bluuebunny/crossref_metadata_2025 huggingface dataset:
Perspectives on the Plastic Surgery Common Application (PSCA): A Survey of 2021–2022 Integrated Plastic Surgery Applicants
Authors: Elmer Nicholas A. , Veeramani Anamika , Bustos Valeria P. , Shiah Eric , Hassell Natalie , Comer Carly D. , Manstein Samuel M. , Laikhter Elizabeth , Lin Samuel J.
Published: February 2023

Background:

The Plastic Surgery Common Application (PSCA) was introduced as a free and specialty-specific application for plastic surgery applicants in the 2020–2021 cycle. Now in its second year, the PSCA is being piloted by all integrated residency programs with future plans to replace Electronic Residency Application Service (ERAS) in the 2022–2023 cycle. This study aimed to explore applicant perspectives related to the PSCA and ERAS applications.

Methods:

An anonymous survey was distributed to integrated plastic surgery residency applicants from the 2021–2022 application cycle. Participants were asked to provide basic demographic information, their perspectives of the PSCA, and overall application preference.

Results:

One hundred forty (43.1%) applicants completed the survey. Nearly, 63% of applicants responded “slightly well” or “not well at all” regarding their ability to highlight at least one aspect of their application. Forty-one percent of applicants believed ERAS best highlighted the strengths of their application compared with 27% who believed their strengths were better highlighted by the PSCA. Seventy-nine percent reported the cost savings associated with the PSCA were “very” or “extremely important.” Overall, 63% of respondents reported a preference to apply with the PSCA alone.

Conclusions:

This is the first study to provide insight on applicants' perspectives of the PSCA. Although the majority preferred applying with the PSCA, there may be challenges with transitioning to this application solely. Future iterations of the PSCA may aim to ameliorate functionality concerns, optimize application content, and incorporate plastic surgery-specific information that may be important to selection committees.
Reducing Opioid Overprescribing through Procedure-specific Prescribing Guidelines
Authors: Zhang Kevin K. , Blum Kevin M. , Chu Jacqueline J. , Sharma Shuchi , Skoracki Roman J. , Moore Amy M. , Janis Jeffrey E. , Barker Jenny C.
Published: February 2023

Background:

Despite advances in opioid-sparing pain management, postdischarge opioid overprescribing in plastic surgery remains an issue. Procedure-specific prescribing protocols have been implemented successfully in other surgical specialties but not broadly in plastic surgery. This study examined the efficacy of procedure-specific prescribing guidelines for reducing postdischarge opioid overprescribing.

Methods:

A total of 561 plastic surgery patients were evaluated retrospectively after a prescribing guideline, which recommended postdischarge prescription amounts based on the type of operation, was introduced in July 2020. Prescription and postdischarge opioid consumption amounts before (n = 428) and after (n = 133) guideline implementation were compared. Patient satisfaction and prescription frequency of nonopioid analgesia were also compared.

Results:

The average number of opioid pills per prescription decreased by 25% from 19.3 (27.4 OME) to 15.0 (22.7 OME; P = 0.001) after guideline implementation, with no corresponding decrease in the average number of postdischarge opioid pills consumed [10.6 (15.1 OME) to 8.2 (12.4 OME); P = 0.147]. Neither patient satisfaction with pain management (9.6‐9.6; P > 0.99) nor communication (9.6‐9.5; P > 0.99) changed. The rate of opioid-only prescription regimens decreased from 17.9% to 7.6% (P = 0.01), and more patients were prescribed at least two nonopioid analgesics (27.5% to 42.9%; P = 0.003). The rate of scheduled acetaminophen prescription, in particular, increased (54.7% to 71.4%; P = 0.002).

Conclusions:

A procedure-specific prescribing model is a straight-forward intervention to promote safer opioid-prescribing practices in plastic surgery. Its usage in clinical practice may lead to more appropriate opioid prescribing.
M-shaped Genioplasty: New Findings after 10 Years of Experience
Authors: Fariña Rodrigo , Valladares-Pérez Salvador , Navarro-Cuellar Carlos , Torrealba Ramón , Fariña-Silva Antonia , Fariña-Silva Gabriel
Published: February 2023

Background:

This study aimed to evaluate changes of the M-shaped genioplasty in sagittal and vertical planes in a group of 34 patients and describe other indications, such as the increase of the mentolabial angle, decrease in the depth of the mentolabial fold, and the centering of the chin.

Methods:

A retrospective analysis was performed on 34 patients between 2010 and 2019. All studies were conducted at T0 (preoperative), T1 (a month after surgery), and T2 (1 year after surgery). The position of the bone pogonion (Pg) was measured vertically and horizontally at T0, T1, and T2; the mentolabial angle and the depth of the mentolabial fold were measured at T0 and T2.

Results:

The average sagittal advancement at T1 was 6.6 mm and at T2 was 6.4 mm. The inferior movement was an average of 5.6 mm at T1 and T2, showing both movements excellent stability. The mentolabial angle increased at T2 an average of 28.2 degrees (5 degrees per each millimeter of inferior movement), whereas the depth of the mentolabial fold decreased an average of 2.8 mm (decreased 49% from the initial depth and decreased 0.56 mm per each mm of inferior movement). The average increase of the lower third of the face was 5 mm. No complications were observed in any patient.

