bluuebunny/crossref_metadata_2025 huggingface dataset:
S7.1d Reliability of bedside point-of-care tests for Candida neoformans , M. tuberculosis and S. pneumoniae in adults living with HIV presenting with suspected central nervous system infection (CNS) in low- and middle-income settings: Preliminary results from the DREAMM study
Authors: Leclere Aude Sturny , Beaumont Emma , Cohen Jérémie F. , Kanyama Cecilia , Mfinanga Sayoki , Kouanfack Charles , Lesikari Sokoine , Nyirenda Saulos , Phiri Samuel , Boyer-Chammard Timothée , Molloy Síle , Hosseinipour Mina , Bradley John , Jaffar Shabbar , Harrison Thomas , Lortholary Olivier , Loyse Angela
Published: September 2022

S7.1 Update in management of fungal infection in adult hematology, September 23, 2022, 10:30 AM - 12:00 PM

 

Background

Bedside point-of-care (POC) testing, with parallel laboratory testing, represents a unique opportunity to improve and speed up the diagnostic workup of people living with HIV with suspected CNS infection in resource-limited settings.

Objectives

To assess the agreement between POC tests for Cryptococcus neoformans, Mycobacterium tuberculosis, and Streptococcus pneumoniae performed at the bedside and in the routine laboratory, in African low- and middle-income countries (LMICs).

Methods

From January 2018 to March 2021, the following POC tests were performed in parallel at the bedside and in the routine laboratory: Cryptococcal antigen lateral flow assay (CrAg LFA, Immy) in blood and cerebrospinal fluid (CSF), tuberculosis lipoarabinomannan (TB-LAM, Alere) in urine, and, where indicated, pneumococcal antigen (Streptococcus pneumoniae (SP), Biosynex) in CSF.

Participants: HIV-infected adults (>18 years old) suspected of CNS infection.

Setting: The prospective multicenter DREAMM project (Driving Reduced AIDS Meningo-Encephalitis Mortality) in five hospital sites in Cameroon, Malawi, and Tanzania.

Primary outcome: Cohen's kappa statistic of agreement between the results of POC tests obtained at the bedside and the routine laboratory.

Results

The study included 356 consecutive participants (mean age 39.5 +/- 10 years; 68.7% ART-experienced; 46.3% male; median CD4 count 75/mm3; abnormal mental status 75%). In total, 148/355 (41.7%) participants had positive bedside CrAg in blood, 140/315 (44.4%) positive bedside CrAg in CSF, 64/339 (18.9%) positive bedside TB-LAM in urine, and 10/175 (5.7%) positive bedside SP in CSF. Kappa statistics evaluating agreement between bedside and laboratory test results were: 0.98 [95% confidence interval (CI) 0.96-1.00; n = 347] for blood CrAg, 0.99 (95%CI, 0.98-1.00; n = 307) for CSF CrAg, 0.92 (95% CI, 0.87-0.98; n = 330) for urinary TB-LAM, and 0.68 (95%CI, 0.40-0.96; n = 34) for CSF SP.

Conclusions

Bedside POC tests for Cryptococcus spp. are highly reliable and can be safely performed in parallel to laboratory testing to expedite targeted treatment in people living with HIV with suspected CNS infection in African LMICs. Other bedside POC tests need further evaluation before large-scale implementation.
The structure at the centre of the giant radio galaxy GRS J0844+4627: a compact symmetric object?
Authors: Marecki A , Sebastian B , Ishwara-Chandra C H
Published: September 2022

We observed the core region of the giant radio galaxy GRS J0844+4627 with e-MERLIN at 1.52 and 5.07 GHz. These observations revealed that the apparent single feature at the centre of GRS J0844+4627, as seen by GMRT, consists of two components separated by 2.7 kpc in projection. Follow-up observations at 1.66 GHz using the EVN unveiled the complex morphologies of the two components. In particular, the south-western component identified with the SDSS J084408.85+462744.2 galaxy morphologically resembles a compact symmetric object (CSO) with a projected linear size of 115 pc. If the CSO hypothesis turns out to be correct, then the overall radio structure of GRS J0844+4627 is triple–double. Given that CSOs are considered young objects, GRS J0844+4627 would appear as a recently restarted active galaxy.
Genomes From Historic DNA Unveil Massive Hidden Extinction and Terminal Endangerment in a Tropical Asian Songbird Radiation
Authors: Wu Meng Yue , Lau Clara Jesse , Ng Elize Ying Xin , Baveja Pratibha , Gwee Chyi Yin , Sadanandan Keren , Ferasyi Teuku Reza , Haminuddin  , Ramadhan Rezky , Menner Jochen K , Rheindt Frank E
Published: September 2022

Quantifying the magnitude of the global extinction crisis is important but remains challenging, as many extinction events pass unnoticed owing to our limited taxonomic knowledge of the world’s organisms. The increasing rarity of many taxa renders comprehensive sampling difficult, further compounding the problem. Vertebrate lineages such as birds, which are thought to be taxonomically well understood, are therefore used as indicator groups for mapping and quantifying global extinction. To test whether extinction patterns are adequately gauged in well-studied groups, we implemented ancient-DNA protocols and retrieved whole genomes from the historic DNA of museum specimens in a widely known songbird radiation of shamas (genus Copsychus) that is assumed to be of least conservation concern. We uncovered cryptic diversity and an unexpected degree of hidden extinction and terminal endangerment. Our analyses reveal that >40% of the phylogenetic diversity of this radiation is already either extinct in the wild or nearly so, including the two genomically most distinct members of this group (omissus and nigricauda), which have so far flown under the conservation radar as they have previously been considered subspecies. Comparing the genomes of modern samples with those from roughly a century ago, we also found a significant decrease in genetic diversity and a concomitant increase in homozygosity affecting various taxa, including small-island endemics that are extinct in the wild as well as subspecies that remain widespread across the continental scale. Our application of modern genomic approaches demonstrates elevated levels of allelic and taxonomic diversity loss in a songbird clade that has not been listed as globally threatened, highlighting the importance of ongoing reassessments of extinction incidence even across well-studied animal groups.

