Northwestern India: A Case Control Study
Authors: Rajni Ekadashi , Singh Ashutosh , Tarai Bansidhar , Jain Kusum , Shankar Ravi , Pawar Kalpana , Mamoria Vedprakash , Chowdhary Anuradha
Published: September 2021

Background

The ongoing pandemic of coronavirus disease 2019 (COVID-19) has overwhelmed healthcare facilities and raises an important novel concern of nosocomial transmission of Candida species in the intensive care units (ICUs).

Methods

We evaluated the incidence and risk factors for development of candidemia in 2384 COVID-19 patients admitted during August 2020–January 2021 in ICUs of 2 hospitals (Delhi and Jaipur) in India. A 1:2 case-control matching was used to identify COVID-19 patients who did not develop candidemia as controls.

Results

A total of 33 patients developed candidemia and accounted for an overall incidence of 1.4% over a median ICU stay of 24 days. A 2-fold increase in the incidence of candidemia in COVID-19 versus non-COVID-19 patients was observed with an incidence rate of 14 and 15/1000 admissions in 2 ICUs. Candida auris was the predominant species (42%) followed by Candida tropicalis. Multivariable regression analysis revealed the use of tocilizumab, duration of ICU stay (24 vs 14 days), and raised ferritin level as an independent predictor for the development of candidemia. Azole resistance was observed in C auris and C tropicalis harboring mutations in the azole target ERG11 gene. Multilocus sequence typing (MLST) identified identical genotypes of C tropicalis in COVID-19 patients, raising concern for nosocomial transmission of resistant strains.

Conclusions

Secondary bacterial infections have been a concern with the use of tocilizumab. In this cohort of critically ill COVID-19 patients, tocilizumab was associated with the development of candidemia. Surveillance of antifungal resistance is warranted to prevent transmission of multidrug-resistant strains of nosocomial yeasts in COVID-19 hospitalized patients.
Development of aerial and belowground tubers in potato is governed by photoperiod and epigenetic mechanism
Authors: Kondhare Kirtikumar R , Kumar Amit , Patil Nikita S , Malankar Nilam N , Saha Kishan , Banerjee Anjan K
Published: September 2021

Plants exhibit diverse developmental plasticity and modulate growth responses under various environmental conditions. Potato (Solanum tuberosum), a modified stem and an important food crop, serves as a substantial portion of the world’s subsistence food supply. In the past two decades, crucial molecular signals have been identified that govern the tuberization (potato development) mechanism. Interestingly, microRNA156 overexpression in potato provided the first evidence for induction of profuse aerial stolons and tubers from axillary meristems under short-day (SD) photoperiod. A similar phenotype was noticed for overexpression of epigenetic modifiers—MUTICOPY SUPRESSOR OF IRA1 (StMSI1) or ENAHNCER OF ZESTE 2 (StE[z]2), and knockdown of B-CELL-SPECIFIC MOLONEY MURINE LEUKEMIA VIRUS INTEGRATION SITE 1 (StBMI1). This striking phenotype represents a classic example of modulation of plant architecture and developmental plasticity. Differentiation of a stolon to a tuber or a shoot under in vitro or in vivo conditions symbolizes another example of organ-level plasticity and dual fate acquisition in potato. Stolon-to-tuber transition is governed by SD photoperiod, mobile RNAs/proteins, phytohormones, a plethora of small RNAs and their targets. Recent studies show that polycomb group proteins control microRNA156, phytohormone metabolism/transport/signaling and key tuberization genes through histone modifications to govern tuber development. Our comparative analysis of differentially expressed genes between the overexpression lines of StMSI1, StBEL5 (BEL1-LIKE transcription factor [TF]), and POTATO HOMEOBOX 15 TF revealed more than 1,000 common genes, indicative of a mutual gene regulatory network potentially involved in the formation of aerial and belowground tubers. In this review, in addition to key tuberization factors, we highlight the role of photoperiod and epigenetic mechanism that regulates the development of aerial and belowground tubers in potato.
Congenital Syphilis Case Surveillance in South Africa 2017–19: Experience, Challenges and Opportunities
Authors: Morifi Mabore , Malevu Ntebogeleng , Odayan Sharika , McCarthy Kerrigan , Kufa Tendesayi
Published: September 2021

Background

Untreated or inadequately treated maternal syphilis infection may be transmitted from mother to child resulting in congenital syphilis (CS) infection. In South Africa (SA), CS is a notifiable medical condition (NMC). The NMC surveillance system (NMCSS) was improved by introducing an electronic notification application, a new case notification form and training resources in July 2017. We describe CS surveillance in SA and report on experiences from implementing an improved NMCSS from August 2017 to December 2019.

