bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolution of somatosensory processing signs after nociceptive targeted surgery in patients with musculoskeletal disorders: a systematic review
Authors: Vervullens Sophie , Meert Lotte , Meeus Mira , Baert Isabel , Heusdens Christiaan H.W. , Caethoven Cleo , Charpentier Nina , Vervliet Amber , Smeets Rob J.E.M.
Published: February 2023

Surgery is often advised when conservative treatment fails in musculoskeletal pain conditions, but a substantial proportion still suffers chronic pain after surgery. Somatosensory processing system (SPS) signs were previously studied as potential predictors for chronic postsurgical pain, but results are inconsistent. Therefore, studying the evolution of SPS signs could be of added value. The aim was to summarize all studies that measured how SPS signs evolved after nociceptive targeted surgery in musculoskeletal disorders and to find preoperative, perioperative, and postoperative predictors for the evolution of these SPS signs. Data were summarized, and risk of bias and level of evidence and recommendation were determined. Twenty-one studies were included. Five scored a low, 3 a moderate, and 13 a high risk of bias. In general, no consistent evolution of SPS signs comparing preoperative and postoperative values and predictors for this evolution in musculoskeletal disorders could be found. In most cases, static quantitative sensory testing (QST) did not change or conflicting results were found. On the other hand, dynamic QST mostly improved after surgery. Worthfully mentioning is that worsening of SPS signs was only seen at a follow-up of <3 months after surgery, that conclusions are stronger when evaluating dynamic QST with a follow-up of ≥3 months after surgery, and that pain improvement postsurgery was an important predictor. Future high-quality research should focus on the evolution of SPS signs after nociceptive targeted surgery, accounting for pain improvement groups and focusing on preoperative, perioperative, and postoperative predictors of this evolution.
Association between maternal factors and fetal macrosomia in full-term singleton births
Authors: Chen Yu-Hsuan , Chen Wei-Yu , Chang Chia-Yuan , Cho Ching-Yi , Tang Yi-Hsuan , Yeh Chang-Ching , Yang Yi-Hsin , Tsao Pei-Chen , Lee Yu-Sheng
Published: February 2023

Background:

Macrosomia, defined as a birth weight of ≥4000 g, is associated with a high risk of birth injury. Fetal growth is highly correlated with maternal conditions, and several maternal factors are associated with neonatal birth size. The current study aimed to assess maternal factors related to fetal macrosomia in a Taiwanese population.

Methods:

The medical records of pregnant mothers and their newborns were retrospectively reviewed. All singleton pregnancies delivered at and after 37 weeks of gestation were included in the analysis. Maternal and neonatal conditions were evaluated according to different birth weights.

Results:

A total of 4262 infants were enrolled in our study. The mean birth weight was 3156 ± 383 g, including 77 (1.8%) cases with birth weight ≥4000 g, and 154 (3.6%) infants with birth weight <2500 g. The mean maternal body weight before delivery was 67.6 ± 10.0 kg. The mean 6-month gestational weight gain (6mGWG) was 12.3 ± 4.2 kg, and the mean maternal body mass index (BMI) was 26.2 ± 3.6 kg/m2. The maternal weight, height, and 6mGWG, gestational age, and placental weight were significantly positively correlated with neonatal birth weight. The odds ratios of macrosomia were 3.1 in neonates born to mothers with a 6mGWG of ≥15 kg, 6.3 in those born to mothers with gestational diabetes mellitus, and 4.1 in those born to mothers with a BMI of ≥30 kg/m2. Newborn macrosomia was associated with adverse events in pregnant mothers and newborn infants.

Conclusion:

Gestational diabetes mellitus, 6mGWG, and maternal BMI are significantly correlated with neonatal macrosomia in full-term singleton births. Further, neonatal macrosomia is an important cause of maternal and neonatal morbidity. Hence, pregnant women should undergo maternal counseling for weight management before and during pregnancy, and the appropriate delivery method should be identified to prevent perinatal adverse events.
Radiomic features derived from pretherapeutic MRI predict chemoradiation response in locally advanced rectal cancer
Authors: Chou Yen , Peng Szu-Hsiang , Lin Hsuan-Yin , Lan Tien-Li , Jiang Jeng-Kae , Liang Wen-Yih , Hu Yu-Wen , Wang Ling-Wei
Published: February 2023

Background:

The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant concurrent chemoradiotherapy (CRT) followed by surgical excision. Current evidence suggests a favorable prognosis for those with pathological complete response (pCR), and surgery may be spared for them. We trained and validated regression models for CRT response prediction with selected radiomic features extracted from pretreatment magnetic resonance (MR) images to recruit potential candidates for this watch-and-wait strategy.

Methods:

We retrospectively enrolled patients with LARC who underwent pre-CRT MR imaging between 2010 and 2019. Pathological complete response in surgical specimens after CRT was defined as the ground truth. Quantitative features derived from both unfiltered and filtered images were extracted from manually segmented region of interests on T2-weighted images and selected using variance threshold, univariate statistical tests, and cross-validation least absolute shrinkage and selection operator (Lasso) regression. Finally, a regression model using selected features with high coefficients was optimized and evaluated. Model performance was measured by classification accuracies and area under the receiver operating characteristic (AUROC).

