bluuebunny/crossref_metadata_2025 huggingface dataset:
High-Dose Inhaled Nitric Oxide for the Treatment of Spontaneously Breathing Pregnant Patients With Severe Coronavirus Disease 2019 (COVID-19) Pneumonia
Authors: Valsecchi Carlo , Winterton Dario , Safaee Fakhr Bijan , Collier Ai-ris Y. , Nozari Ala , Ortoleva Jamel , Mukerji Shivali , Gibson Lauren E. , Carroll Ryan W. , Shaefi Shahzad , Pinciroli Riccardo , La Vita Carolyn , Ackman Jeanne B. , Hohmann Elizabeth , Arora Pankaj , Barth William H. , Kaimal Anjali , Ichinose Fumito , Berra Lorenzo ,   for the DELiverly oF iNO (DELFiNO) Network Collaborators
Published: July 2022

OBJECTIVE:

To evaluate whether the use of inhaled nitric oxide (iNO)200 improves respiratory function.

METHODS:

This retrospective cohort study used data from pregnant patients hospitalized with severe bilateral coronavirus disease 2019 (COVID-19) pneumonia at four teaching hospitals between March 2020 and December 2021. Two cohorts were identified: 1) those receiving standard of care alone (SoC cohort) and 2) those receiving iNO200 for 30 minutes twice daily in addition to standard of care alone (iNO200 cohort). Inhaled nitric oxide, as a novel therapy, was offered only at one hospital. The prespecified primary outcome was days free from any oxygen supplementation at 28 days postadmission. Secondary outcomes were hospital length of stay, rate of intubation, and intensive care unit (ICU) length of stay. The multivariable-adjusted regression analyses accounted for age, body mass index, gestational age, use of steroids, remdesivir, and the study center.

RESULTS:

Seventy-one pregnant patients were hospitalized for severe bilateral COVID-19 pneumonia: 51 in the SoC cohort and 20 in the iNO200 cohort. Patients receiving iNO200 had more oxygen supplementation–free days (iNO200: median [interquartile range], 24 [23–26] days vs standard of care alone: 22 [14–24] days, P=.01) compared with patients in the SoC cohort. In the multivariable-adjusted analyses, iNO200 was associated with 63.2% (95% CI 36.2–95.4%; P<.001) more days free from oxygen supplementation, 59.7% (95% CI 56.0–63.2%; P<.001) shorter ICU length of stay, and 63.6% (95% CI 55.1–70.8%; P<.001) shorter hospital length of stay. No iNO200-related adverse events were reported.

CONCLUSION:

In pregnant patients with severe bilateral COVID-19 pneumonia, iNO200 was associated with a reduced need for oxygen supplementation and shorter hospital stay.
Quality-Improvement Initiative for Expedited Partner Therapy Provision in an Obstetrics and Gynecology Office
Authors: Vasudeva Isha , Hartnett Janice , Bondi Laura , Newmark Alexis , Lindsay Sarah
Published: July 2022

OBJECTIVE:

To perform a quality-improvement project to increase the rate at which expedited partner therapy is offered and prescribed at our clinic, in line with Connecticut Department of Public Health regulations.

METHODS:

We conducted quality-improvement interventions at an urban hospital-based outpatient clinic in Hartford, Connecticut, to improve prescribing of expedited partner therapy to at least 70% of eligible patients. We defined appropriate provision of expedited partner therapy by infection type (gonorrhea or chlamydia only per Centers for Disease Control and Prevention guidelines) and method of prescription per Connecticut Department of Public Health regulations (paper prescription or in-clinic dispensing).

RESULTS:

Rates of appropriate provision of expedited partner therapy improved with our interventions (21.6% vs 75.5%). We found an unexpected decrease in acceptance by patients after initiation of our interventions (81.3% vs 50.5%).

CONCLUSION:

We achieved our goal of improvement of rates of appropriate provision of expedited partner therapy to greater than 70% and have maintained this improvement over time. Future work should investigate potential barriers to expedited partner therapy acceptance, including type of infection, the effect of Department of Public Health regulation of prescribing options, and standard workflow in patient counseling.
Coaching for Surgeons: A Scoping Review of the Quantitative Evidence
Authors: Skinner Sarah C. , Mazza Stéphanie , Carty Matthew J. , Lifante Jean-Christophe , Duclos Antoine
Published: July 2022

Objective:

To characterize quantitative studies on coaching interventions for professional surgeons to understand how surgical coaching is defined; examine how different coaching programs are designed, implemented, and evaluated; and identify any relevant research gaps.

Background:

Surgical coaching is gaining attention as an approach that could help surgeons optimize performance and improve overall wellbeing. However, surgical coaching programs and definitions of coaching vary widely between studies.

Methods:

A systematic literature search of PubMed, Scopus, Web of Science, CENTRAL, clinicaltrials.gov, and WHO ICTRP was conducted according to the PRISMA-ScR framework to identify studies and registered clinical trials written in English. Original quantitative studies on coaching interventions for professional surgeons were included. Characteristics of the coachees, coaching programs, study designs, outcomes, and findings were charted and analyzed.

Results:

From 2589 references, 8 studies (6 published; 2 registered trials) met inclusion criteria. Published studies targeted technical or nontechnical skills, included 2–26 surgeons as coachees, and used coaches who were surgeons. Two studies demonstrated that surgeons react positively to coaching. Studies showed inconsistent effects on technical/nontechnical skills. Only two studies measured patient adverse events and reported no significant positive impacts. The registered randomized trials targeted surgeons’ physiological parameters or wellbeing and used professional coaches. These trials measure surgeon and patient outcomes.

