bluuebunny/crossref_metadata_2025 huggingface dataset:
Multimodal Preoperative Localization Improves Outcomes in Reoperative Parathyroidectomy: A 25-Year Surgical Experience
Authors: Patel Snehal G. , Saunders Neil D. , Jamshed Salman , Weber Collin J. , Sharma Jyotirmay
Published: June 2020

Reoperative parathyroid surgery (REOPS) is often associated with lower cure rates and greater risk of nerve injury and hypoparathyroidism. The aim of this study was to evaluate cure rates, pathology, complications, and the efficacy of preoperative localization in patients requiring REOPS. Between 1992 and 2017, 2491 consecutive patients underwent parathyroidectomy for primary hyperparathyroidism. With Institutional Review Board approval, our prospectively collected parathyroidectomy outcomes database was queried for operative findings, outcomes, pathology, and localization methodology. Three hundred forty-six patients had REOPS (111 men/32% and 235 women/68%), with an overall cure rate of 91 per cent and a mean follow-up of 1.9 ± 0.7 years. The average preoperative serum calcium and parathyroid hormone were 11 ± 1 mg/dL and 373 ± 796 pg/mL, respectively. Normalization of intraoperative parathyroid hormone occurred in 248 patients and it was predictive of cure in 98.8 per cent of patients. A single adenoma was resected in 253 patients (75%), and the superior gland location was most common at 57 per cent. Ectopic glands were identified in only 33 patients. When preoperative imaging localized a lesion, a tumor was identified in that location in 75.4 per cent of sestamibi or SPECT/CTscans, 57.8 per cent of CT, 61.2 per cent of MRI, and 46.2 per cent of US. When at least two imaging modalities were concordant, sensitivity improved to 91.6 per cent ( P < 0.001). Complication rates of permanent hypoparathy-roidism and recurrent nerve palsy occurred in 0.03 per cent of patients. REOP for recurrent or persistent primary hyperparathyroidism has a cure rate of 91 per cent. Most missed parathyroid tumors are in the neck, and multimodal imaging improves preoperative localization and success.
Predictive Value of Preoperative Serum CA19-9 on Margin Status
Authors: Mosquera Catalina , Johnson Helen M. , Mitsakos Anastasios T. , Neill Nina E. , Bellamy Nelly , Irish William , Zervos Emmanuel E. , Laks Shachar
Published: June 2020

Serum carbohydrate antigen (CA19-9) is known to correlate with stage, resectability, and prognosis of pancreatic cancer. The goal of pancreaticoduodenectomy is to achieve an R0 resection because worse outcomes are reported in the presence of positive margins. The purpose of this study was to evaluate the predictive utility of CA19-9 for pancreaticoduodenectomy margin status. A retrospective review of patients with pancreatic adenocarcinoma undergoing pancreaticoduodenectomy between October 2007 and November 2018 at our institution was performed. Patient demographics, preoperative CA19-9, and tumor characteristics were analyzed. Univariate and mul-tivariate logistic regression was performed to determine factors associated with positive margins. A total of 184 patients were included. The mean age was 65 years; most patients were male and white. Majority had a positive preoperative CA19-9 (69%). There were nearly twice as many patients with negative as positive margins. Groups had similar demographics and preoperative CA19-9. A greater proportion of patients with negative margins had smaller tumors and early disease. On univariate and multivariate analysis, larger and higher stage tumors had greater odds of positive margins ( P < 0.05). There was no significant association between margin status and preoperative CA19-9. Preoperative CA19-9 is not predictive of margin status. These results suggest that although preoperative CA19-9 values are associated with both resectability and prognosis, positive margins may not be a contributing mechanism.
Not a Routine Case, Why Expect the Routine Outcome? Quantifying the Infectious Burden of Emergency General Surgery Using the NSQIP
Authors: Arnold Michael R. , Kao Angela M. , Cunningham Kyle W. , Christmas A. Britton , Thomas Bradley W. , Sing Ronald F. , Reinke Caroline E. , Ross Samuel W.
Published: June 2020

Emergent surgeries have different causes and physiologic patient responses than the same elective surgery, many of which are due to infectious etiologies. Therefore, we hypothesized that emergency cases have a higher risk of postoperative SSI than their elective counterparts. The ACS NSQIP database was queried from 2005 to 2016 for all cholecystectomies, ventral hernia repairs, and partial colectomies to examine common emergency and elective general surgery operations. Thirty-day outcomes were compared by emergent status. Any SSI was the primary outcome. There were 863,164 surgeries: 416,497 cholecystectomies, 220,815 ventral hernia repairs, and 225,852 partial colectomies. SSIs developed in 38,865 (4.5%) patients. SSIs increased with emergencies (5.3% vs 3.6% for any SSI). Postoperative sepsis (5.8% vs 1.5%), septic shock (4.7% vs 0.6%), length of stay (8.1 vs 2.9 days), and mortality (3.6% vs 0.4%) were increased in emergent surgery; P < 0.001 for all. When controlling for age, gender, BMI, diabetes, smoking, wound classification, comorbidities, functional status, and procedure on multivariate analysis, emergency surgery (odds ratio 1.15, 95% confidence interval 1.11–1.19) was independently associated with the development of SSI. Patients undergoing emergency general surgery experience increased rates of SSI. Patients and their families should be appropriately counseled regarding these elevated risks when consenting for emergency surgery.
Should Hypotensive Trauma Patients Ever be Transferred to a Trauma Center?
Authors: Chipko John , Davis Donald , Cha John , Herron Thomas , Ciesla David
Published: June 2020