Results:

We extracted 1223 radiomic features from each MRI study of 133 enrolled patients. After tumor excision, 34 (26 %) of 133 patients had pCR in resected specimens. When 25 image-derived features were selected from univariate analysis, classification AUROC was 0.86 and 0.79 with the addition of six clinical features on the hold-out internal validation dataset. When 11 image-derived features were used, the optimized linear regression model had an AUROC value of 0.79 and 0.65 with the addition of six clinical features on the hold-out dataset. Among the radiomic features, texture features including gray level variance, strength, and cluster prominence had the highest coefficient by Lasso regression.

Conclusion:

Radiomic features derived from pretreatment MR images demonstrated promising efficacy in predicting pCR after CRT. However, radiomic features combined with clinical features did not result in remarkable improvement in model performance.
Progress in the use of human pluripotent stem cells for in vitro modeling of leprosy and cutaneous tuberculosis
Authors: Liao Yi , Finelli Mattea , Ou Xia
Published: February 2023

Compared with mature cells, human pluripotent stem cells (PSCs) have cellular and organ functions closer to those of primary cells. In infectious skin disease research, PSCs provide accurate pathophysiology for exploring the specific cellular and molecular mechanisms of refractory disease. Herein, we review the latest knowledge of human embryo model construction under laboratory conditions, focusing on important mycobacterial diseases, such as leprosy and tuberculosis. Moreover, an analysis of SARS‐CoV‐2 research using human PSCs or organoids shows that human PSCs play an important role in modelling dermatological infectious diseases and their complex mechanisms.
An Increase in Plasma Adipsin Levels Is Associated With Higher Cumulative Dust Exposure and Airway Obstruction in Foundry Workers
Authors: Koskela Kirsi , Sauni Riitta , Uitti Jukka , Oksa Panu , Moilanen Eeva , Hämäläinen Mari , Lehtimäki Lauri
Published: February 2023

Objective

The aim of the study was to assess whether plasma adipokine levels (adipsin, adiponectin, leptin, and resistin) are associated with pulmonary function in foundry workers.

Methods

We examined 65 dust-exposed foundry workers and 40 nonexposed controls and analyzed their lung function and plasma adipokine levels at baseline and after approximately 7 years of follow-up.

Results

A higher increase in plasma adipsin was associated with the development of airway obstruction in exposed subjects during follow-up after adjusting for body mass index changes during the follow-up period. Furthermore, the increase in adipsin levels was positively associated with cumulative dust exposure even after adjusting for smoking and body mass index changes during follow-up (P = 0.015).

Conclusion

The results suggest that plasma adipsin is involved in the pathogenesis of subclinical airway inflammation and the development of chronic obstruction and is induced by occupational dust exposure.
Workers' Compensation Claims for Conditions Presumed to Be Occupational Diseases Among Firefighters in Washington State, 2000–2017
Authors: LaSee Claire R. , Bonauto David K. , Marcum Jennifer
Published: February 2023

Objective

Occupational disease presumption laws for firefighters are common, yet little is known about the workers' compensation claims filed for them.

Methods

We identified Washington State’s workers' compensation claims for conditions covered by presumption among firefighters during 2000 to 2017, and described them by disease type and claim characteristics. Claim rates for specific cancers were compared with statewide incidence rates using the Washington State cancer registry.

Results

Firefighters filed 330 claims for conditions covered by presumption (heart problems, 43%; cancer, 35%; respiratory disease, 15%; and infectious diseases, 8%), with acceptance rates varying by disease and insurer type. Cancer claims were associated with the highest claim costs and time loss.

Conclusions

This study provides necessary baseline data to understand the impact of presumption laws on workers' compensation systems, and can inform future decisions presumption law expansions for firefighters.
Associations Between Telework Experience and Psychosocial Working Conditions During the COVID-19 Pandemic
Authors: Svensson Sven , Mathiassen Svend Erik , Hallman David M. , Heiden Marina , Bergström Gunnar
Published: February 2023

Objectives

The aim of the study are to determine to what extent pre–COVID-19 experience of telework was associated with perceived psychosocial working conditions (PWCs; job demands, social support, and influence at work) during the COVID-19 pandemic among white-collar workers in Sweden and to determine to what extent the association depends on demographic factors, organizational tenure, and amount of computer use.

Methods

Cross-sectional questionnaire data from 603 white-collar workers were collected October to December 2020 in an industrial company.

Results

In general, telework experience was not significantly associated with PWCs. Women who began teleworking because of COVID-19 reported more job demands than women not teleworking. For those who began teleworking because of COVID-19, managerial support increased with age.

Conclusions

In general, telework experience was not associated with PWCs, but telework due to COVID-19 may have influenced PWCs differently depending on gender and age.
Heat-Related Illness Among Workers in British Columbia, 2001–2020
Authors: Weinberger Kate R. , Tamburic Lillian , Peters Cheryl E. , McLeod Christopher B.
Published: February 2023

Objective

The aim of this study was to describe the incidence of heat-related illness among workers in British Columbia (BC), Canada, 2001–2020.

Methods

Cases of heat-related illness occurring among workers aged 15 years and older were identified from accepted lost-time claims from WorkSafeBC, the provincial workers’ compensation board. Incidence rates were calculated using monthly estimates of the working population from Statistics Canada’s Labour Force Survey as the denominator.

Results

Between 2000 and 2020, there were 528 heat-related illness claims, corresponding to a rate of 1.21 (95% confidence interval, 1.10–1.31) claims per 100,000 workers. Eighty-four percent of claims occurred between June and August. Rates were higher among male workers, younger workers, and among those working in occupations related to primary industry; trades, transport, and equipment operators; and processing, manufacturing, and utilities.

