bluuebunny/crossref_metadata_2025 huggingface dataset:
PI3K/AKT/mTOR signaling pathway activity in IDH-mutant diffuse glioma and clinical implications
Authors: Mohamed Esraa , Kumar Anupam , Zhang Yalan , Wang Albert S , Chen Katharine , Lim Yunita , Shai Anny , Taylor Jennie W , Clarke Jennifer , Hilz Stephanie , Berger Mitchel S , Solomon David A , Costello Joseph F , Molinaro Annette M , Phillips Joanna J
Published: March 2022

Background

IDH-mutant diffuse gliomas are heterogeneous, and improved methods for optimal patient therapeutic stratification are needed. PI3K/AKT/mTOR signaling activity can drive disease progression and potential therapeutic inhibitors of the pathway are available. Yet, the prevalence of PI3K/AKT/mTOR signaling pathway activity in IDH-mutant glioma is unclear and few robust strategies to assess activity in clinical samples exist.

Methods

PI3K/AKT/mTOR signaling pathway activity was evaluated in a retrospective cohort of 132 IDH-mutant diffuse glioma (91 astrocytoma and 41 oligodendroglioma, 1p/19q-codeleted) through quantitative multiplex immunoprofiling using phospho-specific antibodies for PI3K/AKT/mTOR pathway members, PRAS40, RPS6, and 4EBP1, and tumor-specific anti-IDH1 R132H. Expression levels were correlated with genomic evaluation of pathway intrinsic genes and univariate and multivariate Cox proportional hazard regression models were used to evaluate the relationship with outcome.

Results

Tumor-specific expression of p-PRAS40, p-RPS6, and p-4EBP1 was common in IDH-mutant diffuse glioma and increased with CNS WHO grade from 2 to 3. Genomic analysis predicted pathway activity in 21.7% (13/60) while protein evaluation identified active PI3K/AKT/mTOR signaling in 56.6% (34/60). Comparison of expression in male versus female patients suggested sexual dimorphism. Of particular interest, when adjusting for clinical prognostic factors, the level of phosphorylation of RPS6 was strongly associated with PFS (P < .005). Phosphorylation levels of both PRAS40 and RPS6 showed an association with PFS in univariate analysis.

Conclusions

Our study emphasizes the value of proteomic assessment of signaling pathway activity in tumors as a means to identify relevant oncogenic pathways and potentially as a biomarker for identifying aggressive disease.
A Systematic Review and Meta-Analysis of Smoking and Circulating Sex Hormone Levels Among Premenopausal Women
Authors: Ihenacho Ugonna , Sriprasert Intira , Mack Wendy J , Hamilton Ann S , Unger Jennifer B , Press Michael F , Wu Anna H
Published: March 2022

Introduction

It is established that higher prediagnostic circulating androgen and estrogen levels are associated with increased breast cancer risk in premenopausal and postmenopausal women. Pooled analyses in postmenopausal women report higher androgen and estrogen levels in current heavy cigarette smokers compared to nonsmokers. However, evidence among premenopausal women has been inconsistent.

Aims and Methods

We conducted a systematic review and meta-analysis to estimate differences in standardized mean hormone levels among current premenopausal smokers compared to nonsmokers. We reviewed and collated publications with sex hormone levels by smoking status among healthy, premenopausal women who were nonusers of exogenous hormones, including oral contraceptives, using PubMed through December 2019. A random effects meta-analysis was conducted to combine the standardized mean differences (SMD) and 95% confidence intervals (CIs) for estradiol, progesterone, testosterone, dehydroepiandrosterone, dehydroepiandrosterone-sulfate, and sex hormone-binding globulin by smoking status. Findings were summarized by menstrual cycle phase and overall.

Results

Nineteen published peer-reviewed articles were included. Significantly increased testosterone levels among smokers compared to nonsmokers were identified from cross-sectional studies with varied menstrual phase timing (SMD 0.14; 95% CI 0.0005, 0.29) and significantly increased dehydroepiandrosterone-sulfate levels were found over all phases (SMD 0.12; 95% CI 0.01, 0.22). However, substantial heterogeneity existed in these studies.

Conclusions

This meta-analysis suggests that smoking may increase blood androgen levels in healthy premenopausal women which may increase breast cancer risk; however, the differences were modest. Larger and covariate-adjusted studies with standardized collection over the menstrual cycle are needed to better understand this relationship and to reduce heterogeneity.

Implications

Existing research has described associations between high prediagnostic estradiol and androgen levels with breast cancer risk among premenopausal women and has established active smoking as a breast cancer risk factor. However, the smoking and circulating sex hormone associations among premenopausal women remain inadequately studied. In this meta-analysis, we identified an association between smoking and higher mean testosterone and dehydroepiandrosterone-sulfate levels with consideration of menstrual phase, providing additional information on smoking’s potential pathway to premenopausal breast cancer.
When is Subnational, Supralocal Tobacco Control “just right”? A Qualitative Study in England
Authors: Davies Nathan Philip , Cheeseman Hazel , Arnott Deborah , Pierce Elizabeth , Langley Tessa Elizabeth , Murray Rachael , Bogdanovica Ilze , Bains Manpreet
Published: March 2022

Introduction

Subnational, supralocal (or “regional”) approaches to tobacco control are often central federal nation tobacco control and can be superfluous for very small nations. However, their relevance to countries with weak intermediate tiers of governance are less clear. This study explores expert and policymaker perceptions on the function, form, footprint, and funding of regional tobacco control (RTC) in England.