Methods

We present the CS case definition, data collected by the CS case investigation and notification forms and data flow through the NMCSS. Descriptive statistics were used to analyse CS notifications received from August 2017 to December 2019. Qualitative inductive analysis of the stakeholder communications diary was conducted to identify CS surveillance challenges.

Results

There were 418 CS notifications submitted from 80 facilities in 35 out of 52 districts. Of the notified cases, 194 (46.8%) were male and the median age at notification was 7 days (interquartile range: 3–16 days). The majority were diagnosed in hospital (98.6%). KwaZulu–Natal Province notified the most cases (52.9%) followed by Gauteng (28.0%). Challenges in CS surveillance included the lack of awareness of the CS case definition, completed paper-based notifications not reaching the NMCSS and the limited ability of the system to distinguish improved notifications from increase in disease burden.

Conclusion

Improved CS surveillance through NMCSS was implemented in SA. Training, support and mentoring on CS and the notification system will be needed to inform elimination efforts.
Potassium Phosphite Enhances the Antagonistic Capability of Bacillus amyloliquefaciens to Manage Tomato Bacterial Wilt
Authors: Su Lv , Qiu Pengfei , Fang Zhiying , Sun Juan , Mo Xingxia , Liu Yunpeng , Kuramae Eiko E. , Zhang Ruifu , Shen Biao , Shen Qirong
Published: September 2021

Bacterial wilt caused by Ralstonia solanacearum is a distributed and worldwide soilborne disease. The application of biocontrol microbes or agricultural chemicals has been widely used to manage tomato bacterial wilt. However, whether and how agricultural chemicals affect the antagonistic ability of biocontrol microbes is still unknown. Here, we combined potassium phosphite (K-Phite), an environmentally friendly agricultural chemical, and the biocontrol agent Bacillus amyloliquefaciens QPF8 (strain F8) to manage tomato bacterial wilt disease. First, K-Phite at a concentration of 0.05% (wt/vol) could significantly inhibit the growth of R. solanacearum. Second, 0.05% K-Phite enhanced the antagonistic capability of B. amyloliquefaciens F8. Third, the greenhouse soil experiments showed that the control efficiency for tomato bacterial wilt in the combined treatment was significantly higher than that of the application of B. amyloliquefaciens F8 or K-Phite alone. Overall, our results highlighted a novel strategy for the control of tomato bacterial wilt disease via application and revealed a new integrated pattern depending on the enhancement of the antagonistic capability of biocontrol microbes by K-Phite.
The Evolution, Current Value, and Future of the American Society of Anesthesiologists Physical Status Classification System
Authors: Horvath Balazs , Kloesel Benjamin , Todd Michael M. , Cole Daniel J. , Prielipp Richard C.
Published: September 2021

The American Society of Anesthesiologists (ASA) Physical Status classification system celebrates its 80th anniversary in 2021. Its simplicity represents its greatest strength as well as a limitation in a world of comprehensive multisystem tools. It was developed for statistical purposes and not as a surgical risk predictor. However, since it correlates well with multiple outcomes, it is widely used—appropriately or not—for risk prediction and many other purposes. It is timely to review the history and development of the system. The authors describe the controversies surrounding the ASA Physical Status classification, including the problems of interrater reliability and its limitations as a risk predictor. Last, the authors reflect on the current status and potential future of the ASA Physical Status system.
Surviving Sepsis Campaign: Research Opportunities for Infection and Blood Purification Therapies
Authors: Martin-Loeches Ignacio , Nunnally Mark E. , Hellman Judith , Lat Ishaq , Martin Greg S. , Jog Sameer , Kesecioglu Jozef , De Backer Daniel , Coopersmith Craig M.
Published: September 2021

OBJECTIVES:

Patients with infection can develop sepsis, and their mortality can be high. An important aspect in the treatment of sepsis is adequate management of the infection.

