bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhanced Recovery After Surgery Reduces Postoperative Opioid Use and 90-Day Readmission Rates After Open Thoracolumbar Fusion for Adult Degenerative Deformity
Authors: Adeyemo Emmanuel A , Aoun Salah G , Barrie Umaru , Nguyen Madelina L , Badejo Olatunde , Pernik Mark N , Christian Zachary , Dosselman Luke J , El Ahmadieh Tarek Y , Hall Kristen , Reyes Valery Peinado , McDonagh David L , Bagley Carlos A
Published: August 2020

BACKGROUND

The role of enhanced recovery after surgery (ERAS) pathways implementation has not been previously explored in adult deformity patients.

OBJECTIVE

To determine the impact of ERAS pathways implementation in adult patients undergoing open thoraco-lumbar-pelvic fusion for degenerative scoliosis on postoperative outcome, opioid consumption, and unplanned readmission rates.

METHODS

In this retrospective single-center study, we included 124 consecutive patients who underwent open thoraco-lumbar-pelvic fusion from October 2016 to February 2019 for degenerative scoliosis. Primary outcomes consisted of postoperative supplementary opioid consumption in morphine equivalent dose (MED), postoperative complications, and readmission rates within the postoperative 90-d window.

RESULTS

There were 67 patients in the ERAS group, and 57 patients served as pre-ERAS controls. Average patient age was 69 yr. The groups had comparable demographic and intraoperative variables. ERAS patients had a significantly lower rate of postoperative supplemental opioid consumption (248.05 vs 314.05 MED, P = .04), a lower rate of urinary retention requiring catheterization (5.97% vs 19.3%, P = .024) and of severe constipation (1.49% vs 31.57%, P < .0001), and fewer readmissions after their surgery (2.98% vs 28.07%, P = .0001).

CONCLUSION

A comprehensive multidisciplinary approach to complex spine surgery can reduce opioid intake, postoperative urinary retention and severe constipation, and unplanned 90-d readmissions in the elderly adult population.
Development of a Complication- and Treatment-Aware Prediction Model for Favorable Functional Outcome in Aneurysmal Subarachnoid Hemorrhage Based on Machine Learning
Authors: Maldaner Nicolai , Zeitlberger Anna M , Sosnova Marketa , Goldberg Johannes , Fung Christian , Bervini David , May Adrien , Bijlenga Philippe , Schaller Karl , Roethlisberger Michel , Rychen Jonathan , Zumofen Daniel W , D’Alonzo Donato , Marbacher Serge , Fandino Javier , Daniel Roy Thomas , Burkhardt Jan-Karl , Chiappini Alessio , Robert Thomas , Schatlo Bawarjan , Schmid Josef , Maduri Rodolfo , Staartjes Victor E , Seule Martin A , Weyerbrock Astrid , Serra Carlo , Stienen Martin Nikolaus , Bozinov Oliver , Regli Luca ,   on behalf of the Swiss SOS study group
Published: August 2020

BACKGROUND

Current prognostic tools in aneurysmal subarachnoid hemorrhage (aSAH) are constrained by being primarily based on patient and disease characteristics on admission.

OBJECTIVE

To develop and validate a complication- and treatment-aware outcome prediction tool in aSAH.

METHODS

This cohort study included data from an ongoing prospective nationwide multicenter registry on all aSAH patients in Switzerland (Swiss SOS [Swiss Study on aSAH]; 2009-2015). We trained supervised machine learning algorithms to predict a binary outcome at discharge (modified Rankin scale [mRS] ≤ 3: favorable; mRS 4-6: unfavorable). Clinical and radiological variables on admission (“Early” Model) as well as additional variables regarding secondary complications and disease management (“Late” Model) were used. Performance of both models was assessed by classification performance metrics on an out-of-sample test dataset.

RESULTS

Favorable functional outcome at discharge was observed in 1156 (62.0%) of 1866 patients. Both models scored a high accuracy of 75% to 76% on the test set. The “Late” outcome model outperformed the “Early” model with an area under the receiver operator characteristics curve (AUC) of 0.85 vs 0.79, corresponding to a specificity of 0.81 vs 0.70 and a sensitivity of 0.71 vs 0.79, respectively.

CONCLUSION

Both machine learning models show good discrimination and calibration confirmed on application to an internal test dataset of patients with a wide range of disease severity treated in different institutions within a nationwide registry. Our study indicates that the inclusion of variables reflecting the clinical course of the patient may lead to outcome predictions with superior predictive power compared to a model based on admission data only.
Median Effective Dose of Lidocaine for the Prevention of Pain Caused by the Injection of Propofol Formulated with Medium- and Long-Chain Triglycerides Based on Lean Body Weight
Authors: Tian, Shunping , Zhang Dongsheng , Zhou, Wei , Tan, Chao , Shan, Qing , Ma, Rongrong , Xing, Zhi , Sui, Wei , Zhang Zhuan
Published: August 2020

Objective

To determine the median effective dose (ED50) of prophylactic intravenous lidocaine for the prevention of propofol medium-chain triglyceride/long-chain triglyceride (MCT/LCT) emulsion injection pain.

Design

Prospective trial, Dixon up-and-down sequential method.

Setting

Operating room of a single hospital.

Patients

Thirty patients aged 18–65 years with American Society of Anesthesiologists (ASA) status I or II who were scheduled for elective surgery under general anesthesia (GA) were included.