Conclusions

In BC, lost-time claims for heat-related illness occurred disproportionately among certain subgroups of the workforce.
Immigration and Blood Lead Levels Among Asian Populations in the United States
Authors: Xu Jialin , Ji John S.
Published: February 2023

Objective

The aim of this study was to explore determinants of high BLLs among the Asian population in the United States.

Methods

We used the US nationally representative National Health and Nutrition Examination Survey (NHANES), 2011–2018. We conducted stratified analyses to compare the BLLs of US-born and non–US-born Asians. We used adjusted linear regression to find predictors of high BLLs.

Results

Among 12,563 participants in our analysis, the length of stay in the United States is a predictor of the gradual decrease in BLL among Asian immigrants (P < 0.05). BLLs of immigrants who stayed in the United States for over 50 years were 0.36 μg/dL (95% confidence interval, 0.07 to 0.66) lower than new immigrants, but still higher than their US-born counterparts.

Significance

Asian population in the US has the highest BLLs among all ethnic groups, and the exposure outside of the US among immigrants is likely the driver.
Occupational Firefighting
Authors: Brumfield Lawrence , Miner Sarah , Tydings Donna , Carey Mary
Published: February 2023

Objective

The purpose of the study is to evaluate the effect of an online educational module in increasing awareness of depression, substance use disorder, and sleep deprivation among firefighters in Monroe County, New York.

Method

Firefighters were recruited via work e-mail and the snowball technique. A quantitative preintervention and postintervention study was used. Participants completed four surveys before and after completing educational online modules.

Results

There was a 5.11% increase in overall knowledge about sleep deprivation, depression, and substance (alcohol) use and a small decrease in the group mean for the depression and sleep deprivation scores after completion of the educational modules.

Conclusion

Increasing content knowledge had a positive effect to participants' self-awareness during the project. Incorporating educational modules into annual firefighting training could provide opportunities to improve sleep deprivation, depression, and substance use.
Circumstances Contributing to Installation, Maintenance, and Repair Worker Death by Suicide
Authors: Soupene Victor A. , Davis Jonathan , Fogner Andrew , Casteel Carri
Published: February 2023

Objective

To examine risk factors related to death by suicide among installation, maintenance, and repair (IMR) workers compared with workers in other occupational groups.

Methods

The National Violent Death Reporting System (NVDRS) data for the years 2013 to 2018 was used to identify suicide deaths. Circumstance variables were used to examine differences between IMR workers and other workers.

Results

Having a physical health problem (1.13; 95% confidence interval [CI], 1.03 to 1.23) or a diagnosis of posttraumatic stress disorder (1.24; 95% CI, 1.03 to 1.50) was more likely to contribute to IMR worker suicide compared with other occupations. Installation, maintenance, and repair workers were less likely to receive treatment for a mental health diagnosis or substance use disorder (0.88; 95% CI, 0.81 to 0.94).

Conclusions

Additional support for physical health problems, posttraumatic stress disorder diagnoses, and mental health care access among IMR workers may reduce suicide deaths.
Pharmacology
Authors: Bhandal Amrinder , Muhar Harleen K.
Published: February 2023

Spina bifida is one of the congenital neural tube defects that can lead to loss of bladder control, also known as neurogenic bladder. This can lead to recurrent urinary tract infections and subsequent renal function decline if not properly managed. Proper management may include pharmacological care that aims to prevent improper drainage of the bladder directly by utilizing agents such as anticholinergics, urinary antispasmodics, and botulism toxins. In addition to direct care, patients with neurogenic bladder also may require bowel regimens because of concurrent instances of neurogenic bowels.
Prolene Hernia System Maximum Repair: A New Concept in Sports Hernia Surgery
Authors: Da Rosa André M. , Reusch Marcus , Aguzzoli Marcus , Fonseca Mariana K. , Damin Daniel C.
Published: February 2023

Objective:

To describe and present the clinical results of a new surgical treatment for sports hernia.

Design:

Retrospective cohort study.

Setting:

Tertiary hospital.

Patients:

Athletes who underwent sports hernia repair using the proposed technique between July 2006 and June 2020.

Intervention:

The surgery consists of a combination of a mini-open incision and preperitoneal placement of a three-dimensional bilayer permanent mesh (PHS).

Main outcome Measures:

The main clinical outcomes of the procedure were reviewed, including incidence of complications, long-term results, and recurrence rate.

Results:

Ninety-two sports hernia repairs were performed on 87 patients (79 male and 8 female patients, median age 30.2 ± 7.8 years). No intraoperative complications were observed. The mean follow-up was 15 months. Seventy-seven patients (88.5%) successfully resumed preinjury physical activities within 8 weeks; 80 patients (91.9%) within 12 weeks; and 83 (95.4%) within 6 months (median time of 10 weeks). Only one patient reported recurrence of symptoms.

Conclusion:

Mini-open incision PHS repair seems to be a safe and effective method for treatment of sports hernia, resulting in early return to physical activities, with few complications, and low recurrence rate.
Society for Cardiovascular Angiography and Interventions Shock Classification to Stratify Outcomes of Extracorporeal Membrane Oxygenation
Authors: Mehta Sanket , Fried Justin , Nemeth Samantha , Kurlansky Paul , Kaku Yuji , Melehy Andrew , Char Steven , Masoumi Amirali , Sayer Gabriel , Uriel Nir , Takeda Koji
Published: February 2023

We applied the Society for Cardiovascular Angiography and Interventions (SCAI) schema to cardiogenic shock (CS) patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) to assess performance in this high acuity group of patients.

