bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of procalcitonin-guided antimicrobial stewardship in patients admitted to hospital with COVID-19 pneumonia
Authors: Calderon Maria , Li Ang , Bazo-Alvarez Juan Carlos , Dennis Jonathan , Baker Kenneth F , Schim van der Loeff Ina , Hanrath Aidan T , Capstick Richard , Payne Brendan A I , Weiand Daniel , Hunter Ewan , Schwab Ulrich
Published: August 2021

Background

Procalcitonin is a biomarker that may be able to identify patients with COVID-19 pneumonia who do not require antimicrobials for bacterial respiratory tract co-infections.

Objectives

To evaluate the safety and effectiveness of a procalcitonin-guided algorithm in rationalizing empirical antimicrobial prescriptions in non-critically ill patients with COVID-19 pneumonia.

Methods

Retrospective, single-site, cohort study in adults hospitalized with confirmed or suspected COVID-19 pneumonia and receiving empirical antimicrobials for potential bacterial respiratory tract co-infection. Regression models were used to compare the following outcomes in patients with and without procalcitonin testing within 72 h of starting antimicrobials: antimicrobial consumption (DDD); antimicrobial duration; a composite safety outcome of death, admission to HDU/ICU or readmission to hospital within 30 days; and length of admission. Procalcitonin levels of ≤0.25 ng/L were interpreted as negatively predictive of bacterial co-infection. Effects were expressed as ratios of means (ROM) or prevalence ratios (PR) accordingly.

Results

259 patients were included in the final analysis. Antimicrobial use was lower in patients who had procalcitonin measured within 72 h of starting antimicrobials: mean antimicrobial duration 4.4 versus 5.4 days, adjusted ROM 0.7 (95% CI 0.6–0.9); mean antimicrobial consumption 6.8 versus 8.4 DDD, adjusted ROM 0.7 (95% CI 0.6–0.8). Both groups had similar composite safety outcomes (adjusted PR 0.9; 95% CI 0.6–1.3) and lengths of admission (adjusted ROM 1.3; 95% CI 0.9–1.6).

Conclusions

A procalcitonin-guided algorithm may allow for the safe reduction of antimicrobial usage in hospitalized non-critically ill patients with COVID-19 pneumonia.
Characterizing employment of colorectal cancer survivors using electronic health records
Authors: Varga Alexandra , Gruß Inga , Ritzwoller Debra P , Bradley Cathy J , Sterrett Andrew T , Banegas Matthew P
Published: August 2021

Objective

Although the value of collecting occupational data is well-established, these data are not systematically collected in clinical practice. We assessed the availability of electronic health record (EHR)-based occupation data within a large integrated health care system to determine the feasibility of its use in research.

Materials and Methods

We used a mixed-methods approach to extract EHR data and define employment status, employer, and employment industry of 1107 colorectal cancer survivors. This was a secondary analysis of a subset of the Patient Outcomes Research to Advance Learning (PORTAL) colorectal cancer cohort.

Results

We categorized the employment industry for 46% of the cohort. Employment status was available for 58% of the cohort. The employer was missing for over 95% of the cohort.

Conclusion

By combining data from structured and free-text EHR fields, we identified employment status and industry for approximately half of our sample. Findings demonstrate limitations of EHR data and underscore the need for systematic collection of occupation data in clinical practice.
Smoothed-strain approach to topology optimization – a numerical study for optimal control parameters
Authors: Lee Changkye , Natarajan Sundararajan , Kee Seong-Hoon , Yee Jurng-Jae
Published: August 2021

In this study, three variants of strain smoothing technique, viz. the cell-based, edge-based, and node-based smoothed finite element method, are employed for structural topology optimization. The salient features of the strain smoothing technique are: (i) does not require an explicit form of shape functions and (ii) less sensitive to mesh distortion. Within the proposed framework, the structural materials are modelled as the relative material density powered by the power-law approach. An optimum structural topology is estimated from the condition that minimizes the total strain energy of the structures of interest. The efficacy and the robustness of the strain smoothing technique, when applied to topology optimization, are demonstrated with a few standard benchmark problems. A systematic parametric study is done to find suitable and optimal control parameters for the topology optimization, viz. filter size, tuning parameter, and move limit. The relative performance of different strain smoothing techniques for structural topology optimization is also presented.
Relating structure and power: Comonadic semantics for computational resources
Authors: Abramsky Samson , Shah Nihil
Published: August 2021

Combinatorial games are widely used in finite model theory, constraint satisfaction, modal logic and concurrency theory to characterize logical equivalences between structures. In particular, Ehrenfeucht–Fraïssé games, pebble games and bisimulation games play a central role. We show how each of these types of games can be described in terms of an indexed family of comonads on the category of relational structures and homomorphisms. The index $k$ is a resource parameter that bounds the degree of access to the underlying structure. The coKleisli categories for these comonads can be used to give syntax-free characterizations of a wide range of important logical equivalences. Moreover, the coalgebras for these indexed comonads can be used to characterize key combinatorial parameters: tree depth for the Ehrenfeucht–Fraïssé comonad, tree width for the pebbling comonad and synchronization tree depth for the modal unfolding comonad. These results pave the way for systematic connections between two major branches of the field of logic in computer science, which hitherto have been almost disjoint: categorical semantics and finite and algorithmic model theory.
Countering Avoidant Behaviors
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Franklin Dee Ross , Espel-Huynh Hallie , Boswell James F.
Published: August 2021