Interventions

The initial dose of prophylactic lidocaine before propofol MCT/LCT emulsion injection was set at 0.5 mg/kg lean body weight (LBW). The lidocaine dose was adjusted according to the degree of patients’ injection pain using the Dixon up-and-down sequential method.

Measurements

The ED50 and 95% confidence intervals (CIs) of lidocaine were calculated using the Dixon–Massey formula. Vital signs and adverse effects were recorded. In the postanesthesia care unit (PACU), patients were asked if they recalled feeling any injection pain with visual analog scale (VAS) evaluation.

Results

The ED50 of lidocaine for the prevention of propofol MCT/LCT emulsion injection pain was 0.306 mg/kg LBW (95% CI, 0.262–0.357 mg/kg LBW). No adverse reactions to lidocaine occurred. In the PACU, 90.9% of patients who experienced injection pain recalled this pain (VAS score, 2.8±1.8).

Conclusions

Prophylactic intravenous lidocaine (0.306 mg/kg LBW) effectively prevented propofol MCT/LCT emulsion injection pain in 50% of patients scheduled for elective surgery under GA with no adverse reaction occurring.
A syncing feeling: reductions in physiological arousal in response to observed social synchrony
Authors: Kragness Haley E , Cirelli Laura K
Published: August 2020

Synchronized movements are often key elements in activities where social bonding and emotional connection are a shared goal, such as religious gatherings, sporting events, parties and weddings. Previous studies have shown that synchronous movements enhance prosocial attitudes and affiliative behaviors. Similarly, observers attribute more social closeness to people moving synchronously together than people moving asynchronously. The mechanisms by which synchrony modulates these attributions are not well understood. In the present study, we ask whether viewing synchronous activities influences physiological arousal as measured by skin conductance and whether group size impacts this effect. Undergraduates viewed a series of short videos depicting people moving either (1) in or out of synchrony with each other and (2) in a large or small group. Participants’ skin conductance was measured. Change in skin conductance levels and response counts were attenuated while watching synchronous movement, but only in the large-group condition. Post-hoc analyses suggest that viewer enjoyment/interest in the large-group synchronous videos mediated this association for phasic skin conductance responses, but no evidence of mediation was found for tonic skin conductance levels. Results extend previous research on affiliative effects of first-person interpersonal synchrony and demonstrate that watching others moving synchronously has an attenuating effect on observers’ physiological state.
Understanding Identity Changes in Psychosis: A Systematic Review and Narrative Synthesis
Authors: Conneely Maev , McNamee Philip , Gupta Veenu , Richardson John , Priebe Stefan , Jones Janelle M , Giacco Domenico
Published: August 2020

Background and Objective

Experiencing psychosis can be associated with changes in how people see themselves as individuals and in relation to others (ie, changes in their identity). However, identity changes receive little attention in treatment, possibly due to a lack of clarity or consensus around what identity change means in people with psychosis. We aimed to create a conceptual framework synthesizing how identity changes are understood in the psychosis literature.

Methods

Electronic databases were searched up to April 2020. Studies about identity changes among people with psychotic disorders were analyzed using narrative synthesis by a collaborative review team, including researchers from different disciplines, clinicians, and people who have experienced psychosis.

Results

Of 10 389 studies screened, 59 were eligible. Identity changes are understood in 5 ways as (1) characteristics of psychosis, (2) consequences of altered cognitive functioning, (3) consequences of internalized stigma, (4) consequences of lost roles and relationships, and (5) reflections of personal growth. These 5 understandings are not mutually exclusive. Across a heterogeneous literature, identity changes were mostly framed in terms of loss.

Conclusions

Our conceptual framework, comprising 5 understandings, highlights the complexity of studying identity changes and suggests important implications for practice and research. For clinicians, this framework can inform new therapeutic approaches where the experience and impact of identity changes are acknowledged and addressed as part of treatment. For researchers, the conceptual framework offers a way of locating their understandings of identity changes when undertaking research in this area.
Medications for Opioid use Disorder Associated With Less Against Medical Advice Discharge Among Persons Who Inject Drugs Hospitalized With an Invasive Infection
Authors: Nolan Nathanial S. , Marks Laura R. , Liang Stephen Y. , Durkin Michael J.
Published: August 2020

Objectives:

To identify the incidence, characteristics, and factors associated with against medical advice (AMA) discharge among hospitalized patients with opioid use disorder (OUD) and injection related infections (eg, endocarditis, osteomyelitis, epidural abscesses).

Methods:

This retrospective cohort study evaluated adults with OUD admitted to an academic medical center from January 1, 2016 to January 7, 2019 for an invasive injection related infection. Multivariable logistic regression was used to determine independent factors associated with AMA discharge.

Results:

Among 262 adults admitted with serious injection related infections and comorbid OUD, 138 received inpatient medications for opioid use disorder (MOUD). Univariate analysis showed a decreased odds ratio (OR) of AMA discharge when patients received MOUD inpatient (OR 0.55; 95% CI 0.34–0.91.). Adjusting for covariates associated with social determinants of health and other substance use, inpatient receipt of MOUD was associated with a decreased risk of AMA discharge (adjusted OR 0.49; 95% CI 0.028–0.84).