DATA SOURCES:

Using a modified Delphi approach, the Surviving Sepsis Campaign research committee recently published a series of 26 priorities for sepsis and septic shock.

STUDY SELECTION:

Task force members with specific expertise were tasked with generating expanded reviews for all infection questions and a subset of adjunctive therapy questions from the larger list of sepsis priorities. Each question was addressed by one of the six task force members.

DATA EXTRACTION:

In-depth reviews were then edited by the group as a whole, with added input from the committee cochairs.

DATA SYNTHESIS:

Six questions were addressed: 1) should empiric antibiotic combination therapy be used in sepsis or septic shock? 2) does optimization of antimicrobial pharmacokinetics and pharmacodynamics impact patient outcomes in sepsis? 3) should viral reactivation resulting from sepsis-induced immunosuppression be treated with antiviral therapy in critically ill septic patients? 4) should rapid diagnostic tests be implemented in clinical practice? 5) what is the role of lung-protective ventilation in sepsis patients without acute respiratory distress syndrome? and 6) how do we determine the efficacy of “blood purification” therapies such as endotoxin absorbers, cytokine absorbers, and plasmapheresis.

CONCLUSIONS:

The research committee members for the Surviving Sepsis Campaign aimed to explore research questions in order to provide existing evidence and highlight areas of uncertainty and future directions.
Benchmarking Scholarly Activity by Pharmacists Who Are Fellows Within the American College of Critical Care Medicine
Authors: Sherman Kaitlyn M. , Gagnon David J.
Published: September 2021

OBJECTIVES:

Quantify scholarly activity by pharmacists who are Fellows within the American College of Critical Care Medicine and to develop a potential publication benchmark for fellowship application.

DESIGN:

Review of the Scopus and PubMed online citation databases.

SETTING:

None.

PATIENTS:

None.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Pharmacists designated Fellow of Critical Care Medicine (FCCM) were identified in January 2021 by the Society of Critical Care Medicine. Pharmacists designated Master of Critical Care Medicine (MCCM), without an active license, or were not identified in either online citation database were excluded. Practice setting characteristics were obtained from the American Hospital Association including country, state, geographic region, number of staffed beds, and hospital designation. Two online citation databases (Scopus and PubMed) were queried in February 2021, and year of first publication, total publications, citations, and Hirsch index were recorded. Of the 152 pharmacists designated FCCM, 138 (91%) were evaluable. Reasons for exclusion included MCCM designation (n = 7; 5%), lack of data in either online citation database (n = 4; 3%), and no active pharmacist license (n = 3; 2%). Most pharmacists were practicing in the Southern geographic region of the United States (n = 62; 45%) and at an academic medical center (n = 116; 84%). The median year of FCCM convocation was 2016 (2012–2019) and of the first publication was 2007 (2002–2011). After removing duplicates, 4,488 unique publications were identified. The median number of publications per individual pharmacist was 20 (9–43) with 10 (5–19) between the year of their first publication and FCCM convocation. Most scholarly activity was in the form of original research (n = 3,173; 71%) or reviews (n = 795; 18%). Individual pharmacists have 244 (99–661) citations and an h-index of 8 (5–13).

CONCLUSIONS:

Pharmacists designated FCCM have maintained a high level of scholarly activity. Pharmacists pursuing fellowship may use these data as a benchmark for fulfilling aspects of the core area of scholarly activities related to critical care medicine prior to application.
Biomarkers for Adverse Lung Injury Following Pediatric Cardiopulmonary Bypass
Authors: Asfari Ahmed , Hock Kristal M. , Byrnes Jonathan W. , Borasino Santiago , Halloran Brian A. , Mobley James A. , Ambalavanan Namasivayam
Published: September 2021

OBJECTIVES:

Cardiopulmonary bypass triggers systemic inflammation, resulting in lung injury, and frequently leads to prolonged mechanical ventilation. Biomarkers of systemic inflammation are required to predict the risk of such complications. We hypothesize that specific serum proteins can be used as biomarkers to predict the severity of lung injury following cardiac surgery.