The key concept for this session is emotion avoidance, which means any strategies we use to avoid feeling strong emotions or to prevent our emotions from becoming more intense. Although these responses may be useful in some situations, they rarely work well in the long term, and they can increase the intensity of our emotions when we encounter a similar situation in the future. During this session, clients learn how suppression of thoughts and emotions can be counterproductive. Clients are taught to identify three types of avoidance, which are behavioral avoidance (obvious and subtle), cognitive avoidance, and safety signals.
Interoceptive Exposures
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Franklin Dee Ross , Espel-Huynh Hallie , Boswell James F.
Published: August 2021

In this session, clients practice tolerating physical sensations through interoceptive exposures and learn to recognize the role of such sensations in emotional experiences. If clients practice tolerating such sensations in a nonthreatening environment, they can learn that the physical sensations themselves, and the emotional reactions they have to them, can be reduced with repetition or practice. Clients also learn that they can tolerate those sensations better than they thought they could when they were avoiding them. The catastrophic emotional thoughts clients have about those situations are subjective and flexible, and just by practicing tolerance of the physical sensations, it is sometimes possible to reduce overall emotional distress.
Treatment of Chronic Pain
Authors: Otis John D.
Published: August 2021

Chronic pain is a highly prevalent condition that causes substantial impairment in many domains of life. Recent advances in pain research have elucidated the many biological, psychological, and social factors that can contribute to and impact the subjective experience of pain. In addition to treating patients using medications to manage pain, psychological treatments have now been developed and tested and found to significantly improve the severity of pain and the negative mood that often accompanies pain, as well as disability and impairment. Cognitive behavioral approaches are now considered the “gold standard” psychological treatment for pain. To maximize their efficacy, however, these treatments are not implemented rigidly; rather, they are tailored to the particular needs of the patient. This chapter covers the essential treatment components for pain and offers therapists ideas for effectively tailoring treatment to individual patients, so that pain treatment can be implemented flexibly, but with fidelity.
Flexible Applications of Family-Based Therapy for Youth with Bipolar Spectrum Disorders
Authors: Brickman Haley M. , Fristad Mary A.
Published: August 2021

Bipolar spectrum disorders (BPSD) affect approximately 3.9% of youth and are associated with meaningful impairments across social, academic, and family domains. Early psychosocial treatment, in conjunction with psychotropic intervention, can ameliorate the negative impact of symptoms by equipping youth and their families with knowledge and skills to promote understanding and management of the disorder, leading to improved short- and long-term outcomes. Family-focused treatment for adolescents (FFT-A), family-focused cognitive behavioral therapy (CFF-CBT), and psychoeducational psychotherapy (PEP) represent a well-established class of manual-based interventions that have been found to improve mood symptoms and family functioning through the use of family psychoeducation and skill building. We detail and discuss the core components of these interventions, with a specific focus on how treatment components can be successfully adapted and delivered to ensure an individualized approach for optimal care. Flexibility is further illustrated by a depiction of ways in which PEP has been adapted to meet practical needs of families and clinicians while maintaining fidelity to the intervention.
The Coping Power Program for Children with Aggressive Behavior Problems
Authors: Lochman John E. , Powell Nicole P. , Jones Shannon
Published: August 2021

Flexible adaptations of the Coping Power Program have been made for the delivery of the program. Coping Power is a structured, manualized cognitive-behavioral program, with components for children and parents designed to alter targeted mechanisms that contribute to children’s aggressive behavior problems. The program originated as a targeted prevention program, delivered in school settings, but also has been applied and tested in clinical settings. The contextual social-cognitive model is described, followed by a brief description of program components, of fidelity assessment, and of results from several initial randomized controlled efficacy studies. The bulk of the chapter describes two types of adaptations of the program. The first adaptation is evident in a field trial study of real-world school counselors’ use of the program, and was affected by the intensity of training that counselors received and by their own characteristics and the characteristics of their work setting. Appropriate and inappropriate adaptions were observed, with appropriate adaptations illustrating the concept of flexibility within fidelity. The second type of adaptation involves efforts to optimize the program and to test planned changes. The chapter describes evaluations of planned adaptations to the length of the program (including Internet components), to program targets through inclusion of mindfulness training, to delivery of the program in group versus individual formats, and to a variety of changes made in the structure and cultural relevance of the program in international adaptations.
Accretion geometry of the black hole binary MAXI J1820+070 probed by frequency-resolved spectroscopy
Authors: Axelsson Magnus , Veledina Alexandra
Published: August 2021