Conclusions:

There is an emerging interest in coaching programs to improve surgeons’ performance by targeting their professional skills and personal factors. However, more randomized trials are needed to evaluate the impact of coaching interventions on patient outcomes and surgeon wellness.
Antibiotic Cement-Coated Interlocked Intramedullary Nails for the Treatment of Infected Nonunion After Intramedullary Nailing
Authors: Zalikha Abdul K. , Sayeed Zain , Stine Sasha A. , Bray Ryan , Vaidya Rahul
Published: July 2022

Objective:

To evaluate outcomes using an interlocking antibiotic cement-coated nail and culture-specific systematic antibiotics in the treatment of infected nonunion after intramedullary nailing.

Design:

Retrospective observational cohort study.

Setting:

Urban level I trauma center.

Patients/Participants:

Forty-one nonconsecutive patients who presented to a level I trauma center who underwent interlocked antibiotic nailing for treatment of infected nonunion status after primary intramedullary nailing.

Outcomes:

Eradication of infection, radiographic union by 2-year follow-up.

Results:

Antibiotic nailing successfully eradicated infection and led to fracture healing in 35 patients (85.4%), while 6 patients (14.6%) had persistent infection and required further surgical treatment. Of the 6 patients who required further treatment, 5 eventually went on to heal with fracture union and eradication of their infection, while 1 required a salvage procedure. Of the 5 patients who eventually went on to heal, 4 of them healed with repeat antibiotic or intramedullary nails, while 1 required segmental resection and bone grafting before healing.

Conclusions:

This study suggests that the proposed interlocked antibiotic nailing technique is a viable therapeutic option to eradicate infected nonunion and support fracture healing.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Usefulness of Source Images of Magnetic Resonance Myelograms and Partial Laminectomy for Interlaminar Endoscopic Lumbar Discectomy at L5-S1
Authors: Yun Dong-Ju , Lee Sang-Ho
Published: July 2022

The primary objective of this study was to assess the clinical and radiologic outcomes and introduce the technical notes from 10 patients who underwent interlaminar endoscopic lumbar discectomy (IELD) at L5-S1 using the source images of magnetic resonance (MR) myelograms and performing partial laminectomy. A biportal endoscopic system was used to perform partial laminectomy, followed by fragmentectomy and subtotal discectomy using a uniportal endoscopic system. The source images of MR myelograms were used to identify the anatomical relationship between the herniated disc material, L5 and S1 nerve roots, the thecal sac, and L5 lamina. Preoperative leg and back visual analog scale scores were greatly improved immediately and after 3 months and 6 months postoperatively. Fragmentectomy and subtotal discectomy became easier after performing a partial laminectomy in all IELD cases at L5-S1. The source images of MR myelograms and partial laminectomy is useful for IELD at L5-S1.

Level of Evidence:

Level IV.
What PROMIS Scores Correlate With Severe Disability in Cervical Spine Surgery?
Authors: Barber Lauren A. , Steinhaus Michael , Lafage Renaud , Ross Thomas , Lafage Virginie , Kim Han Jo , Iyer Sravisht
Published: July 2022

Study Design:

Institutional Review Board-approved prospective cohort study.

Objectives:

To establish a conversion between Neck Disability Index (NDI) and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI).

Summary of Background Data:

As the National Institutes of Health (NIH) PROMIS is a global outcome measure, it can be difficult to interpret the clinical implications in patients with cervical spine surgery. To determine how a disease-specific legacy instrument (NDI) correlates with PROMIS PI and define levels of substantial and minimal disability, we developed a formula to convert NDI scores to PROMIS PI.

Materials and Methods:

Adult patients undergoing cervical spine surgery at a single institution from 2016 to 2018 were prospectively enrolled. Patients undergoing surgery for instability due to trauma were excluded. Preoperative questionnaires, demographic data, presenting complaint (radiculopathy, myelopathy, myeloradiculopathy), and procedural data were recorded. Patients were included if they had completed the NDI and PROMIS PI. Correlation and regression analyses were performed.

Results:

One hundred ninety-six patients met inclusion criteria. The average age was 56.9±12.9 years. The mean NDI score was 68.6±38 and PROMIS PI was 60.9±7.3. The PROMIS PI was strongly correlated with the NDI (r=0.76, P<0.001). Linear regression analysis revealed the following formula:

Conclusions:

We performed a regression analysis allowing for the conversion of PROMIS PI scores with NDI. In keeping with the previous studies, our analysis showed that PROMIS PI was most strongly correlated to NDI. A PROMIS PI score >66 was correlated to substantial disability (NDI=50), whereas a PROMIS PI score <59 was correlated to minimal relative impairment (NDI=28). These results provide important reference, as PROMIS reporting becomes more widespread in the literature.
Large Varicose Vein Closure: A Comprehensive Review
Authors: Almukhtar Rawaa M. , Goldman Mitchel P.
Published: July 2022

BACKGROUND

Treatment of chronic venous disease and varicose veins has significant psychosocial and economic impact. The great saphenous vein is a common vein to develop incompetence and reflux and, therefore, been the focus of therapy for many years.

OBJECTIVE

To review the published medical literature relating to large varicose vein closure and provide a guide for closure techniques' efficacy and safety.

METHODS

A comprehensive search of the English language literature was performed up to and including December 2021. All references pertaining to large varicose vein closure were reviewed.