Key words: extinction, introgression, white-rumped shama, conservation.
EGFR, the Lazarus target for precision oncology in glioblastoma
Authors: Lin Benjamin , Ziebro Julia , Smithberger Erin , Skinner Kasey R , Zhao Eva , Cloughesy Timothy F , Binder Zev A , O’Rourke Donald M , Nathanson David A , Furnari Frank B , Miller C Ryan
Published: September 2022

The Lazarus effect is a rare condition that happens when someone seemingly dead shows signs of life. The epidermal growth factor receptor (EGFR) represents a target in the fatal neoplasm glioblastoma (GBM) that through a series of negative clinical trials has prompted a vocal subset of the neuro-oncology community to declare this target dead. However, an argument can be made that the core tenets of precision oncology were overlooked in the initial clinical enthusiasm over EGFR as a therapeutic target in GBM. Namely, the wrong drugs were tested on the wrong patients at the wrong time. Furthermore, new insights into the biology of EGFR in GBM vis-à-vis other EGFR-driven neoplasms, such as non-small cell lung cancer, and development of novel GBM-specific EGFR therapeutics resurrects this target for future studies. Here, we will examine the distinct EGFR biology in GBM, how it exacerbates the challenge of treating a CNS neoplasm, how these unique challenges have influenced past and present EGFR-targeted therapeutic design and clinical trials, and what adjustments are needed to therapeutically exploit EGFR in this devastating disease.
The Role of Race and Insurance Status in Access to Genetic Counseling and Testing Among High-Risk Breast Cancer Patients
Authors: Choi Jihoon J , Fikre Tsion , Fischman Alexandra , Buck Anne K , Ko Naomi Y
Published: September 2022

Purpose

The role of germline genetic testing in breast cancer patients is crucial, especially in the setting of the recent trials showing the benefit of PARP inhibitors. The goal of this study was to identify racial disparities in genetic counseling and testing in patients with high-risk breast cancer.

Methods

Patients with 2 unique breast cancer diagnoses were examined to understand demographics, insurance coverage, characteristics of breast cancer, and whether they were recommended for and received genetic counseling and testing.

Results

A total of 69 patients with a dual diagnosis of breast cancer between the years 2000 and 2017 were identified (42% identified as White compared to 58% that identified as non-White). White patients were more likely to be recommended for genetic counseling (OR = 2.85; 95% CI, 1.07-7.93, P < .05), be referred for genetic counseling (OR = 3.17; 95% CI, 1.19-8.86, P < .05), receive counseling (OR = 3.82; 95% CI, 1.42-10.83, P < .01), and undergo genetic testing (OR = 2.88; 95% CI, 0.97-9.09, P = .056) compared to non-White patients. Patients with private insurance were significantly more likely to be recommended for genetic counseling (OR 5.63, P < .005), referred (OR 6.11, P < .005), receive counseling (OR 4.21, P < .05), and undergo testing (OR 4.10, P < .05). When controlled for insurance, there was no significant racial differences in the rates of GC recommendation, referral, counseling, or testing.

Conclusion

The findings of this study suggest that disparities in genetic counseling and testing are largely driven by differences in health insurance.
Inhibition of the Phosphatidylinositol-3 Kinase Pathway Using Bimiralisib in Loss-of-Function NOTCH1-Mutant Head and Neck Cancer
Authors: Johnson Faye M , Janku Filip , Gouda Mohamed A , Tran Hai T , Kawedia Jitesh D , Schmitz Debora , Streefkerk Hendrik , Lee J Jack , Andersen Clark R , Deng Defeng , Rawal Seema , Shah Pooja A , El-Naggar Adel K , Johnson Jason M , Frederick Mitchell J
Published: September 2022

Background

PI3K/mTOR inhibition leads to apoptosis of NOTCH1-mutant head and neck squamous cell carcinoma (HNSCC) cells. We tested the efficacy of the PI3K/mTOR inhibitor bimiralisib in patients with NOTCH1-mutant HNSCC.

Methods

Patients with recurrent/metastatic NOTCH1-mutant HNSCC who had progressed during chemotherapy and immunotherapy received bimiralisib until unacceptable toxicity or progression. To assess whether NOTCH1 mutations can be detected in blood, we measured circulating tumor DNA (ctDNA). To assess activated NOTCH1 protein levels, we quantitated cleaved NOTCH1 (cl-NOTCH) by immunohistochemistry.

Results

Eight patients were treated, and 6 were evaluable for response. The objective response rate was 17%. For all 8 patients, median progression-free and overall survival was 5 and 7 months, respectively. Bimiralisib was well tolerated, with expected hyperglycemia. Pharmacokinetic values were consistent with published studies. NOTCH1 mutations were detected in 83.3% of ctDNA. Staining for tumor cl-NOTCH1 was negative. The trial closed early due to sponsor insolvency.