Conclusions:

Among patients with OUD and serious injection related infections, inpatient initiation of MOUD is associated with decreased risk of AMA discharge.
Evaluation of the association between olecranon fracture and radial head subluxation or annular ligament displacement in children
Authors: Huang Peng , Pei Xinhong
Published: August 2020

Olecranon fractures are seen substantially more often in children than in adult and are potentially occult in nature. We noticed this fracture pattern in two cases of delayed Monteggia fracture. Our study purpose was to confirm whether olecranon fracture is associated with radial head subluxation or annular ligamentous displacement in children. In addition, we have developed an effective and simple approach to avoid serious treatment-related complications as much as possible. Forty-eight pediatric patients with olecranon fracture and normal radiocapitellar alignment on radiography were enrolled. All patients’ fingers, forearms and elbows were examined carefully, and treated with a modified radial head reduction approach and then cast immobilization. MRI of the affected elbow was performed in 16 symptomatic patients. Overall, 70.83% of patients had a positive clinical finding of radial head subluxation. These symptomatic patients presented with similar clinical findings that typically included painful finger movement actively or passively and movement limitation of forearm and elbow. MRI showed that annular ligaments were interposed and trapped in the radiohumeral joint. In 34 symptomatic patients, 91.18% of them achieved fair radial head reduction during the first reduction attempt. Herein, 95.85 and 100% of patients reported excellent and satisfactory outcomes, respectively. Radial head subluxation occurred in most children with an olecranon fracture. We highly suggest performing a careful physical examination to identify this fracture pattern. Early reduction of the radial head with the modified approach may be a simple and primary option for emergency room doctors.
Severe Hip Dysplasia in Skeletally Mature Patients With Spastic Cerebral Palsy: The Technique and Early Outcome of Comprehensive Surgical Correction (Including the Bernese PAO)
Authors: Miller Mark L. , Clohisy John C. , Pashos Gail E. , Berglund Lisa M. , Schoenecker Perry L.
Published: August 2020

Background:

Treatment of symptomatic hip dysplasia in skeletally mature patients with spastic cerebral palsy (CP) can be challenging. This study examines our technical experience with the Bernese periacetabular osteotomy (PAO) in combination with adjunctive procedures in the treatment of this complex hip deformity.

Methods:

Sixteen consecutive patients (18 hips) with symptomatic CP hip dysplasia were treated with a PAO and variable adjunctive procedures and retrospectively reviewed. Two patient (2 hips) were excluded due to insufficient follow-up. The average age at the time of surgery was 17.7 years (range: 13 to 28 y). We compared the preoperative to postoperative changes in radiographic parameters as well as early outcomes as measured by patient assessment of hip pain and function using the modified Harris Hip Score (mHHS).

Results:

The average time of follow-up was 3.3 years (range: 2.0 to 6.3 y). Tönnis angles decreased from a median of 30 degrees (range: 18 to 45 degrees) preoperatively to a median of 6 degrees (range: −9 to 21 degrees) postoperatively. Lateral center-edge angles increased from a median of −8 degrees (range: −28 to 15 degrees) to a median of 32 degrees (range: 19 to 38 degrees). Anterior center-edge angles increased from a median of 2 degrees (range: −22 to 39 degrees) to a median of 35 degrees (range: 22 to 47 degrees). The extrusion index decreased from a median of 57% preoperatively (range: 35% to 73%) to a median of 21% (range: 11% to 36%) postoperatively.

The median mHHS was 62 (range: 37 to 81) preoperatively and 85 (range: 65 to 100) postoperatively. Notably, the pain component of the mHHS improved from 20 (range: 0 to 44) to 42 (range: 30 to 44). Tönnis osteoarthritis grade preoperatively was either 0 (11 hips) or 1 (5 hips) and remained unchanged in 11 hips and increased by 1 grade in 5 hips.

Conclusions:

It has been our experience that the Bernese PAO in combination with appropriate adjunctive treatments has provided a very satisfactory surgical approach in the treatment of CP hip dysplasia. In the adolescent and young adult with spastic CP, utilizing the Bernese PAO technique makes it possible to obtain redirection of often a very severe acetabular dysplasia. Adjunctive soft tissue procedures and a proximal femoral osteotomy are frequently necessary to maintain postoperative stability. A notable improvement in the quality of life and function directly attributable to our surgical treatment of their pre-existing problematic hip dysplasia has been consistently noted in early follow-up for our patients.

Level of Evidence:

Level IV—therapeutic.
The Frequency of Mediastinal Injury in Acute Posterior Sternoclavicular Dislocations: A Multicenter Study
Authors: Fournier Matthew N. , Sinclair Mark R. , Zheng Evan T. , Spiegel David A. , Johnson Anna L. , Shah Apurva S. , Riccio Anthony I. , Elliott Marilyn E. , Bae Donald S. , Sawyer Jeffrey R.
Published: August 2020

Background:

Acute posterior sternoclavicular dislocations (APSCD) are rare injuries that historically have prompted concern for injury to the great vessels and other mediastinal structures from initial trauma or subsequent treatment, resulting in the recommendation that a thoracic or vascular surgeon be present or available during operative treatment. The objectives of the study were to characterize the demographic, clinical, and radiographic characteristics of a large series of APSCDs in skeletally immature patients and to describe the rate and nature of any vascular or mediastinal complications that occurred during treatment.

Methods:

Following Institutional Review Board approval, records of consecutive patients under 25 years of age treated for APSCD were collected from each of 6 participating centers. Only acute injuries (sustained fewer than 10 days before presentation) were included. Patient demographics, injury mechanism, associated mediastinal injuries, and need for thoracic/vascular surgery were recorded. Mediastinal structures injured or compressed by mass effect were specifically characterized by review of preoperative computed tomography imaging.