DESIGN:

Retrospective chart review study.

SETTING:

Clinical variables were collected and used in conjuncture with unbiased proteomic analysis using mass spectrometry that was performed on frozen plasma samples from a study group (patients with mechanical ventilation > 48 hr post surgery) and a control group (patients with mechanical ventilation < 48 hr post surgery).

SUBJECTS:

Subjects included were infants who underwent cardiac surgery with similar complexity (Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery 3 or 4) using cardiopulmonary bypass. Patients in both groups were matched for their weight, age, and duration of cardiopulmonary bypass.

INTERVENTION:

None.

MEASUREMENTS AND MAIN RESULTS:

Four-hundred eighty-three proteins were identified (99% minimum confidence and two peptides minimum, protein false discovery rate 0.1%) on proteomic analysis of four control and four study patients at precardiopulmonary bypass, 0, and 48 hours postcardiopulmonary bypass samples. Thirty-six of 178 proteins were significantly different (≥ 1.5-fold; p < 0.05) at precardiopulmonary bypass (top increased: tenascin; top decreased: tetranectin), 18 of 140 proteins at 0 hour (top increased: hemoglobin beta; top decreased: C8 beta), and 25 of 166 proteins at 48 hours post surgery (top increased: proteoglycan 4; top decreased: galectin-3–binding protein). The top pathway involved cytoskeleton remodeling. Other pathways involved immune response and blood coagulation. Proteoglycan 4 was validated by enzyme-linked immunosorbent assay in a different set of samples (n = 20/group; mean ± sd: 128 ± 67 vs 195 ± 160 ng/mL) (p = 0.037).

CONCLUSIONS:

Multiple proteomic biomarkers were associated with worse respiratory outcomes. Precardiopulmonary bypass biomarkers might indicate risk factors (e.g., abnormalities of coagulation), whereas those identified at 0 hour and post cardiopulmonary bypass may reflect mechanisms of ongoing pathobiology.
Clinical Characteristics, Management, and Outcomes of Cancer Patients With Coronavirus Disease 2019 Admitted to the ICU
Authors: Dang Michael K. M. , Bhatt Isha , Dulu Alina O. , Zhang Hao , Kostelecky Natalie , Pastores Stephen M.
Published: September 2021

OBJECTIVES:

Adult patients with cancer have a greater likelihood of developing severe illness and death from coronavirus disease 2019 compared with patients without cancer. We sought to characterize the clinical characteristics and outcomes of cancer patients who tested positive for severe acute respiratory syndrome coronavirus 2 and were admitted to the ICU at the peak of the first wave of the pandemic in the United States.

DESIGN:

A single-center retrospective cohort study.

SETTING:

Two medical-surgical ICUs of a tertiary-care cancer center.

PATIENTS/SUBJECTS:

All consecutive adult patients (≥ 18 yr) with current or past (< 2 yr) diagnosis of cancer who were admitted to the ICU with coronavirus disease 2019 between March 1, and June 30, 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Demographic, clinical, and laboratory data of 89 critically ill cancer patients were extracted from electronic medical records. Median age was 65 years (interquartile range, 57–70 yr), 66% were White, and 58% male. Approximately a third of patients had three or more comorbidities. Fifty-one patients (57%) had solid tumors, and 38 (42%) had hematologic malignancies. Sixty-one patients (69%) received cancer-directed therapy within the previous 90 days. Sixty patients (67%) required mechanical ventilation, 56% required prone positioning, 28% underwent tracheostomy, and 71% required vasopressors. Hospital mortality was 45% (40/89). Among those who required mechanical ventilation, mortality was 53% (32/60). Hospital mortality was significantly higher among patients with hematologic malignancies, higher severity of illness and organ failure scores, need for invasive mechanical ventilation and vasopressor therapy, lower hemoglobin and platelet count, and higher d-dimer levels at ICU admission. ICU and hospital length of stay were 10 and 26 days, respectively. At 9-month follow-up, the mortality rate was 54% (48/89).