Conclusion

Although the trial was small, outcomes with bimiralisib were better than the historical standard of care; Results will need to be confirmed in a larger trial. The lack of cl-NOTCH1 was consistent with loss-of-function mutations and validated our mutation function algorithm. The ability to detect NOTCH1 mutations in blood will help future studies. (ClinicalTrials.gov Identifier: NCT03740100).
Grade 3/4 Adverse Event Costs of Immuno-oncology Combination Therapies for Previously Untreated Advanced Renal Cell Carcinoma
Authors: McGregor Bradley , Geynisman Daniel M , Burotto Mauricio , Porta Camillo , Suarez Cristina , Bourlon Maria T , Del Tejo Viviana , Du Ella X , Yang Xiaoran , Sendhil Selvam R , Betts Keith A , Huo Stephen
Published: September 2022

Background

Despite 4 approved combination regimens in the first-line setting for advanced renal cell carcinoma (aRCC), adverse event (AE) costs data are lacking.

Materials and Methods

A descriptive analysis on 2 AE cost comparisons was conducted using patient-level data for the nivolumab-based therapies and published data for the pembrolizumab-based therapies. First, grade 3/4 AE costs were compared between nivolumab + ipilimumab vs. nivolumab + cabozantinib vs. pembrolizumab + axitinib using data from the CheckMate 214 (median follow-up [mFU]: 13.1 months), CheckMate 9ER (mFU: 12.8 months), and KEYNOTE-426 (mFU: 12.8 months) trials, respectively. Second, grade 3/4 AE costs were compared between nivolumab + ipilimumab vs. nivolumab + cabozantinib vs. pembrolizumab + lenvatinib using data from the CheckMate 214 (mFU: 26.7 months), CheckMate 9ER (mFU: 23.5 months), and KEYNOTE-581 (mFU: 26.6 months) trials, respectively. Per-patient costs for all-cause and treatment-related grade 3/4 AEs with corresponding any-grade AE rates ≥ 20% were calculated based on the Healthcare Cost and Utilization Project database and inflated to 2020 US dollars.

Results

Per-patient all-cause grade 3/4 AE costs for nivolumab + ipilimumab vs. nivolumab + cabozantinib vs. pembrolizumab + axitinib were $2703 vs. $4508 vs. $5772, and treatment-related grade 3/4 AE costs were $741 vs. $2722 vs. $4440 over ~12.8 months of FU. For nivolumab + ipilimumab vs. nivolumab + cabozantinib vs. pembrolizumab + lenvatinib, per-patient all-cause grade 3/4 AE costs were $3120 vs. $5800 vs. $9285, while treatment-related grade 3/4 AE costs were $863 vs. $3162 vs. $5030 over ~26.6 months of FU.

Conclusion

Patients with aRCC treated with first-line nivolumab-based therapies had lower grade 3/4 all-cause and treatment-related AE costs than pembrolizumab-based therapies, suggesting a more favorable cost-benefit profile.
Cost-Effectiveness Analysis of Wait Time Reduction for Intensive Behavioural Intervention in Ontario
Authors: Piccininni C , Penner M
Published: September 2022

BACKGROUND: In Ontario, the Autism Intervention Program funds intensive behavioral intervention (IBI) for children severely affected by autism spectrum disorder (ASD). Accessing IBI before age four is associated with significantly better outcomes compared with later access; however, the average wait time for this program is 2.7 years. There have been no analyses modeling lifetime cost-effectiveness of wait time reduction for IBI.

OBJECTIVES: 1) Model the change in starting age for IBI with halved and eliminated wait times; 2) Perform a cost-effectiveness analysis (CEA) comparing wait time reduction and elimination to the current status quo from both provincial government and societal perspectives.

DESIGN/METHODS: Published wait list statistics were used to calculate average starting age for IBI for current wait time, wait time halved, and wait time eliminated. The target population was children diagnosed with severe ASD. The outcome modeled was independence measured in dependency-free life years (DFLYs) to age 65. To derive this, expected IQ was modeled for each comparator based on probability of early (< age 4) or late (4 or older) access to IBI. Probabilities of having an IQ in the normal (70+) or intellectual disability range (<70) were calculated. IQ strata were assigned probabilities of achieving an Independent (60 DFLYs), Semi-Dependent (30 DFLYs) or Dependent (0 DFLYs) outcome. Costs were determined from provincial government and societal perspectives. Parameters were inputted into a decision analytic model, with an annual discount rate of 3% applied to costs and DFLYs. Incremental cost-effectiveness ratios (ICERs) were determined for each strategy. One-way and probabilistic sensitivity analyses were performed to assess the impact of model uncertainty.

RESULTS: Average starting ages for IBI were determined to be 5.24 years for current wait time, 3.89 years for wait time halved, and 2.71 years for wait time eliminated. From the provincial government perspective, eliminated wait time was the dominant strategy, generating the most DFLYs for $6,500 less per individual than current wait time. From the societal perspective, eliminated wait time again dominated the other strategies, with lifetime savings of $38,000 per individual compared with current wait time. ICERs were most sensitive to uncertainty associated with probability of having an IQ greater than 70 and probability of achieving an independent outcome when IQ was greater than 70.