Aims and Methods

One-to-one semistructured interviews (n = 16) and four focus groups (n = 26) exploring knowledge and perceptions of the past, present, and future of RTC in England were conducted with public health leaders, clinicians, tobacco control practitioners, civil servants, and politicians. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically.

Results

Participants reported several key functions for RTC, including illicit tobacco control, media campaigns, advocacy, policy development, and network facilitation for local actors. A small minority of participants reported little role for RTC. Broader perceived features of effective RTC included subject expertise, strong regional ties, systems leadership, and a distinctive program of work. Views varied on whether regional programs should be developed nationally or locally, and their optimal footprint. Participants generally agreed stable funding was a prerequisite for success, although there was lesser agreement on funding sources.

Conclusions

Pooling resources at the regional level in countries with weak intermediate tiers of governance may increase reach, cost-effectiveness and impact of campaigns, policy interventions, and advocacy, whilst retaining the ability to tailor approaches to regional populations.

Implications

There are likely to be greater funding and governance challenges associated with introducing or strengthening RTC in countries with weak intermediate tiers of governance. Despite this, evidence from England shows it is possible to develop RTC approaches reported as effective by key stakeholders. Possible benefits of regional approaches in this context include cost-effective delivery of illicit tobacco control, media campaigns, advocacy, research, policy development, and coordinated support for local action on tobacco.
Investor Information Choice with Macro and Micro Information
Authors: Glasserman Paul , Mamaysky Harry
Published: March 2022

We develop a model of information and portfolio choice in which ex ante identical investors choose to specialize because of fixed attention costs required in learning about securities. Without this friction, investors would invest in all securities and would be indifferent across a wide range of information choices. When securities’ dividends depend on an aggregate (macro) risk factor and idiosyncratic (micro) shocks, fixed attention costs lead investors to specialize in either macro or micro information. Our results favor Samuelson’s dictum that markets are more micro than macro efficient. We derive testable predictions from our model and find empirical support for our predictions in specialization by U.S. equity mutual funds. (JEL G12, G14, G23)

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Systemic glucocorticoid use and the occurrence of flares in psoriatic arthritis and psoriasis: a systematic review
Authors: Vincken Nanette L A , Balak Deepak M W , Knulst André C , Welsing Paco M J , van Laar Jacob M
Published: March 2022

Objectives

The use of systemic glucocorticoids (SGCs) is traditionally discouraged in the treatment of PsA and psoriasis due to the risk of psoriatic flares. However, despite this recommendation, SGCs are frequently prescribed for these patients. In this study we reappraise the old paradigm that SGCs are contra-indicated in the treatment of PsA and psoriasis.

Methods

A systematic search of MEDLINE, EMBASE and the Cochrane Library databases was performed in November 2019 to identify articles on any SGC use compared with no use in the PsA and psoriasis population. Topical glucocorticoid treatment was excluded. Our two primary outcomes focused on the prescribing characteristics and the occurrence of any type of flare.

Results

Our search yielded 4922 articles, and of these 21 full-text articles were eligible for inclusion. There were 11 retro- and prospective cohorts involving a total of 4,171,307 patients. Of these, 6727 (37.82%) of the patients with PsA and 1 460 793 (35.17%) of the patients with psoriasis were treated with any type of SGC. Ten observational/interventional studies did not report an increased risk or occurrence of psoriatic flares related to SGC use.

Conclusion

Our results indicate that SGCs are frequently prescribed for PsA and psoriasis patients. The occurrence of psoriatic flares appears to be low upon SGC exposure. In patients with a clear indication for SGCs, e.g. in need of rapid anti-inflammatory therapy or bridging of therapies, the use of SGCs should be considered in view of the low risk of skin flaring. It remains of importance to weigh risks for short- and long-term SGC-related side effects in clinical decision making.
FIXED-POINT OBSERVATION AND CHARACTERIZATION OF RADIOACTIVE CS IN SOIL COLLECTED AT KAWASAKI, JAPAN
Authors: Saito Rintaro , Inose Satoshi , Koike Yuya
Published: March 2022

Radioactive Cs derived from the Fukushima Daiichi Nuclear Power Plant accident was detected in soils sampled at Kawasaki, Japan. Radioactive Cs adsorbed on soil is hard to be removed. Fixed-point observation of radioactive Cs concentration was performed on two observation sites of Meiji University. The soil samples were also analyzed for the distribution of radioactive Cs concentration and chemical form. 10 years after the accident, the activity concentration of radioactive Cs in soil samples at the Ikuta Campus of Meiji University ranged from 127 to 448 Bq kg−1. The sequential extraction method results indicated that most radioactive Cs in the surface soil exists in a poorly soluble form.
Social cognitive network neuroscience
Authors: Krendl Anne C , Betzel Richard F
Published: March 2022