CONCLUSIONS:

We report the largest case series and intermediate-term follow-up of cancer patients with coronavirus disease 2019 who were admitted to the ICU. Hospital mortality was 45%. Intermediate-term outcome after hospital discharge was favorable.
Risk Factors Associated With the Prescription of Opioids Among Service Members Following a First Mild Traumatic Brain Injury
Authors: Hoover Peter , Johnson Dara , Wu Tim , French Louis M. , Caban Jesus
Published: September 2021

Objective:

To evaluate factors impacting opioid receipt among active-duty service members (SMs) following a first mild traumatic brain injury (mTBI).

Setting:

Active-duty SMs receiving care within the Military Health System.

Participants:

In total, 14 757 SMs who have sustained an initial mTBI, as documented within electronic health records (EHRs), between 2016 and 2017.

Design:

A retrospective analysis of EHR metadata.

Main Measures:

Multivariable logistic regression assessed factors impacting opioid receipt and initiation. Factors include demographics, military characteristics, and preexisting clinical conditions, including prior opioid prescription.

Results:

Of the sample population, 33.4% (n = 4927) were prescribed opioids after their initial mTBI, of which, 60.6% (n = 2985) received opioids for the first time following injury. Significant risk factors associated with the increased probability of opioid receipt included age, gender, and preexisting behavioral health and musculoskeletal conditions. Military characteristics also exhibited changes in the probability of opioid receipt, both among initiation and new prescription. No changes were observed among race, nor among those with preexisting headaches or migraines.

Conclusion:

Despite concerns about the negative impact on recovery, the prescribing of opioids is common in this population of active-duty SMs first diagnosed with an mTBI. As several demographic and preexisting health conditions are factors in the receipt of opioids post-mTBI, the entire medical history of these patients should be considered prior to prescription. Understanding these factors may further inform policy for opioid use in the Military Health System.
Dorsal root ganglion toll-like receptor 4 signaling contributes to oxaliplatin-induced peripheral neuropathy
Authors: Illias Amina M. , Yu Kai-Jie , Hwang Seon-Hee , Solis Jacob , Zhang Hongmei , Velasquez Jose F. , Cata Juan P. , Dougherty Patrick M.
Published: September 2021

Activation of toll-like receptor 4 (TLR4) in the dorsal root ganglion (DRG) and spinal cord contributes to the generation of paclitaxel-related chemotherapy-induced peripheral neuropathy (CIPN). Generalizability of TLR4 signaling in oxaliplatin-induced CIPN was tested here. Mechanical hypersensitivity developed in male SD rats by day 1 after oxaliplatin treatment, reached maximum intensity by day 14, and persisted through day 35. Western blot revealed an increase in TLR4 expression in the DRG of oxaliplatin at days 1 and 7 after oxaliplatin treatment. Cotreatment of rats with the TLR4 antagonist lipopolysaccharide derived from Rhodobacter sphaeroides ultrapure or with the nonspecific immunosuppressive minocycline with oxaliplatin resulted in significantly attenuated hyperalgesia on day 7 and 14 compared with rats that received oxaliplatin plus saline vehicle. Immunostaining of DRGs revealed an increase in the number of neurons expressing TLR4, its canonical downstream signal molecules myeloid differentiation primary response gene 88 (MyD88) and TIR-domain–containing adapter-inducing interferon-β, at both day 7 and day 14 after oxaliplatin treatment. These increases were blocked by cotreatment with either lipopolysaccharide derived from Rhodobacter sphaeroides or minocycline. Double staining showed the localization of TLR4, MyD88, and TIR-domain–containing adapter-inducing interferon-β in subsets of DRG neurons. Finally, there was no significant difference in oxaliplatin-induced mechanical hypersensitivity between male and female rats when observed for 2 weeks. Furthermore, upregulation of TLR4 was detected in both sexes when tested 14 days after treatment with oxaliplatin. These findings suggest that the activation of TLR4 signaling in DRG neurons is a common mechanism in CIPN induced by multiple cancer chemotherapy agents.
Spinal cord injury in mice affects central and peripheral pathology in a severity-dependent manner
Authors: Bannerman Courtney A. , Douchant Katya , Segal Julia P. , Knezic Mitra , Mack Alexandra E. , Lundell-Creagh Caitlin , Silva Jaqueline R. , Duggan Scott , Sheth Prameet , Ghasemlou Nader
Published: September 2021