CONCLUSION: The results suggest that funding expanded program capacity would optimize the likelihood of positive IBI outcomes, improve future independence, and lessen the cost burden from provincial and societal perspectives.
Screens and Sleep: Are Interactive Screen Activities Associated with Short and Inefficient Sleep?
Authors: Irving R , Paquin S , Tesfaye R , Gruber R
Published: September 2022

BACKGROUND: Although sleep is essential for healthy development, school-aged children are not getting the recommended number of hours of sleep each night. There is evidence that screen-based activity use is associated with shorter sleep duration and poorer sleep quality in pediatric populations. Findings also suggest that using more interactive activities, such as video games, might be associated with shorter and less efficient sleep, when compared to more passive activities, such as watching television. Few studies have examined this connection in school-aged children and none have employed objective measurements of sleep.

OBJECTIVES: The aim of the present study was to assess the associations between devices that are different in their level of interactivity with quantity and quality of sleep. We hypothesized that more interactive screen activities will explain more of the variability in sleep efficiency and sleep duration compared to less interactive activities.

DESIGN/METHODS: Participants included 78 school-aged children (M=8.57, SD=1.81). Sleep was assessed objectively using actigraphy, a non-invasive device worn to examine sleep-wake patterns by measuring movement. Variables of interest included sleep duration and sleep efficiency. Time spent engaging in screen time activities was assessed via parental reports on the Children’s Leisure Activities Study Survey. Screen activities included time spent watching television/videos, playing video games, and using the computer.

RESULTS: Multiple linear regression analyses were performed to determine possible associations between screen activities and sleep variables. In the first analysis, longer time spent on computer use and playing video gameswas negatively associated with sleep duration (b= -0.04, p<.01; b = -0.05, p<.01, respectively) and the full model explained 24% of the variance. In a second analysis, using the computer was negatively associated with sleep efficiency (b = -0.01, p<.05) and the full model explained 14% of the variance.

CONCLUSION: The current study found that interactive screen activities, including video games playing and computer use, but not watching television, were associated with significantly shorter sleep duration and poorer sleep efficiency. These findings support previous research in school-aged children that suggests video games and other interactive activities are associated with short and inefficient sleep.
Phantom Experimental Study on Patient Doses Obtained from 320-Multidetector-Row Computed Tomography in Whole-Brain Perfusion Scan
Authors: Lu Heqing , Meng Ting , You Yang , Liu Ying , He Kai , Kan Yandong , Zhang Haowei
Published: September 2022

This study aimed to precisely evaluate organ dose and effective dose (E) obtained from a 320-multidetector-row computed tomography (CT) scanner in brain perfusion scans and to estimate the conversion factor (k) between E and dose length product (DLP). A total of 270 thermoluminescent dosemeters were implanted in a male anthropomorphic phantom to measure air kerma. The ratios of mass-energy absorption coefficients were used to convert air kerma into organ doses. The organ doses ranged from 0.01 to 150 mGy. Doses in brain, salivary glands and red bone marrow were relatively high, and dose in eye lens reached about 110 mGy. The resulting effective dose was 5.30 mSv. The resulting conversion factor k = (0.0022 ± 0.0002) mSv·(mGy·cm)−1 was not significantly different from that of 0.0021 mSv·(mGy·cm)−1 reported for head CT scan in ICRP Publication 102.
DIAGNOSTIC REFERENCE LEVELS OF RADIOGRAPHIC AND CT EXAMINATIONS IN SAUDI ARABIA: A SYSTEMATIC REVIEW
Authors: Alrehily Faisal
Published: September 2022

A systematic search was conducted to explore the literature on the existing diagnostic reference level (DRL) of radiographic and computed tomography (CT) examinations in Saudi Arabia. The search was performed using Web of Science, Scopus and EBSCO. The search identified 19 studies that reported DRL values for radiographic and CT examinations in Saudi Arabia. Six of those studies reported DRL values for projection radiography, and the remaining studies reported DRL values for CT examinations (n = 13). The entrance surface dose, volume CT dose index (CTDIvol) and dose-length product (DLP) were the most common methods used for establishing the DRLs. Variations were observed in the Saudi DRL values, and this is consistent with the DRL values reported in the literature. Educating and training radiographers to better understand dose minimizing techniques may result in lower patient doses and lower variances in DRL values.
Description and Utilization of Telewound Monitoring Services in Primary Care Patients with Acute Wounds in Singapore: A Retrospective Study
Authors: Zhu Xiaoli , Ren Barnabas Felix Soh Jia , Lim Voon Hooi , Wan Lili , Chen Yan , Wang Xiuhong , Weng Jiayi , Goh Ling Jia
Published: September 2022

OBJECTIVE

To describe an inaugural telewound monitoring service (TMS) designed for the remote monitoring of acute wounds to empower primary care patients, and identify factors associated with the utilization of the TMS.

METHODS

Retrospective data were collected from 204 patients who participated in the TMS between June 19, 2016 and August 31, 2017 and analyzed using both descriptive and multiple regression analysis.

RESULTS

The mean patient age was 27.9 years (SD, 12.4); wound area was 7.8 cm2 (SD, 21.2); and duration of healing was 11.7 days (SD, 6.9). A multiple regression model based on patients’ demographics and wound factors predicted which patients were likely to have more telewound sessions than face-to-face sessions. The model was statistically significant (F = 2.093 (11, 124), P = .025) with 15.7% of variance explained by the variables. An increase in age (P = .043) and increased days to healing (P = .043) were associated with a reduction in the number of telewound sessions.