Conclusions:

M-shaped genioplasty is an anterior osteotomy of the mandible, which allows the chin to move forward and downward. Additionally, it allows an increase of the mentolabial angle and decreases the mentolabial fold.
Distraction Osteogenesis to Treat the Sequel of Early Undiagnosed Childhood Trauma
Authors: Al-Tamimi Bouthayna , Patel Brijesh , Mills Caroline
Published: February 2023

Undiagnosed trauma to the condylar head can later cause growth deficits secondary to mechanical restrictions created by scarring and loss of motion. This case illustrates how through a multidisciplinary team effort, distraction osteogenesis was successfully used with a hybrid functional appliance to correct a mandibular asymmetry caused by early undiagnosed childhood trauma. An intra-oral distraction device was placed to lengthen the mandibular ramus and body. Following distraction, a hybrid functional orthodontic appliance was used during growth to correct the cant of the occlusal plane. The patient’s growth potential was advantageous in this case because it allowed for selective and controlled eruption on the deficient side using the hybrid functional appliance while impeding further vertical development on the left side by using a bite plane. This bite plane was serially reduced to achieve gradual eruption of the maxillary teeth and alveolar process. In this way, the patient’s own growth potential was harnessed to correct the maxillary cant, which, if left uncorrected, would have necessitated orthognathic surgery once skeletal growth was complete. Through liaison with the surgeon and the orthodontist, there was substantial improvement in facial symmetry and occlusion.
Predicting Final Implant Volume in Two-stage Prepectoral Breast Reconstruction
Authors: Atia Andrew N. , Sergesketter Amanda R. , Morris Miranda X. , Biswas Sonali , Zhang Gloria , Langdell Hannah C. , Hollins Andrew W. , Phillips Brett T.
Published: February 2023

Background:

Two-stage implant-based breast reconstruction remains the most commonly performed reconstructive modality following mastectomy. Although prior studies have explored the relationship between tissue expander (TE) features and permanent implant (PI) size in subpectoral reconstruction, no such study exists in prepectoral reconstruction. This study aims to identify pertinent TE characteristics and evaluate their correlations with PI size for prepectoral implant-based reconstruction.

Methods:

This study analyzed patients who underwent two-stage prepectoral tissue expansion for breast reconstruction followed by implant placement. Patient demographics and oncologic characteristics were recorded. TE and PI features were evaluated. Significant predictors for PI volume were identified using linear and multivariate regression analyses.

Results:

We identified 177 patients and 296 breast reconstructions that met inclusion criteria. All reconstructions were performed in the prepectoral plane with the majority using acellular dermal matrix (93.8%) and primarily silicone implants (94.3%). Mean TE size was 485.4 cm3 with mean initial fill of 245.8 cm3 and mean final fill of 454.4 cm3. Mean PI size was 502.9 cm3 with a differential fill volume (PI-TE) of 11.7 cm3. Multivariate analysis identified significant features for PI size prediction, including TE size (R2 = 0.60; P < 0.0001) and TE final fill volume (R2 = 0.57; P < 0.0001). The prediction expression for TE final fill and TE size was calculated as 26.6 + 0.38*(TE final fill) + 0.61*(TE size).

Conclusions:

TE size and final expansion volume were significant variables for implant size prediction. With prepectoral implant placement gaining popularity, the predictive formula may help optimize preoperative planning and decision-making in prepectoral reconstructions.
Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery
Authors: Kennedy Diana , Novak Christine B. , Phillips John H. , Der Tara , Forrest Christopher R.
Published: February 2023

Background:

Pediatric craniofacial surgery performed in tertiary care centers by dedicated teams is associated with high levels of safety and low rates of mortality. However, catastrophic and life-threatening events may occur as a result of surgical management of these complex patients. This study reviewed the incidence and acute outcomes of catastrophic and critical events during craniofacial surgery at a single high-volume center.

Methods:

The data reviewed included the operative procedures of two senior craniofacial surgeons over an 18-year period at a tertiary care pediatric craniofacial center. Catastrophic or critical intraoperative events were defined as events requiring the activation of an emergency code during surgery. The operative details and acute outcomes were reviewed and analyzed.

Results:

This study reviewed 7214 procedures performed between January 2002 and January 2019. There were 2072 (29%) cases classified as major craniofacial procedures (transcranial, mixed trans-and-extracranial, or major extracranial facial osteotomies), and code events occurred in 14 cases (0.67%; one in 148 patients): venous air embolism (n = 4), cardiac complications (n = 3), major hemorrhage (n = 3), trigeminocardiac reflex (n = 2), acute intracranial hypertension (n = 1), and acute airway obstruction (n = 1). Two cases (14%) experienced a critical event that was anesthesia-related. Cardiac arrest requiring compressions and/or defibrillation was necessary for eight patients. There were no mortalities. Surgery was curtailed in seven cases and successfully completed in seven patients.

Conclusions:

Catastrophic life-threatening events during pediatric craniofacial surgery are, fortunately, rare. In our institution, experienced teams in the management of catastrophic and critical intraoperative events during major pediatric craniofacial procedures resulted in no mortalities.
Minimally Required Personal Protective Equipment during Local Anesthesia Surgery in COVID-19: A Simulation Study
Authors: Shyr Bor-Uei , Yeh Yi-Ting , Teng Wei-Nung , Liu Chin-Su , Chen Paul Chih-Hsueh , Huang Ling-Ju , Tseng Ling-Ming , Ma Hsu
Published: February 2023

Background:

In the era of the coronavirus disease 2019 (COVID-19) pandemic, surgeons and medical staff are often at a high risk of infection in the operating room, especially when the patient is spontaneously breathing. In this study, we examined the minimum requirements for personal protective equipment with double surgical masks to potentially reduce unnecessary waste of supplies.