Over the past three decades, research from the field of social neuroscience has identified a constellation of brain regions that relate to social cognition. Although these studies have provided important insights into the specific neural regions underlying social behavior, they may overlook the broader neural context in which those regions and the interactions between them are embedded. Network neuroscience is an emerging discipline that focuses on modeling and analyzing brain networks—collections of interacting neural elements. Because human cognition requires integrating information across multiple brain regions and systems, we argue that a novel social cognitive network neuroscience approach—which leverages methods from the field of network neuroscience and graph theory—can advance our understanding of how brain systems give rise to social behavior. This review provides an overview of the field of network neuroscience, discusses studies that have leveraged this approach to advance social neuroscience research, highlights the potential contributions of social cognitive network neuroscience to understanding social behavior and provides suggested tools and resources for conducting network neuroscience research.
Insomnia Diagnosis, Prescribed Hypnotic Medication Use, and Risk for Serious Fall Injuries in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Thomas S Justin , Sakhuja Swati , Colantonio Lisandro D , Li Mei , Muntner Paul , Reynolds Kristi , Bowling C Barrett
Published: March 2022

Study Objectives

Insomnia is common among older adults and associated with an increased risk for falls. Determining if falls are more strongly associated with insomnia or prescribed hypnotic medications could be used to guide interventions to reduce falls risk.

Methods

We examined the prospective association of a diagnosis of insomnia and/or prescribed hypnotic medication use with the risk for serious fall injuries among 9087 Reasons for Geographic and Racial Differences in Stroke (REGARDS) study participants aged 65 years or older with Medicare fee-for-service health insurance at baseline (2003–2007). A diagnosis of insomnia was based on ICD-9 codes in Medicare claims and prescribed hypnotic medication use was determined through a pill bottle review. Serious fall injuries were identified by Medicare claims between baseline and December 31, 2018.

Results

Over a median of 6.8 years, 1660 (18.3%) participants had a serious fall injury. The incidence rates for a serious fall injury per 1000 person-years were 24.8 (95%CI: 23.5, 26.1), 28.8 (95%CI: 18.6, 38.9), 32.6 (95%CI: 28.2, 37.0), and 46.6 (95%CI: 26.7, 66.5) for participants without insomnia or taking prescribed hypnotic medication (–insomnia/–hypnotics), with insomnia only (+insomnia/–hypnotics), taking prescribed hypnotic medication only (–insomnia/+hypnotics), and with insomnia and taking prescribed hypnotic medication (+insomnia/+hypnotics), respectively. Compared with the –insomnia/–hypnotic group, the multivariable-adjusted hazard ratios for a serious fall injury were 1.13 (95%CI: 0.79, 1.61), 1.29 (95%CI: 1.11, 1.50), and 1.60 (95%CI: 1.01, 2.56) for +insomnia/–hypnotics, –insomnia/+hypnotics, and +insomnia/+hypnotics, respectively.

Conclusions

The risk for serious fall injuries was higher for those taking prescribed hypnotic medications but not with an insomnia diagnosis.
First case of Zika virus infection during an outbreak of chikungunya in a rural region of Maharashtra state, India
Authors: Gurav Yogesh K , Alagarasu Kalichamy , Yadav Pragya D , Sapkal Gajanan , Gokhale Mangesh , Parashar Deepti , Jadhav Ujwala , Bote Minal , Kakade Mahadeo , Nyayanit Dimpal , Kumar Abhinendra , Deshpande Gururaj Rao , Cherian Sarah , Awate Pradip S , Abraham Priya
Published: March 2022

Background

In July 2021, an outbreak of chikungunya virus (CHIKV) was reported in a rural region of Maharashtra state, India.

Methods

Serum samples of symptomatic cases (n=33) were screened for dengue virus (DENV), CHIKV and Zika virus (ZIKV) by molecular and serological assays.

Results

The first case of ZIKV infection from Maharashtra was detected and confirmed by molecular and serological assays. Complete genome sequencing revealed that the ZIKV sequence belongs to the Asian genotype and had a closer homology with pre-epidemic strains present before 2007.

Conclusions

ZIKV surveillance needs to be strengthened in the regions experiencing dengue and chikungunya outbreaks.
Detection and significance of neuronal autoantibodies in patients with meningoencephalitis in Vientiane, Lao PDR
Authors: Uy Christopher E , Mayxay Mayfong , Harrison Ruby , Al-Diwani Adam , Jacobson Leslie , Rattanavong Sayaphet , Dubot-Pérès Audrey , Vongsouvath Manivanh , Davong Viengmon , Chansamouth Vilada , Phommasone Koukeo , Waters Patrick , Irani Sarosh R , Newton Paul N
Published: March 2022

Background

The importance of autoimmune encephalitis and its overlap with infectious encephalitides are not well investigated in South-East Asia.

Methods

We report autoantibody testing, using antigen-specific live cell-based assays, in a series of 134 patients (cerebrospinal fluid and sera) and 55 blood donor controls (sera), undergoing lumbar puncture for suspected meningoencephalitis admitted in Vientiane, Lao People's Democratic Republic (PDR).

Results

Eight of 134 (6%) patients showed detectable serum neuronal autoantibodies, against the N-methyl-D-aspartate and gamma-aminobutyric acid A receptors (NMDAR and GABAAR), and contactin-associated protein-like 2 (CASPR2). Three of eight patients had accompanying autoantibodies in cerebrospinal fluid (two with NMDAR and one with GABAAR antibodies), and in two of these the clinical syndromes were typical of autoimmune encephalitis. Three of the other five patients had proven central nervous system infections, highlighting a complex overlap between diverse infectious and autoimmune causes of encephalitis. No patients in this cohort were treated with immunotherapy, and the outcomes were poor, with improvement observed in a single patient.