RESULTS

There are multiple safe and effective minimally invasive methods to achieve occlusion of incompetent great saphenous vein, the most widely used of which is endovenous thermal ablation. Other nonthermal, tumescent, and nontumescent methods can also be used.

CONCLUSION

Proper knowledge of vein anatomy, ultrasound, and vein closure procedures is needed to ensure safe and effective outcomes.
Socioeconomic Status Affects Pre- and Postoperative Two-point Discrimination in Patients with Carpal Tunnel Syndrome
Authors: Prabhakar Gautham , Ghali Abdullah , Momtaz David , Rose Ryan
Published: July 2022

Background:

Carpal tunnel release is a life-changing procedure within hand surgery. Multiple factors may have an impact on the outcome following surgery.

Methods:

In this retrospective cohort study, we reviewed all patients who underwent carpal tunnel release in our institutional database from 2018 to 2020. We included patients with a minimum of 6-week follow-up. Patient demographics were identified, including insurance status and comorbidities. Patients were categorized as “improved” or “not improved” based on two-point test differences. Results were analyzed using the Fisher exact test. We ran a logistic regression model to analyze the relationship between income status (operationalized by having Medicaid/Carelink) and preoperative scores, and inferential statistics were computed with appropriate t tests.

Results:

Of the 125 patients who met the inclusion criteria, 47 (37.6%) had Medicaid or Carelink, and 79 (62.4%) had commercial insurance. Medicaid/ Carelink patients presented with worse two-point discrimination on initial presentation (P < 0.001). Compared to commercial insurance, Medicaid/Carelink patients were less likely to show improvement in postoperative two-point discrimination (P < 0.001). Male patients were also less likely to show improvement. Race, ethnicity, medical comorbidities, and age were not shown to have a significant effect on improvement in two-point discrimination.

Conclusions:

Although medical comorbidities did not have a significant effect on postoperative two-point, patients with low-income status (Medicaid/Carelink) may have a less predictable outcome. These socioeconomic considerations are critical in appropriately risk stratifying surgical candidates, and counseling patients in whom tactile acuity may be less predictable.
Cardiorespiratory Optimal Point Is a Submaximal Exercise Test Variable and a Predictor of Mortality Risk
Authors: Peterman James E. , Harber Matthew P. , Fleenor Bradley S. , Whaley Mitchell H. , Araújo Claudio G. , Kaminsky Leonard A.
Published: July 2022

Purpose:

The cardiorespiratory optimal point (COP) is the minimum ventilatory equivalent for oxygen. The COP can be determined during a submaximal incremental exercise test. Reflecting the optimal interaction between the respiratory and cardiovascular systems, COP may have prognostic utility. The aim of this investigation was to determine the relationship between COP and all-cause mortality in a cohort of apparently healthy adults.

Methods:

The sample included 3160 apparently healthy adults (46% females) with a mean age of 44.0 ± 12.5 yr who performed a cardiopulmonary exercise test. Cox proportional hazards models were performed to assess the relationship between COP and mortality risk. Prognostic peak oxygen uptake (V˙o
2peak) and COP models were compared using the concordance index.

Results:

There were 558 deaths (31% females) over a follow-up period of 23.0 ± 11.9 yr. For males, all Cox proportional hazards models, including the model adjusted for traditional risk factors and V˙o
2peak, had a positive association with risk for mortality (P < .05). For females, only the unadjusted COP model was associated with risk for mortality (P < .05). The concordance index values indicated that unadjusted COP models had lower discrimination compared with unadjusted V˙o
2peak models (P < .05) and V˙o
2peak did not complement COP models (P ≥ .13).

Conclusions:

Cardiorespiratory optimal point is related to all-cause mortality in males but not females. These findings suggest that a determination of COP can have prognostic utility in apparently healthy males aged 18-85 yr, which may be relevant when a maximal exercise test is not feasible or desirable.
Epidemiology of ectopia lentis and outcomes after surgery in a Danish population
Authors: Rasul Asrin , Roos Laura , Groth Kristian , Riise Per , Bach-Holm Daniella , Kessel Line
Published: July 2022

Purpose:

To describe the causes of ectopia lentis (EL) and the outcomes after surgery in a Danish population.

Setting:

The Eye Clinic Rigshospitalet and Kennedy Center in Copenhagen.

Design:

Retrospective cohort study.

Methods:

Medical records of patients with nontraumatic EL born after 1980 and seen at the Eye Clinic Rigshospitalet and Kennedy Center from 1983 to 2019 were reviewed. Clinical information regarding family history, comorbidities, genetic workup, ophthalmological examinations, and surgical history was retrieved.

Results:

72 patients (38 males), of whom 68 had bilateral EL (94.4%) were identified. Marfan syndrome (MFS) was found in 34 (47.2%) and biallelic variants in ADAMTSL4 in 4 (5.6%). Surgery was performed in 38 (52.8%) patients, 66 eyes, with a median age at the time of first eye surgery of 8.4 years (range 0.8 to 39.0 years) and a follow-up of 2.3 years (range 0 to 25.7 years). Intraocular lenses were implanted in 9 (23.7%) (11 eyes). Corrected distance visual acuity improved from 0.7 to 0.2 logMAR (median) in right eyes and from 0.7 to 0.3 logMAR in left eyes postoperatively. 21 patients (56.8%), 42 eyes, did not experience any surgery-related complications. 3 patients (3 eyes) experienced a perioperative tear in the posterior capsule. Temporary postoperative ocular hypertension was reported in 3 patients (7.9%) (3 eyes), and 2 patients (5.4%) (2 eyes) developed persistent ocular hypertension. There were no cases of postoperative retinal detachment.