Results:

Review identified 125 patients with a mean age of 14.7 years; 88% were male. APSCD most commonly resulted from a sporting injury (74%) followed by falls from standing height (10%) and high-energy motor vehicle trauma (10%). The most common finding on cross-sectional imaging was compression without laceration of the ipsilateral brachiocephalic vein (50%). Eleven patients had successful closed reduction, and 114 (90%) had open reduction and internal fixation, with 25 failed or unstable closed reductions preceding open treatment. There were no vascular or mediastinal injuries during reduction or fixation that required intervention.

Conclusions:

In this multicenter series of 125 APSCDs no injuries to the great vessels/mediastinal structures requiring intervention were identified. Although more than half of patients had evidence of extrinsic vascular compression at the time of injury, careful open reduction of acute injuries can be safely performed. Although vascular injuries following APSCD seem to be quite rare, vascular complications can be catastrophic. Treating providers should consider these data and their own institutional resources to maximize patient safety during the treatment of APSCD.

Level of Evidence:

Level III—therapeutic case control study.
An Updated Analysis of the Pediatric Section of the Orthopaedic In-Training Examination
Authors: Ellsworth Bridget K. , Premkumar Ajay , Shen Tony , Lebrun Drake G. , Cross Michael B. , Widmann Roger F.
Published: August 2020

Background:

An updated analysis of the pediatrics section of the Orthopaedic In-Training Examination (OITE) is helpful for resident education and preparation for the OITE. The purpose of this study is to provide an updated evaluation of the pediatric category of the OITE, and to explore trends in question topics and taxonomy compared with the previously published analysis from 2011 to 2014.

Methods:

Five years (2015-2019) of OITE questions, answers, and references were reviewed. The number of pediatric questions per year was recorded, and questions were subcategorized based on topic tested. The presence or absence of imaging or a clinical photograph was noted. Each question was also assigned a cognitive taxonomy level, based on a previously published classification system.

Results:

The percentage of pediatric questions on the 2015-2019 OITEs averaged 11.4% compared with 12.6% from 2011 to 2014 (P=0.349). The 3 most commonly tested pediatric topics were general trauma (17.8%), elbow trauma (13.2%), and genetic disorders/syndromes (11.2%). There was a significant increase in questions that required diagnosis and interpretation (27.6% vs. 8%, P<0.001) and a slight but not significant decrease in the questions requiring simple knowledge recall (26.3% vs. 35.5%, P=0.120) and decisions about management (46.1% vs. 56.5%, P=0.077). Overall, 65% of questions utilized clinical photographs or imaging studies compared with 62% from 2011 to 2014 (P=0.621). The most common references were the Journal of Pediatric Orthopaedics, Journal of American Academy of Orthopaedic Surgeons, and Journal of Bone and Joint Surgery. Textbooks were cited less frequently than in the past.

Conclusions:

While the percentage of pediatric questions on the OITE has remained consistent over time, the percentage of questions requiring diagnosis and interpretation has increased. In addition, questions testing genetic disorders/syndromes have become more prevalent in recent years. The most commonly cited resources were high-impact journal articles, with textbooks cited less frequently than in previous years.

Clinical Relevance:

Knowledge of the most frequently tested topics and resources cited may assist orthopaedic residents in preparing for the OITE and orthopaedic faculty to focus didactic sessions on the most commonly tested topics.
Patella Alta in Ambulatory Children With Cerebral Palsy: Prevalence and Functional Significance
Authors: Davids Jon R. , Kulkarni Vedant A. , Bagley Anita M. , Cung Nina Q. , Davis Roy B. , Westberry David E. , Carpenter Ashley
Published: August 2020

Background:

Gait dysfunction associated with patella alta (PA) in subjects with cerebral palsy (CP) has been presumed but not objectively established clinically or through biomechanical modeling. It is hypothesized that PA is associated with increasing level of motor impairment, increasing age, obesity, and worse stance phase knee kinematics and kinetics in children with CP.

Methods:

Retrospective case series of 297 subjects with CP studied in our Motion Analysis Center. Data analyzed included patient demographics (age, body mass index, CP classification), patella height (Koshino-Sugimoto Index), and knee kinematics and kinetics.

Results:

PA was present in 180 of 297 subjects (61%), in 68 of the 146 (47%) with unilateral CP, and 112 of 151 subjects (74%) with bilateral CP. For unilateral CP, the prevalence of PA was not significantly different between Gross Motor Function Classification System (GMFCS) I and II (P=0.357). For bilateral CP, the prevalence of PA in GMFCS III was significantly greater than in GMFCS I and II (P=0.02). Regression analysis showed a significant trend between increasing age and PA in unilateral and bilateral groups (P<0.001 and 0.001, respectively). The prevalence of PA was not significantly different across body mass index categories for either unilateral or bilateral groups. There were only 2 of 10 significant correlations between PA and gait parameters for subjects with unilateral CP functioning at the GMFCS I and II levels. There were 8 of 12 significant correlations between PA and gait parameters for subjects with bilateral CP functioning at the GMFCS I, II, and III levels.

Conclusions:

PA is common in ambulatory children with CP across topographic types and motor functional levels. PA is well tolerated with respect to gait dysfunction in unilateral CP, but may contribute to crouch gait in bilateral CP. Gait dysfunction cannot be inferred from the radiographic assessment of patellar height, and radiographic evidence of PA by itself does not justify surgical correction with patellar tendon advancement or shortening.