Many trauma patients present to nontrauma centers with emergency conditions. The Emergency Medical Treatment and Active Labor Act dictates that nontrauma centers attempt stabilization and provide appropriate transfer. Our goal was to determine whether there was a survival benefit in transferring hypotensive patients. The Tampa General Hospital trauma registry database was queried for adult trauma transfers from January 2012 to April 2018 including the first recorded systolic blood pressure (SBP) and other pertinent data. A manual chart review in hypotensive (SB P < 90) patients determined blood pressure at the time of transfer. Of the 3038 patients, 40 patients were hypotensive on arrival, with 40% (16) mortality. Eight of nine (88%) patients with SB P <70 on arrival, 3 of 11 (27%) with SBP 70 to 79, and 5 of 20 (25%) with SBP 80 to 89 died. The only survivor in the <70 group was normotensive at transport. Patients in these groups who were hypotensive at the time of transport died (4/4, 100%). Our data show no benefit in transferring patients with refractory hypotension at the time of transport; although the numbers are small, an SB P <70 should be considered prohibitive to transfer.
Bedside Incentive Spirometry Predicts Risk of Pulmonary Complication in Patients with Rib Fractures
Authors: Sadler Craig A. , Burgess Jessica R. , Dougherty Kristen E. , Collins Jay N.
Published: June 2020

This retrospective chart review demonstrates the relationship between bedside incentive spirometry (ICS) volumes and risk of pulmonary complications. Two hundred patients admitted for rib fractures between April and October 2016 were reviewed. The inclusion criteria were age 18–98 years, diagnosis of rib or sternal fractures, and no procedures requiring postoperative intubation within 48 hours of admission. The exclusion criteria were intubation before arrival, unable to participate in ICS, or previous tracheostomy. ICS volumes recorded in daily progress notes were collected. Of 200 charts reviewed, 154 met the inclusion criteria. In all, 25 endured at least one pulmonary complication. The average ICS on admission was 1355 cc. Patients who did not experience a complication had significantly higher admission ICS volumes than those who did (1441 ± 660 cc vs 920 ± 451 cc, P = 0.0003). They also achieved higher volumes at discharge (1705 ± 662 cc vs 1211 ± 453 cc, P = 0.006). The groups had similar demographics. An admission ICS volume <1 L was associated with 3.33 relative risk of pulmonary complication. Lower volumes were also associated with discharge to nonhome locations. Bedside ICS is a useful tool to identify patients at risk of pulmonary complications from rib fractures. Patients with admission ICS volume <1 L carry a higher risk of complication.
Laparoscopic Sleeve Gastrectomy or Laparoscopic Gastric Bypass for Patients with Metabolic Syndrome: An MBSAQIP Analysis
Authors: Alizadeh Reza Fazl , Li Shiri , Gambhir Sahil , Hinojosa Marcelo W. , Smith Brian R. , Stamos Michael J. , Nguyen Ninh T.
Published: June 2020

In patients undergoing bariatric surgery, the presence of metabolic syndrome (MetS) contributes to perioperative morbidity. We aimed to evaluate the utilization and outcome of severely obese patients with MetS who underwent laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB). Using the 2015 and 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, data were obtained for patients with MetS undergoing LSG or LRYGB. There were 29,588 MetS patients (LSG: 58.7% vs LRYGB: 41.3%). There was no significant difference in 30-day mortality (0.1% for LSG vs 0.2% for LRYGB, adjusted odds ratio (AOR) 0.58, confidence interval (CI) 0.32–1.05, P = 0.07) or length of stay between groups (2 ± 2 for LSG vs 2.2 ± 2 days for LRYGB, P = 0.40). Compared with LRYGB, LSG was associated with significantly shorter operative time (78 ± 39 vs 122 ± 54 minutes, P < 0.01), lower overall morbidity (2.3% vs 4.4%, AOR 0.53, CI 0.46–0.60, P < 0.01), lower serious morbidity (1.5% vs 2.3%, AOR 0.64, CI 0.53–0.76, P < 0.01), lower 30-day reoperation (1.2% vs 2.3%, AOR 0.52, CI 0.43–0.63, P < 0.01), and lower 30-day readmission (4.2% vs 6.6%, AOR 0.62, CI 0.55–0.69, P < 0.01). In conclusion, LSG is the predominant operation being performed for severely obese patients with MetS, and its popularity may in part be related to its improved perioperative safety profile.
Primary Skin Closure after Repair of Hollow Viscus Injuries
Authors: Holloway Janell , Lett Elle , Marcia Lobsang , Putnam Brant , Neville Angela , Patel Neil , Chong Vincent , Kim Dennis Y.
Published: June 2020

Decisions regarding whether to close the skin in trauma patients with hollow viscus injuries (HVIs) are based on surgeon discretion and the perceived risk for an SSI. We hypothesized that leaving the skin open would result in fewer wound complications in patients with HVIs. We performed a retrospective analysis of all adult patients who underwent operative repair of an HVI. The main outcome measure was superficial or deep SSIs. Of 141 patients, 38 (27%) had HVIs. Twenty-six patients developed SSIs, of which 13 (50%) were superficial or deep SSIs. On adjusted analysis, only female gender ( P = 0.03) and base deficit were associated ( P = 0.001) with wound infections Open wound management was not associated with a decreased incidence of SSIs ( P = 0.19) in patients with HVIs. Further research is required to determine optimal strategies for reducing wound complications in patients sustaining HVIs.
Should All Complicated Appendicitis be Treated the Same? the Answer is No
Authors: Wang Victoria , Kriger Diego , Fanous Elias , Lee Alfred , Zakhary Bishoy , Coimbra Raul , Depew Aron J.
Published: June 2020