Methods:

Two mannequins were each connected to a test lung machine simulating a surgeon and patient with spontaneous breathing. An aerosol generator containing severe acute respiratory syndrome coronavirus 2 virion particle substitutes was connected to the patient mannequin. The sampling points for the target molecules were set at different distances from the patient mannequin and sent for multiplex quantitative polymerase chain reaction analysis. Three clinical scenarios were designed, which differed in terms of the operating room pressure and whether a fabric curtain barrier was installed between the mannequins.

Results:

Analysis of the multiplex quantitative polymerase chain reaction results showed that the cycle threshold (Ct) value of the target molecule increased as the distance from the aerosol source increased. In the negative-pressure operating room, the Ct values were significantly increased at all sample points compared with the normal pressure room setting. The Ct value sampled at the surgeon mannequin wearing double face masks was significantly increased when a cloth curtain barrier was set up between the two mannequins.

Conclusion:

Double surgical masks provide elementary surgeon protection against COVID-19 in a negative pressure operating room, with a physical barrier in place between the surgeon and patient who is spontaneously breathing during local anesthesia or sedated surgery.
Multimodal Management of Facial Keloid with Tissue Expansion, Excision, and Injection of 5-FU and Triamcinolone
Authors: Marquez Jessica L. , Sudduth Jack D. , Ormiston Laurel , Patel Bhupendra Ck , Gociman Barbu
Published: February 2023

Keloids are benign, fibroproliferative dermal growths that occur in response to injury of the skin. These hypertrophic scars can cause pain and discomfort and have been associated with negative effects on social well-being, prompting physicians to seek effective treatment modalities with minimal risk of recurrence. Although surgical excision of the keloid initially removes the scar tissue, surgery alone triggers a fibroproliferative response similar to the initial insult, resulting in a high recurrence rate. Thus, a multimodal approach may be most appropriate when surgery is indicated to limit recurrence. We present the successful treatment of recalcitrant keloid formation of the face that was treated with tissue expansion, excision, and intralesional triamcinolone and 5-flurouracil injections.
SARS-CoV-2 vaccine alleviates disease burden and severity in liver transplant recipients even with low antibody titers
Authors: Khalaileh Abed , Imam Ashraf , Jammal Alaa , Hakimian David , Amer Johnny , Shafrir Asher , Milgrom Yael , Massarwa Muhammad , Hazou Wadi , Khader Majd , Safadi Rifaat
Published: February 2023

Background and Aims:

We retrospectively assessed the clinical Pfizer’s mRNA SARS-CoV-2 BNT162b2 vaccination outcomes and the serologic impact on liver transplant (LT) recipients.

Patients and Methods:

One hundred and sixty-seven LT cases followed between March 1, 2020 and September 25, 2021, and were stratified into two groups: (1) 37 LT recipients after SARS-CoV-2 infection before vaccine era and (2) 130 LT recipients vaccinated with 2 doses without earlier SARS-CoV-2 exposure. Serum SARS-CoV-2 spike immunoglobulins (anti-S) were assessed 7 days following vaccination (Liaison assay).

Results:

In addition to the 37 nonvaccinated cases (22.2% of total group) who experienced SARS-CoV-2 infection (34 symptomatic and 3 asymptomatic), another 8 vaccinated symptomatic recipients (4.8%) were infected (5 from the third and three from the fourth waves). Three of the 45 infected cases died (6.7%) before the vaccine program. Vaccinated group: of the 130 LT vaccinated recipients, 8 (6.2%) got infected postvaccination (added to the infected group) and were defined as clinical vaccine failure; 38 (29.2%) were serological vaccine failure (total failure 35.4%), and 64.6% cases were serological vaccine responders (anti-S≥19 AU/mL). Longer post-LT interval and lower consumption of immunosuppressants (steroids, FK506, and mycophenolate mofetil) correlated with favorable SARS-CoV-2 vaccine response. Mammalian target of rapamycin inhibitors improved vaccine outcomes associated with lower FK506 dosages and serum levels. Patients with anti-S levels <100 AU/mL risked losing serologic response or being infected with SARS-CoV-2. A booster dose achieved an effective serologic response in a third of failures and most responders, securing better and possibly longer protection.

Conclusion:

Pfizer’s BNT162b2 vaccine seems to lessen SARS-CoV-2 morbidity and mortality of LT recipients even with weak serological immunogenicity. Switching mycophenolate mofetil to mammalian target of rapamycin inhibitors might be effective before boosters in vaccine failure cases. A booster vaccine should be considered for nonresponders and low-responders after the second dose.
Development and validation of a primary sclerosing cholangitis-specific health-related quality of life instrument: CLDQ-PSC
Authors: Younossi Zobair M. , Stepanova Maria , Younossi Issah , Racila Andrei
Published: February 2023

Objectives:

To understand the full impact of primary sclerosing cholangitis (PSC) on patients’ health, it is important to assess their health-related quality of life (HRQL). Using the Chronic Liver Disease Questionnaire (CLDQ), we aimed to develop and validate a PSC-specific HRQL instrument.

Methods:

Previously collected clinical and patient-reported outcome data from PSC patients were used. The original CLDQ with 29 items was subjected to item reduction, followed by factor analysis. A standard HRQL instrument validation pipeline was then applied to the new CLDQ-PSC.