Level of Evidence:

Level III—prognostic, retrospective series.
The Association Between Endotracheal Tube Size and Aspiration (During Flexible Endoscopic Evaluation of Swallowing) in Acute Respiratory Failure Survivors
Authors: Krisciunas Gintas P. , Langmore Susan E. , Gomez-Taborda Stephanie , Fink Daniel , Levitt Joseph E. , McKeehan Jeffrey , McNally Edel , Scheel Rebecca , Rubio Alix C. , Siner Jonathan M. , Vojnik Rosemary , Warner Heather , White S. David , Moss Marc
Published: August 2020

Objectives:

To determine whether a modifiable risk factor, endotracheal tube size, is associated with the diagnosis of postextubation aspiration in survivors of acute respiratory failure.

Design:

Prospective cohort study.

Setting:

ICUs at four academic tertiary care medical centers.

Patients:

Two hundred ten patients who were at least 18 years old, admitted to an ICU, and mechanically ventilated with an endotracheal tube for longer than 48 hours were enrolled.

Interventions:

Within 72 hours of extubation, all patients received a flexible endoscopic evaluation of swallowing examination that entailed administration of ice, thin liquid, thick liquid, puree, and cracker boluses. Patient demographics, treatment variables, and hospital outcomes were abstracted from the patient’s medical records. Endotracheal tube size was independently selected by the patient’s treating physicians.

Measurements and Main Results:

For each flexible endoscopic evaluation of swallowing examination, laryngeal pathology was evaluated, and for each bolus, a Penetration Aspiration Scale score was assigned. Aspiration (Penetration Aspiration Scale score ≥ 6) was further categorized into nonsilent aspiration (Penetration Aspiration Scale score = 6 or 7) and silent aspiration (Penetration Aspiration Scale score = 8). One third of patients (n = 68) aspirated (Penetration Aspiration Scale score ≥ 6) on at least one bolus, 13.6% (n = 29) exhibited silent aspiration, and 23.8% (n = 50) exhibited nonsilent aspiration. In a multivariable analysis, endotracheal tube size (≤ 7.5 vs ≥ 8.0) was significantly associated with patients exhibiting any aspiration (Penetration Aspiration Scale score ≥ 6) (p = 0.016; odds ratio = 2.17; 95% CI 1.14–4.13) and with risk of developing laryngeal granulation tissue (p = 0.02).

Conclusions:

Larger endotracheal tube size was associated with increased risk of aspiration and laryngeal granulation tissue. Using smaller endotracheal tubes may reduce the risk of postextubation aspiration.
Myoclonus in Patients With Coronavirus Disease 2019: A Multicenter Case Series
Authors: Anand Pria , Zakaria Asma , Benameur Karima , Ong Charlene , Putman Maryann , O’Shea Sarah , Greer David , Cervantes-Arslanian Anna M.
Published: August 2020

Objectives:

To describe the risk factors for and outcomes after myoclonus in a cohort of patients with coronavirus disease 2019.

Design:

Multicenter case series.

Setting:

Three tertiary care hospitals in Massachusetts, Georgia, and Virginia.

Patients:

Eight patients with clinical myoclonus in the setting of coronavirus disease 2019.

Interventions & Measurements and Main Results:

Outcomes in patients with myoclonus were variable, with one patient who died during the study period and five who were successfully extubated cognitively intact and without focal neurologic deficits. In five cases, the myoclonus completely resolved within 2 days of onset, while in three cases, it persisted for 10 days or longer. Seven patients experienced significant metabolic derangements, hypoxemia, or exposure to sedating medications that may have contributed to the development of myoclonus. One patient presented with encephalopathy and developed prolonged myoclonus in the absence of clear systemic provoking factors.

Conclusions:

Our findings suggest that myoclonus may be observed in severe acute respiratory syndrome coronavirus 2 infected patients, even in the absence of hypoxia. This association warrants further evaluation in larger cohorts to determine whether the presence of myoclonus may aid in the assessment of disease severity, neurologic involvement, or prognostication.
Timing of Intubation and Mortality Among Critically Ill Coronavirus Disease 2019 Patients: A Single-Center Cohort Study
Authors: Hernandez-Romieu Alfonso C. , Adelman Max W. , Hockstein Maxwell A. , Robichaux Chad J. , Edwards Johnathan A. , Fazio Jane C. , Blum James M. , Jabaley Craig S. , Caridi-Scheible Mark , Martin Greg S. , Murphy David J. , Auld Sara C.
Published: August 2020

Objectives:

Increasing time to mechanical ventilation and high-flow nasal cannula use may be associated with mortality in coronavirus disease 2019. We examined the impact of time to intubation and use of high-flow nasal cannula on clinical outcomes in patients with coronavirus disease 2019.

Design:

Retrospective cohort study.

Setting:

Six coronavirus disease 2019-specific ICUs across four university-affiliated hospitals in Atlanta, Georgia.

Patients:

Adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who received high-flow nasal cannula or mechanical ventilation.

Interventions:

None.

Measurements and Main Results:

Among 231 patients admitted to the ICU, 109 (47.2%) were treated with high-flow nasal cannula and 97 (42.0%) were intubated without preceding high-flow nasal cannula use. Of those managed with high-flow nasal cannula, 78 (71.6%) ultimately received mechanical ventilation. In total, 175 patients received mechanical ventilation; 44.6% were female, 66.3% were Black, and the median age was 66 years (interquartile range, 56–75 yr). Seventy-six patients (43.4%) were intubated within 8 hours of ICU admission, 57 (32.6%) between 8 and 24 hours of admission, and 42 (24.0%) greater than or equal to 24 hours after admission. Patients intubated within 8 hours were more likely to have diabetes, chronic comorbidities, and higher admission Sequential Organ Failure Assessment scores. Mortality did not differ by time to intubation (≤ 8 hr: 38.2%; 8–24 hr: 31.6%; ≥ 24 hr: 38.1%; p = 0.7), and there was no association between time to intubation and mortality in adjusted analysis. Similarly, there was no difference in initial static compliance, duration of mechanical ventilation, or ICU length of stay by timing of intubation. High-flow nasal cannula use prior to intubation was not associated with mortality.