CONCLUSIONS

The TMS is a valuable alternative to face-to-face wound care that enables patients with acute wounds to assume the roles of both patient and carer simultaneously. Age and healing duration are predictors for utilization of this service. Prompt attention to these predictors may improve service allocation and utilization.
Promoting Person-Centered Care for Health Baccalaureate Students: Piloting an Interprofessional Education Approach to Wound Management
Authors: Parker Christina N. , Johnston Sandra , Theobald Karen A.
Published: September 2022

OBJECTIVE

To describe and analyze the implementation of a wound management interprofessional education experience for nursing, podiatry, pharmacy, and exercise and nutrition science health baccalaureate students. The disciplines outside of nursing were invited to join the classes of a wound care elective unit in nursing.

METHODS

This study included the development and implementation of a wound care program and observation of all students enrolled in the health disciplines where wound management education was relevant.

RESULTS

Results indicated an increase in students’ recognition of their roles and the roles of others within an interprofessional healthcare team. Facilitators reported that students learned to share information and work collaboratively to plan care for people with wounds.

CONCLUSIONS

The outcomes confirm that the structured wound management program of interprofessional education within a Faculty of Health course promoted student recognition of wound management and the essential shared approach to person-centered care.
Effect of Combined Epidural Morphine and Midazolam on Postoperative Pain in Patients Undergoing Major Abdominal Cancer Surgery
Authors: Abdelemam Rania M. , Fares Khaled M. , Kamal Shereen M.
Published: September 2022

Objective:

The objective was to compare analgesic effect of combined epidural morphine-midazolam with either drug alone on postoperative pain in patients undergoing major abdominal cancer surgery.

Materials and Methods:

Eighty-four patients were allocated in prospective randomized double-blind study to receive epidural analgesia. Patients received 5 mg morphine in morphine (Mor) group, 5 mg midazolam in midazolam (Mid) group, 5 mg morphine + 5 mg midazolam in morphine-midazolam (MM) group, 0.25% bupivacaine was added to injected solution with same volume in all groups. All groups were compared with time of first analgesic request, total analgesic consumption, number of epidural doses, postoperative Visual Analog Scale score, and adverse events.

Results:

Time of first analgesic request was 4 to 8 hours in Mid versus 12 to 23 and 14 to 24 hours in Mor and MM groups, respectively, with significant difference between Mid versus Mor (P<0.001), Mid versus MM (P<0.001), and Mor versus MM groups (P<0.031). Analgesic consumption was more in Mid than Mor and MM groups, with significant difference between Mid versus Mor (P<0.008), Mid versus MM (P<0.001), with no significant difference between Mor and MM groups (P<0.6). The number of epidural doses in Mid was 1 to 3 versus 1 to 3, and 1 to 2 in Mor and MM groups, respectively, with significant difference between Mid versus Mor (P<0.025), Mid versus MM (P<0.004), with no significant difference between Mor and MM groups (P=1.0).

Conclusions:

Addition of midazolam to epidural morphine prolonged time of first analgesic request and decreased total analgesic consumption.
Does the technique of limb lengthening affect physeal growth in patient with achondroplasia? Comparison of the simultaneous and consecutive tibia and femur lengthening with external fixators
Authors: Balci Halil İbrahim , Anarat Fikret Berkan , Bayram Serkan , Eralp Levent , Şen Cengiz , Kocaoğlu Mehmet
Published: September 2022

We aimed to retrospectively investigate and compare patients who underwent bilateral simultaneous and consecutive lengthening surgery of the femur and tibia in terms of the effect on physeal growth. We hypothesize that compared with the sequential lengthening technique, simultaneous lengthening of the bilateral femur and tibia affects physeal growth to a greater extent. Twenty-six patients with achondroplasia who operated in our clinic between 1995 and 2015 for limb lengthening were included in the study. Fourteen patients with bilateral lengthening of the femur and tibia at the same time were named as simultaneous bilateral lengthening (SBL). Twelve patients with bilateral lengthening of the femur and then bilateral tibia lengthening in other sections or vice versa, at a different time was named consecutive bilateral lengthening (CBL). All patients were followed until at least 18 years old. The physeal arrest was measured with predicted final length at the first visit (investigated with the multiplier method), the total amount of lengthening, and final clinical, and radiological length. Mean limb lengthening was 145 mm (48.5%) and 151 mm (46.6%) for simultaneous and consecutive groups respectively. For lower extremity length, the first group reached 527.6 mm while the expected was 447.3 mm. Considering 151 mm lengthening, the mean growth disturbance for the SBL group was 70.7 mm and for the CBL group was 47.5 mm. For total height comparing between two groups, disturbance for height was 80.5 mm and 65.4 mm, respectively. Although there was no statistical difference, simultaneous bilateral femoral and tibial lengthening has more physiological physeal disturbance effects than consecutive lengthening in patients with achondroplasia.
Untreated congenital vertical talus deformity in walking age: minimally invasive method works
Authors: Cummings Jason L. , Hosseinzadeh Pooya
Published: September 2022