Delayed presentation of acute appendicitis is associated with increased complications. We hypothesized that the outcomes of appendectomy in delayed presentations of acute appendicitis (>72 hours of pain) were dependent on radiologic findings rather than late presentation. We reviewed records from 2009 to 2015 and analyzed delayed presentations of acute appendicitis. We divided patients into three groups based on specific CT findings: uncomplicated appendicitis (UA), phlegmon or abscess (PA), and other perforated appendicitis (PERF, signs of perforation without abscess or phlegmon). One hundred thirty-eight patients were included in this study (58 in the UA, 67 in the PA, and 13 in the PERF groups). Overall, 78 (57%) patients underwent early appendectomy (EA) and 60 (43%) underwent initial conservative management. The incidence of adverse events was lower in EA than that in initial conservative management (17% vs 42%, P = 0.005). EA in the UA group was associated with shorter hospitalization (3.2 vs 5.6 days, P < 0.001) and less adverse events (6% vs 29%, P < 0.05). Severe adverse events (two colectomies and one fecal fistula) were observed in the PA group. In conclusion, in these late presentations of appendicitis, complicated appendicitis was common. EA was safe in selected patients, however, and associated with decreased adverse events.
Postoperative Prophylactic Antibiotics Reduce Surgical Site Infection Rates after Ventral Hernia Repair: A Systematic Review
Authors: Baltodano Pablo A. , Chattha Anmol , Johnson Philip K. , Kittredge Justin , Ricci Joseph A. , Patel Ashit
Published: June 2020

SSIs after ventral hernia repair (VHR) represent a significant complication. The impact of postoperative prophylactic antibiotics on the SSI rates after VHRs is unclear. A systematic review of PubMed and Web of Science databases from inception through March 2016 investigating the effect of postoperative prophylactic antibiotics after VHRs was performed. Strict inclusion and exclusion criteria were implemented, and the methodological quality of the included studies was assessed. After systematic independent assessment of 216 citations, four studies, involving 344 patients, met the inclusion criteria. Among the included studies, 164 patients received >24 hours of postoperative prophylactic antibiotics, whereas 180 patients were controls. The overall incidence of SSI among patients receiving postoperative antibiotics was 14.6 per cent (95% confidence interval [CI], 9.9 to 20.9) which compares favorably with the control group: 35.5 per cent (95% CI, 28.9 to 42.7) (odds ratio: 0.3, 95% CI: 0.2 to 0.5, P < 0.01). Among patient's receiving postoperative antibiotics, the pooled average duration of postoperative antibiotic treatment was 6.2 ± 0.4 days. Based on the available evidence, the use of postoperative prophylactic antibiotics seems to be associated with lower SSI rates after VHRs. Future prospective randomized controlled trials should be conducted to further confirm the efficacy of this prophylactic intervention.
Risk Factors for Adverse Outcomes after Ostomy Reversal in Infants Less than Six Months Old
Authors: Kauffman Jeremy D. , Danielson Paul D. , Chandler Nicole M.
Published: June 2020

The purpose of this study was to determine risk factors for 30-day complications, reoperation, and readmission after ostomy reversal in infants less than six months old. Infants aged two weeks to six months who underwent ostomy reversal were identified in the 2012 to 2016 ACS NSQIP Pediatric database. Demographics, comorbidities, and 30-day outcomes were assessed. Multivariable logistic regression was used to estimate the independent effects of clinical variables on risk of 30-day complications, reoperation, and readmission. Among 1021 infants, 163 (16%) suffered a 30-day complication. SSIs were the most common complication (5.7%), followed by unplanned reintubation (5.2%) and bleeding (3%). Mortality was 0.4 per cent. Dependence on nutritional support and hematologic disorders were independently associated with postoperative complications. Forty-five children (4.4%) required reoperation and 22 (2.2%) were readmitted for conditions related to the procedure. Younger age and preoperative dependence on oxygen or nutritional support were associated with increased length of stay. SSI, unplanned reintubation, and bleeding are the most frequent complications after ostomy takedown in infants less than six months old. Attention to risk factors predisposing to these complications, including dependence on nutritional support and hematologic disorders, may contribute to improved surgical outcomes.
Use of Postmastectomy Radiation in Patients Treated for Invasive Breast Cancer with Mastectomy and Immediate Reconstruction
Authors: Hayek Genevieve , Winslow Mary , Maier Morgan , Corsetti Ralph , Rivere Amy , Mackey Aimee , Tanaka Shoichiro , Fuhrman George
Published: June 2020