Results:

There were 100 PSC patients (44±13 y, 32% male, 79% college educated, 39% cirrhosis, 67% inflammatory bowel disease, 66% ulcerative colitis, and 50% on ursodeoxycholic acid After item reduction and exploratory factor analysis, there were 24 items and 5 factors left; based on factor loadings, the factors were named emotional function, fatigue, symptoms, worry, and sleep. Internal consistency assessment returned Cronbach alpha 0.85–0.94, item-to-own domain correlations >0.66 for 22/24 items. Known-groups validity suggests discrimination between PSC patients with and without cirrhosis or its complications, obesity, history of depression, weight loss, and PSC patients on versus not on ursodeoxycholic acid (p<0.05 for all or select CLDQ-PSC domains). Relevant items of Short Form-36 and CLDQ-PSC were highly correlated (all p<0.0001). Matching with items of another PSC-specific instrument (PSC-patient-reported outcome; 42 items) for relevance and redundancy suggests that CLDQ-PSC is a relevant, comprehensive, and short HRQL instrument, which can be used for patients with PSC.

Conclusions:

The CLDQ-PSC is a PSC-specific HRQL instrument that was developed using an established methodology and demonstrated good psychometric characteristics.
Association between blood pressure and angiotensin-converting enzymes activity in prepubertal children∗
Authors: Gaspar Ana R. , Andrade Beatriz , Mosca Sara , Ferreira-Duarte Mariana , Teixeira Ana , Cosme Dina , Albino-Teixeira António , Ronchi Fernanda A. , Leite Ana P. , Casarini Dulce E. , Areias José C. , Sousa Teresa , Afonso Alberto C. , Morato Manuela , Correia-Costa Liane
Published: February 2023

Objectives:

Angiotensin-converting enzymes’ (ACEs) relationship with blood pressure (BP) during childhood has not been clearly established. We aimed to compare ACE and ACE2 activities between BMI groups in a sample of prepubertal children, and to characterize the association between these enzymes’ activities and BP.

Methods:

Cross-sectional study of 313 children aged 8–9 years old, included in the birth cohort Generation XXI (Portugal). Anthropometric measurements and 24-h ambulatory BP monitoring were performed. ACE and ACE2 activities were quantified by fluorometric methods.

Results:

Overweight/obese children demonstrated significantly higher ACE and ACE2 activities, when compared to their normal weight counterparts [median (P25−P75), ACE: 39.48 (30.52–48.97) vs. 42.90 (35.62–47.18) vs. 43.38 (33.49–49.89) mU/ml, P for trend = 0.009; ACE2: 10.41 (7.58–15.47) vs. 21.56 (13.34–29.09) vs. 29.00 (22.91–34.32) pM/min per ml, P for trend < 0.001, in normal weight, overweight and obese children, respectively]. In girls, night-time systolic BP (SBP) and diastolic BP (DBP) increased across tertiles of ACE activity (P < 0.001 and P = 0.002, respectively). ACE2 activity was associated with higher night-time SBP and DBP in overweight/obese girls (P = 0.037 and P = 0.048, respectively) and night-time DBP in the BMI z-score girl adjusted model (P = 0.018). Median ACE2 levels were significantly higher among nondipper girls (16.7 vs. 11.6 pM/min per ml, P = 0.009).

Conclusions:

Our work shows that obesity is associated with activation of the renin−angiotensin−aldosterone system, with significant increase of ACE and ACE2 activities already in childhood. Also, we report sex differences in the association of ACE and ACE2 activities with BP.
Training, detraining and retraining effects of moderate vs. high intensity exercise training programme on cardiovascular risk factors
Authors: Ávila-Gandía Vicente , Ramos-Campo Domingo Jesús , García-Sánchez Esther , Luque-Rubia Antonio Jesús , López Asensio , López-Román Francisco Javier
Published: February 2023

Background:

The aim of the present study was to analyse the effect of 12 weeks of training, 7 weeks of detraining and 16 weeks of retraining using a moderate or high intensity training programme on cardiovascular risk factors in hypertensive patients.

Method:

Thirty-four patients took part in the study. The intensity training was 80–90% of maximum heart rate for the high-intensity training (HIT) group (n = 15) and at 50–70% of maximum heart rate for the moderate training (MT) group (n = 19). Blood pressure, body composition, lipid profile, fasting glucose, strength and cardiovascular fitness were analysed.

Results:

The first training period did not decrease blood pressure, but the second training period saw significant decreases in blood pressures in HIT group. Moreover, 12 weeks of MT or HIT did not decrease body mass, body mass index or fat mass. However, after 7 weeks of detraining, the inclusion of a second training period using HIT saw decreases in these body composition variables. Both training periods and intensities improved high-density lipoprotein and low-density lipoprotein, but only HIT decreased total cholesterol. In addition, after 7 weeks of detraining, the lipid profile variables returned to baseline values. Additionally, 16 weeks of retraining with HIT or MT decreased blood glucose significantly. Moreover, MT and HIT training programmes in both periods improved cardiorespiratory fitness, but with 7 weeks of detraining, it returned to baseline values.

