bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Early-Life Seizures on Cognitive and Motor Development: A Case Series
Authors: Jensen-Willett Sandra , Cunha Andrea , Lobo Michele A. , Harbourne Regina , Dusing Stacey C. , McCoy Sarah W. , Koziol Natalie A. , Hsu Lin-Ya , Marcinowski Emily C. , Babik Iryna , An Mihee , Bovaird James A.
Published: June 2022

Purpose:

This case series documents developmental changes over time and in response to a novel intervention, Sitting Together and Reaching to Play (START-Play), in children with early-life seizures.

Methods:

Thirteen children with early-life seizures were included from a subset of participants in the START-Play multisite, randomized controlled trial. Seven received 3 months of twice weekly START-Play intervention; 6 continued with usual care early intervention. Bayley Scales of Infant Development-III (Cognitive Composite), Gross Motor Function Measure-66 Item Set, Assessment of Problem-Solving in Play, and reaching assessments were administered at baseline, 3, 6, and 12 months postbaseline. Change scores are reported at 3 and 12 months postbaseline.

Results:

Over time, plateau or decline was noted in standardized cognition measures; motor development improved or was stable. Children receiving START-Play showed positive trends in problem-solving (71.4%) and reaching behaviors (57.2%).

Conclusions:

Interventions such as START-Play that combine motor and cognitive constructs may benefit children with early-life seizures.
Let's Talk About It: A Narrative Review of Digital Approaches for Disseminating and Communicating Health Research and Innovation
Authors: Coyne Paige , Kustra Erika , Woodruff Sarah J.
Published: June 2022

Best health practice and policy are derived from research, yet the adoption of research findings into health practice and policy continues to lag. Efforts to close this knowledge-to-action gap can be addressed through knowledge translation, which is composed of knowledge synthesis, dissemination, exchange, and application. Although all components warrant investigation, improvements in knowledge dissemination are particularly needed. Specifically, as society continues to evolve and technology becomes increasingly present in everyday life, knowing how to share research findings (with the appropriate audience, using tailored messaging, and through the right digital medium) is an important component towards improved health knowledge translation. As such, this article presents a review of digital presentation formats and communication channels that can be leveraged by health researchers, as well as practitioners and policy makers, for knowledge dissemination of health research. In addition, this article highlights a series of additional factors worth consideration, as well as areas for future direction.
‘Knowing the noise that surrounds the athlete’: a qualitative study exploring the health seeking behaviours of athletes with limb deficiency drawing on the experiences and perceptions of the medical staff and athletes
Authors: Jones Eleanor , Martin Paul , Barr Marc , Soundy Andy , Heneghan Nicola R.
Published: June 2022

Objective

To explore the health seeking behaviours (HSB) of athletes with limb deficiency, drawing on the experiences and perception of the SMT and athletes.

Design

An interpretive hermeneutic phenomenological methodology with a subtle realist paradigmatic view to investigate commonality in unique experiences within reality. Data collection was completed with two focus groups in December 2019 and March 2020. Thirteen participants took part including athletes and SMT members (Physiotherapists, Doctors, and Strength and Conditioning Coaches) working in Parasports. Focus group manuscripts were transcribed verbatim from audio recordings. An inductive, iterative process was used to identify themes and subthemes, with processes in place to establish rigour.

Results

Two themes and five sub themes emerged in relation to the ‘internalisation and adjustment to social identity’ and ‘the importance and impact of factors which impact the athlete social identity’.

Conclusions

HSB of athletes with limb deficiency were influenced by a unique blend of personal and environmental factors that contribute towards social identity. The SMT require specific awareness of factors that may diminish HSB to deliver a personalised approach and negate consequences.
Feasibility and Acceptability of HIV Self-Test Kit Distribution Through PrEP Clients' Social and Sexual Networks to Increase HIV Testing and PrEP Information
Authors: King Katherine , Balan Shuba , Kanamori Mariano , Shrader Cho-Hee , Arroyo-Flores Juan , Johnson Ariana , Whiteside Patrick , Michniewicz Mara , Doblecki-Lewis Susanne
Published: June 2022

Objective:

To determine the feasibility, acceptability, and implementation of a HIV self-test (HIVST) program through PrEP clients' social and sexual networks.

Background:

HIV testing is critical for treatment and prevention engagement. HIVST kits can overcome barriers to testing. A negative result is an opportunity to provide PrEP information. We describe implementation factors associated with engaging current Mobile PrEP (MP) clients to distribute HIVST kits and PrEP information through their networks.

Setting:

Community venues in Miami-Dade County, Florida.

Methods:

A baseline survey collected network information and explored distribution plans for offering HIVST kits. A follow-up survey evaluated use and distribution. A logic model describes the process of implementation and evaluation. Up to 4 Ora-Quick HIV ST kits were offered to 81 MP clients. A brief training included resources for posttest engagement.

Results:

Forty-four percent of the kits were reported as distributed. Of 81 MP clients offered kits, 50 (62%) accepted. In a follow-up survey, 77% of MP clients distributed at least 1 kit. Fifty-six (86%) social network members were Latino, and 9 (14%) were Black. Three of 4 MP clients engaged in PrEP discussions (77%) with SN members. Reported reasons for HIVST kit use included convenience, confidentiality, privacy concerns, and discomfort with going to a testing site. MP clients reported that kit distribution was affected by the COVID-19 pandemic.