Conclusions

In Lao PDR, autoimmune encephalitis is underdiagnosed and has a poor prognosis. Empiric immunotherapy should be considered after treatable infectious aetiologies are considered unlikely. Awareness and diagnostic testing resources for autoimmune encephalitis should be enhanced in South-East Asia.
Accessibility of Pharmacist-Prescribed Contraceptives in Utah
Authors: Magnusson Brianna M. , Christensen Sarah R. , Tanner Ashley B. , Eyring J. B. , Pilling Emily B. , Sloan-Aagard Chantel D.
Published: March 2022

(Abstracted from Obstet Gynecol 2021;138:871–877)

Nearly half (45%) of US pregnancies are unintended, and almost all (95%) of unintended pregnancies are attributable to inconsistent, incorrect, or nonuse of contraceptives. Access to hormonal contraception in the United States typically involves an initial visit with a health care provider.
British Gynaecological Cancer Society Recommendations for Women With Gynecological Cancer Who Received Non-standard Care During the COVID-19 Pandemic
Authors: Taylor Alexandra , Sundar Sudha S. , Bowen Rebecca , Clayton Rick , Coleridge Sarah , Fotopoulou Christina , Ghaem-Maghami Sadaf , Ledermann Jonathan , Manchanda Ranjit , Maxwell Hilary , Michael Agnieszka , Miles Tracie , Nicum Shibani , Nordin Andrew , Ramsay Bruce , Rundle Stuart , Williams Sarah , Wood Nicholas J. , Yiannakis Dennis , Morrison Jo
Published: March 2022

(Abstracted from Int J Gynecol Cancer 2022;32:9–14)

Because of the overwhelming pressure placed on the health care system during the COVID-19 pandemic, resource prioritization and infection risk led to deviation from standard of care treatment for women with gynecologic cancer. The loss of intensive care availability, surgical capacity, as well as radio- and systemic therapy availability particularly impacted this vulnerable population.
Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force
Authors: Henderson Jillian T. , Vesco Kimberly K. , Senger Caitlyn A. , Thomas Rachel G. , Redmond Nadia
Published: March 2022

(Abstracted from JAMA 2021;326:1192–1206)

Preeclampsia is a systemic hypertensive disorder in pregnancy that increases risks for serious maternal and neonatal health complications including eclamptic seizures, stroke, small for gestational age, intrauterine growth restriction (IUGR), preterm birth, placental abruption, and death. The incidence of preeclampsia in the United States was approximately 46.6 per 1000 deliveries in 2014, with a significant increase in preeclampsia with severe features in the decade preceding.
Commentary on “Application of an Existing Syndromic Surveillance System to Quantify Possible Cases of Opioid-associated Amnestic Syndrome in Massachusetts”
Authors: Dutton Richard P.
Published: March 2022

Barash and colleagues have demonstrated the use of a statewide database to identify potential cases of opioid-associated amnestic syndrome. While a valuable step towards establishing the epidemiology of this condition, it does not answer the more fundamental question of whether opioids are truly a cause of the observed amnesia. Counterfactual arguments are offered, as well as next steps for further research.
Quality Measures for Pediatric Orthopaedic Surgery: A Systematic Review
Authors: Montgomery Blake K. , Welch Jessica M. , Shapiro Lauren M. , Shea Kevin G. , Kamal Robin N.
Published: March 2022

Background:

Quality measures provide a way to assess health care delivery and to identify areas for improvement that can inform patient care delivery. When operationalized by a hospital or a payer, quality measures can also be tied to physician or hospital reimbursement. Prior work on quality measures in orthopaedic surgery have identified substantial gaps in measurement portfolios and have highlighted areas for future measure development. This study aims to identify the portfolio of quality measures in pediatric orthopaedic surgery.

Methods:

We used methodology of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and reviewed PubMed/ MEDLINE and EMBASE, the American Academy of Orthopaedic Surgery (AAOS), National Quality Forum (NQF), and the Agency for Healthcare Research and Quality (AHRQ), for quality measures and candidate quality measures. Quality measure and candidate quality measures were categorized as structure, process, or outcome. Measures were also classified into 1 of the 6 National Quality Strategy priorities (safety, effective, patient centered, timely, efficient, and equitable).

Results:

A review of PubMed/EMBASE returned 1640 potential quality measures and articles. A review of AAOS, NQF, and AHRQ databases found 80 potential quality measures. After screening we found a total of 18 quality measures and candidate quality measures specifically for pediatric orthopaedic surgery. Quality measures addressed conditions such as supracondylar humerus fractures, developmental dysplasia of the hip, and osteochondritis dissecans. There were 10 process measures, 8 outcome measure, and 0 structure measures. When we categorized by National Quality Strategy priorities and found 50% (9/18) were effective clinical care, 44% (8/18) were person and care-giver centered experience and outcomes, 6% (1/18) were efficient use of resources.

Conclusions:

There are few quality measures and candidate quality measures to assess pediatric orthopaedic surgery. Of the quality measure available, process measures are relatively over-represented. Pediatric orthopaedic surgeons can lead the development of outcome (eg, patient-reported outcomes after surgery) and structure measures (eg, subspecialty training certification) to assess quality of care in pediatric orthopaedic surgery.