Conclusions:

In this cohort of critically ill patients with coronavirus disease 2019, neither time from ICU admission to intubation nor high-flow nasal cannula use were associated with increased mortality. This study provides evidence that coronavirus disease 2019 respiratory failure can be managed similarly to hypoxic respiratory failure of other etiologies.
Real-world Outcomes of First-line Anti-PD-1 Therapy for Advanced Melanoma: A Nationwide Population-based Study
Authors: van Zeijl Michiel C.T. , Haanen John B.A.G. , Wouters Michel W.J.M. , de Wreede Liesbeth C. , Jochems Anouk , Aarts Maureen J.B. , van den Berkmortel Franchette W.P.J. , de Groot Jan Willem B. , Hospers Geke A.P. , Kapiteijn Ellen W. , Piersma Djura , van Rijn Rozemarijn S. , Suijkerbuijk Karijn P.M. , ten Tije Albert J. , van der Veldt Astrid A.M. , Vreugdenhil Gerard , van der Hoeven Koos J.M. , van den Eertwegh Alfons J.M.
Published: August 2020

The efficacy of anti-programmed death-1 (PD-1) monotherapy for advanced melanoma has been established, but it is unknown to what extent patients benefit in the real world. In this observational study with nationwide population-based data from the Dutch Melanoma Treatment Registry, we analyzed real-world outcomes of first-line anti-PD-1 monotherapy in advanced melanoma patients diagnosed in 2015 to 2016. Overall survival (OS) was estimated with the Kaplan-Meier method. Competing risks analysis was used to estimate probabilities for second-line treatment, with death as competing risk. With a Cox model, the association of factors with OS was estimated. Patients who received anti-PD-1 monotherapy (n=550) had a median age of 65 years and 502 (95%) patients had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0-1, 383 (70%) had normal lactate dehydrogenase (LDH), 370 (67%) had stage IV-M1c disease, and in 441 (81%), brain metastases were absent. The median OS was 24 months [95% confidence interval (CI): 20-30 mo]. The median OS of patients normally eligible for phase III trial participation was 31 months (95% CI: 23-not estimable). The BRAF mutation was associated with superior OS. ECOG PS of ≥1, symptomatic brain metastases, and liver metastases were associated with inferior OS and, together with elevated LDH, with death before second-line treatment. Patients with a complete response had a 2-year OS probability from first reported complete response of 92% (95% CI: 86%-99%). Real-world advanced melanoma patients in the Netherlands have benefitted from anti-PD-1 monotherapy. ECOG PS ≥1, symptomatic brain metastasis, liver metastasis, and elevated LDH are important prognostic factors for survival. The additional information that this study provides could help to improve more effective use in the real world.
Prognostic Value of Preoperative Imaging
Authors: St. Laurent Jessica D. , Davis Michelle R. , Feltmate Colleen M. , Goodman Annekathryn , Del Carmen Marcella G. , Horowitz Neil E. , Lee Susanna I. , Growdon Whitfield B.
Published: August 2020

Objective:

18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) increases the sensitivity for preoperative detection of lymph nodes and distant metastases in endometrial cancer. The objective of this investigation was to determine the prognostic value of preoperative PET-CT compared with computed tomography (CT) alone for high-risk endometrial carcinoma.

Materials and Methods:

We performed a retrospective review of high-risk histology endometrial cancer from 2008 to 2015. Clinical variables including surgical procedure, preoperative imaging modality, and outcome were collected. Survival analysis was performed utilizing the Kaplan-Meier and Cox proportional hazards methodologies.

Results:

Of the 555 women treated for high-risk histology endometrial cancer, 88 (16%) had preoperative PET-CT, and 97 (17%) CT without PET available. PET-CT demonstrated positive findings in 37 women (42%) compared with 33 (30%) with preoperative CT alone. PET-CT had a positive predictive value of 96% for nodal metastasis compared with 60% for CT alone. The median follow-up time for the entire cohort was 59 months (range, 12 to 96 mo). Patients with a negative preoperative PET-CT (n=54) had a median progression-free survival (PFS) that was not reached, whereas the median PFS in the PET-CT positive group was 13 months (n=34). Women with a negative PET-CT had a longer median overall survival (OS) not yet reached compared with 34 months in the PET-CT positive cohort (hazard ratio, 2.4; P<0.001). CT findings did not associate with PFS or OS.

Conclusions:

PET-CT demonstrated superior sensitivity for lymph node metastasis and detecting distant disease compared with CT. Preoperative PET-CT, whether positive or negative, offered OS and PFS prognostic value not observed with CT alone.
Racial Disparities in Time to Treatment Initiation and Outcomes for Early Stage Anal Squamous Cell Carcinoma
Authors: Goksu Suleyman Y. , Ozer Muhammet , Kazmi Syed M.A. , Aguilera Todd A. , Ahn Chul , Hsiehchen David , Sanjeevaiah Aravind , Maxwell Mary C. , Beg Muhammad S. , Sanford Nina N.
Published: August 2020

Objectives:

Although cure rates for early stage anal squamous cell cancer (ASCC) are overall high, there may be racial disparities in receipt of treatment and outcome precluding favorable outcomes across all patient demographics. Therefore, the authors aimed to assess the time to treatment initiation and overall survival (OS) in Black and White patients receiving definitive chemoradiation for early stage ASCC.