Conclusions:

The main reason for EL was MFS. Surgery improved visual acuity, and postoperative ocular hypertension was the most common complication, whereas retinal detachment was not observed.
Pancreatic head sparing surgery for solid pseudopapillary tumor in patients with agenesis of the dorsal pancreas
Authors: Shyr Bor-Shiuan , Wang Shin-E , Chen Shih-Chin , Shyr Yi-Ming , Shyr Bor-Uei
Published: July 2022

Background:

This study aimed to clarify the feasibility and justification of pancreatic head sparing (PHS) enucleation for patients with agenesis of the dorsal pancreas (ADP) associated with a solid pseudopapillary tumor (SPT).

Methods:

Data of the SPT patients with and without ADP, including clinical presentations, surgical options, and surgical and survival outcomes, were recruited for comparison.

Results:

A total of 31 patients with SPTs were included, three of whom displayed ADP and underwent PHS enucleation. Surgical complications were comparable between the groups. Overall, the 5- and 10-year disease-free survival rates were 100% and 90%, respectively. The 20- and 25-year overall survival rates were 100% and 66.7%, respectively. Only one patient (3.2%) developed tumor recurrence 7.3 years after pancreatectomy for an SPT with lymph node involvement, and the patient survived 24.5 years after the initial operation. No tumor recurrence occurred in any patient with ADP after PHS enucleation.

Conclusion:

PHS enucleation seems to be feasible and justifiable for SPT patients with ADP in terms of surgical and survival outcomes, and this approach could be recommended to avoid pancreatic insufficiency.
What Makes a Trauma Patient “Pediatric”? Survey of Providers' Admission Decision Making for Pediatric Trauma Patients
Authors: Fakhry Samir M. , Berg Gina M. , Wilson Nina Y. , Slivinski Andrea , Morse Jennifer L. , Shen Yan , Wyse Ransom J. , Garland Jeneva M. , Worthley Aaron , Brady Jessica L. , Franklin Kelli , Dunne James R. , Turner Jennifer , Rhodes Heather , Palladino Kelsey , Watts Dorraine D.
Published: July 2022

Background:

Only a fraction of pediatric trauma patients are treated in pediatric-specific facilities, leaving the remaining to be seen in centers that must decide to admit the patient to a pediatric or adult unit. Thus, there may be inconsistencies in pediatric trauma admission practices among trauma centers.

Objective:

Describe current practices in admission decision making for pediatric patients.

Methods:

An email survey was distributed to members of three professional organizations: The American Association for the Surgery of Trauma, Society of Trauma Nurses, and Pediatric Trauma Society. The survey contained questions regarding pediatric age cutoffs, institutional placement decisions, and scenario-based assessments to determine mitigating placement factors.

Results:

There were 313 survey responses representing freestanding children's hospitals (114, 36.4%); children's hospitals within general hospitals (107, 34.2%), and adult centers (not a children's hospital; 90, 28.8%). The mean age cutoff for pediatric admission was 16.6 years. The most reported cutoff ages were 18 years (77, 25.6%) and 15 years (76, 25.2%). The most common rationales for the age cutoffs were “institutional experience/tradition” (139, 44.4%) and “physician preference” (89, 28.4%).

Conclusion:

There was no single widely accepted age cutoff that distinguished pediatric from adult trauma patients for admission placement. There was significant variability between and within the types of facilities, with noted ambiguity in the definition of a “pediatric” patient. Thresholds appear to be based primarily on subjective criteria such as traditions or preferences rather than scientific data. Institutions should strive for objective, evidence-based policies for determining the appropriate placement of pediatric patients.
Clinical Prediction Rule Validation for Ambulation Outcome After Traumatic Spinal Cord Injury in a Spanish Population
Authors: García-Rudolph Alejandro , Wright Mark Andrew , Benito Jesus , Vidal Joan , Tormos Josep Maria , Opisso Eloy , Murillo Narda
Published: July 2022

BACKGROUND:

Predicting the ability to walk after traumatic spinal cord injury is of utmost importance in the clinical setting. Nevertheless, only a small fraction of predictive models are evaluated on their performance by other authors using external data. The Dutch Clinical Prediction Rule for long-term walking ability was developed and validated using neurological assessments performed within 15 days postinjury. However, in reality, this assessment is most often performed between 11 and 55 days. When considering a longer time from injury to neurological assessments, the Dutch Clinical Prediction Rule has only been externally validated for patients after non–traumatic spinal cord injury.

OBJECTIVE:

We aimed to validate the Dutch Clinical Prediction Rule with neurological assessment performed within 3–90 days after traumatic spinal cord injury, using (a) the Dutch Clinical Prediction Rule logistic regression coefficients (Equation 1); (b) the Dutch Clinical Prediction Rule weighted coefficients (Equation 2); and (c) the reestimated (using a Spanish population) weighted coefficients (Equation 3).

METHODS:

We conducted a retrospective (STROBE-compliant) study involving 298 adults with traumatic spinal cord injury admitted to a hospital between 2010 and 2019 in Spain. The Spinal Cord Independence Measure item-12 was used for walking assessment.

RESULTS:

Using Equation 1, the model yielded 86.2% overall classification accuracy, 94.5% sensitivity, and 83.4% specificity (area under the curve [AUC] = 0.939, 95% confidence interval [CI]: 0.915–0.965; p < .001).