There is sparse literature evaluating the outcomes in toddlers with congenital vertical talus (CVT) deformity who undergo treatment with the recently introduced minimally invasive Dobbs Method. We present the first study of this patient cohort to determine the efficacy of this method in patients 18 months of age and older. A list of all patients over 18 months of age who underwent CVT correction at our institution was created. Retrospective chart review was performed, and all follow-up notes were reviewed for clinical outcomes and complications. Eligible patients completed Patient-Reported Outcome Measurement Information System (PROMIS) questionnaires. Statistical analysis was performed using an alpha of 0.05. Sixteen children (24 feet) met all inclusion criteria and were included in the final analysis. Initial radiographic correction of all measured angles was seen, but by the latest follow-up, the average lateral TAMBA had increased from 12.04 degrees immediately postoperatively to 28.8 degrees at the latest follow-up (P = 0.0012). Radiographic recurrence of deformity was seen in 9 (37.5%) feet and additional unplanned surgery was required in 3 (12.5%) feet. Residual radiographic pes planus was seen in 5 (20.8%) feet. PROMIS pain interference and peer relationship scores were near the population mean. Although the recurrence rate in this patient population seems to be higher than that of younger patients, the majority of toddlers who undergo treatment with this method do experience successful outcomes. We recommend attempting this treatment method in toddlers before performing extensive soft tissue releases or salvage procedures.
Individualised flow-controlled ventilation versus pressure-controlled ventilation in a porcine model of thoracic surgery requiring one-lung ventilation
Authors: Spraider Patrick , Martini Judith , Abram Julia , Putzer Gabriel , Ranalter Manuela , Mathis Simon , Hell Tobias , Barnes Tom , Enk Dietmar
Published: September 2022

BACKGROUND

Flow-controlled ventilation (FCV) enables precise determination of dynamic compliance due to a continuous flow coupled with direct tracheal pressure measurement. Thus, pressure settings can be adjusted accordingly in an individualised approach.

OBJECTIVE

The aim of this study was to compare gas exchange of individualised FCV to pressure-controlled ventilation (PCV) in a porcine model of simulated thoracic surgery requiring one-lung ventilation (OLV).

DESIGN

Controlled interventional trial conducted on 16 domestic pigs.

SETTING

Animal operating facility at the Medical University of Innsbruck.

INTERVENTIONS

Thoracic surgery was simulated with left-sided thoracotomy and subsequent collapse of the lung over a period of three hours. When using FCV, ventilation was performed with compliance-guided pressure settings. When using PCV, end-expiratory pressure was adapted to achieve best compliance with peak pressure adjusted to achieve a tidal volume of 6 ml kg−1 during OLV.

MAIN OUTCOME MEASURES

Gas exchange was assessed by the Horowitz index (= PaO2/FIO2) and CO2 removal by the PaCO2 value in relation to required respiratory minute volume.

RESULTS

In the FCV group (n = 8) normocapnia could be maintained throughout the OLV trial despite a significantly lower respiratory minute volume compared to the PCV group (n = 8) (8.0 vs. 11.6, 95% confidence interval, CI -4.5 to -2.7 l min−1; P < 0.001), whereas permissive hypercapnia had to be accepted in PCV (PaCO2 5.68 vs. 6.89, 95% CI -1.7 to -0.7 kPa; P < 0.001). The Horowitz index was comparable in both groups but calculated mechanical power was significantly lower in FCV (7.5 vs. 22.0, 95% CI -17.2 to -11.8 J min−1; P < 0.001).

CONCLUSIONS

In this porcine study FCV maintained normocapnia during OLV, whereas permissive hypercapnia had to be accepted in PCV despite a substantially higher minute volume. Reducing exposure of the lungs to mechanical power applied by the ventilator in FCV offers a possible advantage for this mode of ventilation in terms of lung protection.
Predicting personalised remifentanil effect site concentration for surgical incision using the nociception level index
Authors: Perrin Laurent , Bisdorff Max , Saxena Sarah , Tabolcea Ionut , Huybrechts Isabelle , Van Obbergh Luc , Engelman Edgard , Barvais Luc , Coeckelenbergh Sean
Published: September 2022

BACKGROUND

Inadequate antinociception can cause haemodynamic instability. The nociception level (NOL) index measures response to noxious stimuli, but its capacity to predict optimal antinociception is unknown.

OBJECTIVE

To determine if NOL index change to a tetanic stimulus in cardiac and noncardiac surgery patients could predict the required remifentanil concentration for haemodynamic stability at skin incision.

DESIGN

A prospective two-phase cohort study.

SETTING

University hospital.

PATIENTS

Patients undergoing remifentanil-propofol target controlled infusion (TCI) anaesthesia.

INTERVENTIONS

During the calibration phase, investigators evaluated the tetanic stimulus induced NOL index change under standardised TCI remifentanil-propofol anaesthesia during a no-touch period [bispectral index (BIS) between 40 and 60, NOL index under 15]. If the NOL index change was 20 or greater following tetanic stimulation, investigators repeated the tetanus at higher remifentanil concentrations until the response was blunted. Surgeons incised the skin at this remifentanil concentration. The investigators derived a prediction model and in the validation phase calculated, using the NOL response to a single tetanus, the required incision remifentanil concentration for the start of surgery.

MAIN OUTCOME

Haemodynamic stability at incision [i.e. maximum heart rate (HR) < 20% increase from baseline, minimum HR (40 bpm) and mean arterial pressure (MAP) ± <20% of baseline].

RESULTS

During the calibration phase, no patient had hypertension. Two patients had a HR increase slightly greater than 20% (25.4 and 26.7%) within the first 2 min of surgery, but neither of these two patients had a HR above 76 bpm. Two patients were slightly hypotensive after incision (MAP 64 and 73 mmHg). During the validation phase, neither tachycardia nor hypotension occurred, but MAP increased to 21.5% above baseline for one patient.