Conclusion:

Our data demonstrated the effectiveness of the inclusion of a MT or HIT programme as adjuvant therapy in hypertensive patients.
Unilateral renal atrophy 4 years after renal sympathetic denervation: a case report
Authors: Zeijen Victor J.M. , Hirsch Alexander , Betjes Michiel G.H. , Daemen Joost
Published: February 2023

Renal sympathetic denervation (RDN) carries a low risk of renal artery stenosis, and most cases occur within the first year. However, limited data are available on long-term incidence. Here, we present a case of a 68-year-old woman who underwent radiofrequency RDN for resistant hypertension. Ambulatory blood pressure improved following RDN and uptitration of antihypertensive drugs. Between year 3 and 4 after RDN, eGFR reduced from 87 to 50 ml/min per 1.73 m2. Ultrasound imaging revealed left renal atrophy, while subsequent magnetic resonance angiography showed a haemodynamically significant stenosis of the left renal artery. The patient remained in good clinical condition with stable blood pressure, while eGFR mildly deteriorated during a 6-year follow-up period. This case of renal artery stenosis occurred in a patient with multiple risk factors. A causal relationship to the RDN procedure cannot be confirmed nor ruled out. Long-term surveillance for adverse events should be considered in all RDN patients.
One-month changes in blood pressure-adjusted pulse wave velocity for predicting long-term cardiovascular outcomes in patients undergoing percutaneous coronary intervention
Authors: Kim Hack-Lyoung , Joh Hyun Sung , Lim Woo-Hyun , Seo Jae-Bin , Kim Sang-Hyun , Zo Joo-Hee , Kim Myung-A
Published: February 2023

Objective:

The prognostic value of changes in arterial stiffness has not been well evaluated. This study was conducted to investigate whether the change in arterial stiffness one month after percutaneous coronary intervention (PCI) affects the long-term cardiovascular prognosis.

Methods:

A total of 405 patients (mean age, 62.0 ± 11.0 years; female sex, 27.7%) who underwent PCI with drug-eluting stent (DES) implantation was prospectively enrolled. The measurement of brachial-ankle pulse wave velocity (baPWV) was taken in all the study patient at the time of admission for index PCI. Major adverse cardiovascular event (MACE), a composite of cardiac death, nonfatal myocardial infarction, coronary revascularization and ischemic stroke, was assessed during clinical follow-up after index PCI.

Results:

During the median follow-up duration of 5.3 years (interquartile range. 2.9–7.9 years), there was 65 MACE (16.0%). There was no significant difference in clinical characteristics between patients with and without MACE except for higher prevalence of triple vessel disease in those with MACE. The baPWV value decreased at one month after index PCI (1560 ± 305 to 1530 ± 318 cm, P < 0.001). In multivariable cox regression analysis, the change of baPWV at one month was not associated with MACE occurrence (P > 0.05). However, the change in systolic blood pressure (SBP)-adjusted baPWV (baPWV/SBP) at one month (increased vs. decreased) was significantly associated with MACE occurrence even after controlling for potential confounders (hazard ratio, 2.25; 95% confidence interval, 1.37–3.69; P = 0.001).

Conclusion:

The baPWV/SBP change at one month was associated with long-term MACE in patients undergoing DES implantation. The results of this study suggest that baPWV/SBP changes at one month may be helpful in risk stratification of patients at a high coronary risk.
Effects of blood pressure unawareness and poor adherence to antihypertensive drugs on outcomes of cerebrovascular accidents among patients with their first-ever stroke
Authors: Bawand Rashed , Ghiasian Masoud , Khazaei Mojtaba , Samadyan Mustapha , Moradi Abbas
Published: February 2023

Aims:

Our main target was to investigate the relationship of blood pressure (BP) unawareness and poor antihypertensive drug adherence with the clinical outcomes of the stroke including hospitalization time, degree of disability, and mortality rate.

Methods and results:

In this cross-sectional study, we evaluated 530 eligible patients (male = 313; female = 217), aged 18 years and older who had a proven diagnosis of nontraumatic first-ever stroke and were referred to the Shahid Beheshti Hospital of Hamadan, Iran, during the period from March 2019 to September 2021. The prevalence of BP unawareness was 19.6%, and 31.8% of antihypertensive drug users (14.3% of all studied population) had poor drug adherence, in which, older age, male gender, marriage, rural residence, and smoking were associated with the lack of appropriate drug adherence. There was no significant difference between patients with diverse stroke types (ischemic or hemorrhagic) from the points of BP awareness and adherence to antihypertensive drugs; nevertheless, patients with a positive history of cardiac diseases had a significantly higher awareness of their BP status (P = 0.037). BP unawareness was associated with poor clinical prognosis, and could significantly increase stroke mortality (P = 0.001) and disability (P < 0.001) rates as well as the duration of hospitalization (P < 0.001). Moreover, those who survived the stroke (modified Rankin Scale < 6) had the highest odds to be aware of their BP status (adjusted odds ratio [AOR] = 2.380 [95% confidence interval [CI] = 1.39–4.07]). Additionally, nonsmokers (AOR = 7.740), urban residents (AOR = 3.314), and literate patients (AOR = 2.092) had the highest odds of having appropriate drug adherence.

Conclusion:

Stroke mortality and morbidity rates can be significantly modified by persuading people to monitor their BP regularly and maximize antihypertensive medication adherence. In the meantime, increasing the literacy level in society and reducing the smoking rate can play important roles in achieving these goals.
The effect of age, sex and BMI on the aldosterone-to-renin ratio in essential hypertensive individuals
Authors: Alnazer Rawan M. , Veldhuizen Gregory P. , de Leeuw Peter W. , Kroon Abraham A.
Published: February 2023

Objective:

The aldosterone-to-renin ratio (ARR) is widely used as a screening test for primary aldosteronism, but its determinants in patients with essential hypertension are not fully known. The purpose of the present investigation is to identify the impact of age, sex and BMI on renin, aldosterone and the ARR when measured under strict, standardized conditions in hypertensive patients without primary aldosteronism.