Level of Evidence:

Level II—systematic review.
Biomechanical Effects of Thoracolumbosacral Orthosis Design Features on 3D Correction in Adolescent Idiopathic Scoliosis
Authors: Guy Aymeric , Coulombe Maxence , Labelle Hubert , Rigo Manuel , Wong Man-Sang , Beygi Babak Hassan , Wynne James , Hresko Michael Timothy , Ebermeyer Eric , Vedreine Philippe , Liu Xue-Cheng , Thometz John G. , Bissonnette Benoît , Sapaly Charlotte , Barchi Soraya , Aubin Carl-Éric
Published: March 2022

Study Design.

Multicenter numerical study.

Objective.

To biomechanically analyze and compare various passive correction features of braces, designed by several centers with diverse practices, for three-dimensional (3D) correction of adolescent idiopathic scoliosis.

Summary of Background Data.

A wide variety of brace designs exist, but their biomechanical effectiveness is not clearly understood. Many studies have reported brace treatment correction potential with various degrees of control, making the objective comparison of correction mechanisms difficult. A Finite Element Model simulating the immediate in-brace corrective effects has been developed and allows to comprehensively assess the biomechanics of different brace designs.

Methods.

Expert clinical teams (one orthotist and one orthopedist) from six centers in five countries participated in the study. For six scoliosis cases with different curve types respecting SRS criteria, the teams designed two braces according to their treatment protocol. Finite Element Model simulations were performed to compute immediate in-brace 3D correction and skin-to-brace pressures. All braces were randomized and labeled according to 21 design features derived from Society on Scoliosis Orthopaedic and Rehabilitation Treatment proposed descriptors, including positioning of pressure points, orientation of push vectors, and sagittal design. Simulated in brace 3D corrections were compared for each design feature class using ANOVAs and linear regressions (significance P ≤ 0.05).

Results.

Seventy-two braces were tested, with significant variety in the design approaches. Pressure points at the apical vertebra level corrected the main thoracic curve better than more caudal locations. Braces with ventral support flattened the lumbar lordosis. Lateral and ventral skin-to-brace pressures were correlated with changes in thoracolumbar/lumbar Cobb and lumbar lordosis (r =− 0.53, r = − 0.54). Upper straps positioned above T10 corrected the main thoracic Cobb better than those placed lower.

Conclusions.

The corrective features of various scoliosis braces were objectively compared in a systematic approach with minimal biases and variability in test parameters, providing a better biomechanical understanding of individual passive mechanisms’ contribution to 3D correction.
Resection of Lumbar Spinal Facet Joint Cysts and Cerebrospinal Fluid Leakage
Authors: Schmidt Dominic , Setzer Matthias , Seifert Volker , Marquardt Gerhard , Bruder Markus
Published: March 2022

Study Design:

Single-center series.

Objective:

Intraspinal facet joint cysts can lead to nerve root compression symptoms with severe discomfort and disability. Permanent improvement can be achieved by surgical resection of the cyst. However, cerebrospinal fluid (CSF) leakage is a common problem in resection of facet joint cyst.

The aim of the study was to investigate the frequency of CSF leak after resection of a joint cyst and to determine predictive factors.

Methods:

A total of 176 consecutive patients underwent surgery for lumbar spinal facet joint cyst in our institution between 1997 and 2018. Patients with a CSF leak were compared with patients without a CSF leak (control group).

Results:

CSF leakage occurred in 14 patients (8.0%) In 2 of the cases (14.3%), the CSF leak was recognized only postoperatively, in 12 cases (85.7%), the CSF leak was detected intraoperatively. Despite intraoperative dura repair, 4 of these 12 patients (33.3%) presented with CSF leakage postoperatively. Altogether 6 patients had postoperative CSF leakage. Compared with patients without CSF leak, there were no differences in preoperative symptoms, surgical technique, complications, or postoperative findings. Adhesion of the cyst to the dura mater was present in all 14 patients with CSF leakage (100%), but only 61.7% of the control group (P<0.005). All patients in the CSF leak group showed an improvement of their preoperative symptoms.

Conclusions:

The rate of CSF leakage in resection of spinal facet joint cyst was 8% in the present study. The occurrence of a CSF leakage was independent of clinical factors, level, or side of the cyst, but significantly correlated to dural adhesion of the cyst.

Since neither clinical recovery nor recurrence rates do depend on complete removal of the cyst, aggressive resection of dural adherend parts of the cyst wall should be avoided to prevent CSF leakage.
Outcomes After Direct Discharge Home From Critical Care Units
Authors: Martin Claudio M. , Lam Melody , Le Britney , Pinto Ruxandra , Lau Vincent , Ball Ian M. , Wunsch Hannah , Fowler Robert A. , Scales Damon C.
Published: March 2022

Objectives:

To compare health service use and clinical outcomes for patients with and without direct discharge to home (DDH) from ICUs in Ontario.

Design:

Population-based, observational, cohort study using propensity scoring to match patients who were DDH to those not DDH and a preference-based instrumental variable (IV) analysis using ICU-level DDH rate as the IV.

Setting:

ICUs in Ontario.

Patients:

Patients discharged home from a hospitalization either directly or within 48 hours of care in an ICU between April 1, 2015, and March 31, 2017.