Materials and Methods:

The authors identified patients diagnosed with early stage (stage I-II) ASCC and treated with chemoradiation diagnosed between 2004 and 2016 in the National Cancer Database. Clinical and treatment variables were compared by race using the χ2 test, and OS assessed through Cox regression with 1:1 nearest neighbor propensity score matching.

Results:

Among 9331 patients, 90.6% were White. Black patients had longer median time to treatment initiation as compared with White patients (47 vs. 36 d, P<0.001), and on multivariable analysis, the Black race was associated with higher odds of >6 weeks of time to treatment initiation (hazard ratio, 1.78; 95% confidence interval, 1.53-2.08; P<0.001). Furthermore, Black patients had worse OS (5-year survival 71% vs. 77%; P<0.001), which persisted after propensity score matching (P=0.007).

Conclusions:

Black patients had a longer time to treatment initiation and worse OS as compared with White patients with early stage ASCC treated with chemoradiation. Further research is needed to better elucidate the etiologies of these disparities.
Inpatient Palliative Care Use Among Critically III Brain Metastasis Patients in the United States
Authors: Rubens Muni , Ramamoorthy Venkataraghavan , Saxena Anshul , McGranaghan Peter , Bhatt Chintan , Das Sankalp , Shehadeh Nancy , Veledar Emir , Viamonte-Ros Ana , Odia Yazmin , Mehta Minesh P. , Kotecha Rupesh
Published: August 2020

Objective:

The objective of this study was to understand the trends and characteristics of palliative care delivery among critically ill brain metastasis patients using a nationally representative database.

Materials and Methods:

This study was a retrospective analysis of Nationwide Inpatient Sample data collected during 2005 to 2014. This study included critically ill patients, 18 years and above, diagnosed with brain metastasis, identified using International Classification of Diseases-Ninth Revision-Clinical Modification diagnosis and procedure codes. Multivariable logistic regression models were used for predicting factors associated with inpatient palliative care use.

Results:

Among 18,309 critically ill patients with brain metastasis, 3298 (18.0%) received inpatient palliative care. The rate of inpatient palliative care use among these patients increased from 3.2% to 28.5%, during 2005 to 2014 (P<0.001). Regression analysis showed that hospital teaching status (odds ratio [ORs], 1.45; 95% confidence interval [CI], 1.14-1.84), primaries located in head and neck (OR, 1.42; 95% CI, 1.21-2.05) or lung (OR, 1.32; 95% CI, 1.22-1.44), and primary diagnosis of pneumonia (OR, 1.42; 95% CI, 1.22-1.97) or septicemia (OR, 1.59; 95% CI, 1.30-1.97), were associated with higher palliative care use. Hispanic ethnicity (OR, 0.86; 95% CI, 0.67-0.96), and hospital location in Northeast (OR, 0.73; 95% CI, 0.54-0.96), Midwest (OR, 0.63; 95% CI, 0.45-0.87), or South (OR, 0.64; 95% CI, 0.48-0.86) were associated with lower palliative care use.

Conclusions:

Inpatient palliative care use increased significantly among critically ill patients with brain metastases, though overall rate was low. There were geographical and racial disparities among these patients. Health care providers and policy makers should focus on decreasing these disparities. In addition, hospitals should focus on adopting more palliative care services.
Dissecting the role of alternative splicing in the regulation of autophagy: a narrative review
Authors: Zhang Mengjiao , Zhang Yingmei
Published: August 2020

Alternative splicing plays a pivotal role in the posttranscriptional regulation of gene expression, contributing to the generation of proteome diversity. Autophagy is a conserved cellular machinery governing degradation and recycling of long-lived or damaged proteins and organelles. However, there is limited knowledge of the roles of alternative splicing in autophagy, in particular mitochondrial selective autophagy, termed mitophagy. Emerging evidence suggests autophagy-related proteins (Atg), key molecules in autophagy process, are involved. This review highlights recent advances in the understanding of mechanisms by which alternative splicing affects the functions of
ATG
genes including
BECN1
,
ATG5
,
ATG16L1,
and
Bim
genes, and thus manipulates autophagy levels in various diseases. This review found that the effects of splicing of ATG genes generally result in inhibiting autophagy. However, very few of the many autophagy associated proteins have been studied. More research into the transcriptional and post-transcriptional regulation of splicing factors will be necessary to understand their roles in pathological conditions associated with autophagy and mitophagy.
Organizational Change Associated With DPT Curricular Transformation: A Qualitative Study of Faculty Experiences in One Program
Authors: Macauley Kelly , Jette Diane U. , Callahan Janet , Brudvig Tracy J. , Levangie Pamela K.
Published: August 2020

Introduction.

Faculty perceptions of organizational change and culture shifts created by major curricular revision in higher education have been described. However, there are no similar descriptions for faculty in physical therapist education.

Methods.

All faculty from one Doctor of Physical Therapy program were recruited and agreed to participate in this study (n = 19). A qualitative thematic approach was applied to deidentified transcripts of faculty interviews conducted at the end of the first year (round 1) of a new curriculum and again after all academic courses had been taught at least once (round 2). Independently coded themes were discussed and further refined iteratively. All data and themes were sent to an external reviewer with feedback incorporated into findings.