Methods:

We analysed the data of 423 consecutive hypertensive patients with no concomitant cardiac or renal disorders from two different hospitals (Rotterdam and Maastricht) who had been referred for evaluation of their hypertension. Those who were diagnosed with secondary causes of hypertension, including primary aldosteronism, were excluded from analysis. Patients who used oral contraceptives or had hormonal replacement therapy were excluded as well. Plasma aldosterone concentration (PAC), active plasma renin concentration (APRC) and the ARR were measured under standardized conditions. All measurements were taken in the supine position at 10.00 h in the morning, with one subgroup of patients adhering to a sodium-restricted diet (55 mmol/day) for no less than 3 weeks, and the other subgroup maintaining an ad libitum diet. In those who were receiving antihypertensive treatment, all medications were discontinued at least 3 weeks before testing.

Results:

In neither group did aldosterone correlate with age. Renin, however, was inversely related to age both during low-salt diet (P < 0.001) and during ad lib salt intake (P = 0.05). This resulted in a significant positive correlation between age and the ARR in both groups. Although on both dietary regimens, PAC and APRC were significantly higher in men when compared with women, the ARR was not significantly different between the two sexes. The age-relationships of renin and the ARR were comparable in men and women on both diets, albeit with greater variability in women. There was an upward trend between BMI and the ARR, which reached statistical significance only in men on low-salt diet. In multivariable regression analysis, age remained the only independent determinant of the ARR.

Conclusion:

In our essential hypertensive population, the ARR increased significantly with age but was not affected by sex or BMI.
Stagnating rates of blood pressure control in Australia: insights from opportunistic screening of 10 046 participants of the May Measurement Month campaigns
Authors: Carnagarin Revathy , Nolde Janis M. , Yang Jun , Marques Francine Z. , Picone Dean S. , Lambert Gavin W. , Beaney Thomas , Poulter Neil R. , Schutte Aletta E. , Reid Christopher M. , Brockman Derrin , Schlaich Markus P.
Published: February 2023

Background:

Raised blood pressure (BP) remains the single most important modifiable risk factor contributing to cardiovascular and all-cause mortality in Australia and worldwide. May Measurement Month, a global BP measurement and screening campaign initiated by the International Society of Hypertension and carried out in Australia since its inception in 2017, aimed at obtaining standardized BP measurements from members of the community to increase awareness of high BP and its associated risks.

Method:

Adults participants (≥18 years) were recruited through opportunistic sampling across Australia during the month of May in 2017, 2018 and 2019. Trained volunteers recorded BP readings in a standardized manner and collected data on demographic, lifestyle factors and comorbidities. Hypertension was defined as SBP of at least 140 mmHg, or DBP of at least 90 mmHg, or taking antihypertensive medication. Data were collated centrally and analysis was carried out using regression models to evaluate the associations between BP and participant characteristics.

Results:

A total of 10 046 participants were screened, of whom 3097 (31.0%) had hypertension, only 48.5% were aware of their condition and 44.4% were taking antihypertensive medication. Of those taking antihypertensive medication, 53.2% were controlled to less than 140/90 mmHg, whereas the remaining 46.8% of participants had BP of at least 140/90 mmHg suggestive of inadequately treated hypertension.

Conclusion:

Consecutive data obtained over a 3-year period in Australia demonstrated stagnating awareness, treatment and control rates with the latter two being substantially lower than global rates and those in other high-income countries. Concerted efforts from all stakeholders will be required to help overcome the unacceptably poor rates of BP treatment and control in Australia.
Call to focus on digital health technologies in hospitalized children's pain care: clinician experts' qualitative insights on optimizing electronic medical records to improve care
Authors: Pope Nicole , Korki de Candido Ligyana , Crellin Dianne , Palmer Greta , South Mike , Harrison Denise
Published: February 2023

Most hospitalized children experience pain that is often inadequately assessed and undertreated. Exposure to undertreated childhood pain is associated with negative short-term and long-term outcomes and can detrimentally affect families, health services, and communities. Adopting electronic medical records (EMRs) in pediatric hospitals is a promising mechanism to transform care. As part of a larger program of research, this study examined the perspectives of pediatric clinical pain experts about how to capitalize on EMR designs to drive optimal family-centered pain care. A qualitative descriptive study design was used and 14 nursing and medical experts from 5 countries (United States, Canada, United Kingdom, Australia, and Qatar) were interviewed online using Zoom for Healthcare. We applied a reflexive content analysis to the data and constructed 4 broad categories: “capturing the pain story,” “working with user-friendly systems,” “patient and family engagement and shared decision making,” and “augmenting pain knowledge and awareness.” These findings outline expert recommendations for EMR designs that facilitate broad biopsychosocial pain assessments and multimodal treatments, and customized functionality that safeguards high-risk practices without overwhelming clinicians. Future research should study the use of patient-controlled and family-controlled interactive bedside technology to and their potential to promote shared decision making and optimize pain care outcomes.
Heart rate variability is not suitable as a surrogate marker for pain intensity in patients with chronic pain
Authors: Moens Maarten , Billet Bart , Molenberghs Geert , De Smedt Ann , Pilitsis Julie G. , De Vos Ruben , Hanssens Karel , Billot Maxime , Roulaud Manuel , Rigoard Philippe , Goudman Lisa
Published: February 2023