Using Equation 2 yielded 86.2% overall classification accuracy, 93.2% sensitivity, and 83.9% specificity (AUC = 0.9392, 95% CI: 0.914–0.964; p < .001).

Using Equation 3 yielded 86.9% overall classification accuracy, 68.9% sensitivity, and 92.8% specificity (AUC = 0.939, 95% CI: 0.914–0.964; p < .001).

CONCLUSIONS:

This study validates the Dutch Clinical Prediction Rule in a Spanish traumatic spinal cord injury population with assessments performed up to 90 days postinjury with similar performance, using the original coefficients and including a reestimation of the coefficients.
Autoimmune progesterone dermatitis: a retrospective case series
Authors: Aghazadeh Nessa , Berry Nicholas A. , Torgerson Rochelle R. , Park Miguel A. , Davis Dawn Marie R.
Published: July 2022

Background:

Autoimmune progesterone dermatitis (APD) is a rare hypersensitivity disorder characterized by recurring dermatologic manifestations during the luteal phase of the menstrual cycle in women. Well-defined clinical and diagnostic criteria, outcomes measurements, and standard treatments are lacking.

Methods:

We performed a single-institution retrospective review of adult patients (older than 20 years at the time of diagnosis) with APD.

Results:

Fourteen patients were included with mean age of clinical onset of 34.3 ± 7.7 (range 24-54) years. There was a delay of 3.9 ± 5.5 (range 0.4-20) years between the onset of disease symptoms and diagnosis. The onset of APD was after exposure to exogenous progesterone in 9 of 14 patients. Progesterone skin test was performed in 9 patients and 6 were positive. Patients frequently presented with urticaria (9/14, 64.3%) and dermatitis (4/14, 28.6%). Continuous combined oral contraceptives (4/14, 28.6%), gonadotropin-releasing hormone agonist (3/14, 21.4%), and hysterectomy with bilateral salpingo-oophorectomy (2/14, 14.3%) were the most common attempted treatments with reliable outcomes.

Conclusions:

APD is a rare disorder which lacks universal diagnostic measures and criteria, contributing to a significant delay in diagnosis. Large-scale multicenter studies are needed to develop accurate tests, establish diagnostic criteria, and define treatment outcomes.
The current state of lesbian, gay, bisexual, and transgender cultural competency among U.S. dermatology residents
Authors: Nowaskie Dustin Z. , Garcia-Dehbozorgi Sara , Cortez Jose L.
Published: July 2022

Background:

Lesbian, gay, bisexual, and transgender (LGBT) people interface with dermatology providers for many reasons. Implementing culturally competent LGBT dermatologic care necessitates evaluating provider competency to identify where gaps remain.

Objectives:

To assess the LGBT cultural competency among U.S. dermatology residents.

Methods:

A self-reporting, cross-sectional survey was emailed to U.S. dermatology program coordinators (N = 143). LGBT patient exposure, LGBT educational hours, and LGBT cultural competency via the LGBT-Development of Clinical Skills Scale (with the subscales Clinical Preparedness, Attitudinal Awareness, and Basic Knowledge) were measured.

Results:

Dermatology residents (N = 119) across the United States completed the survey. They reported caring for less than 20 LGBT patients per year and receiving less than 75 minutes of LGBT education per year. They reported significantly higher Attitudinal Awareness than both Clinical Preparedness and Basic Knowledge; they reported significantly higher Basic Knowledge than Clinical Preparedness. They reported significantly less adequate clinical training and supervision, experience, and competence to assess transgender patients compared to lesbian, gay, and bisexual patients. In general, dermatology residents who reported more LGBT patients and LGBT education also reported higher LGBT cultural competency.

Limitations:

A larger national sample of U.S. dermatology residents is necessary for generalizability.

Conclusions:

Currently, there is a lack of LGBT education in U.S. dermatology residency curricula, which may delay addressing the health disparities that exist in this patient population. Due to such dearth of standardized LGBT education, dermatology residents likely do not feel adequately knowledgeable or prepared to address LGBT needs. Both LGBT education and LGBT patient experiences may help alleviate these shortcomings and help LGBT patients feel affirmed in their dermatologic care.
Comparing Outcomes and Billing Costs of Middle Cranial Fossa and Transmastoid Approaches for Otogenic Encephalocele and Cerebrospinal Fluid Leak Repair
Authors: Patel Tirth R. , Piracha Ali Z. , Roy Alexa S. , Byrne Richard , Jhaveri Miral , Michaelides Elias , Wiet R. Mark
Published: July 2022

Objective

Comparison of outcomes and billing costs of patients treated at our institution using transmastoid (TM), middle cranial fossa (MCF), and combined approaches for repair of otogenic cerebrospinal fluid (CSF) leaks and encephaloceles.

Study Design

Retrospective cohort review.

Setting

Tertiary-care hospital.

Patients

Seventy-seven cases of otogenic CSF leaks or encephaloceles.

Interventions

Surgical repair of an otogenic encephalocele or CSF leak using either a TM, MCF, or combined approach.

Main Outcome Measures

Success of repair, length of operation, cost of operating room materials, postoperative need for intensive care, and postoperative length of stay.

Results

Forty cases (52%) were performed by the TM approach, 27 (35%) by MCF, and 10 (13%) by combined TM/MCF. Mean length of stay was not statistically different amongst TM patients (2.1 d), MCF patients (3.3 d), and combined TM/MCF patients (3.70; p = 0.112). Only 3/40 TM cases required intensive care during their admission while all MCF and combined TM/MCF approach cases were admitted to the intensive care unit for at least one night (p < 0.001). On follow-up, CSF leak recurred in 3/77 (4%) cases: 3/27 (11%) MCF, 0/40 TM, and 0/10 combined TM/MCF patients (p = 0.056). The mean cost of operating room materials charged to the patient was significantly greater in the MCF group ($9,883) than the TM group ($3,748; p = 0.001).