Intervention:

DDH from ICU.

Measurements and Main Results:

Among 76,737 patients in our cohort, 46,859 (61%) were DDH from the ICU. In the propensity matched cohort, the odds for our primary outcome of hospital readmission or emergency department (ED) visit within 30 days were not significantly different for patients DDH (odds ratio [OR], 1.00; 95% CI, 0.96–1.04), and there was no difference in mortality at 90 days for patients DDH (OR, 1.08; 95% CI, 0.97–1.21). The effect on hospital readmission or ED visits was similar in the subgroup of patients discharged from level 2 (OR, 0.98; 95% CI, 0.92–1.04) and level 3 ICUs (OR, 1.02; 95% CI, 0.96–1.09) and in the subgroups with cardiac conditions (OR, 1.03; 95% CI, 0.96–1.12) and noncardiac conditions (OR, 0.98; 95% CI, 0.94–1.03). Similar results were obtained in the IV analysis (coefficient for hospital readmission or ED visit within 30 d = –0.03 ± 0.03 (SE); p = 0.3).

CONCLUSIONS:

There was no difference in outcomes for patients DDH compared with ward transfer prior to discharge when two approaches were used to minimize confounding within a large health systemwide observational cohort. We did not evaluate how patients are selected for DDH. Our results suggest that with careful patient selection, this practice might be feasible for routine implementation to ensure efficient and safe use of limited healthcare resources.
A diagnostic prediction model for hypertension in Han and Yugur population from the China National Health Survey (CNHS)
Authors: Yu Chengdong , Ren Xiaolan , Cui Ze , Pan Li , Zhao Hongjun , Sun Jixin , Wang Ye , Chang Lijun , Cao Yajing , He Huijing , Xi Jin’en , Zhang Ling , Shan Guangliang
Published: March 2022

Background:

The prevalence of hypertension is high among Chinese adults, thus, identifying non-hypertensive individuals at high risk for intervention will help to improve the efficiency of primary prevention strategies.

Methods:

The cross-sectional data on 9699 participants aged 20 to 80 years were collected from the China National Health Survey in Gansu and Hebei provinces in 2016 to 2017, and they were nonrandomly split into the training set and validation set based on location. Multivariable logistic regression analysis was performed to develop the diagnostic prediction model, which was presented as a nomogram and a website with risk classification. Predictive performances of the model were evaluated using discrimination and calibration, and were further compared with a previously published model. Decision curve analysis was used to calculate the standardized net benefit for assessing the clinical usefulness of the model.

Results:

The Lasso regression analysis identified the significant predictors of hypertension in the training set, and a diagnostic model was developed using logistic regression. A nomogram with risk classification was constructed to visualize the model, and a website (https://chris-yu.shinyapps.io/hypertension_risk_prediction/) was developed to calculate the exact probabilities of hypertension. The model showed good discrimination and calibration, with the C-index of 0.789 (95% confidence interval [CI]: 0.768, 0.810) through internal validation and 0.829 (95% CI: 0.816, 0.842) through external validation. Decision curve analysis demonstrated that the model was clinically useful. The model had a higher area under receiver operating characteristic curves in training and validation sets compared with a previously published diagnostic model based on Northern China population.

Conclusion:

This study developed and validated a diagnostic model for hypertension prediction in Gansu Province. A nomogram and a website were developed to make the model conveniently used to facilitate the individualized prediction of hypertension in the general population of Han and Yugur.
D2 lymphadenectomy with complete mesogastrium excision vs. conventional D2 gastrectomy for advanced gastric cancer
Authors: Meng Xiangyu , Wang Lu , Liu Guangcong , Zhang Jun , Wang Yue , Yang Dong , Zheng Guoliang , Zhang Tao , Zheng Zhichao , Zhao Yan
Published: March 2022

Background:

The complete mesogastrium excision (CME) based on D2 radical gastrectomy is believed to significantly reduce the local-regional recurrence compared with D2 radical gastrectomy in advanced gastric cancer, and it is widely used in China. This study aimed to explore whether D2 + CME is superior to D2 on surgical outcomes during gastrectomy from Chinese data.

Methods:

Feasible studies comparing the D2 + CME (D2 + CME group) and D2 (D2 group) published up to March 2020 are searched from electronic databases. The data showing surgical and complication outcomes are extracted to be pooled and analyzed.

Results:

Fourteen records including 1352 patients were included. The D2 + CME group had a shorter mean operative time (weighted mean difference [WMD] = —16.72 min, 95% confidence interval [CI]: −26.56 to −6.87 min, P 
< 0.001), lower mean blood loss (WMD = −39.08 mL, 95% CI: −49.94 to −28.21 mL, P < 0.001), higher mean number of retrieved lymph nodes (WMD = 2.13, 95% CI: 0.58–3.67, P = 0.007), shorter time to first flatus (WMD = −0.31 d, 95% CI: −0.53 to − 0.10 d, P = 0.005), and postoperative hospital days (WMD = −1.09, 95% CI: −1.92 to −0.25, P = 0.010) than the D2 group. Subgroup analysis suggested that the advantages from the D2 + CME group were obvious in traditional open radical gastrectomy, proximal gastrectomy, and distal gastrectomy compared with D2 group. The evaluations of post-operative complications showed that the patients who underwent D2 + CME had a lower incidence of post-operative complications than the patients who underwent D2 surgery alone (relative risk [RR] = 0.65, 95% CI: 0.45–0.87, P = 0.003). The D2 radical gastrectomy plus CME improved 3-year overall survival (OS) (RR = 1.16, 95% CI: 1.02–1.32, P = 0.020) and lowered the local recurrence rate (RR = 0.51, 95% CI: 0.28–0.94, P = 0.030). The patients undergoing laparoscopic surgery or total gastrectomy had more significant advantages compared between D2 + CME and D2 groups in 3-year OS.