CONCLUSION

During a no-touch period in patients under steady-state general anaesthesia [propofol effect site concentration (Ce) required for BIS between 40 and 60], the NOL index response to a tetanic stimulus under remifentanil antinociception can be used to personalise remifentanil Ce for the start of surgery and ensure stable haemodynamics.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03324269
Harvesting the Entire Seventh Costal Cartilage for Secondary Rhinoplasty
Authors: Jung Dong-Woo , Lee Myung Ju
Published: September 2022

Background:

As rhinoplasty is becoming increasingly common, the number of revision cases is also increasing. These cases require more cartilage, and costal cartilage is considered a good material. We introduce a method of harvesting the entire seventh costal cartilage.

Methods:

This study was performed from April 2019 to March 2020. The seventh costal cartilage was harvested from 156 patients. The incision was placed at the inframammary fold in women and directly above the cartilage in men. The length of incision was approximately 3.5 cm. After skin incision, we found a muscle fascia plane, and wide dissection was performed. We opened the muscle fascia and split the rectus abdominis muscles. Then, the seventh costal cartilage was exposed. Careful subperichondrial dissection was continued circumferentially. After the posterior aspect of the cartilage was exposed, the costochondral junction was cut and dislocated. The remaining perichondral dissection was performed under direct vision to avoid violating the perichondrium. Then, we dislocated the synchondrosis between the sixth and seventh cartilages and the seventh and eighth cartilages in turn. Finally, we cut the sternocostal area while protecting the underlying perichondrium and removed the cartilage. We checked for pneumothorax and then closed the wound layer by layer using 2-0 and 3-0 Vicryl sutures. Skin closure was performed with Steri-Strips.

Results:

The mean time for cartilage harvesting was 52 minutes. The average length of the cartilage was 9.33 mm. No cases of pneumothorax or postoperative morbidities were noted.

Conclusion:

We used sufficient amounts of cartilage to perform satisfactory rhinoplasty.
Overview of the US Food and Drug Administration's Medical Device Databases and Applications for Healthcare Technology Management Professionals
Authors: Konkani Avinash , Waheed Saphia
Published: September 2022

Healthcare technology management professionals play a role in assisting hospital leadership teams to make informed decisions related to the purchase, maintenance, and management of medical devices and other healthcare technologies. To do so, they use various resources both internal and external to their organization. One such external source is the US Food and Drug Administration databases. The intent of this article is to provide an overview of US Food and Drug Administration's medical device databases that may be relevant to healthcare technology management professionals and an explanation of how healthcare technology management professionals can leverage this information during their day-to-day operations.
Chronic obstructive pulmonary disease and obstructive sleep apnoea overlap: co-existence, co-morbidity, or causality?
Authors: O’Neill Emily , Ryan Silke , McNicholas Walter T.
Published: September 2022

Purpose of review

The chronic obstructive pulmonary disease and obstructive sleep apnoea overlap syndrome is associated with higher morbidity and mortality rates than either disease alone. There is evidence of a bidirectional relationship between the two conditions, with the overlap syndrome encompassing a spectrum of clinical phenotypes.

Recent findings

This review examines the evidence for the various factors that determine the overlap syndrome, the impact overlap syndrome has on co-morbidities, and implications for diagnosis and treatment.

The accurate diagnosis of the overlap syndrome is critical given its implications for treatment optimisation and reduction in healthcare utilisation and costs.
Veterans’ Use of Telehealth for Veterans Health Administration Community Care Urgent Care During the Early COVID-19 Pandemic
Authors: Cordasco Kristina M. , Yuan Anita H. , Rollman Jeffrey E. , Moreau Jessica L. , Edwards Lisa K. , Gable Alicia R. , Hsiao Jonie J. , Ganz David A. , Vashi Anita A. , Mehta Paril A. , Jackson Nicholas J.
Published: September 2022

Background:

Since the onset of the COVID-19 pandemic, telehealth has been an option for Veterans receiving urgent care through Veterans Health Administration Community Care (CC).

Objective:

We assessed use, arrangements, Veteran decision-making, and experiences with CC urgent care delivered via telehealth.

Design:

Convergent parallel mixed methods, combining multivariable regression analyses of claims data with semistructured Veteran interviews.

Subjects:

Veterans residing in the Western United States and Hawaii, with CC urgent care claims March 1 to September 30, 2020.

Key Results:

In comparison to having in-person only visits, having a telehealth-only visit was more likely for Veterans who were non-Hispanic Black, were urban-dwelling, lived further from the clinic used, had a COVID-related visit, and did not require an in-person procedure. Predictors of having both telehealth and in-person (compared with in-person only) visits were other (non-White, non-Black) non-Hispanic race/ethnicity, urban-dwelling status, living further from the clinic used, and having had a COVID-related visit. Care arrangements varied widely; telephone-only care was common. Veteran decisions about using telehealth were driven by limitations in in-person care availability and COVID-related concerns. Veterans receiving care via telehealth generally reported high satisfaction.