Conclusions

In carefully selected patients, the TM approach is an effective and less costly alternative to MCF approaches for repair of otogenic CSF leaks and encephaloceles.
History of the Chinese Medicinal Gelatin
Authors: Kubo Teruyuki , Zhao Zhong-Zhen
Published: July 2022

This article discusses the history of animal glue (gelatin) used in medical practice in China. In ancient times, gelatin was widely made from cowhide and has been found in excavations and wall paintings older than 2000 years in Egypt, Greece, and China. However, it has been used medicinally almost exclusively in China and other East Asian countries influenced by Chinese medicine. Since 11th century, donkey-hide has gradually been replaced with cowhide in medicinal gelatin. Currently, donkey-hide gelatin is widely used medicinally in China. During the Edo period, medicinal gelatin was imported to Japan from China. Owing to the distaste for eating animal flesh in traditional Japanese culture, the production of gelatin and its medicinal use is not widespread in Japan.
Binocular treatment for individual with amblyopia: A systematic review and meta-analysis
Authors: Jin Liwen , Fang Yiming , Jin Can
Published: July 2022

Objective:

To assess the efficacy of binocular treatment for individual with amblyopia.

Methods:

In this meta-analysis, a comprehensive search of literatures was performed from PubMed, Embase, Cochrane Library and Web of Science databases up to December 21, 2020. Sensitivity analysis was performed for all outcomes. The Begg’s test was used to assess the publication bias. Heterogeneity test was conducted for each effect indicator. Indicators were analyzed by random-effects model when the heterogeneity statistic I2 ≥ 50%, on the contrary, indicators were analyzed by fixed-effect model. Standard mean difference (SMD) or weighted mean difference (WMD) was adopted as effect indicators, and the effect amount was expressed as 95% confidence intervals (CIs).

Results:

A total of 13 literatures including 1146 participants were finally enrolled, with 595 in the intervention group and 551 in the control group. The results indicated that the improvement of amblyopic eye visual acuity [SMD: 0.882, 95%CI: (0.152, 1.613), P = 0.018] in binocular treatment group was better than that in control group. And binocular treatment could improve stereo acuity in individual with amblyopia [WMD: 0.138, 95%CI: (0.068, 0.208), P < 0.001].

Conclusion:

Binocular treatment may be beneficial to visual acuity, stereo acuity and binocular function improvement for individual with amblyopia. In clinical practice, binocular treatment can be used as one of the treatments for individual with amblyopia.
Using the forest plot to compare citation achievements in bibliographic and meta-analysis studies since 2011 using data on PubMed Central: A retrospective study
Authors: Wu Jian-Wei , Chien Tsair-Wei , Tsai Ya-Ching , Wang Hsien-Yi , Kan Wei-Chih , Wang Lin-Yen
Published: July 2022

Background:

We saw a steady increase in the number of bibliographic studies published over the years. The reason for this rise is attributed to the better accessibility of bibliographic data and software packages that specialize in bibliographic analyses. Any difference in citation achievements between bibliographic and meta-analysis studies observed so far need to be verified. In this study, we aimed to identify the frequently observed MeSH terms in these 2 types of study and investigate whether the highlighted MeSH terms are strongly associated with one of the study types.

Methods:

By searching the PubMed Central database, 5121 articles relevant to bibliometric and meta-analysis studies were downloaded since 2011. Social network analysis was applied to highlight the major MeSH terms of quantitative and statistical methods in these 2 types of studies. MeSH terms were then individually tested for any differences in event counts over the years between study types using odds of 95% confidence intervals for comparison.

Results:

In these 2 studies, we found that the most productive countries were the United States (19.9%), followed by the United Kingdom (8.8%) and China (8.7%); the most number of articles were published in PLoS One (2.9%), Stat Med (2.5%), and Res Synth (2.4%); and the most frequently observed MeSH terms were statistics and numerical data in bibliographic studies and methods in meta-analysis. Differences were found when compared to the event counts and the citation achievements in these 2 study types.

Conclusion:

The breakthrough was made by developing a dashboard using forest plots to display the difference in event counts. The visualization of the observed MeSH terms could be replicated for future academic pursuits and applications in other disciplines using the odds of 95% confidence intervals.
Predictors of osteoporosis prevention behaviors in women in their 20s and 30s
Authors: Kang Suni , Kim Young A
Published: July 2022

There is a need to provide insight into the management and health care fields for the prevention of osteoporosis in young women by analyzing the factors affecting the prevention of osteoporosis. This descriptive survey aimed to identify the predictors of osteoporosis prevention behaviors in women in their 20s and 30s by examining their body mass index (BMI), weight control experience, osteoporosis knowledge, osteoporosis self-efficacy, and osteoporosis prevention behaviors.

One hundred fifty participants were conveniently sampled, and data were collected from August to September 2020. Participants in their 20s and 30s completed a questionnaire concerning the general characteristics, osteoporosis-related characteristics, osteoporosis knowledge, osteoporosis self-efficacy, and osteoporosis prevention behaviors.