Conclusion:

The data from China show that D2 radical gastrectomy plus CME are reliable procedures and safety compared to D2 radical gastrectomy with faster recovery, lower risk, and better prognosis.
Dissemination of Plastic Surgery Research: An Analysis of PRS and PRS-GO
Authors: Nasser Jacob S. , Billig Jessica I. , Horiuchi Sakura , Chung Kevin C.
Published: March 2022

Background:

Plastic and Reconstructive Surgery (PRS) recently developed an open access counterpart, PRS Global Open (PRS-GO), to increase dissemination of research in an efficient and widespread manner. We aimed to (1) examine the differences in the dissemination of research published in PRS and PRS-GO, and (2) identify differences in the authorship between the journals.

Methods:

We extracted data on Altmetric Attention Scores, article mentions, citations, and author characteristics using the Altmetric Explorer Database from January 1, 2018, to January 1, 2020. We stratified research outputs into traditional dissemination and social media dissemination. Additionally, multivariable linear regression models were used to examine differences in dissemination between the journals.

Results:

A total of 1798 articles were included in the analysis (PRS = 1031, PRS-GO = 767). The average Altmetric Attention Score was higher for PRS compared with PRS-GO (PRS = 15.2, PRS-GO = 8.1). Articles in PRS had a greater Altmetric Attention Score (β-coefficient: 7.50, P < 0.001), higher measures of traditional dissemination (β-coefficient: 3.11, P < 0.001), and higher measures of social media dissemination than articles in PRS-GO (β-coefficient: 4.38, P = 0.73).

Conclusions:

Despite being an open access journal, PRS-GO had significantly fewer measures of social media and traditional dissemination compared with PRS. Given that numerous factors may influence the dissemination of scientific literature, it is imperative that publications identify specific ways to provide a fair advantage for both researchers and readers. Additional initiatives to engage readership for open access may include creative campaigns targeting an appropriate audience.
Autologous Breast Reconstruction with Bilateral Stacked Free Flaps in Massive Weight Loss Patients
Authors: Yoo Aran , Palines Patrick A. , Maier Mark A. , Maddox Suma S. , St. Hilaire Hugo , Stalder Mark W.
Published: March 2022

Patients with a history of massive weight loss who are undergoing autologous breast reconstruction after mastectomy represent a unique surgical challenge. Although these patients often have an abundance of excess skin, it may be difficult to acquire sufficient tissue volume for adequate reconstruction of bilateral breasts using single flap techniques due to the paucity of subcutaneous fat. Stacked flap techniques have emerged as an effective method in thinner patients with suboptimal fat distribution who desire autologous breast reconstruction. This can serve as an ideal strategy, specifically in this patient population, when it serves the dual function of providing adequate volume for bilateral breast reconstruction and the secondary benefit of removing the excess skin present after massive weight loss. In this article, we discuss surgical techniques used during two cases of bilateral stacked flap breast reconstruction in cancer patients subsequent to massive weight loss.
The landscape of cardiogenic shock: epidemiology and current definitions
Authors: Palacios Ordonez Cesar , Garan Arthur Reshad
Published: March 2022

Purpose of review

Despite novel technologies for treating shock patients, cardiogenic shock mortality remains high. Trends of cardiogenic shock associated with acute myocardial infarction (AMI) have previously been described, though little is known about cardiogenic shock resulting from other causes, which has progressively been documented as a distinct entity from AMI-cardiogenic shock. Herein, we review the evolving epidemiology, novel classification schema, and future perspectives of cardiogenic shock.

Recent findings

While AMI or mechanical complications of AMI are the most common causes, the incidence of etiologies of cardiogenic shock not related to AMI, particularly acute on chronic heart failure, may be increasing, with a growing burden of noncoronary structural heart disease.

Mortality in cardiogenic shock remains high. Overall, these findings highlight the need to address the lack of effective treatments in this field, particularly for cardiogenic shock caused by diseases other than AMI. Novel classification systems may facilitate cardiogenic shock research.
Postinjury Care and Complications Among U.S. Military Women With Combat-Related Major Limb Traumatic Amputation
Authors: Dye Judy L. , Dougherty Amber L. , Shannon Kaeley B. , Eskridge Susan L. , Galarneau Michael R.
Published: March 2022

BACKGROUND:

U.S. servicewomen may be at greater risk of injury in future conflicts as they integrate into combat occupations. More than 1,000 servicewomen were wounded during military conflicts in Iraq and Afghanistan. Some women sustained traumatic amputations, and research on their postinjury health is needed.

OBJECTIVE:

To describe acute care, complications, and health care utilization among servicewomen with combat-related amputations, comparing them with injured men.