Immediate reconstruction after mastectomy helps women manage the psychological impact of deforming surgery. Postmastectomy radiation therapy (PMRT) can negatively impact the aesthetic result after breast reconstruction. We performed this study to achieve a better understanding of how PMRT is used after reconstruction in our institution. We conducted a retrospective review of a pro-spectively maintained database of all women who underwent mastectomy for invasive breast cancer followed by immediate reconstruction from 2006 to 2017. Patients were divided into two groups depending on whether PMRT was included in their treatment, and we compared clinical and pathologic characteristics to determine which factors were likely to lead to PMRT. A total of 315 women treated with mastectomy and immediate reconstruction were identified. A total of 96 were treated with PMRT; 219 had mastectomy and immediate reconstruction without radiotherapy. Tumor characteristics, tumor stage, demographics, and comorbidities did not predict the use of PMRT. Neoadjuvant chemotherapy (NAC) was the most powerful predictor for using PMRT. In 47 of 81 (58%) patients treated with NAC, PMRT was used. Whereas 49 of 234 (21%) patients who did not receive NAC were treated with PMRT ( P = 0.0001, risk ratio 2.77, 95 per cent confidence interval 2.03–3.77). In our institution, patients treated with NAC followed by mastectomy and immediate reconstruction are significantly more likely to receive PMRT. The increased use of PMRTafter NAC should be factored into the preoperative discussion with patients choosing mastectomy and immediate reconstruction.
Survey of Surgeons’ Perspectives of Wound Care Centers and Chronic Wound Care
Authors: Rendell Victoria R. , Esposito Thomas J. , Gibson Angela
Published: June 2020

Multidisciplinary management of chronic wounds using comprehensive wound centers improves outcomes. With an increasing need for wound providers, little is known about surgeons’ roles in wound centers. An online survey of two national surgical organization members covered demographics, wound center characterization, and surgeons’ perspectives of wound centers and wound care. Surgeon perspectives were compared by age, gender, and relationship status. Three hundred sixty-four surgeons responded. Respondents were mostly older than 50 years, male, in practice older than 10 years, and used wound centers. Most respondents reported favorable experiences with wound centers but uncertainty about financial details. Most respondents were interested in formal wound care certification and participation in a wound practice, particularly as a transition to the retirement option for older surgeons. Surgeons are interested in pursuing a career focus in wound care. Further efforts are needed to educate surgeons and create a pathway for surgeons to become wound center directors. In a nationwide survey, surgeon perspectives on wound centers and wound specialization were positive, although financial understanding was limited. The importance of this finding is the support of wound care pathways for surgeons.
The Impact of Hemodynamic Transesophageal Echocardiography on Acute Kidney Injury Management and Use of Continuous Renal Replacement Therapy in Trauma
Authors: Sapp Alex , Drahos Andrew , Lashley Madison , Christie Amy , Christie D. Benjamin
Published: June 2020

Resuscitation of critically ill trauma patients can be precarious, and errors can cause acute kidney injuries. If renal failure develops, continuous renal replacement therapy (CRRT) may be necessary, but adds expense. Hemodynamic transesophageal echocardiography (hTEE) provides objective data to guide resuscitation. We hypothesized that hTEE use improved acute kidney injury (AKI) management, reserved CRRT use for more severe AKIs, and decreased cost and resource utilization. We retrospectively reviewed 2413 trauma patients admitted to a Level I trauma center's ICU between 2009 and 2015. Twenty-three patients required CRRT before standard hTEE use and 11 required CRRTafter; these are the “CRRT” and “CRRT/hTEE” groups, respectively. The hTEE group comprised 83 patients evaluated with hTEE, with AKI managed without CRRT. We compared the average creatinine, change in creatinine, and Acute Kidney Injury Network (AKIN) of “CRRT” with “CRRT/hTEE” and “hTEE.” We also analyzed several quality measures including ICU length of stay and cost. “CRRT” had a lower AKIN score (1.6) than “CRRT/hTEE” (2.9) ( P = 0.0003). “hTEE” had an AKIN score of 2.1 ( P = 0.0387). “CRRT” also had increased ICU days (25.1) compared with “CRRT/hTEE” (20.2) ( P = 0.014) and “hTEE” (16.8) ( P = 0.003). “CRRT” accrued on average $198,695.81 per patient compared with “CRRT/ hTEE” ($167,534.19) and “hTEE” ($53,929.01). hTEE provides valuable information to tailor resuscitation. At our institution, hTEE utilization reserved CRRT for worse AKIs and decreased hospital costs.
Efficacy and Safety of Recurrent Paraesophageal Hernia Repair with Roux-en-Y Gastric Bypass
Authors: Spann Matthew D. , Harrison Noah J. , English Wayne J. , Bolduc Aaron R. , Aher Chetan V. , Williams D. Brandon , Hawkins Alexander T.
Published: June 2020

Roux-en-Y gastric bypass (RYGB) has been explored as a revisional option to failed paraesophageal hernia (PEH) repair with fundoplication, particularly in patients suffering from obesity. However, few studies have assessed long-term outcomes of RYGB with revisional PEH repairin regard to acid-suppressing medication use. We retrospectively identified 19 patients who underwent revisional PEH repair with RYGB between 2011 and 2018. The median operative time was 232 minutes with a median hospital length of stay of two days. The median length of follow-up was 24 months. Two patients (10.5%) had complications in the first 30 days, and five patients (26.3%) had complications within one year. Of the 12 patients on preoperative acid suppression, 6 (50%) were either off medication or on reduced dose at 12 months. The median BMI decrease was 14.4 kg/m2 at 12 months and did not change significantly afterward. Although rates of acid-suppression medication use did not change overall after revisional PEH repair with RYGB, patients experienced successful long-term management of morbid obesity and sustained weight loss. Revisional PEH repair with RYGB is a safe and effective option, with a complication rate comparable with the reported rates after revisional foregut procedures such as revisional Nissen fundoplication.
What are Women Being Advised by Mentors When Applying to Surgery?
Authors: Altieri Maria S. , Price Kristie L. , Yang Jie , Jones Daniel B. , Pryor Aurora D.
Published: June 2020