Records of adult patients receiving VA-ECMO for CS at our institution from 01/2015 to 12/2019 were reviewed. Post-cardiotomy and noncardiogenic shock patients were excluded.

A total of 245 patients were included, with a median age of 59 years [IQR: 48–67]; 159 (65%) were male. There were 34 (14%) patients in Stage C, 82 (33%) in D, and 129 (53%) in E. Of E patients, 88 (68%) were undergoing cardiopulmonary resuscitation. Median ECMO duration decreased with stage (C:7, D:6, E:4 days, P < 0.001). In-hospital mortality increased (C:35%, D:56%, E:71%, P < 0.001) and myocardial recovery decreased with stage (C:65%, D:35%, E:30%, P < 0.001). Acute kidney injury (C:35%, D:45%, E:54%, P = 0.045), acute liver failure (C:32%, D:66%, E:76%, P < 0.001), and infection (C:35%, D:28%, E:16%, P = 0.004) varied among groups. Multivariable analysis revealed age (HR=1.02), male sex (HR=0.62), and E classification (HR=2.69) as independently associated with 1-year mortality. Competing-risks regression identified D (SHR=0.53) and E classification (SHR=0.45) as inversely associated with myocardial recovery.

In patients treated with VA-ECMO for CS, the SCAI classification provided robust risk stratification.
Utility of the CANUKA Scoring System in the Risk Assessment of Upper GI Bleeding
Authors: Goff Sara , Friedman Emily , Toro Butros , Almonte Matthew , Wilson Carlie , Lu Xiaoning , Yu Daohai , Friedenberg Frank
Published: February 2023

Background:

The Canada-United Kingdom-Adelaide (CANUKA) score was developed to stratify patients who experience upper gastrointestinal bleeding (UGIB) to predict who could be discharged from the emergency department. Our aim was to determine if the CANUKA score could be utilized for UGIB in-patients undergoing endoscopy in predicting adverse outcomes. We additionally sought to establish a CANUKA score cut point to predict adverse outcomes and in-hospital mortality and compare this to established scoring systems.

Methods:

Between January 1, 2018 to June 30, 2019 all patients who underwent upper endoscopy after admission for UGIB were identified. We assigned a CANUKA score and compared the area under the receiver operating curve to established scoring systems.

Results:

Our data set included 641 patients, with a mean age of 59.5±14.5 years. A CANUKA score ≥10 was associated with an adverse outcome [unadjusted odds ratio, 3.08 (1.79, 5.27)]. No patients experienced an adverse outcome with a CANUKA score <4. No patients died with a CANUKA score <6. Those with a CANUKA score of <10 had an in-hospital mortality of 2.1% compared with 6.8% for those with a score ≥10 (P=0.008). AIMS65 had the best area under the receiver operating characteristic curve (0.809) for predicting mortality.

Conclusions:

The CANUKA score may serve utility as a predictor of adverse outcomes and mortality in patients admitted with UGIB undergoing endoscopy. Future studies, ideally prospective and multicenter, will be needed to validate its clinical utility.
Understanding the Role of a Technology and EMR-based Social Determinants of Health Screening Tool and Community-based Resource Connections in Health Care Resource Utilization
Authors: Gupta Deeksha , Self Stella , Thomas Darin , Supra John , Rudisill Caroline
Published: February 2023

Background:

Health systems are increasingly investing in social determinants of health (SDoH), but there is limited research on how such efforts impact health care resource use. This study presents pilot work on an SDoH screening and referral platform recently implemented in South Carolina’s largest private nonprofit health system.

Objectives:

To assess the feasibility and sustainability of SDoH screening and SDoH-related referrals in a large health system and examine how they affect health resource use.

Research Design:

Observational study using electronic medical records and SDoH screening data from June 1, 2019 to December 31, 2020.

Subjects:

Patients (18 y+) engaged in community health, inpatient case management, or ambulatory care and condition management programs.

Measures:

We describe the use of SDoH screening by providers (community health workers, nurse case managers, and social workers) and SDoH referral volumes among patients. We use multivariate analyses to predict changes in emergency department visits, inpatient admissions (length of stay and volume), and primary care visits from referral volume, SDoH screening question responses, and patient characteristics (eg, comorbidities).

Results:

Of 2687 patients, 662 (24.6%) screened positive for 1 or more SDoH domains. SDoH screening performance remained consistent among providers over time. Six hundred fifty-eight (24.5%) patients received SDoH referrals. Patients receiving an increasing volume of referrals had decreasing primary care visits but their comorbidities moderated this effect.

Conclusions:

The study provides initial descriptive information on SDoH needs, implementation of referrals and resource use, guiding SDoH screening implementation in population health, and care management programs.
Defining ‘control’ of chronic rhinosinusitis
Authors: Sedaghat Ahmad R. , Phillips Katie M.
Published: February 2023

Purpose of review

Control is a global disease metric defined as the extent to which manifestations of a disease are within acceptable limits. Control serves as the goal of treatment for chronic diseases, such as chronic rhinosinusitis (CRS), that cannot be cured. The objective of this review is to summarize recommendations for assessment of CRS control with a specific focus on how these recommendations align with patients’ and healthcare providers’ perspectives of CRS control.