The geometry of the inner accretion flow in the hard and hard-intermediate states of X-ray binaries remains controversial. Using Neutron star Interior Composition Explorer observations of the black hole X-ray binary MAXI J1820+070 during the rising phase of its 2018 outburst, we study the evolution of the timing properties, in particular the characteristic variability frequencies of the prominent iron K α line. Using frequency-resolved spectroscopy, which is robust against uncertainties in the line profile modelling, we find that reflection occurs at large distances from the Comptonizing region in the bright hard state. During the hard-to-soft transition, the variability properties suggest that the reflector moves closer to the X-ray source. In parallel, the peak of the iron line shifts from 6.5 to ∼7 keV, becoming consistent with that expected of from a highly inclined disc extending close to the black hole. We additionally find significant changes in the dependence of the root-mean-square (rms) variability on both energy and Fourier frequency as the source softens. The evolution of the rms-energy dependence, the line profile, and the timing properties of the iron line as traced by the frequency-resolved spectroscopy all support the picture of a truncated disc/inner flow geometry.
Accelerating self-gravitating hydrodynamics simulations with adaptive force updates
Authors: Grudić Michael Y
Published: August 2021

Many astrophysical hydrodynamics simulations must account for gravity, and evaluating the gravitational field at the positions of all resolution elements can incur significant cost. Typical algorithms update the gravitational field at the position of each resolution element every time the element is updated hydrodynamically, but the actual required update frequencies for hydrodynamics and gravity can be different in general. We show that the gravity calculation in hydrodynamics simulations can be optimized by only updating gravity on a time-scale dictated by the already determined maximum time-step for accurate gravity integration Δtgrav, while staying well within the typical error budget of hydro schemes and gravity solvers. Our implementation in the gizmo code uses the time-scale derived from the tidal tensor $t_{\rm tidal} = \Vert \mathbf {T}\Vert ^{-1/2}$ to determine Δtgrav and the force update frequency in turn, and uses the rate of change of acceleration evaluated by the gravity solver to construct a predictor of the acceleration for use between updates. We test the scheme on standard self-gravitating hydrodynamics test problems, finding solutions very close to the standard scheme while evaluating far fewer gravity forces, optimizing the simulations. We also demonstrate a $\sim 70{{\ \rm per\ cent}}$ speed-up in an example simulation of a giant molecular cloud. In general, this scheme introduces a new tunable parameter for obtaining an optimal compromise between accuracy and computational cost, in conjunction with, e.g. time-step tolerance, numerical resolution, and gravity solver tolerance.
Deep learning applications based on SDSS photometric data: detection and classification of sources
Authors: He Zhendong , Qiu Bo , Luo A-Li , Shi Jinghang , Kong Xiao , Jiang Xia
Published: August 2021

Most astronomical source classification algorithms based on photometric data struggle to classify sources as quasars, stars, and galaxies reliably. To achieve this goal and build a new Sloan Digital Sky Survey photometric catalogue in the future, we apply a deep learning source detection network built on YOLO v4 object detection framework to detect sources and design a new deep learning classification network named APSCnet (astronomy photometric source classification network) to classify sources. In addition, a photometric background image generation network is applied to generate background images in the process of data sets synthesis. Our detection network obtains a mean average precision score of 88.02 when IOU = 0.5. As for APSCnet, in a magnitude range with 14–25, we achieve a precision of 84.1 ${{\ \rm per\ cent}}$ at 93.2 ${{\ \rm per\ cent}}$ recall for quasars, a precision of 94.5 ${{\ \rm per\ cent}}$ at 84.6 ${{\ \rm per\ cent}}$ recall for stars, and a precision of 95.8 ${{\ \rm per\ cent}}$ at 95.1 ${{\ \rm per\ cent}}$ recall for galaxies; and in a magnitude range with less than 20, we achieve a precision of 96.6 ${{\ \rm per\ cent}}$ at 94.7${{\ \rm per\ cent}}$ recall for quasars, a precision of 95.7${{\ \rm per\ cent}}$ at 97.4${{\ \rm per\ cent}}$ recall for stars, and a precision of 98.9 ${{\ \rm per\ cent}}$ at 99.2 ${{\ \rm per\ cent}}$ recall for galaxies. We have proved the superiority of our algorithm in the classification of astronomical sources through comparative experiments between multiple sets of methods. In addition, we also analysed the impact of point spread function on the classification results. These technologies may be applied to data mining of the next generation sky surveys, such as LSST, WFIRST, and CSST etc.
Virtual Recruitment Is Here to Stay: A Survey of ID Fellowship Program Directors and Matched Applicants Regarding Their 2020 Virtual Recruitment Experiences
Authors: Rockney Danica , Benson Constance A , Blackburn Brian G , Chirch Lisa M , Konold Victoria J L , Luther Vera P , Razonable Raymund R , Tackett Sean , Melia Michael T
Published: August 2021

Background

Graduate Medical Education training programs transitioned to all-virtual recruitment in 2020. Limited data have been published regarding the consequences of this transition. We aimed to understand (1) infectious diseases (ID) fellowship programs’ recruitment efforts and the effect of virtual recruitment on application and interview numbers and (2) the number of programs to which matched applicants applied and interviewed and applicants’ perspectives on virtual recruitment.

Methods

In 2020–2021, we surveyed all US ID fellowship program directors (PDs) and matched applicants. Descriptive data analysis was performed on quantitative survey items. Free-text responses were analyzed through a quantitative content analysis approach.