Despite an increase in percentage of women entering the surgical field, women tend to favor certain surgical subspecialties. The purpose of this study was to investigate how surgeons advise trainees in pursuit of a surgical career. An 18-question survey was administered to members of the American College of Surgeons through their monthly newsletter NewScope. Respondents were asked to identify subspecialties that they would consider to be most receptive to men or women and how they would advise men and women pursuing a surgical specialty. There were 663 respondents, of which the majority (n = 465, 70.99%) were male. When asked if participants had a role model in medical school, 61.10 per cent had male role models/mentors, whereas only 7.96 per cent had female role models/mentors. Among the 23 surgical subspecialties listed, the top five specialties viewed as receptive for women were breast surgery, obstetrics and gynecology, plastic surgery, ophthalmology, and GS. Surgical specialty and gender of the respondent played a role in how surgeons advised men and women trainees, especially in specialties that traditionally have less female representation. There is inherent gender-based bias in advisement of trainees that may affect surgical specialty choice. Surgeon gender, age, and surgical specialty could be predictors as to how trainees are advised.
Age-Based Trends of Gastric Adenocarcinoma in the United States
Authors: Trumbull Denslow , Lemini Riccardo , F. Elli Enrique , P. Bagaria Sanjay , Attwood Kristopher , Gabriel Emmanuel
Published: June 2020

Background

Recent studies have shown an increase in the incidence of gastric cancer (GC) among young adults in Asia and Latin America. However, it is unknown if a similar trend is happening in the United States.

Methods

A retrospective review of the National Cancer Database was conducted to identify patients diagnosed with gastric adenocarcinoma between the years of 2004 and 2013.

Results

A total of 93 734 patients were included. The two age groups below 40 did not see a change in GC incidence; however, age groups above 40 had increasing incidence. Patients aged 18 to 25 had the largest proportion of stage 4 disease and a poor survival (median 11.5 months), compared to older patients.

Conclusion

Despite the increasing trend of GC among individuals, the incidence of GC among young adults is not increasing. However, this subpopulation presents at more advanced stages (clinical stage 4) and thus has worse survival.
Likelihood of Aortic Valve Preservation During Repair of Acute Type A Aortic Dissection
Authors: Thornhill Rosanne , Shih Wendy , Amen Marvin I. , John Mohan M. , Floridia Rosario , Razzouk Anees J. , Rabkin David G.
Published: June 2020

Background

We sought risk factors for replacement of the aortic valve with or without the root (AVR/root) in the setting of acute type A aortic dissection (ATAD) repair.

Methods

All ATAD repairs at our institution from January 2005 to June 2018 were reviewed. Baseline characteristics were recorded. For patients with aortic valve preservation we documented the degree of aortic insufficiency (AI) postoperatively and on subsequent echocardiograms when available. Logistic regression was used to determine the association between preoperative characteristics and the odds ratio of AVR/root.

Results

A total of 206 patients underwent repair of ATAD. Thirty-four were excluded for no documented AI grading. Forty-six underwent AVR/root during repair of the ATAD (including 40 root replacements). Of 126 that did not undergo AVR/root, 42 (33.33%) had follow-up echocardiograms at a median of 68 months postoperatively and 2 required reintervention for valve insufficiency. Increase in degree of AI, bicuspid valve morphology, size of the aortic root, and connective tissue disorder were significantly associated with increased risk of AVR/root. Of 130 patients without connective tissue disorder, bicuspid aortic valve, aortic root aneurysm, or intimal root tear, the rate of valve preservation was 65/65 (100%), 25/29 (86.2%), and 22/40 (55%) for those presenting with mild, moderate, and severe AI, respectively.

Discussion

Degree of preoperative AI, bicuspid valve morphology, size of the aortic root, and connective tissue disorder significantly correlate with failure of aortic valve preservation in patients with ATAD. The vast majority of tricuspid valves in patients without connective tissue disorder or aortic root pathology can be salvaged.
Drawbacks of the Current Algorithm for Patients With Symptoms of Gastroesophageal Reflux Disease and the Impact of Adding Wireless pH Study to the Initial Diagnostic Endoscopy: Data From High-Volume Rural Antireflux Center
Authors: Fanous Medhat Y. , Hughes Tyler
Published: June 2020

Background

Patients with symptoms of gastroesophageal reflux disease (GERD) are often given a trial of proton pump inhibitors (PPIs). When they respond, patients usually continue PPI therapy. If this empiric treatment fails, esophagogastroduodenoscopy (EGD) is recommended. When EGD findings are equivocal, pH study is warranted. We hypothesize that this algorithm results in prolonged PPI therapy, repetition of EGDs and patient dissatisfaction. This study evaluates the impact of placing a pH probe at the time of the initial EGD.

Methods

IRB approval was obtained for retrospective chart review of patients who presented with GERD symptoms between August 2015 and March 2019. Patients were included if they underwent EGD with placement of wireless pH probe.

Results

A total of 379 patients (260 females, 119 males) with average age was 56.7±14.2 years. There were 253/379 (66.7%) patients who had previous EGDs (1-10). Health Satisfaction Survey was completed by 357/379 (94.2%) patients and 250/357 (70%) reported dissatisfaction with GERD control. PPI use was noted in 299/379 (78.8%) patients with average duration of 10.9±9.1 years. Testing off antisecretory medication was performed in 360/379 (94.9%). The average time interval between the clinic visit and performing EGD and pH study was 22±25 days.