Recent findings

Several staging systems for CRS control have been developed with the first and most widely recognized by the 2012 European Position Paper on Rhinosinusitis and Nasal Polyps, which was developed through expert opinion. Patients’ and providers’/guideline-based assessments of CRS control frequently do not align. Patients understand the concept of CRS control and their assessment is dominated by the perceived severity of nasal symptoms. In comparison, providers’ and guideline-based assessments of control are more global, incorporating nasal and extra-nasal symptoms, need for systemic antibiotics and corticosteroids, and nasal endoscopy.

Although more research is needed, future development of CRS control criteria through consensus around explicitly determined perspectives of healthcare providers and patients may one day serve as the foundation for a standardized approach to treatment of CRS.
Developing and Evaluating the Effectiveness of a Nursing Leadership Mentoring Pilot Program
Authors: Hedenstrom Margot L. , Spiva LeeAnna , Thurman Susan , Hale Regina L. , Toney Sharlene , Case-Wirth Jill , Kairu Mumbi , Sneha Sweta
Published: February 2023

The nurse leader role is a vital role in ensuring quality, safety, and staff retention in the health care setting. A new nurse manager often receives little mentoring support when assuming a new role. Fifteen mentor/mentee pairs were provided with 6 training sessions specifically designed using the Hale Mentoring Up theoretical framework. Surveys and focus groups were conducted at mid- and endpoints. Data were digitally recorded, transcribed verbatim, and loaded into NVivo 12. Two attributes that facilitated a positive mentoring relationship emerged from the qualitative analysis: interpersonal and organizational skills. Interpersonal skills included a mentor-mentee relationship that was built upon trust, flexibility, and learning and development; and organizational skills included building relationships both internally and externally. Furthermore, time was identified as a barrier to mentoring. A mentoring program is a vehicle to help support new nurse leaders through an educational intervention and mentoring support program. The development of a mentoring pilot program helps to strengthen future nursing leadership to support new leaders in their roles.
Relationships Among Physical Activity, Daylight Exposure, and Rest-Activity Circadian Rhythm in Patients With Esophageal and Gastric Cancer
Authors: Chen Hui-Mei , Lee Mei-Chen , Tian Jiu-Yun , Dai Mei-Fen , Wu Yu-Chung , Huang Chien-Sheng , Hsu Po-Kuei , Duong Linh Thuy
Published: February 2023

Background

Although rest-activity circadian rhythm (RACR) disruption is associated with mortality in patients with cancer, few studies have examined the effect of RACR on patients with esophageal and gastric cancer.

Objective

The aim of this study was to identify the predictors of RACR.

Methods

This cross-sectional, single-site study included 276 patients with esophageal and gastric cancer recruited from chest-surgery and general-surgery outpatient departments. Actigraphy was used to assess objective physical activity (PA), daylight exposure, and RACR, and 3-day PA was used to indicate the subjective amount of PA. The parameter of objective PA was the up activity mean; the parameter of daylight exposure was >500 lx, and the parameters of RACR were the 24-hour correlation coefficient, in-bed less than out-of-bed dichotomy index, midline estimating statistic of rhythm, and amplitude. The subjective amount of PA was calculated as the sum of mild, moderate, and vigorous PA.

Results

The up activity mean predicted 24-hour correlation coefficient. The PA amount and up activity mean predicted in-bed less than out-of-bed dichotomy index. The up activity mean and >500-lx daylight exposure predicted midline estimating statistic of rhythm. Finally, the PA amount and up activity mean predicted the amplitude.

Conclusions

Increased PA and daylight exposure may improve RACR.

Implications for Practice

Patients with esophageal and gastric cancer should be encouraged to engage in outdoor PA during the daytime as part of their regular lifestyle to maintain a robust circadian rhythm.
Creating a Peer Review Process for Faculty-Developed Next Generation NCLEX Items
Authors: Hensel Desirée , Billings Diane M.
Published: February 2023

Background:

This article reports the findings from a pilot study of a peer review process used with a group of faculty champions who were writing items for a state-wide initiative to establish a Next Generation NCLEX item teaching test bank.

Methods:

Champions were oriented to the peer review process in a face-to-face session and completed reviews using theClinical Judgment Item Peer Review Formcreated for the project.

Results:

Eighteen faculty from 13 different schools attended the session and completed 55 reviews of 40 cases and 35 stand-alone items. Champions took approximately an hour to complete each case study and related stand-alone item review and give actionable feedback.

Conclusions:

The peer review process benefits reviewers and authors learning to write Next Generation NCLEX questions. The process used in this project can be replicated by other faculty in their own programs.
Added Value of Extragenital Sexually Transmitted Infection Testing in “IWantTheKit” Program Users
Authors: Yu Tong , Melendez Johan H. , Armington Gretchen S. , Silver Barbara , Gaydos Charlotte A. , Ruby Kenneth , Olthoff Glen , Greenbaum Adena , Hamill Matthew M. , Manabe Yukari C.
Published: February 2023

Background

The 2021 Centers for Disease Control and Prevention sexually transmitted infection treatment guidelines recommend extragenital testing for gonorrhea and chlamydia in men who have sex with men and for women based on reported behaviors and exposures. The “IWantTheKit (IWTK)” program is a free online platform for specimen self-collection and mail-in for combined chlamydia/gonorrhea testing. We sought to assess the additional diagnostic value of extragenital testing compared with genital testing only for chlamydia/gonorrhea and determine factors associated with a positive extragenital test result among IWTK users.

Methods

From August 2013 to January 2022, 7612 unique IWTK users returned swabs for testing; 3407 (45%) users requested both genital and extragenital tests and were included in this analysis. Descriptive statistics were summarized for demographic characteristics, reported behaviors, and genital and extragenital test results, and data were stratified by gender and age group. A logistic regression model was used to estimate associations between factors and extragenital sexually transmitted infection positivity.