The search towards more objective outcome measurements and consequently surrogate markers for pain started decades ago; however, no generally accepted biomarker for pain has qualified yet. The goal is to explore the value of heart rate variability (HRV) as surrogate marker for pain intensity chronic pain setting. Pain intensity scores and HRV were collected in 366 patients with chronic pain, through a cross-sectional multicenter study. Pain intensity was measured with both the visual analogue scale and numeric rating scale, whereas 16 statistical HRV parameters were derived. Canonical correlation analysis was performed to evaluate the correlation between the dependent pain variables and the HRV parameters. Surrogacy was determined for each HRV parameter with point estimates between 0 and 1 whereby values close to 1 indicate a strong association between the surrogate and the true endpoint at the patient level. Weak correlations were revealed between HRV parameters and pain intensity scores. The highest surrogacy point estimate was found for mean heart rate as marker for average pain intensity on the numeric rating scale with point estimates of 0.0961 (95% confidence interval [CI] 0.0384-0.1537) and 0.0209 (95% CI 0-0.05) for patients without medication use and with medication, respectively. This study indicated that HRV parameters as separate entities are no suitable surrogacy candidates for pain intensity, in a population of chronic pain patients. Further potential surrogate candidates and clinical robust true endpoints should be explored, to find a surrogate measure for the highly individual pain experience.
Cost Utility of Transcatheter Aortic Valve Replacement: Sapien 3 Versus CoreValve Evolut R
Authors: Posawatz David , Bloom Joshua , Massed Alison , Chatterjee Abhishek , Resor Charles , Zhan Yong , Weintraub Andrew , Kawabori Masashi
Published: February 2023

Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis. Previous studies compare clinical outcomes of leading TAVR valves, but there is no evidence of cost-utility comparison, leaving a clinical information gap when selecting valves. Here we share a cost-utility analysis comparing the Sapien 3 (S3) (Edwards Lifesciences, Irvine, CA) and CoreValve Evolut R (ER) (Medtronic, Dublin, IR) across five clinical endpoints. Utility scores from patient surveys and clinical outcomes from the literature were used to estimate quality-adjusted life years (QALYs) associated with successful procedure and postoperative complications for S3 and ER. A decision tree was constructed with rollback analysis to highlight the more cost-effective strategy. An incremental cost-utility ratio (ICUR) analysis was performed with a willingness to pay at $50,000. Deterministic and probabilistic sensitivity analyses were performed to validate robustness of results and account for uncertainty. S3 was found to be more costly ($68,377 vs. $66,072), but more effective (1.87 vs. 1.66) compared with ER. An ICUR of 11,288.12 favored S3, making it the more cost-effective option with a moderate confidence of 73.68% in Monte Carlo analysis. Cost-utility analysis can be used to aid in healthcare economics decision-making when selecting between comparable technologies used for TAVR procedures.
What is really new in triglyceride guidelines?
Authors: Hussain Aliza , Al Rifai Mahmoud , Hermel Melody , Slipczuk Leandro , Virani Salim S.
Published: February 2023

Purpose of review

In this review, we will summarize some of the landmark clinical trials of triglyceride-lowering therapies and review updates in clinical guidelines with regards to treatment of elevated triglyceride levels.

Recent findings

Accumulating evidence from epidemiologic and Mendelian randomization studies has shown that triglyceride and are causally linked to atherosclerotic cardiovascular disease (ASCVD) and contribute to atherosclerosis. However, most clinical trials evaluating use of triglyceride-lowering therapies, including fibrates, niacin and fish oils [combined eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] have not been able to demonstrate significant cardiovascular risk reduction. REDUCE-IT is the only randomized clinical trial that showed significant cardiovascular benefit with the use of icosapent ethyl esters (a purified EPA), in patients with ASCVD or diabetes with elevated risk on maximally tolerate statin.

Current guidelines and expert consensus documents from multiple societies strongly endorse therapeutic lifestyle interventions to effectively lower TG as the first-line therapy for treatment of hypertriglyceridemia. Evaluation and treatment of secondary causes of hypertriglyceridemia including optimal glycaemic control is crucial. Statins lower ASCVD risk in patients with elevated triglycerides and are first-line for treatment of elevated triglyceride. In a patient with residual mild to moderate hypertriglyceridemia on maximally tolerate statin and elevated cardiovascular risk icosapent, ethyl ester may be used for further ASCVD risk reduction.
Role of 18F-fluorodeoxyglucose PET/computed tomography in the diagnosis and treatment response assessment of primary bone lymphoma
Authors: Pu Yongzhu , Wang Chun , Xie Ran , Zhao Sheng , Li Kun , Yang Conghui , Li Jindan , Xiang Anshi , Wang Yasong , Chen Long , Sun Hua
Published: February 2023

Objective

Primary bone lymphoma (PBL) is a rare type of extranodal lymphoma, and the clinical application value of 18F-fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) in PBL has not been fully evaluated. This study aimed to determine the imaging characteristics of PBL and investigate the value of 18F-FDG PET/CT parameters.

Methods

A total of 25 patients with PBL who underwent PET/CT examination before treatment were included in this study. The clinicopathological parameters and PET/CT parameters were analyzed.