Approximately 82.6% of the participants had at least 1 type of weight control experience. The mean participants’ age and BMI were 28.94 (±5.32) years and 21.62 (±3.21) kg/m2, respectively. No significant differences in weight control experience according to the participants’ characteristics were observed. However, significant differences were noted in BMI and age, osteoporosis knowledge and educational background, osteoporosis prevention behavior and educational background, and household type. Osteoporosis prevention behaviors were significantly positively correlated with weight control experience, osteoporosis knowledge, and osteoporosis self-efficacy. Osteoporosis prevention behaviors increased with increasing osteoporosis self-efficacy (β = 0.53, P < .001), among multiperson households (β = 0.20, P = .003), and among those with a weight control experience (β = 0.18, P = .007), and these factors explained 47.2% of the variance (F = 23.11, P < .001).

Based on the study results, further studies are needed to identify and analyze the predictors of osteoporosis prevention behaviors in women to increase the awareness of osteoporosis and osteoporosis prevention and management in this group and expand similar efforts.
Associations of HIV persistence, cigarette smoking, inflammation, and pulmonary dysfunction in people with HIV on antiretroviral therapy
Authors: Cyktor Joshua , Qin Shulin , Staines Brittany , Nouraie Mehdi , Fitzpatrick Meghan , Kessinger Cathy , DeSensi Rebecca , Huang Laurence , Rinaldo Charles R. , Kingsley Lawrence , Tien Phyllis C. , Mellors John W. , Morris Alison
Published: July 2022

We aimed to investigate the relationship between measures of HIV persistence with antiretroviral therapy (ART) and cigarette smoking, systemic markers of inflammation, and pulmonary function.

Retrospective study of 82 people with HIV (PWH) on ART for a median of 6.9 years (5.6–7.8) and plasma HIV RNA levels <50 copies/mL.

HIV DNA and cell-associated HIV RNA (CA-RNA) were measured in peripheral blood mononuclear cells (PBMC) and plasma HIV RNA was measured by single-copy assay (SCA). Plasma levels of 17 inflammatory mediators were measured by Bio-Plex, and standard pulmonary function tests (PFT) were performed in all participants.

Median age was 52 years and 41% were women. Most had preserved CD4+ T cell counts (median (IQR) 580 (361–895) cells/mm3). Median plasma HIV RNA was 1.3 (0.7–4.6) copies/mL, and median levels of HIV DNA and CA-RNA in PBMC were 346 (140–541) copies and 19 (3.7–49) copies per 1 million PBMC, respectively. HIV DNA was higher in smokers than in nonsmokers (R = 0.3, P < 0.05), and smoking pack-years positively correlated with HIV DNA and CA-RNA (R = 0.3, P < 0.05 and R = 0.4, P < 0.01, respectively). HIV DNA, CA-RNA, and plasma HIV RNA were not significantly associated with any measure of pulmonary function or inflammation.

Cigarette smoking was associated with HIV DNA and CA-RNA levels in blood, but measures of HIV persistence were not associated with pulmonary function or inflammation.
Gamma knife radiotherapy in a neurofibromatosis type 1 Chinese pedigrees with NF1 gene frameshift mutation: A case report
Authors: Dong Meng-Jie , Yang Zhong-Kun , Yang Ji , Guo Rui-Qin , Xiao Yu-Yuan , Liu Hai
Published: July 2022

Rationale:

Neurofibromatosis type 1 (NF1) is a common autosomal dominant genetic disorder. NF1 is a multisystemic disease and its pathogenesis involves mutations in the NF1 gene on chromosome 17q11.2 causing RAS overactivation to stimulate abnormal cell proliferation. In this article, a Chinese family with neurofibromatosis type 1 was reported and the relationship between the phenotype and gene mutation was analyzed.

Patient concerns:

The patient was a 9-year-old-male child diagnosed with right eye exophthalmos combined with right eye glioma, optic edema, and peripheral visual field defect. There were multiple cafe-au-lait spots in the whole body of the child. His mother had multiple cafe-au-lait spots, and the eye examination showed no abnormalities.

Diagnosis:

The proband was diagnosed with NF1 and a heterozygous frameshift mutation (c. 6641delG p. Arg2214Asnfs*30) in the NF1 gene was identified, and his mother also carried the same pathogenic mutation.

Interventions:

To protect the vision of the right eye, he was treated with gamma knife radiotherapy.

Outcomes:

After therapy, his fundus optic disc edema was decreased and the best corrected visual acuity of the right eye was increased.

Lessons:

Gene detection is helpful to diagnose the disease and guide the treatment. Gamma knife radiotherapy can preserve better neurological function.
Semi-occlusive management of fingertip injuries with finger caps: A randomized controlled trial in children and adults
Authors: Schultz Jurek , Wruck Juliane Emily , Trips Evelyn , Pfeiffer Roland , Grählert Xina , Münchow Sandra , Schröttner Percy , Dragu Adrian , Fitze Guido
Published: July 2022

Background:

Human fingertips can regenerate functionally and cosmetically excellent skin and soft tissues. Physiological conditions suppress scar formation and are thus a prerequisite for regenerative healing. Self-adhesive film dressings can provide such favorable conditions. The semi-occlusive treatment is superior to surgery. However, standard dressings leak malodorous wound fluid eventually until the wound is dry. Therefore, we developed and tested a silicone finger cap that forms a mechanically protected, wet chamber around the injury. Its puncturable reservoir allows access to the wound fluid for diagnostic and research purposes and the delivery of pro-regenerative drugs in the future.