Results

Chlamydia positivity rates were 4.7%, 2.4%, and 1.5% at genital, extragenital, and both sites, respectively; for gonorrhea, 0.4%, 1.1%, and 0.4% were positive at those sites, respectively. Among women, age 25 years and younger was significantly associated with extragenital chlamydia (odds ratio [OR], 4.0; P = 0.010). Being in high-risk quiz score group was associated with extragenital chlamydia (OR, 2.6; P = 0.005) and extragenital gonorrhea in men and women (OR, 8.5; P = 0.005).

Conclusions

Extragenital testing detected additional chlamydia and gonorrhea cases in the IWTK user population that would have been missed by genital-only testing, especially for women younger than 25 years and people reported to be at high risk.
Monkeypox Infection with primarily mucosal involvement
Authors: Pestana Mafalda , Caldeira Margarida Brito , Martins Inês Aparício , Valente Clara , Neves José M. , Fernandes Cândida
Published: February 2023

Since May 2022, several non-endemic countries face a monkeypox outbreak, with clinic and epidemiological characteristics distinct from the classic ones. Primarily affecting the sexually active population, these cases present with mucocutaneous lesions mainly localized in perioral, genital, and anal areas. A retrospective study was conducted in a tertiary center in Lisbon, to characterize the population diagnosed with monkeypox infection with primarily mucosal involvement.
Defining Daily Disposable Contact Lens Wear in a Clinical Study
Authors: Wagner Heidi , Zimmerman Aaron B. , Lam Dawn , Kinoshita Beth , Rosner Bernard , Mitchell G. Lynn , Richdale Kathryn
Published: February 2023

Significance

The United States Food and Drug Administration regulates contact lenses as prescription medical devices and defines daily disposable lenses for single use; however, safety comparisons between daily disposable and reusable lenses rely on the lens-wearing regimen. When inappropriately discerned, studies may erroneously report replacement regimen, resulting in inaccurate risk rates.

Purpose

To explore different measures for defining daily disposable wearers in the context of a clinical study.

Methods

A secondary analysis of data from five multi-site fieldings (n = 1,059) from the Contact Lens Risk Survey was performed. Descriptive statistics were used to examine self-reported lens replacement, use of lens case, and manufacturer’s recommended replacement frequency as defined by the participants’ selection of their habitual lenses using a photographic aide. Daily disposable wearers were identified as reporting daily replacement (by self-report and lens identification) and not using a lens case. If there was a discrepancy among these three factors, the lens assignment was assessed as a majority response (2 of 3) or as missing if conflicting information was reported.

Results

The cohort was approximately two-thirds (68.7%) female and ranged from 12-33 years of age. A total of 154 participants (14.5%) were classified as daily disposable wearers and 896 (84.6%) as reusable wearers. Congruence was observed among all three daily disposable assignment factors for only 106 (68.8%) wearers. The greatest discrepancy among daily disposable wearers was the report of using a lens case (n = 32; 20.8%). In contrast, reusable lens wearers were more likely to report agreement across all three factors (n = 798; 89.1%, P < .001).

Conclusions

This analysis suggests that the report of not using a lens case is a more conservative surrogate for true single-use lens wear, as one in five may be storing and reusing their daily disposable lenses.
Nested Subtype of Urothelial Carcinoma in the Upper Urinary Tract
Authors: Fatima Aisha , Russell Daniel H. , Epstein Jonathan I.
Published: February 2023

Nested subtype of urothelial carcinoma (NVUC) of the upper urinary tract is rare. While this subtype has an aggressive behavior in the urinary bladder, little is known about this subtype in the renal pelvis and ureter. In addition, due to NVUC’s bland morphology and resemblance to von Brunn nests proliferation, which can be florid in the renal pelvis and ureter, establishing a diagnosis of NVUC in these sites can be difficult, especially on small biopsies. Nineteen cases of NVUC of the renal pelvis and the ureter were identified. One was in-house and 18 cases were sent to the genitourinary pathology consult service. Four cases were excluded due to difficulty in obtaining the slides from other institutions. In all, 8/15 (53.33%) cases showed large nested morphology, 4/15 (26.66%) cases showed mixed large and small nested morphology, and only 3/15 (20%) cases showed predominantly small nested morphology. In all cases, the invasive component was pure nested subtype, and tumors were all unifocal. In 8/15 cases, there was the presence of an overlying low-grade papillary urothelial carcinoma. An associated desmoplastic stromal reaction was none/minimal in 12/15 (80%) cases, with a prominent reaction in the remaining 3/15 (20%) cases. Pathologic stages for the resections were pT1 (n=1), pT2 (n=3), pT3 (n=8), and pT4 (n=1). There was only 1 case with a lymph node metastasis at the time of resection who had pT4 disease. Follow-up was available in 10/15 cases, 7/10 cases showed no recurrences or metastases, and the remaining 3/10 cases later developed urothelial carcinoma of the bladder. In 5/15 cases, follow-up could not be obtained. Similar to NVUC in the urinary bladder, NVUC in the upper tract typically lacks an associated desmoplastic reaction and has by definition bland cytology. In contrast to NVUC of the urinary bladder, NVUC in the upper urothelial tract is: (1) more frequently associated with an overlying papillary urothelial carcinoma; (2) more commonly has a large nested pattern; and (3) appears to behave less aggressively.
COL1A1-PDGFB Fusion Associated Fibrosarcoma of the Uterine Corpus: A Case Report and Literature Review
Authors: Panwar Vandana , Liu Yu , Gwin Katja , Chen Hao
Published: February 2023