Results.

Ten themes emerged from the analysis of the interviews—7 from round 1 interviews and 3 additional themes from round 2 interviews, including Convoluted Planning Process, Challenging Management Processes & Structure, Overwhelming Workload, New Pedagogy, Integrated Curricular Structure, Crucial Teamwork and Communication, Insufficient Resources, Evolving Attitudes and Approaches, Personal & Professional Growth, and Cautious Optimism.

Discussion and Conclusion.

The themes that emerged from this study—as well as faculty observations, insights, and concerns—parallel those experienced by non-PT faculty going through similar changes to innovative curricula although with greater levels of angst than evident elsewhere in the literature. The themes also fit the framework by Armenakis and Bedeian that identified 4 common issues across the organizational change literature. Most of our faculty remained hopeful that the original goal of a patient-centered, integrated, active learning curriculum could be reached with continued curricular development and faculty growth. There are increasingly urgent calls to rethink physical therapy education to better prepare graduates for a dynamic health care environment, to respond to emerging biopsychosocial research and pandemic demands, and to reduce graduate indebtedness. These will likely lead to extensive curricular change across programs in the near future. Our findings may facilitate more realistic expectations of physical therapy faculty when facing the challenges of major curriculum change.
Improvement of the frontal QRS-T angle after successful percutaneous coronary revascularization in patients with chronic total occlusion
Authors: Uzun Fatih , Güner Ahmet , Demir Ali Riza , Can Arda , Yalçin Ahmet Arif , Aguş Hicaz Zencirkiran , Kalkan Ali Kemal
Published: August 2020

Background

The QRS-T angle (QRS-Ta) is a novel marker of myocardial repolarization heterogeneity which is related to adverse cardiovascular events. Our aim in this study was to investigate the effect of successful percutaneous coronary intervention (PCI) on frontal QRS-Ta in patients with chronic total occlusion (CTO).

Materials and methods

A total of 132 patients undergoing PCI for CTO were included in this study. Successful PCI of CTO segment was performed in 84 patients (group 2) while 48 who failed CTO were observed (group 1). Baseline demographic and clinical variables were evaluated and, 12-lead surface ECGs of all subjects were recorded before performing coronary angiography and 1-month and 6-month after the index procedure.

Results

QRS-Ta values significantly decreased during follow-up visits compared to baseline values [92.5 (63.25–110.75); 85.0 (59.0–101.0); 80.0 (53.0–99.0), P < 0.001] in group 2 patients. Moreover, there was no significant difference in frontal QRS-Ta measurements in group 1 patients in their clinical 6-month follow-up [87.0 (48.25–103.0); 86.5 (46.0–101.75); 84.0 (49.0–103.75); P = 0.320]. First month frontal QRS-Ta values [92.5 (63.25–110.75); 85.0 (59.0–101.0), P = 0.002] and sixth month frontal QRS-Ta values [92.5 (63.25–110.75); 80.0 (53.0–99.0), P < 0.001] were lower than baseline values while sixth month values [85.0 (59.0–101.0); 80.0 (53.0–99.0), P = 0.002] was lower compared to first month values. Additionally, a decrease in frontal QRS-Ta was observed regardless of target vessel or Rentrop classification.

Conclusion

Successful percutaneous revascularization of CTO was effective in ventricular repolarization. Frontal QRS-Ta significantly decreased after successful PCI on CTO patients at a 6-month follow-up.
Lipoprotein(a) as a predictor for the presence and severity of premature coronary artery disease: a cross-sectional analysis of 2433 patients
Authors: Shi Yan-Pu , Cao Ye-Xuan , Jin Jing-Lu , Liu Hui-Hui , Zhang Hui-Wen , Guo Yuan-Lin , Gao Ying , Zhu Cheng-Gang , Wu Na-Qiong , Li Jian-Jun
Published: August 2020

Background

Lipoprotein(a) [Lp(a)] has been emerged as a risk factor for coronary artery disease (CAD), but there is currently insufficient data on the relationship between Lp(a) and premature CAD (PCAD). Thus, this study aimed to examine the association between Lp(a) and PCAD in a Chinese cohort.

Methods

Data on 2433 individuals (male <55 years old and female <65 years old) who underwent coronary angiography from March 2016 to February 2019 were included in this study and were divided into the PCAD group (n = 1751) and non-CAD group (n = 682) according to the angiography results. Their clinical and laboratory parameters were collected, and plasma Lp(a) level was measured by immunoturbidimetry. The severity of CAD was evaluated using Gensini score (GS) and divided into three subgroups. The relationship between plasma Lp(a) levels and the presence and severity of PCAD was analyzed.

Results

The level of plasma Lp(a) in the PCAD group was significantly higher than that in the non-CAD group (P < 0.001). The plasma Lp(a) concentration in the highest GS group was significantly higher than that in the lowest GS group (P < 0.001). Multivariate linear regression analysis showed that elevated plasma Lp(a) levels were correlated with higher GS (b = 0.41, P < 0.001). Multivariate logistic regression showed that elevated plasma Lp(a) levels were independently associated with PCAD (odds ratio = 2.91, P < 0.001). Moreover, elevated plasma Lp(a) levels correlated with higher GS (b = 0.41, P < 0.001).

Conclusion

In this study, Lp(a) concentration was associated with the presence and severity of PCAD, suggesting that Lp(a) may be a marker or target for patients with PCAD.