Chronic pain is a common medical complication experienced by those living with spinal cord injury (SCI) and leads to worsened quality of life. The pathophysiology of SCI pain is poorly understood, hampering the development of safe and efficacious therapeutics. We therefore sought to develop a clinically relevant model of SCI with a strong pain phenotype and characterize the central and peripheral pathology after injury. A contusion (50 kdyn) injury, with and without sustained compression (60 seconds) of the spinal cord, was performed on female C57BL/6J mice. Mice with compression of the spinal cord exhibited significantly greater heat and mechanical hypersensitivity starting at 7 days postinjury, concomitant with reduced locomotor function, compared with those without compression. Immunohistochemical analysis of spinal cord tissue revealed significantly less myelin sparing and increased macrophage activation in mice with compression compared with those without. As measured by flow cytometry, immune cell infiltration and activation were significantly greater in the spinal cord (phagocytic myeloid cells and microglia) and dorsal root ganglia (Ly6C+ monocytes) after compression injury. We also decided to investigate the gastrointestinal microbiome, as it has been shown to be altered in patients with SCI and has recently been shown to play a role in immune system maturation and pain. We found increased dysbiosis of the gastrointestinal microbiome in an injury severity–dependent manner. The use of this contusion–compression model of SCI may help advance the preclinical assessment of acute and chronic SCI pain and lead to a better understanding of mechanisms contributing to this pain.
Reducing Catheter-Associated Urinary Tract Infection: The Impact of Routine Screening in the Geriatric Hip Fracture Population
Authors: Singh Shridevi , Angus L. D. George , Munnangi Swapna , Shaikh Dooniya , Digiacomo Jody C. , Angara Vivek C. , Brown Aaron , Akadiri Tayo
Published: September 2021

Background:

Catheter-associated urinary tract infection (CAUTI) is a noted complication among geriatric hip fracture patients. This complication results in negative outcomes for both the patients and the institution providing care. Screening measures to identify predisposing factors, with early diagnosis and treatment of urinary tract infection (UTI) present on admission, may lead to reduced rates of CAUTI.

Objective:

The goals of this study were to determine the prevalence of UTI on admission among geriatric hip fracture patients and whether routine screening for UTI or predisposing factors at presentation resulted in reduced rates of CAUTI.

Methods:

A retrospective observational study of geriatric hip fracture patients from January 2017 to December 2018 at a Level I trauma center was performed. Rates of UTI on admission and CAUTI were calculated using routine admission urinalysis.

Results:

Of the 183 patients in the sample, 36.1% had UTI on admission and 4.4% of patients developed CAUTI. There were no significant differences in patient demographics, comorbidities, and complications between those with UTI on admission and those without.

Conclusions:

Urinary tract infection on admission may be present among a large portion of geriatric hip fracture patients, leading to increased rates of CAUTI. Routine screening for UTI and its predisposing factors at admission can identify these patients earlier and lead to earlier treatments and prevention of CAUTI.
Prehospital Hemorrhage Assessment Criteria: A Concise Review
Authors: Di Carlo Sara , Cavallaro Giuseppe , Palomeque Kenia , Cardi Maurizio , Sica Giuseppe , Rossi Piero , Sibio Simone
Published: September 2021

Objective:

Early assessment of the clinical status of trauma patients is crucial for guiding the treatment strategy, and it requires a rapid and systematic approach. The aim of this report is to critically review the assessment parameters currently used in the prehospital setting to quantify blood loss in trauma.

Data Sources:

Studies regarding hemorrhagic shock in trauma were pooled from PubMed, EMBASE, and Cochrane databases using key words such as “hemorrhagic shock,” “vital signs evaluation,” “trauma,” “blood loss,” and “emergency medical service,” alone or combined.