Uterine collagen type 1 alpha 1 (COL1A1) and platelet-derived growth factor beta chain (PDGFB) fusion associated fibrosarcoma is a recently described entity characterized by a specific translocation t(17;22) (q22;q13) leading to the formation of COL1A1-PDGFB fusion transcripts that are typically associated with dermatofibrosarcoma protuberans. So far, only 4 cases of COL1A1-PDGFB fusion associated fibrosarcoma involving the female reproductive system have been reported in the literature. All cases showed strong diffuse expression of CD34. COL1A1-PDGFB fusion associated fibrosarcomas are aggressive tumors with a propensity for chemotherapy resistance and a poor prognosis. We are reporting the fifth case of a uterine COL1A1-PDGFB fusion associated fibrosarcoma. A 58-yr-old female presented with a large uterine mass with extension into bilateral pelvic sidewalls, mesentery of rectosigmoid colon and the vagina. A hysterectomy, bilateral salpingo-oophorectomy, and tumor debulking procedure was performed. Microscopic evaluation revealed a mitotically active cellular spindle cell neoplasm with focal osteoclast like giant cells, myxoid changes and necrosis. CD34 was diffusely and strongly positive throughout the tumor. Next-generation sequencing showed presence of the COL1A1-PDGFB fusion. The patient was treated with multiple chemotherapy regimens, however, progressed under therapy with worsening symptoms and development of extensive pelvic disease. She died of disease 13 mo after the initial diagnosis. In summary, uterine COL1A1-PDGFB fusion associated fibrosarcomas are rare tumors with aggressive clinical behavior that need to be considered in the differential diagnosis of CD34-positive uterine spindle cell neoplasms. Novel treatment options may include imatinib, a tyrosine kinase inhibitor used for treatment of advanced and unresectable dermatofibrosarcoma protuberans that was given in 1 uterine sarcoma case and showed promising initial response.
Training Characteristics, Academic Accomplishments, and Motivation of Current Program Directors in Physical Medicine and Rehabilitation
Authors: Martinez Claudia I. , Sanchez Ashley N. , Frontera Joel , Lee Michael Y. , Escalon Miguel X. , Verduzco-Gutierrez Monica
Published: February 2023

This study aimed to report the training characteristics, academic accomplishments, and motivation of current US academic physical medicine and rehabilitation program directors.

A 22-question survey was developed and disseminated via email in May 2020 to 91 current residency program directors who are members of the Association of Academic Physiatrists Residency Fellowship Program Director Committee. Follow-up emails were sent 2 and 4 wks after initial distribution, and the survey was closed after 6 wks in June 2020. Data collected were deidentified. Descriptive analysis was performed.

Response rate was 49.5% (45/91); 64.4% of program directors were men, and 35.6% were women. Of the respondents, 75.4% were White/Caucasian, 6.7% were Hispanic/Latinx, 15.6% were Asian, and 2.2% were Black/African American. Moreover, 56% (9/16) of female program directors vs. 0% (0/29) of male program directors reported experiencing sex discrimination in the workplace.

Four percent of program directors were full professors in physical medicine and rehabilitation when first appointed, 17% were associate professors, and 72% were assistant professors. Thirty-four percent of program directors had at least six peer-reviewed publications when first appointed.

This survey provides insight to the training characteristics, accomplishments, and motivation of current program directors for physiatrists aspiring to enter these ranks and highlights the underrepresentation of women/minorities among leadership positions in physical medicine and rehabilitation.
Superiorly-Based Short-Scar Mastopexy Augmentation: A 10-Year Review of 1217 Consecutive Cases
Authors: Wall Simeon , Claiborne Jeffrey R , Wall Holly Casey
Published: February 2023

Goals/Purpose:

Mastopexy augmentation is a challenging procedure, and a technique to create desirable, consistent, predictable results with a low rate of problems has not been well standardized. The inherent difficulty lies in competing surgical maneuvers. This study sought to evaluate our experience and describe the key concepts and steps that allow safe, efficient, predictable results with a low complication and long-term reoperative rate.

Methods/Technique:

A 10-year retrospective review of all aesthetic breast surgeries between 2005 and 2015 was performed. Two senior surgeons performed 1217 one-stage, superiorly-based, short-scar mastopexy augmentation procedures. The data was evaluated in the context of other published series in the literature.

Results/Complications:

The overall revision rate was 4.8%. Patients who had undergone prior breast surgery were statistically more likely to require a revision compared with patients who had virgin breast tissue (10.4% vs 3.8%, p = 0.0005). Average follow-up was 39 months. 28% of revisions were performed more than two years after the original surgery, 16% were performed more than 6 years later. All revisions were included, regardless of procedure scope or timing. Of the 58 revision cases, 86% were purely implant or implant-pocket related, 7% were purely tissue related. There was one case of partial nipple necrosis. There were no cases of emergent reoperation, implant loss, implant exposure or major wound dehiscence.