Results

The PD response rate was 68/158 (43%); the applicant response rate was at least 23% (85/365). PDs reported a 27% increase in mean number of applications received and a 45% increase in mean number of applicants interviewed compared with the previous year. Applicants especially valued the online program structure information, PD program overview videos, didactic and curriculum content, and fellow testimonials and profiles. Most applicants preferred interviews lasting no more than 40 minutes and interview days lasting no more than 5 hours. Nearly all (60/64, 94%) PDs adequately learned about candidates; most (48/64, 75%) felt unable to showcase their program as well as when in-person. Most PDs (54/64, 84%) and applicants (56/73, 77%) want an option for virtual recruitment.

Conclusions

Virtual recruitment enabled programs to accommodate more applicants and highlighted applicants’ preferences for programs’ augmented online presences and time-limited interview days. Most programs and applicants want an option for virtual interviews.
Identification and characteristic analysis of enhancers across 13 major cancer types
Authors: Qian Mingming , Wang Wenzhu , Zhang Yana , Zhao Yi , Quan Huige , Chen Yuting , Dai Xinyue , Guo Zhiyun
Published: August 2021

Enhancers are often mutated and dysregulated in various diseases such as cancer. By integrating the function annotation of the mammalian genome (FANTOM) enhancers expression profiles and RNA-seq data from The Cancer Genome Atlas (TCGA) of 13 cancers and their corresponding para-cancerous tissues, we systematically identified a total of 4702 significantly differentially expressed (DE) enhancers. Furthermore, a total of 1036 DE genes regulated by DE enhancers were identified. It was found that in these 13 cancers, most (61.13%) enhancers were ubiquitously expressed, whereas DE enhancers were more likely to be tissue-specific expressed, and the DE genes regulated by DE enhancers were significantly enriched in cancer-related pathways. Finally, it was manifested that 74 single nucleotide polymorphisms (SNPs) were located in 37 DE enhancers, and these SNPs affected the gain and loss of functional transcription factor binding sites of 758 transcription factors, which were shown to be highly correlated with tumorigenesis and development.
Neonatal Care Provider Tasks in the NICU and Delivery Room
Authors: Smith Misty , Bosque Elena
Published: August 2021

Background:

Decreased availability of pediatric residents in neonatal intensive care units (NICUs) has created demand for other neonatal medical care providers. No recent publications exist about how to approach the organization of tasks involved in that care.

Purpose:

The purpose of this article is to present a structure and resources to guide the organization of tasks in the care of sick and premature infants in the NICU.

Methods:

The methods included a literature review to develop evidenced-based practice resources. The literature was reviewed regarding the relevant history and resources to support task organization during patient rounds and care in the NICU, and for delivery attendance by skilled providers. The goal, to establish a reference to support education about these approaches, is based upon evidence, which appears to be rooted in tradition.

Findings:

Evidence-based resources include documentation templates, problem list in order of systems, and provider tasks for NICU and delivery attendance.

Implication for Research:

Future studies can measure mentor or learner perceptions of the value of these resources, critical thinking improvement, safety, and clinical outcomes.

Implication for Practice:

These resources may provide structure for learners and providers who have studied the physiology, pathophysiology, and problem management concepts, but need to learn how to execute their responsibilities in these busy environments.
Determination of Guanfacine in Oral Fluid and Serum of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Short Communication
Authors: Wohkittel Christopher , Scherf-Clavel Oliver , Fekete Stefanie , Romanos Marcel , Högger Petra , Gerlach Manfred
Published: August 2021

Background:

Guanfacine, a selective α2A-adrenoreceptor agonist, is a second-line medication for treating children and adolescents with attention-deficit/hyperkinetic disorder. The dosage administered as milligram per body weight to balance the potential benefits and risks of treatment. Therapeutic drug monitoring (TDM) is useful for identifying a patient's therapeutic window to optimize individual drug dosing and reduce the risk of adverse drug reactions. However, in children and adolescents, intravenous sample collection is especially stressful and thus remains a primary challenge, restricting the use of TDM. Therefore, evaluating alternative specimens to facilitate TDM is a worthwhile task. The aim of this study was to assess the feasibility of using oral fluid for TDM of guanfacine in children and adolescents.

Methods:

In this article, 9 patients (median age 8.1 years; 6 boys and 3 girls) undergoing treatment with guanfacine were included. Simultaneously collected oral fluid and serum samples were deproteinized using methanol containing a stable isotope-labeled internal standard before the determination of guanfacine by liquid chromatography–tandem mass spectrometry. Pearson correlation and paired t test were used for statistical analysis.

Results:

The mean serum guanfacine concentration was 3 times higher than that detected in oral fluid (7.47 ng/mL versus 2.36 ng/mL; t (8) = 5.94; P < 0.001). A strong positive linear correlation (r = 0.758, P = 0.018) was identified between oral fluid and serum concentrations. A strong but nonsignificant negative correlation (r = −0.574, P = 0.106) was detected between the oral fluid pH and oral fluid-to-serum concentration ratio.