Study Selection:

Articles published since 2009 in English and Italian were considered eligible if containing data on assessment parameters in blood loss in adults.

Data Extraction:

Sixteen articles matching the inclusion criteria were considered in our study.

Data Synthesis:

Current prehospital assessment measures lack precise correlation with blood loss.

Conclusions:

Traditional assessment parameters such as heart rate, systolic blood pressure, shock index, and Glasgow Coma Scale score often lag in providing accurate blood loss assessment. The current literature supports the need for a noninvasive, continuously monitored assessment parameter to identify early shock in the prehospital setting.
Effect of acetazolamide for exudative retinal detachment in Sturge-Weber syndrome
Authors: Kinouchi Rina , Okumichi Hideaki , Sakata Hajime , Ohara Hiromi , Hirooka Kazuyuki , Kiuchi Yoshiaki
Published: September 2021

Introduction:

Choroidal hemangiomas are present in 20% to 70% of patients with Sturge–Weber syndrome (SWS) and may lead to exudative retinal detachment. The treatment includes retinal photocoagulation, photodynamic therapy, and cryocoagulation, however they are frequently ineffective. We report a case of exudative retinal detachment secondary to SWS that appears to have improved with oral acetazolamide.

Patient concerns:

A 22-year-old man was diagnosed with congenital SWS due to a hemangioma in the first and second branches of the right trigeminal nerve. In April 2009, the patient was referred to the Ophthalmological department with reduced vision. The best-corrected visual acuity (decimal) of the right eye was reduced while its intraocular pressure was increased. The right anterior chamber depth was shallow, and exudative retinal detachment associated with choroidal hemangioma in the right eye was observed. Fluorescein angiography showed fluorescence leakage from a choroidal hemangioma.

Diagnosis:

We diagnosed exudative retinal detachment secondary to SWS.

Interventions:

Acetazolamide was taken orally at 500 mg daily for 2 weeks.

Outcomes:

Following the 2-week acetazolamide treatment, both the laterality of the anterior chamber depth and the exudative retinal detachment resolved and the best-corrected visual acuity and intraocular pressure improved. There was no fluorescence leakage from hemangioma observed on fluorescein angiography. In July 2013, a blunt trauma to the right eye caused a relapse of the exudative retinal detachment in this eye. Similarly, oral acetazolamide treatment for 2 weeks relieved exudative retinal detachment, and no subsequent relapse was observed.

Conclusions:

Oral acetazolamide appeared to be effective for exudative retinal detachment associated with choroidal hemangiomas in a patient with SWS.
Effect of goal-directed fluid management guided by non-invasive device on incidence of postoperative complications in neurosurgery
Authors: Hrdy Ondrej , Duba Milos , Dolezelova Andrea , Hlavaty Martin , Traj Rudolf , Bönisch Vit , Roskova Ivana , Smrcka Martin , Gal Roman
Published: September 2021

Introduction:

Goal-directed hemodynamic therapy aims to reduce the incidence of postoperative complications in patients undergoing surgical procedures. Optimal preload is mandatory to achieve adequate cardiac output and oxygen supply to organs and tissues. Neurosurgical patients are at risk of inadequate preload, decreased blood flow and reduced oxygen delivery, all of which can lead to organ dysfunction. Current knowledge regarding the effect of fluid management on patient-orientated outcomes in neurosurgery is limited. Therefore, this study aims to compare the safety and feasibility of goal-directed therapy with standard management in patients undergoing neurosurgical procedures.

Methods and analysis:

Patients undergoing neurosurgical operation will be randomised into two groups. Therapy in the first group of patients will be guided by standard perioperative monitoring. In the second group, perioperative therapy will be guided using non-invasive hemodynamic monitoring in addition to standard monitoring. Administration of fluids and vasoactive drugs will depend on the assessment of stroke volume variation and cardiac index. The safety of goal-directed hemodynamic therapy protocol will be assessed by comparing incidences of adverse events between groups.
Movement Disorders in Multiple Sclerosis and Other Demyelinating Diseases
Authors: Suarez-Cedeno Gerson , Mehanna Raja
Published: September 2021

Background:

Movement disorders (MDs) have been described in demyelinating diseases (DDs). However, data is lacking in the effective treatment of these MD as well as in a potential correlation between DD lesions localization and the phenomenology of the MD and its response to treatment.