Conclusions:

Our approach has been refined to maximize aesthetics, longevity, consistency, and surgical efficiency, and to minimize complications. This study demonstrates that safe and predictable results can be attained in one stage with low complication and reoperative rates.
Targeting the glycolytic enzyme PGK1 to inhibit the Warburg effect: a new strategy for keloid therapy
Authors: Wang Pu , Wang Qifei , Yang Xin , An Yang , Wang Jingyi , Nie Fangfei , Pan Bailin , Bi Hongsen , Qin Zelian
Published: February 2023

Background:

Aerobic glycolysis (the Warburg effect) may play an important role in keloid pathogenesis, which may be aggravated by the hypoxic microenvironment in keloids. Phosphoglycerate kinase 1 (PGK1), a key glycolytic enzyme, is essential for cellular aerobic glycolysis, but its role in keloid formation remains unknown. This study aimed to detect PGK1 expression in keloid tissue and investigate the effects of inhibiting PGK1 expression on keloid fibroblasts (KFbs) under hypoxia and normoxia.

Methods:

Normal skin and keloid samples were separated into two parts, one was used for immunohistochemistry, and one for primary cell culture. PGK1 tissue expression was detected by immunohistochemistry. RT-PCR and Western blotting were used to detect PGK1, GLUT1, LDHA, and COL1 expression, and glucose uptake and lactate production were detected with a microplate reader. Cell proliferation and apoptosis were investigated with IncuCyte and flow cytometry. Cell migration and invasion were detected with Transwell assays. Glycolytic function was explored with the Seahorse XF96 system.

Results:

Immunohistochemistry showed PGK1 overexpression in keloid tissue compared with normal skin tissue (p<0.05). Consistently, PGK1 expression was significantly higher in KFbs than in normal skin fibroblasts (NFbs), and hypoxia stimulated PGK1 expression in KFbs and NFbs (p<0.05). PGK1 knockdown significantly inhibited KFbs glycolysis, proliferation, migration, invasion, glucose consumption, and lactate production (p<0.05). Furthermore, GLUT1, LDHA, and COL1 expression was decreased in KFbs compared to NFbs (p<0.05). Additionally, suppressing PGK1 may mediate the PI3K/AKT pathway to downregulate GLUT1, LDHA, and COL1 expression (p<0.05).

Conclusions:

These findings provide new evidence that suppressing PGK1, inhibiting glycolysis, reduces KFbs proliferation, migration, invasion, and type I collagen expression. Targeting PGK1 to inhibit the Warburg effect may be a new therapeutic strategy for keloids.
Alternate Soft Tissue Free Flaps for Head and Neck Reconstruction: The Next Generation of Workhorse Flaps
Authors: Chang Edward I.
Published: February 2023

Introduction:

There is little debate regarding the workhorse flaps for soft tissue defects in head and neck reconstruction. However, in certain circumstances the workhorse flaps are not available or suitable, and an alternate flap is needed.

Methods:

Retrospective review of single surgeon experience with alternate soft tissue flaps performed over a 10-year period.

Results:

Overall, 156 alternate soft tissue free flaps were performed in 155 patients. The distribution of free flaps was 60 ulnar artery perforator (UAP) flaps, 28 lateral arm perforator (LAP) flaps, 33 medial sural artery perforator flaps (MSAP), and 35 profunda artery perforator (PAP) flaps with one patient who received two PAP flaps. Defects included glossectomy, facial defects following parotidectomy or resection of cutaneous malignancies, and other intraoral defects. Eleven patients suffered donor site complications: two UAP patients with partial skin graft loss, two patients with delayed wound healing in the MSAP donor site and one developed compartment syndrome with primary closure of the MSAP donor site, one patient with a radial nerve palsy following a LAP flap, and six patients with delayed wound healing in the PAP donor site which healed secondarily with conservative management. There was one total flap loss of a LAP and MSAP flap.

Conclusions:

The reconstructive microsurgeon performing high volume head and neck reconstruction may need to incorporate alternate donor sites into their armamentarium in the setting the primary workhorse flaps are not suitable or available.
SUPERIORITY OF THE SEPTAL EXTENSION GRAFT OVER THE COLUMELLAR STRUT GRAFT IN PRIMARY RHINOPLASTY: EVIDENCE FOR IMPROVED LONG-TERM TIP STABILITY
Authors: Bellamy Justin L. , Rohrich Rod J.
Published: February 2023

PURPOSE:

Columellar strut grafts and septal extension grafts are commonly used support structures, however their relative effectiveness remains debated. The purpose of this study was to compare the long-term stability of septal extension grafts to columellar strut grafts.

METHODS:

Retrospective review of all primary rhinoplasties performed by the senior author from 2016-2019 was performed. All adult patients undergoing primary open rhinoplasty with at least year follow-up were included. Revisionary cases and those utilizing rib graft were excluded. Standardized post-operative imaging was assessed at 2-months (early) and 12-month (long-term) to measure projection/rotation change over time. Univariate and multivariable statistical comparisons were performed.

RESULTS:

Chart query yielded 133 patients. Of these, 40 patients were treated with a columellar strut and 37 with a septal extension graft. Projection loss at one-year was 4.7% for the Columellar Strut group compared to 0.2% for the Septal Extension Graft group (p<0.0001). On multivariable logistic regression, there was a 5.1-fold increased risk of >4% projection loss when using columellar strut (p<0.005).

Mean rotation loss for the columellar strut group was 4.9 degrees compared to 1.3 degrees for the septal extension graft group (p<0.0001). The independent effect of columellar strut use resulted in a 2.8-fold increased risk of rotation loss ≥5 degrees (p<0.05).

CONCLUSION:

Septal extension grafts result in effectively no loss of projection and minimal loss in rotation. A small degree of projection and rotation loss can be expected with the use of columellar strut alone. These long-term graft tendencies should be anticipated and accounted for appropriately.