Conclusions:

The strong correlation between oral fluid and serum concentration and the probable small effect of oral fluid pH on oral fluid-to-serum concentration ratio supports guanfacine as a suitable candidate for TDM in oral fluid.
Intensity of Home-Based Telework and Work Engagement During the COVID-19 Pandemic
Authors: Nagata Tomohisa , Nagata Masako , Ikegami Kazunori , Hino Ayako , Tateishi Seiichiro , Tsuji Mayumi , Matsuda Shinya , Fujino Yoshihisa , Mori Koji
Published: August 2021

Objective:

The present study examined the relationship between the intensity of home-based telework and work engagement.

Methods:

This cross-sectional study using a self-administrated questionnaire survey was conducted from December 22 to 25, 2020, in Japan. The subjects were asked single-item questions about the intensity of telework and three-item questions about work engagement using the Utrecht Work Engagement Scale. Coefficients were estimated using a multilevel regression model nested by the prefecture of residence and adjusted for covariates.

Results:

High-intensity (4 or more days per week) telework was not associated with high work engagement for men or women. In contrast, low and moderate intensity (3 days per week to once per month) were associated with high work engagement. The results were consistent when stratified by sex.

Conclusions:

Reasonable-intensity telework may have beneficial effects on work engagement.
Re-induction with intravenous Ustekinumab after secondary loss of response is a valid optimization strategy in Crohn’s disease
Authors: ten Bokkel Huinink Sebastiaan , Biemans Vince , Duijvestein Marjolijn , Pierik Marieke , Hoentjen Frank , West Rachel L. , van der Woude Christien J. , de Vries Annemarie C.
Published: August 2021

Background and aim

Re-induction with intravenous ustekinumab after secondary loss of response in Crohn’s disease is a relatively new strategy to regain efficacy. This real-world cohort study aimed to evaluate its effectiveness and safety.

Methods

Crohn’s disease patients with loss of response after initial response to ustekinumab and treated with a second intravenous dose of ustekinumab were included. Clinical, biochemical and endoscopic data were collected. Primary outcome was drug survival. Secondary effectiveness outcomes included clinical remission, primary nonresponse and adverse events.

Results

In total, 31 Crohn’s disease patients were included after re-induction with intravenous ustekinumab. All patients had failed prior biologic therapy, that is 77% were exposed to two or more antitumor necrosis factor agents and 65% were exposed to vedolizumab prior to initiation of ustekinumab treatment. Median treatment duration between initial treatment and re-induction with intravenous ustekinumab was 11.1 months (interquartile range 6.9–19.5). Ustekinumab therapy after a second dose of intravenous ustekinumab was maintained in 74 and 71% of the patients at weeks 20 and 52. Clinical remission rates after re-induction at weeks 8, 20 and 52 were 37, 56 and 45%, respectively. Nonresponse occurred in 16% of the patients. Adverse events were reported in four patients.

Conclusions

Re-induction with intravenous ustekinumab after secondary loss of response results in continuation of ustekinumab treatment for at least 1 year in almost three-quarters of patients and in clinical remission in half of patients after 1 year. Therefore, ustekinumab re-induction may be considered an important rescue treatment option in patients with refractory Crohn’s disease.
Costs of a Train-the-Trainer Program to Teach Primary Care Faculty Mental Health Care
Authors: Luo Zhehui , Gardiner Joseph C. , Smith Robert C.
Published: August 2021

Background:

Mental health care must improve in this country. With the worsening shortage of psychiatrists and other mental health professionals, the next generation of physicians in primary care will need to be better trained in mental health care.

Objectives:

We estimate the direct cost of implementing an evidence-based Train-the-Trainer (3T) program to disseminate mental health training to allopathic medical school faculty; once trained, faculty can teach a much-enhanced curriculum of mental health care to medical students and residents.

Methods:

A combination of published standardized unit costs and an activity-based costing approach is used to estimate the direct costs (labor and nonlabor) for implementing the 3T program.

Results:

The estimated direct cost of implementing the 3T program at one prototypical school, including the 12-month start-up period (1.1 million) and 18-month rollout period (8.6 million), is ∼9.7 million dollars.

Conclusions:

Successfully adopted in all US allopathic medical schools, the 3T program will provide over 3800 attitudinally competent and mental health skills-qualified primary care faculty members. They would then be available to train nearly 100,000 medical students per year and 55,000 primary care residents to be as competent in basic mental health care as in medical care. This 3T program will begin to meet the needs each year for the millions of adults with major mental disorders that now are largely unrecognized and untreated.
Developing and Assessing a Competency-Based Nurse Orientation in Pediatric Ambulatory Infusion Clinics
Authors: Zatko Lora , Frost Kasey , Duffy Elizabeth A.
Published: August 2021