Conclusion

The current GERD algorithm results in prolonged PPI therapy, repeated endoscopies and patient dissatisfaction. Placing a pH probe at the time of initial endoscopy is safe and expedient in a rural setting. Positive pH studies avoid repeating EGDs and negative pH studies warrant a search for potential alternative diagnosis.
Book review: Nilamadhab Mohanty, Different Colours: Reflections of a Civil Servant
Authors: Misra S. K.
Published: June 2020

Nilamadhab Mohanty, Different Colours: Reflections of a Civil Servant. Haranand Publications, 220 pp., ₹600.00 (Paperback). ISBN: 978-93-88409-48-3.
Work and Unemployment in the Time of COVID-19: The Existential Experience of Loss and Fear
Authors: Blustein David L. , Guarino Paige A.
Published: June 2020

This article explores the existential loss, anxiety, and terror that is evoked by the massive unemployment brought on by the COVID-19 pandemic. Growing inequality and marginalization in the workforce prior to the advent of this health crisis is reviewed as a major antecedent that set the stage for the unemployment crisis that now defines this era. An overview of the nature of the needs that working optimally can fulfill is presented, which include survival, social connection/contribution, and self-determination. The loss of work is then connected to the notion of existential terror, which captures the emotional imperative to survive as well as the need to manage the psychological consequences of threats that undermine existence. Suggestions for mitigating the impact of job loss and its attendant sense of terror are then presented, which include systemic interventions, relational and psychotherapeutic support, and individual coping strategies
Do Populist Parties Increase Voter Turnout? Evidence From Over 40 Years of Electoral History in 31 European Democracies
Authors: Leininger Arndt , Meijers Maurits J
Published: June 2020

While some consider populist parties to be a threat to liberal democracy, others have argued that populist parties may positively affect the quality of democracy by increasing political participation of citizens. This supposition, however, has hitherto not been subjected to rigorous empirical tests. The voter turnout literature, moreover, has primarily focused on stable institutional and party system characteristics – ignoring more dynamic determinants of voter turnout related to party competition. To fill this double gap in the literature, we examine the effect of populist parties, both left and right, on aggregate-level turnout in Western and Eastern European parliamentary elections. Based on a dataset on 315 elections in 31 European democracies since 1970s, we find that turnout is higher when populist parties are represented in parliament prior to an election in Eastern Europe, but not in Western Europe. These findings further our understanding of the relationship between populism, political participation and democracy.
Rule Following Mitigates Collaborative Cheating and Facilitates the Spreading of Honesty Within Groups
Authors: Gross Jörg , De Dreu Carsten K. W.
Published: June 2020

Compared with working alone, interacting in groups can increase dishonesty and give rise to collaborative cheating—the joint violation of honesty. At the same time, collaborative cheating emerges some but not all of the time, even when dishonesty is not sanctioned and economically rational. Here, we address this conundrum. We show that people differ in their extent to follow arbitrary and costly rules and observe that “rule-followers” behave more honestly than “rule-violators.” Because rule-followers also resist the temptation to engage in collaborative cheating, dyads and groups with at least one high rule-follower have fewer instances of coordinated violations of honesty. Whereas social interaction can lead to a “social slippery slope” of increased cheating, rule-abiding individuals mitigate the emergence and spreading of collaborative cheating, leading to a transmission advantage of honesty. Accordingly, interindividual differences in rule following provide a basis through which honest behavior can persist.
Education, Gender Ideology, and Housework in the Palestinian Family in Israel: Implications of Contradictory Social Change
Authors: Sabbah-Karkabi Maha
Published: June 2020

This article focuses on how the socio-economic status of Palestinian women in Israel influences the housework division in a cultural context where social change, such as advancement in education occurs while traditional gender roles continue to exist. Logistic regression analysis was used including factors such as a woman’s employment status, her educational achievement, her spouse’s education, and her attitudes. The findings show that a greater sharing of household chores is positively associated with woman’s time constraints and her attitudes. Attitudes also have a significant effect on a more equal division of childcare tasks. Woman’s full-time employment and whose education is similar to her spouse’s has influence on financial management. Although the current study’s findings show that women may need to decrease their availability around the house, in order to gain a more equal sharing of household tasks, attitudes, and values, are essential to modifying the allocation of household.
Cerebrovascular reactivity in retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations
Authors: Hoogeveen Evelien S , Pelzer Nadine , Ghariq Eidrees , van Osch Matthias JP , Dahan Albert , Terwindt Gisela M , Kruit Mark C
Published: June 2020

Retinal Vasculopathy with Cerebral Leukoencephalopathy and Systemic manifestations (RVCL-S) is a small vessel disease caused by TREX1 mutations. RVCL-S is characterized by retinal vasculopathy and brain white matter lesions with and without contrast enhancement. We aimed to investigate cerebrovascular reactivity (CVR) in RVCL-S. In this cross-sectional observational study, 21 RVCL-S patients, 23 mutation-negative family members, and 31 healthy unrelated controls were included. CVR to a hypercapnic challenge was measured using dual-echo arterial spin labeling magnetic resonance imaging. Stratified analyses based on age were performed. We found that CVR was decreased in gray and white matter of RVCL-S patients compared with family members and healthy controls (ANCOVA; P < 0.05 for all comparisons). This was most noticeable in RVCL-S patients aged ≥40 years (ANCOVA, P < 0.05 for all comparisons). In RVCL-S patients aged < 40 years, only CVR in white matter was lower when compared to healthy controls ( P < 0.05). Gray matter CVR was associated with white matter lesion volume in RVCL-S patients ( r = –0.527, P = 0.01). In conclusion, impaired cerebrovascular reactivity may play an important role in the pathophysiology of RVCL-S and may be an useful early biomarker of cerebrovascular disease severity.
Peer Victimization and Depressive Symptoms During Adolescence: Examining the Roles of Social Support and Internalizing Coping
Authors: Spiekerman Allie M. , Witkow Melissa R. , Nishina Adrienne
Published: June 2020