METHODS:

In this retrospective matched-pairs study, women were identified from the Expeditionary Medical Encounter Database between 2003 and 2012 and matched with men on amputation injuries, injury severity, and age. Differences were assessed with nonparametric tests for paired data.

RESULTS:

Of 20 women identified for analysis, 13 received tourniquets, three were administered procoagulants, and six had massive transfusions. Women averaged 3.4 (SD = 1.6) postinjury complications, and the most frequent were heterotopic ossification (n = 17), posthemorrhagic anemias (n = 13), and bacterial wound infections (n = 10). Acute care and complications were similar among men. Women averaged more acute care days (M = 49.8, SD = 30.6) than men (M = 46.1, SD = 27.4) but fewer intensive care unit days (women: M = 2.6, SD = 4.0; men: M = 4.4, SD = 8.3). No statistical differences were observed.

CONCLUSION:

Postinjury care among servicewomen with combat-related amputations was comparable with servicemen, and complications were common. This information can aid providers and nursing staff in the management of these injuries.
Virtual Trauma Center Surveys, Are They Virtually the Same?
Authors: Krichten Amy E. , Gondell Darlene , Over Anna
Published: March 2022

BACKGROUND:

The coronavirus pandemic forced regulatory agencies to develop innovative methods for achieving regulatory compliance. The accrediting body for trauma centers in Pennsylvania, the Pennsylvania Trauma Systems Foundation (PTSF), was one of the many agencies forced to find creative and safe ways to maintain prepandemic processes of evaluating trauma centers for compliance with trauma standards. With the uncertainty of government and hospital regulations prohibiting on-site participation and precautionary efforts to protect the health and well-being of survey participants, a virtual site visit survey process was developed to facilitate trauma center accreditation within the Commonwealth of Pennsylvania.

OBJECTIVE:

The purpose of this article is to describe an accrediting body's experience with implementing a virtual accreditation site visit survey process for Level I and II trauma centers.

METHODS:

In 2021, the PTSF piloted the virtual survey process and completed two virtual accreditation surveys.

RESULTS:

Feedback from participants included both positive and negative responses. The virtual format was effective in maintaining a high-quality accreditation process. However, multiple downsides were identified, including loss of interactive participation, loss of collaboration, limited educational opportunities, and increased presurvey workload for all participants.

CONCLUSION:

The in-person and virtual formats can accomplish the goal of the accreditation survey. The negative implications identified suggest that a traditional on-site accreditation process is preferred, with the virtual format reserved for extenuating circumstances.
Incidence and Nature of Respiratory Events in Patients Undergoing Bronchoscopy Under Conscious Sedation
Authors: Tariq Asma , Hill Nicholas S. , Price Lori Lyn , Ismail Khalid
Published: March 2022

Background:

During diagnostic bronchoscopies, conscious sedation improves patient tolerance, but it can contribute to hypercapnia and hypoxia by various mechanisms including depression of ventilatory drive. This prospective study was undertaken to determine the frequency of respiratory events and associated oxygen desaturations during bronchoscopy with conscious sedation.

Patients and Methods:

The Nox-T3 monitoring system was placed before starting the bronchoscopy and remained in place for 30 minutes following the procedure. The primary endpoint was the occurrence of obstructive and central apneic events during bronchoscopy under conscious sedation.

Results:

Obstructive events (apnea and hypopnea) occurred in 100% of patients (n=31), and central apneas occurred in 58% of patients (n=18) during the procedure with a median of 9 and 2 events per patient, respectively. During recovery, a significant proportion of patients had detectable obstructive (86%) and central (36%) events. Higher body mass index was associated with oxygen desaturation to <90% and with the need for escalation of care. Furthermore, a conscious sedation regimen that included propofol was significantly associated with central apneic events.

Conclusion:

Respiratory events are common during and immediately postprocedure after conscious sedation for bronchoscopy. Most events are obstructive, and the use of propofol predisposes to central apneas during the procedure. Both types of events are associated with a higher body mass index. Oxygen desaturation to <90% triggers escalation of care. A further prospective study will be required to determine the clinical significance of these apneic events and whether alleviating these events will improve the safety and outcomes of bronchoscopic procedures performed under conscious sedation.
Electrical impedance tomography in the adult intensive care unit: clinical applications and future directions
Authors: Rubin Jonah , Berra Lorenzo
Published: March 2022

Purpose of review

Electrical impedance tomography (EIT) is a novel, noninvasive, radiation-free, bedside imaging and monitoring tool to assess and visualize regional distribution of lung ventilation and perfusion. Although primarily a research tool, rapidly emerging data are beginning to define its clinical role, and it is poised to become a ubiquitous addition to the arsenal of the intensive care unit (ICU). In this review, we summarize the data supporting clinical use of EIT in adult ICUs, with an emphasis on appropriate application while highlighting future directions.

Recent findings

Recent major studies have primarily focused on the role of EIT in setting correct positive end-expiratory pressure to balance regional overdistention and collapse. Over the last few years, our Lung Rescue Team has demonstrated that incorporating EIT into a multimodal approach to individualizing ventilator management can improve outcomes, particularly in the obese. We also review recent data surrounding EIT use during COVID, as well as other broad potential applications.

As EIT becomes more common and its clinical role more defined, intensivists will benefit from a clear understanding of its applications and limitations.