Methods:

Patients >2 years with full-thickness fingertip injuries unsuitable for simple primary closure were randomized to start treatment with either the film dressing or the silicone finger cap. After 2 weeks, we changed to the other treatment. Patients’ choice on the preferred treatment after 4 weeks was the primary outcome parameter. Additionally, we monitored adverse events, unplanned visits, tissue gain, functionality, cosmetic outcome, and quality of life.

Results:

We randomized 11 patients 2 to 72 years to each group. Eighteen to 20 (90%, intention-to-treat) patients preferred the finger cap. All patients were satisfied with the cosmetic outcome, 88.9% had no disturbing sensibility changes, and 73.7% could report no distortion in the finger’s daily use. Epithelialization took between 5 weeks for Allen II and up to 9 weeks in Allen IV injuries. There were 19 device-related adverse events under film dressing and 13 under the finger cap. There were neither severe adverse device effects nor unexpected severe adverse device effects.

Conclusion:

Employing the summative or synthetic primary endpoint "patient decision for one or the other procedure," our pseudocross-over-designed RCT succeeded in statistically significantly demonstrating the superiority of the silicone finger cap over conventional film therapy. The finger cap was safe and effective, reaching excellent results on all treated injuries without any need for disinfection, antibiotics, shortening of protruding bones, or treatment of hypergranulations. Distal to the tendon insertions, we did not see any limitations regarding injury mechanism, amputation plane, or patients' age.
Hyperacute iris neovascularization following cataract surgery
Authors: Sim Ha Eun , Hwang Je Hyung
Published: July 2022

Rationale:

We describe a case of acute neovascularization of the iris after uneventful cataract surgery.

Patient concerns:

A 78-year-old man visited our clinic for cataract surgery and glaucoma management.

Diagnoses:

The patient underwent bilateral laser iridotomy 4 years ago. On ocular examination, the best-corrected visual acuity was no light perception in the right eye and 20/100 in the left eye. We observed pseudophakic bullous keratopathy in the right eye and cataracts and hemicentral retinal vein occlusion (CRVO) in the left eye.

Interventions:

The patient underwent cataract surgery in the left eye without complications.

Outcomes:

The day after surgery we observed 360° of neovascularization in the iris and aggravated hemi-CRVO with macular edema. Therefore, we administered intravitreal bevacizumab in the left eye, after which the iris neovascularization and macular edema improved.

Lessons:

Cataract surgery can rapidly aggravate hemi-CRVO and cause iris neovascularization, which is responsive to bevacizumab.
Infectious native valve endocarditis by Streptococcus agalactiae species: Case report of pathogen identification only through metagenomic sequencing technology
Authors: Wang Ruoxin , Cao Xuejie , Wu Fang , Zhao Jinlong , Fu Liang , Yuan Ziming , Ni Yinkai , Chen Zonghui , Li Feng
Published: July 2022

Introduction:

Streptococcus agalactiae is a common pathogen in infective endocarditis, but the positive rate of traditional blood culture diagnosis is not high. It is challenging to obtain a good outcome in the absence of pathogen information for patients with infectious endocarditis.

Patient concerns and diagnosis:

Here, we report the case of a patient with infective endocarditis caused by S. agalactiae. The initial manifestations of this patient were coma, urinary incontinence, and fecal incontinence and had no history of heart disease or infectious diseases before admission.

Interventions and outcomes:

When the blood culture was negative 3 consecutive times, the pathogen S. agalactiae was diagnosed in a timely and accurate manner by metagenome sequencing. Eventually, the patient was discharged following surgery and antibiotic treatment.

Conclusions:

For IE patients with infective endocarditis, metagenome sequencing is a valuable and selective tool for rapid, sensitive, and accurate pathogen detection, especially when the blood culture is negative.
Swallowing study using water-soluble contrast agents may increase aspiration sensitivity and antedate oral feeding without respiratory and drug complications: A STROBE-compliant prospective, observational, case-control trial
Authors: Hwang Chang Ho
Published: July 2022

Although the modified barium swallowing study (MBSS) is considered the gold standard for assessing aspiration risk, aspiration of lipid-soluble barium can cause chemical pneumonitis or impair radiologic interpretation of the lungs. Water-soluble contrast agents (WSCAs) may avoid these complications while maintaining sensitivity on aspiration.

This prospective, observational, case-control cohort trial evaluated all patients >3 years old referred for swallowing study from September 2015 to November 2017. Repeat evaluations of individuals were excluded. High-risk patients were evaluated by WSCA (iohexol)-based swallowing study (WSS) and others by MBSS.

The study included 829 evaluations of 762 patients. After excluding 74 evaluations, 365 WSSs and 390 MBSSs were performed. The most frequent underlying condition was brain lesion, followed by aspiration pneumonia. Aspiration occurred more frequently in WSS (147 patients: 40.3%) than in MBSS (36 patients: 9.2%) (P = .00). However, neither aspiration volume (6.72 cc [3.09-10.35] vs 5.53 cc [2.21-8.85]) nor radiographic alterations differed between the 2 groups (P > .05). Moreover, the swallowed (16.62 cc [8.45-24.79]) and aspirated amounts of iohexol were not correlated with radiologic changes or deterioration (P > .05). Switching to oral feeding following WSS was more frequent (164 patients: 44.9%), whereas aspiration pneumonia was not (P = .00). WSS did not prolong the interval to patient discharge (P = .06) or induce an allergic reaction or chemotoxicity over 1 week.

The absence of aspiration-induced complications and adverse drug effects suggests that, compared with MBSS, WSS may increase aspiration sensitivity and early switching to oral feeding.