Clinical nurse competency can be well supported through the institution of competency-based nurse orientation programs. The aims of this quality improvement project are twofold: to develop an orientation checklist that contains competency-based education techniques and assessment tools and to evaluate the usability of the competency-based orientation checklist by nursing staff. The project used a pre–post survey design to assess usability. The findings demonstrate that competency-based education and assessment increase checklist usability and increase staff satisfaction.
High-grade Follicular Lymphomas Exhibit Clinicopathologic, Cytogenetic, and Molecular Diversity Extending Beyond Grades 3A and 3B
Authors: Laurent Camille , Adélaïde José , Guille Arnaud , Tesson Bruno , Gat Elodie , Evrard Solene , Escudié Frederic , Syrykh Charlotte , Canioni Danielle , Fabiani Bettina , Meignin Véronique , Chassagne-Clement Catherine , Dartigues Peggy , Traverse-Glehen Alexandra , Parrens Marie , Huet Sarah , Copie-Bergman Christiane , Salles Gilles , Birnbaum Daniel , Brousset Pierre , Morschhauser Franck , Xerri Luc
Published: August 2021

Although follicular lymphoma (FL) is usually graded as FL1-2, FL3A, and FL3B, some borderline cases can be observed and led us to investigate the clinicopathologic diversity of grade 3 FL (FL3). Among 2449 FL patients enrolled in Lymphoma Study Association (LYSA) trials, 1921 cases with sufficient material underwent a central pathologic review. The resulting diagnoses comprised 89.6% FL1-2 (n=1723), 7.2% FL3A (n=138), and 0.5% purely follicular FL3B (n=9). The remaining 51 unclassifiable cases (2.7%) exhibited high-grade features but did not meet WHO criteria for either FL3A or FL3B; and were considered as “unconventional” high-grade FL (FL3U). FL3U morphological pattern consisted of nodular proliferation of large cleaved cells or small-sized to medium-sized blast cells. Compared with FL3A, FL3U exhibited higher MUM1 and Ki67 expression, less BCL2 breaks and more BCL6 rearrangements, together with a higher number of cases without any BCL2, BCL6 or MYC rearrangement. FL3U harbored less frequent mutations in BCL2, KMT2D, KMT2B, and CREBBP than FL3A. MYC and BCL2 were less frequently mutated in FL3U than FL3B. Rituximab cyclophosphamide, doxorubicin, vincristine, and prednisone treated FL3U patients had a worse survival than FL1-2 patients with similar follicular lymphoma international prognostic index and treatment. These results suggest that high-grade FLs encompass a heterogeneous spectrum of tumors with variable morphology and genomic alterations, including FL3U cases that do not strictly fit WHO criteria for either FL3A or FL3B, and display a worse outcome than FL1-2. The distinction of FL3U may be useful to allow a better comprehension of high-grade FLs and to design clinical trials.
A New 3-Stage Approach for Reoperative Hypospadias
Authors: Jordan Ashley , Sumfest Joel , DeSantis Joseph
Published: August 2021

Background

Most hypospadias patients undergo 1 surgical procedure and go on to live normal lives. However, there is a small subset of patients who have remaining functional complications after their repair. Patients presenting with diffuse scarring of the urethral plate and a shortage of penile skin for closure are referred to as “hypospadias cripples.” We present our experience using tissue expanders in the treatment of reoperative hypospadias with skin deficiency.

Methods

We retrospectively reviewed hospital records from 2009 to 2019. Five hypospadias cripple patients were encountered. A multidisciplinary team involving plastic surgery and pediatric urology collaborated a 3-stage reconstructive plan:

Stage 1—Scar excision and buccal mucosal graft harvest

Stage 2—Dorsal tissue expander placement

Stage 3—Tissue expander explantation, creation of neourethra, and skin closure.

Results

Successful skin closures were achieved in all patients. There were no cases of expander explanation. Average time between tissue expander placement and final reconstruction ranged from 3 to 4 months. Complications included 2 cases of penile cellulitis, 1 with an associated abscess, and 2 limited urethrocutaneous fistulas, which were addressed with an additional operative procedure.

Conclusions

The 3-stage approach is advantageous in treating hypospadias cripple patients. This population can benefit greatly from tissue expander placement after buccal result with an acceptable complication rate. Using a multidisciplinary approach is beneficial in treating these complex patients.
Pediatric Mandibular Reconstruction Using the Vascularized Fibula Free Flap
Authors: Zavala Abraham , Ore Juan F. , Broggi Alfredo , De Pawlikowski Wieslawa
Published: August 2021

Background

The vascularized fibula free flap is a workhorse flap in pediatric mandibular reconstruction. This study aimed to address functional outcomes, complications, and morbidity associated with the fibula resection in a consecutive series of mandibular reconstruction using this technique in skeletally immature patients.

Methods

Functional outcomes in terms of maximal mouth opening capacity, patient-reported eating ability, occlusion, and gait were retrospectively reviewed in 34 consecutive pediatric patients (18 males, 16 females) who underwent mandibular reconstruction using the vascularized free fibula flap. Data regarding donor and recipient site complications were also retrieved.

Results

The mean follow-up period was 50.6 months (range, 12–108 months). The average age was 10.3 years (range, 2–15 years). Underlying pathologies included ossifying fibroma, ameloblastoma, mandibular arteriovenous malformation, fibrous dysplasia, Goldenhar syndrome, dentigerous cyst, mandibular lymphoma, odontogenic fibroma, adenomatoid odontogenic tumor, aneurysmal bone cyst, neurogenic sarcoma, and central giant cell granuloma. Defect length ranged from 8 to 17 cm. Mean return to normal ambulation was achieved 12 days postoperatively. All patients reported ability to eat solids and liquids, with 29 of 34 achieving normal mouth opening. Normal or minimally disturbed occlusion was maintained postoperatively in most patients. Temporomandibular joint ankylosis and condylar displacement were each developed in one patient. Two patients reported gait disturbances that receded after physical therapy. No other major donor site complications, including flexion contracture of the great toe, were identified.