Conclusions:

CC urgent care via telehealth played an important role in providing Veterans with care access early in the COVID-19 pandemic. Use of telehealth differed by Veteran characteristics; lack of in-person care availability was a driver. Future work should assess for changes in telehealth use with pandemic progression, geographic differences, and impact on care quality, care coordination, outcomes, and costs to ensure Veterans’ optimal and equitable access to care.
Esophageal Dilation in Children
Authors: Shahein Abdul R. , Krasaelap Amornluck , Ng Kenneth , Bitton Samuel , Khan Muhammad , Manfredi Michael A. , Lerner Diana G.
Published: September 2022

Esophageal dilations in children are performed by several pediatric and adult professionals. We aim to summarize improvements in safety and new technology used for the treatment of complex and refractory strictures, including triamcinolone injection, endoscopic electro‐incisional therapy, topical mitomycin‐C application, stent placement, functional lumen imaging probe assisted dilation, and endoscopic vacuum‐assisted closure in the pediatric population.
Routine Elective Gastrojejunostomy Tube Changes Are Associated With Reduced Tube Complications and Radiation Exposure
Authors: Hoang Thomas T. , Maroo Sanjay , Lee Esther J. , Dewan Tammie , Heran Manraj , Avinashi Vishal
Published: September 2022

Gastrojejunostomy tubes (GJTs) can be a long‐term solution for patients with intragastric feeding intolerance. Our retrospective study of 101 patients correlates the frequency of routine and urgent GJT changes, as well as complications and radiation exposure. Over a 2.75‐year median duration, 60%, 33%, and 28% of patients had >1 episodes of a tube dislodgement/malpositioning, blockage, or leakage, respectively. Aspiration pneumonia hospital admission was required for 23% of patients. Patients with <1 routine tube change/year had more urgent changes/year (3.0) compared to patients with 1–2 (1.2) or >2 (0.8) routine yearly change. These patients required more frequent sedation for tube placement (21% vs 4.7%, P = 0.03) and experienced greater annual radiation exposure (9599 vs 304.5 and 69.1 μGym2, P = 0.01 and 0.008, respectively). Overall, aiming for a routine tube change at least every 6–12 months is associated with fewer urgent changes and complications as well as reduced radiation exposure and sedation requirements.
Thick Placenta in Pregnancy: A Review
Authors: Strebeck Ryan , Jensen Brooke , Magann Everett F.
Published: September 2022

Importance

A thickened placenta is easily identified on ultrasound and provides insight into maternal and fetal wellbeing as well as underlying structural and physiologic anomalies.

Objectives

The aim of this study was to review the literature to clarify what classifies a placenta as “thickened” and to review the associated incidence, maternal and fetal comorbidities, and management during pregnancy.

Evidence Acquisition

Electronic databases (PubMed and Web of Science) were searched from 2000 to 2020 in the English language. Studies were selected that examined associations between placental thickness, potential etiologies, and obstetric outcomes.

Results

There were 140 abstracts identified. After reviewing the articles, 60 were used in this review. Routine assessment of the placenta in the prenatal period is an easy and inexpensive way to assess the maternal and fetal patients. The criteria for a “thickened placenta” vary between studies based on gestational age, placental location, measurement technique, and maternal or fetal factors. Whereas most suggest thickness exceeding 4 cm is pathologic, a review had a threshold of 6 cm in the third trimester to classify placentomegaly. Several maternal and fetal conditions have been associated with a thickened placenta, such as obesity, parity, anemia, diabetes, preeclampsia, cardiac dysfunction, infection, assisted reproductive technology, multiple pregnancy, sacrococcygeal teratomas, and Beckwith-Wiedemann syndrome. A thickened placenta in pregnancy is associated with a higher incidence of adverse pregnancy outcomes and neonatal morbidity and mortality.

Conclusions

The literature is clear that early evaluation of the placenta using ultrasound should be a standard practice. A thickened placenta found on routine imaging should prompt a more thorough investigation to determine the etiology of the placentomegaly. At the time of this literature review, there are no recommendations regarding modality or frequency of antenatal surveillance in pregnancies complicated by a thickened placenta. However, serial ultrasounds and weekly antenatal testing in the third trimester should be considered.

Relevance

A thickened placenta has been associated with a variety of maternal and fetal conditions and increases the risk of adverse pregnancy outcomes and neonatal morbidity and mortality.

Target Audience

Obstetricians, nurse midwives, pediatricians, family physicians

Learning Objectives

After completion of this article, the reader should be able to classify the diagnostic criteria of thickened placenta in pregnancy; identify associated maternal and fetal conditions in the setting of a thickened placenta; and predict the adverse outcomes of pregnancy related to a thickened placenta.
Sural nerve biopsy as a standardized baseline clinical model for the translational evaluation of bioengineered nerve guides: A single-blinded randomized controlled prospective study
Authors: Dastagir Khaled , Radtke Christine , Dastagir Nadjib , Bucan Vesna , Strauß Sarah , Jokuszies Andreas , Vogt Peter Maria
Published: September 2022

Objective:

Autologous nerve transplantation is accepted as the clinical gold standard for reconstruction of peripheral nerve defects. A high number of bioengineered nerve guides as an alternative to the autologous nerve transplantation has been described in previous studies and several different types are commercially available. The implementation of these devices in the clinical setting is the most important step to proof their applicability in reconstructive nerve surgery.

Patients and Methods:

We examined in a single- blinded randomized controlled prospective study 34 patients undergoing diagnostic nerve biopsy (2 cm). The biopsy-induced nerve gap was interposed using a segment of the lesser saphenous vein in 16 patients. 18 patients had no nerve reconstruction as control group. Further 10 participants were included as healthy cohort. Nerve regeneration was assessed using von Frey filaments preoperatively and 1 day, 3, 6, 9 and 12 months postoperatively.

Results:

The result of this study revealed that patients, who received a defect bridging of the sural nerve with a venous graft, showed a better regeneration of the lateral foot sensitivity than patients without venous graft.

Conclusion:

The distal sural nerve biopsy model can serve as a preliminary nature of the injuries or baseline nerve lesion model. In a subsequent step, newly developed nerve guides could be tested in more unpredictable and challenging clinical peripheral nerve lesions.