The purpose of this study was to examine how two coping strategies together moderate the relationship between peer victimization and adjustment among young adolescents. Sixth-grade adolescents from California, Oregon, and Wisconsin ( N = 1,058) self-reported peer victimization, depressive symptoms, and their utilization of social support seeking and internalizing coping. A regression analysis showed a significant three-way interaction between peer victimization, internalizing coping, and social support seeking in predicting depressive symptoms. Further analyses revealed that social support seeking only buffered the negative effects of peer victimization for participants who scored high on internalizing coping. Despite mean-level gender differences in these variables, gender did not moderate this association, suggesting that social support is an effective buffer against depressive symptoms following peer victimization for both boys and girls. These results suggest that attending to the variety of coping strategies adolescents employ simultaneously will help further our understanding of peer victimization outcomes.
Increased tortuosity of bilateral distal internal carotid artery is associated with white matter hyperintensities
Authors: Liu Jiyang , Ke Xiaoting , Lai Qingquan
Published: June 2020

Background

Although the pathophysiology of white matter hyperintensities remains unclear, we can recently explore the possible relationship with white matter hyperintensities by using quantitative parameter.

Purpose

To demonstrate the relationship between bilateral distal internal carotid arterial tortuosity and total brain white matter hyperintensities volume in elderly individuals.

Material and Methods

A total of 345 patients (age > 65 years) with brain magnetic resonance (MR) examinations were retrospectively included (44.1% men; mean age = 72.1 ± 6.25 years; 55.9% ≥ 70 years). We measured the Tortuosity Index (TI) of the bilateral distal internal carotid artery and basilar artery on MR angiography imaging, and white matter hyperintensities volume on fluid-attenuated inversion recovery MR sequence. Multiple linear regression was used to assess the association of the TI with quantitatively derived brain white matter hyperintensity volume, after adjusting for demographics (age, sex), vascular risk factors (hypertension, diabetes, heart disease), and vessel diameters, total intracranial volume (TIV).

Results

Increased tortuosity of bilateral distal internal carotid artery was associated with greater burden of white matter hyperintensity volume (right: β = 11.223, P = 0.016; left: β = 20.701, P < 0.001). This relationship was independent of age and hypertension, both of which have been considered the strongest risk factors for white matter hyperintensities.

Conclusion

Our results suggest that tortuosity of the bilateral distal internal carotid artery is associated with white matter hyperintensities, independent of age and hypertension.
Carnivore Protoparvovirus-1 Associated With an Outbreak of Hemorrhagic Gastroenteritis in Small Indian Civets
Authors: Chaiyasak Surangkanang , Piewbang Chutchai , Banlunara Wijit , Techangamsuwan Somporn
Published: June 2020

Carnivore protoparvovirus-1 (CPPV-1) infection has been reported frequently in both domestic and wildlife species including wild carnivores. Fifty-five captive small Indian civets ( Viverricula indica), farmed for perfume production in Eastern Thailand, showed clinical signs of acute bloody diarrhea, anorexia, vomiting, circling, and seizures. The disease spread within the farm and resulted in the death of 38 of the 55 civets (69% mortality) within a month. Fecal swabs were collected from the 17 surviving civets, and necropsy was performed on 7 of the dead civets. Pathologic findings were severe hemorrhagic gastroenteritis with generalized lymphadenopathy. CPPV-1 was identified in both fecal swabs and postmortem samples by species-specific polymerase chain reaction. Further whole-gene sequencing and restriction fragment length polymorphism analysis suggested feline panleukopenia virus (FPV) as the causative agent. The viral tropism and tissue distribution were confirmed by immunohistochemistry, with immunolabeling in the cytoplasm and nucleus of small intestinal crypt epithelial cells, villous enterocytes, histiocytes in lymphoid tissues, myenteric nerve plexuses, and cerebral and cerebellar neurons. Phylogenetic analysis of civet-derived CPPV-1 indicated a genetic similarity close to the FPV HH-1/86 strain detected in a jaguar ( Panthera onca) in China. To our knowledge, this mass die-off of civets is the first evidence of disease associated with CPPV-1 infection in the subfamily Viverrinae. These findings support the multi-host range of parvovirus infection and raises awareness for CPPV-1 disease outbreaks in wildlife species.
Evaluation of the Precision and Accuracy of Cycle-Average Light Duty Gasoline Vehicles Tailpipe Emission Rates Predicted by Modal Models
Authors: Wei Tongchuan , Frey H. Christopher
Published: June 2020