Conclusions

The vascularized fibula free flap is reaffirmed to be the criterion standard for mandible reconstruction in pediatric patients, providing satisfactory functional results and adequate adaptation to the growing facial skeleton with minimal sequelae. Complications regarding hallux function may be prevented by assessing the vascularity of the flexor hallucis longus intraoperatively and ensuring tension-free closure of the donor site.
Comparative Study of the Clinical Effects of Reverse Digital Artery Island Flaps and Antegrade Homodigital Neurovascular Island Flaps for Fingertip Reconstruction
Authors: Xiong Xu , Xu Min , Shuai Ming , Guo Chao-Jian , Wang Chao , He Zhi-Ling , Li Hao
Published: August 2021

Objective

This retrospective study aimed to compare the clinical effects of reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in fingertip reconstruction.

Patients and Methods

We retrospectively analyzed the data of 30 consecutive patients with fingertip defects who had undergone 2 types of surgery from January 2016 to January 2019. We used reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in 14 and 16 patients, respectively. Flap sensitivity was evaluated using the Semmes-Weinstein monofilament test and static 2-point discrimination test. Finger appearance was assessed using the Michigan Hand Outcomes Questionnaire. The operation time, flap sensitivity, range of motion of the interphalangeal joint, and complications were evaluated.

Results

The static 2-point discrimination results of the fingers were significantly different between the antegrade homodigital neurovascular island flap group and reverse digital artery island flap group (8.07 ± 1.54 vs 5.94 ± 1.73; P < 0.05). The appearance of the fingers was significantly better in the antegrade homodigital neurovascular island flap group. Surgery using antegrade homodigital neurovascular island flaps required less time than surgery using reverse digital artery island flaps. No significant differences were found between the 2 groups in the range of motion of the interphalangeal joint or complications.

Conclusions

The functional outcomes were identical between the reverse digital artery island flap and antegrade homodigital neurovascular island flap methods for fingertip reconstruction. Antegrade homodigital neurovascular island flaps lead to a shorter operation time, a more satisfying appearance, and better sensory recovery.
The Incidence of Traumatic Optic Neuropathy Associated With Subtypes of Orbital Wall Fracture
Authors: Sakong Yong , Chung Kyu Jin , Kim Yong Ha
Published: August 2021

Background:

Traumatic optic neuropathy (TON) is a rare disease but leaves critical sequelae to patient. Purpose of this study is to evaluate the incidence of TON in each orbital wall fracture.

Materials and Methods:

Retrospective review of 2629 patients with orbital wall fracture was performed in from January 2010 to March 2019, based on diagnostic code, Korean Standard Classification of Diseases, 7th Revision. The orbital wall fractures were divided into 4 subtypes: superior, medial, inferior, and lateral wall. Incidence of TON is analyzed according to subtypes, single and multiple wall fracture.

Results:

Among 2629 patients with orbital wall fractures, 27 patients were diagnosed with TON with an incidence of 1.02%. In single wall fracture, only lateral wall showed significantly high TON incidence, which only zygomatic fracture was included in single lateral wall fracture. In multiple wall fracture, it was statistically significant in the superior wall.

Conclusions:

Fracture on lateral and superior orbital wall showed a tendency to increase the incidence of TON. Based on the above results, radiologic evaluation and physical examination is necessary for patient who has lateral and superior orbital wall fracture.
NonSurgical Approach to Treat Lip Vascular Complication Caused by Hyaluronic Acid Filler
Authors: Alcantara Allan Rafael , Machado-Filho Daniel Augusto , Provenzano Renato Goulart , Vieira Leonardo Caldas , Kim Jun Ho , Cortes Arthur Rodriguez Gonzalez
Published: August 2021

The use of hyaluronic acid (HA) fillers in lip augmentation represents today 1 of the most widely used nonsurgical aesthetic procedures in the world. Regarding the severe complications are rare, insufficient professional experience for recognizing signs of vascular impairment and inadequate technique could lead to severe lip skin necrosis complications. Several of existing treatment protocols in the literature to treat vascular complication are mainly based on the use of hyaluronidase. Nevertheless, there is no consensus on dosage, interval between doses and complementary protocol among the aforementioned studies. This case aims to present a conservative approach for the clinical management of serious vasculature complications with HA injection. A high dose of hyaluronidase(11500 IU) with additional multimodal treatment was performed to the upper lip, nasolabial fold, and nose that successfully reversed a vascular complication process. The present findings suggest that the use of high doses of hyaluronidase with the complementary protocol used herein might be a promising approach in the treatment of severe vascular complication in the lips caused by HA filling.
Oral Mucosal Melanoma
Authors: Nisi Marco , Izzetti Rossana , Gennai Stefano , Pucci Angela , Lenzi Chiara , Graziani Filippo
Published: August 2021

Purpose:

Primary oral mucosal melanoma (OMM) is a rare neoplasm accounting for the 0.2% to 0.8% of all melanomas. The aim of the present manuscript is (1) to describe 2 cases of primary OMM treated at our department, and (2) to perform a systematic literature review on primary OMM occurrence and treatment

Methods:

Two cases of primary OMM were described. A systematic review is presented in order to assess the treatment options, recurrence, metastasis development, and survival rate of primary OMM.