Results

Among the 25 patients, 7 patients had single lesions, 15 patients had nonsingle lesions (≥2) and 3 patients had diffuse distribution in the medullary cavity. The bone destruction types included osteolytic, osteogenic, normal density, mixed lytic and osteogenic. All patients showed increased FDG uptake, and the CT detection rate was 88%. Five patients underwent PET/CT assessment mid-treatment, and when assessed using the Deauville five-point scale, four patients were PET-negative and one patient was PET-positive. There were two PET-positive and three PET-negative patients when assessed using the Δ maximum standardized uptake value (SUVmax) method. Six patients underwent PET/CT imaging at the end of treatment. When assessed using the Deauville five-point scale, five patients (83%) were PET-negative and one patient (17%) was PET-positive. The same results were obtained when evaluated by the ΔSUVmax method.

Conclusion

PET/CT plays a substantial role in the diagnosis and treatment efficacy evaluation of PBL, and it should be recognized by clinicians and radiologists. Changes in metabolic parameters such as SUV, metabolic tumor volume and total lesion glycolysis have considerable potential for application in PBL diagnostics and treatment efficacy evaluation.
Neonatal Golden Hour: a review of current best practices and available evidence
Authors: Lamary Michelle , Bertoni C. Briana , Schwabenbauer Kathleen , Ibrahim John
Published: February 2023

Purpose of review

Recommendations made by several scientific bodies advocate for adoption of evidence-based interventions during the first 60 min of postnatal life, also known as the ‘Golden Hour’, to better support the fetal-to-neonatal transition. Implementation of a Golden Hour protocol leads to improved short-term and long-term outcomes, especially in extremely premature and extreme low-birth-weight (ELBW) neonates. Unfortunately, several recent surveys have highlighted persistent variability in the care provided to this vulnerable population in the first hour of life.

Recent findings

Since its first adoption in the neonatal ICU (NICU) in 2009, published literature shows a consistent benefit in establishing a Golden Hour protocol. Improved short-term outcomes are reported, including reductions in hypothermia and hypoglycemia, efficiency in establishing intravenous access, and timely initiation of fluids and medications. Additionally, long-term outcomes report decreased risk for bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP).

Critical to the success and sustainability of any Golden Hour initiative is recognition of the continuous educational process involving multidisciplinary team collaboration to ensure coordination between providers in the delivery room and beyond. Standardization of practices in the care of extremely premature neonates during the first hour of life leads to improved outcomes.

Video Abstract

http://links.lww.com/MOP/A68.
Physical Fitness Among Adolescents Who are Hispanic With Overweight or Obesity
Authors: Benzo Roberto M. , St. George Sara M. , Messiah Sarah E. , Lovan Padideh , Leite Rafael , Patel Anmol , Lee Tae K. , Prado Guillermo J.
Published: February 2023

Purpose:

To describe cardiorespiratory, strength, muscular endurance, and flexibility fitness outcomes in a sample of adolescents who are Hispanic aged 11 to 15 years with overweight or obesity, stratified by age and sex.

Methods:

The sample included 280 adolescents (mean age: 13.0 ± 0.83 years, mean body mass index percentile: 94.6). Anthropometric measures included height, weight, body mass index percentile, and waist and hip circumference. Fitness measures included handgrip strength, sit-ups in 60 seconds, sit-and-reach test, and 6-minute walk test. We report mean scores for each fitness outcome measure and correlation coefficients with anthropometric measures.

Results:

Mean handgrip was 23.7 ± 6.48 kg, sit-and-reach test was 25.3 ± 8.13 cm, average sit-ups in 60 seconds were 19.4 ± 9.28, and 6-minute walk distance was 1960 ± 271 ft. Males outperformed females in all tests except sit-and-reach test.

Discussion:

Compared with published fitness values of healthy weight adolescents, our sample of adolescents who are Hispanic with overweight/obesity living in southern Florida is unconditioned in terms of cardiorespiratory fitness, strength, muscular endurance, and flexibility.
Barriers and Facilitators to the Acceptance of eHealth Interventions by Dutch Pediatric Physical Therapists in Times of the COVID-19 Pandemic: A Mixed-Methods Approach
Authors: Pelckmans Maud , Nijmolen Petra , Bloemen Manon , Kuijpers Eline , Meershoek Agnes , Rameckers Eugene
Published: February 2023

Background:

The COVID-19 pandemic created an urgent need for eHealth as the relevance of infection control and social distancing continues. Evidence describing the acceptability of implementing eHealth into pediatric physical therapy services is limited.

Purpose:

To investigate the determinants of eHealth acceptance by Dutch pediatric physical therapists during the COVID-19 pandemic.

Methods:

A mixed-methods approach was used. It included a quantitative exploratory questionnaire of 154 pediatric physical therapists and qualitative in-depth interviews of 16 pediatric physical therapists.

Results:

The eHealth interventions were beneficial for collaboration between health care professionals and face-to-face therapy. eHealth interventions were, however, found to be unsuitable especially in the diagnostic phase. Barriers to more extensive application include costs, technical difficulties, and a perceived negative attitude of children.

Conclusion:

Pediatric physical therapists used eHealth interventions extensively in times of the COVID-19 pandemic. However, the acceptance of eHealth interventions is dependent on the pediatric physical therapist's perception of usefulness in private practice, rehabilitation setting, or clinical hospital.