Methods:

Retrospective review of 185 patients with MD and DD seen at our center over a period of 7 years. Clinical imaging, medications, and therapeutic responses to both MD and DD treatments were reviewed.

Results:

Of the 185 patients, 62 were excluded because of a diagnosis of spasticity without any other MD. One hundred twenty three patients with DD (75% female, age 48.8±12.8 y) had one or more MD. The most common MD was ataxia followed by isolated tremor. Forty-two patients (34%) received any treatment for MD, 29 (69%) of which responded at least partially to a first MD agent and 78.6% responded at least partially to a second or third agent. Responders to the first MD therapy were more likely to have a lesion in the basal ganglia or the cerebellum, and less likely to have a lesion in the brainstem or the spinal cord, but these results could be biased by a lower-than-expected frequency of tonic spasms in our series. No correlation between DD lesions localization and the phenomenology of the MD was discovered.

Conclusions:

MD are common in DD and are frequently overlooked or undertreated. MD in this sample have a 69% therapeutic response to a first trial. Greater awareness of potential therapeutic options is needed to decrease disability.
Current Review of Leptomeningeal Amyloidosis Associated With Transthyretin Mutations
Authors: Qin Qi , Wei Cuibai , Piao YueShan , Lian Fang , Wu Hao , Zhou Aihong , Wang Fen , Zuo Xiumei , Han Yue , Lyu Jihui , Guo Dongmei , Jia Jianping
Published: September 2021

Introduction:

Leptomeningeal amyloidosis (LA) represents a rare subtype of familial transthyretin (TTR) amyloidosis, characterized by deposition of amyloid in cranial and spinal leptomeninges. Of >120 TTR mutations identified, few have been associated with LA.

Case Report:

A 27-year-old male presented with a 2-year history of progressive symptoms including cognitive decline and right-sided weakness and numbness. Cerebrospinal fluid (CSF) analyses demonstrated high protein level. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed extensive leptomeningeal enhancement over the surface of the brain and spinal cord. Pathologic analyses revealed a TTR mutation c.113A>G (p.D38G).

Review Summary:

Fifteen mutations and genotype-phenotype correlation of 72 LA patients have been summarized to provide an overview of LA associated with transthyretin mutations. The mean age of clinical onset was 44.9 years and the neurological symptoms primarily included cognitive impairment, headache, ataxia seizures and hearing, visual loss. CSF analysis showed elevated high CSF protein level and MRI revealed extensive leptomeningeal enhancement.

Conclusion:

Clinicians should be aware of this rare form of familial transthyretin amyloidosis as well as its typical MRI enhancement and high CSF protein. The important role of biopsy, genetic testing and the potential early diagnosis value of contrast MRI were suggested. Early recognition of these characteristics is important to provide misdiagnosis and shorten the time before correct diagnosis. These findings expand the phenotypic spectrum of TTR gene and have implications for the diagnosis, treatment, and systematic study of LA.
A Multifaceted Approach to Improving Postischemic Stroke Dysphagia Screening at a Community Hospital
Authors: Shenoy Anant M. , McCune Marie , AbdelRazek Mahmoud A.
Published: September 2021

Background:

Dysphagia is a common complication seen in acute ischemic stroke patients, and can lead to morbidity and mortality. As such, quality measures have been instituted to track adherence to dysphagia screening in all stroke patients. In our 217-bed community hospital, we were faced with a low rate in successfully screening for dysphagia.

Methods:

Quality control interventions were implemented after an analysis of the reasons for dysphagia screening failures was performed. Interventions included online educational sessions for nurses, face-to-face sessions with medical residents, distribution of educational laminated cards, changing the method of documenting the dysphagia screen in our electronic record and others.

Results:

There was an increase of rates of screening for dysphagia from 67% to 91%.

Conclusion:

We conclude that failure analysis, implementation of quality control measures to address the cause of failures and re-evaluating success rates periodically was effective to address this problem.