A vehicle specific power (VSP) modal model and the MOtor Vehicle Emission Simulator (MOVES) Operating Mode (OpMode) model have been used to evaluate and quantify the fuel use and emission rates (FUERs) for on-road vehicles. These models bin second-by-second FUERs based on factors such as VSP, speed, and others. The validity of binning approaches depends on their precision and accuracy in predicting variability in cycle-average emission rates (CAERs). The objective is to quantify the precision and accuracy of the two modeling methods. Since 2008, North Carolina State University has used portable emission measurement systems to measure tailpipe emission rates for 214 light duty gasoline vehicles on 1,677 driving cycles, including 839 outbound cycles and 838 inbound cycles on the same routes. These vehicles represent a wide range of characteristics and emission standards. For each vehicle, the models were calibrated based on outbound cycles and were validated based on inbound cycles. The goodness-of-fit of the calibrated models was assessed using linear least squares regression without intercept between model-predicted versus empirical CAERs for individual vehicles. Based on model calibration and validation, the coefficients of determination ( R2) typically range from 0.60 to 0.97 depending on the vehicle group and pollutant, indicating moderate to high precision, with precision typically higher for higher-emitting vehicle groups. The slopes of parity plots for each vehicle group and all vehicles typically range from 0.90 to 1.10, indicating good accuracy. The two modeling approaches are similar to each other at the microscopic and macroscopic levels.
A Grounded Theory Study of Burnout among Youth Workers in Korean Immigrant Churches
Authors: Kim Youngjun
Published: June 2020

This research aimed to explore the factors that contribute to burnout among Korean (American) youth workers. Twenty youth workers serving at Korean immigrant churches in California participated in in-depth interviews ( n = 20). The four key themes found, include multidimensional contributors to burnout, symptoms of burnout, impact of burnout, and the resolution of burnout. Based on the findings, this study discusses conclusions and implications for helping youth workers deal with a sense of burnout adequately and ways of thriving in their ministry.
Effects of different sulfonation times and post-treatment methods on the characterization and cytocompatibility of sulfonated PEEK
Authors: Ma Rui , Wang Jialin , Li Chengxin , Ma Kai , Wei Jie , Yang Pei , Guo Dagang , Wang Kunzheng , Wang Wei
Published: June 2020

Polyetheretherketone (PEEK) has been becoming a popular implant material in orthopaedic applications. The lack of bioactivity affects PEEK’s long-term lifetime, and appropriate surface modification is an effective way to enhance its bioactivity. Sulfonation of PEEK can endow PEEK with a 3 D porous network surface and improve its bioactivity. This study is aimed at exploring an optimal sulfonation time and a post-treatment method of PEEK sulfonation. PEEK was immersed into concentrated sulfuric acid for different sulfonation times and experienced different post-treatment methods to turn into sulfonated PEEK (SPEEK). The immersion times were 0.5 min (SPEEK0.5), 1 min (SPEEK1), 3 min (SPEEK3), 5 min (SPEEK5) and 7 min (SPEEK7), and the post-treatment methods were acetone rinsing (SPEEK-T1), hydrothermal treatment (SPEEK-T2) and NaOH immersion (SPEEK-T3). Scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), Fourier transform infrared spectroscopy, hydrophilic property, ion release and cell viability evaluations were performed to optimize the sulfonation time, and the SEM, EDS, ion release and cell viability were analysed to optimize the post-treatment method. The results showed a porous network structure was formed on all samples of SPEEK, and the porous structure became more obvious and the S concentration increased with increasing sulfonation time. However, too long of an immersion time (SPEEK7) tended to damage the superficial porous structure and left a higher content of sulfuric acid, which could inhibit the growth of MC3T3E1 cells on its surface. In addition, the surface morphology, residual sulfuric acid and cytocompatibility of SPEEK-T1, SPEEK-T2 and SPEEK-T3 were not distinctly different. In conclusion, a 5-min sulfonation time was considered to be the optimal selection, and acetone rinsing, hydrothermal treatment and NaOH immersion showed the same effect in removing the residual sulfuric acid. The understanding of optimal sulfonation time and post-treatment method can provide a theoretical basis in preparing SPEEK for orthopaedic applications.
Alcohol-Involved Family and Domestic Violence Reported to Police in Australia
Authors: Mayshak Richelle , Curtis Ashlee , Coomber Kerri , Tonner Lorraine , Walker Arlene , Hyder Shannon , Liknaitzky Paul , Miller Peter
Published: June 2020

Family and domestic violence (FDV) is a significant social issue that causes major harm across Australia. Alcohol has been identified as a contributing factor to FDV, and as such increased understanding of the role of alcohol in police-reported FDV incidents may provide the basis for developing specific clinical and forensic approaches. This study aims to identify the key correlates of alcohol-related FDV within police-reported FDV incidence. Data sourced from several states and territories across Australia were used to profile demographic and personal factors involved in police-reported FDV incidents, and to identify the types of incidents involving alcohol. For each state, three separate binary regressions were conducted for family violence, intimate partner violence, and FDV incidents in which alcohol was involved. Between 24% and 54% of FDV incidents reported to police were classified as alcohol-related. Although there appeared to be an association between relative socioeconomic disadvantage and an incident being alcohol-related, this association varied across states. Where victim and offender data were available, offenders were significantly more likely to be alcohol-affected than victims. Alcohol-related FDV incidents were also twice as likely to involve severe physical violence including injuries that were life threatening, as well as an increased likelihood of recidivism. This study demonstrates that alcohol plays a substantial role in police-reported FDV across Australia. It also demonstrates that other factors such as drug use, breach of orders, and repeat offending are associated with alcohol involvement across family violence and intimate partner violence.