Results:

Two patients were referred for the development of a lesion of the hard palate and the maxillary gingival mucosa, respectively. An incisional biopsy was performed in both patients, followed by extensive surgical resection after a thorough consideration of patient history and systemic involvement. The literature search retrieved 447 primary OMM cases. In the 30% of cases, distant metastases were already present at the time of diagnosis. The management of primary OMM most frequently involved surgical treatment and adjuvant radiotherapy.

Conclusions:

Primary OMM still represents a challenge for the clinician, as the diagnosis is often performed when metastases have already developed. The prognosis is generally poor, thus highlighting the need for further investigations to improve early diagnosis.
Effect of Dichotomous Conchal Cartilage Transplantation on Correction of Unilateral Cleft Lip Nasal Deformity
Authors: Han Zhiqiang , Wu Beibei , Jiang Banghong , Song Peijun , Li Guangzao , Xu Jing
Published: August 2021

Background:

Autologous conchal cartilage is becoming increasingly popular as a source of material for secondary reconstruction. The aim of this study was to verify the effect of dichotomous autologous conchal cartilage transplantation in the treatment of unilateral cleft lip nasal deformity.

Methods:

Eighteen patients (10 males and 8 females) with unilateral cleft lip nasal deformity treated from August 2018 to August 2019 were selected for the study. The cut C-shaped conchal cartilage was trimmed into a strip shape and a shield shape and transplanted into the alar cartilage and the tip of the nose, respectively. The effect of the operation was evaluated in terms of patient satisfaction, two-dimensional linear quantitative results, and three-dimensional spatial differences after the operation.

Results:

During follow-up from 6 months to 2 years, the nasal appearance of 18 patients was significantly improved. The postoperative patient satisfaction survey revealed more than 93% satisfaction for each research index. Two-dimensional linear quantitative analysis revealed that the height of the nasal columella and nostril was significantly increased and that the nasal base and breadth were significantly decreased after the operation. Evaluation of the three-dimensional spatial difference between the unaffected side and the affected side before and after the operation revealed a significant decrease in the difference in the soft tissue volume between the unaffected side and the affected side (P < 0.05).

Conclusions:

Dichotomous autologous conchal cartilage transplantation is an ideal method for the treatment of unilateral cleft lip nasal deformity.
Outcomes and Healthcare Utilization Among New Persistent Opioid Users and Nonopioid Users After Curative-intent Surgery for Cancer
Authors: Lin Na , Dabas Eashita , Quan May Lynn , Cheung Winson Y. , Cuthbert Colleen , Feng Yuanchao , Kong Shiying , Sauro Khara M. , Brenner Darren R. , Yang Lin , Lu Mingshan , Xu Yuan
Published: August 2021

Objective:

The aim of the study was to compare the health outcomes and resource use of cancer patients who were new persistent opioid users with those who were not, after undergoing curative intent surgery for cancer.

Background:

Little is known about long-term health outcomes (overdose, mortality) and resource utilization of new persistent opioid users among cancer patients undergoing curative-intent surgery.

Methods:

This retrospective cohort study included all adults with a diagnosis of solid cancers who underwent curative-intent surgery during the study period (2011–2015) in Alberta, Canada and were opioid-naïve before surgery, with a follow-up period until December 31, 2019. The key exposure, “new persistent opioid user,” was defined as a patient who was opioid-naive before surgery and subsequently filled at least 1 opioid prescription between 60 and 180 days after surgery. The primary outcome was opioid overdose that occurred within 3 years of surgery. All-cause death, noncancer caused death, and department visit (yes vs. no), and hospitalization (yes vs. no) in the follow-up periods were also included as outcomes.

Results:

In total, 19,219 patients underwent curative intent surgery with a median follow-up of 47 months, of whom 1530 (8.0%) were identified as postoperative new persistent opioid users. In total, 101 (0.5%) patients experienced opioid overdose within 3 years of surgery. Compared with nonopioid users, new persistent opioid users experienced a higher rate of opioid overdose (OR = 2.37, 95% CI: 1.44–3.9) within 3 years of surgery. New persistent opioid use was also associated with a greater likelihood of being hospitalized (OR = 2.03, 95% CI: 1.76–2.33) and visiting an emergency room (OR = 1.83, 95% CI: 1.62–2.06) in the first year after surgery, and a higher overall (HR = 1.28, 95% CI: 1.1–1.49) and noncancer caused mortality (HR = 1.33, 95% CI: 1.12–1.58), when compared with nonopioid users.

Conclusion:

Postoperative new persistent opioid use among cancer patients undergoing curative-intent surgery is associated with subsequent opioid overdose, worse survival, and more health resource utilization.