Conclusion:

HIV ST kits allowed PrEP users to engage others in their social and sexual networks for HIV testing and information regarding PrEP. Work to scale-up this intervention is underway.
Proyecto Compadre: Using Implementation Science to Tailor Peer Navigation for Latino Men in the US–Mexico Border Region
Authors: Tsuyuki Kiyomi , Stockman Jamila K. , Stadnick Nicole A. , Moore Veronica , Zhu Helen , Torres Vicente , Cano Rosalinda , Penninga Katherine , Aldous Jeannette L.
Published: June 2022

Background:

Latino men who have sex with men (MSM) in San Diego have poor HIV testing and prevention outcomes compared with non-Latino White men. Peer navigation (PN) is a promising evidence-based intervention to reduce disparities but needs tailoring for Latino MSM.

Settings:

Health centers near the US–Mexico border.

Methods:

Using the Exploration, Preparation, Implementation, Sustainment Framework, we conducted mixed-methods implementation science study. In phase I, we conducted interviews with Latino men (n = 15), focus groups with staff (n = 7), and surveys with all to understand the Exploration, Preparation, Implementation, Sustainment factors associated with HIV testing and care linkage. In phase II, we conducted 31 web-based surveys with Latino men and staff to rank intervention and implementation strategies from phase I. Quantitative data were analyzed descriptively, integrated with qualitative data, and reviewed by our community–academic partnership to develop an implementation model.

Results:

Latino men (N = 15) were 94% Spanish speaking, 67% gay identified, 27% US born, and their suggestions were to have navigators use peer referral to address barriers such as stigma; use the Latino social network to expand reach, leverage social media for peer-led intervention, and disseminate HIV information. Staff (N = 26) were 77% Spanish speaking, 35% gay-identified, 96% trained in cultural competency, and suggested including culturally appropriate HIV educational materials in Spanish, status and identity neutral programs, administrative/supervisorial/training structure for PNs, and PN compensation and team integration. Overall, results emphasized a need for a formalized PN model centered on referrals and using existing Latino community social networks.

Conclusions:

Findings can be packaged for future implementation of PN programs for Latino MSM.
Comprehensive Process Mapping and Qualitative Interviews to Inform Implementation of Rapid Linkage to HIV Care Programs in a Mid-Sized Urban Setting in the Southern United States
Authors: Pettit April C. , Pichon Latrice C. , Ahonkhai Aima A. , Robinson Cedric , Randolph Bruce , Gaur Aditya , Stubbs Andrea , Summers Nathan A. , Truss Kimberly , Brantley Meredith , Devasia Rose , Teti Michelle , Gimbel Sarah , Dombrowski Julia C.
Published: June 2022

Background:

Rapid antiretroviral therapy (ART) initiation, in which people living with HIV start ART within days of diagnosis, is a key component of the US Ending the HIV Epidemic initiative.

Setting:

The Memphis Metropolitan Statistical Area ranked fourth in the United States for the highest HIV incidence per 100,000 population in 2018. Rapid ART programs are limited in the Memphis Metropolitan Statistical Area, and our objective was to identify local implementation barriers.

Methods:

We conducted participatory process mapping and in-depth interviews to detail steps between HIV testing at the municipal health department's Sexually Transmitted Infections Clinic and ART prescription from a nearby high-volume Ryan White–funded HIV Clinic.

Results:

Process mapping identified 4 modifiable, rate-limiting rapid ART barriers: (1) requiring laboratory-based confirmatory HIV results, (2) eligibility documentation requirements for Ryan White–funded services, (3) insufficient HIV Clinic medical provider availability, and (4) variability in ART initiation timing among HIV Clinic providers. Staff at both sites highlighted suboptimal communication and sense of shared management between facilities, limited resources to address important social determinants of health, and lack of Medicaid expansion in Tennessee as key barriers. In-depth interview themes negatively affecting rapid ART initiation included clinic burden; provider knowledge, attitudes, and beliefs; and client psychosocial needs.

Conclusions:

Our preimplementation work identified modifiable and systemic barriers to systems flow and patient-level outcomes. This work will inform the design and implementation of a locally relevant rapid ART program in Memphis, a community disproportionately affected by the HIV epidemic.
Image Quality of High-Resolution 3-Dimensional Neck MRI Using CAIPIRINHA-VIBE and GRASP-VIBE
Authors: Seo Minkook , Yoon Jimin , Choi Yangsean , Nickel Dominik , Jang Jinhee , Shin Na-Young , Ahn Kook-Jin , Kim Bum-Soo
Published: June 2022

Objectives

Acquiring high-quality magnetic resonance imaging (MRI) of the head and neck region is often challenging due to motion and susceptibility artifacts. This study aimed to compare image quality of 2 high-resolution three-dimensional (3D) MRI sequences of the neck, controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA)–volumetric interpolated breath-hold examination (VIBE), and golden-angle radial sparse parallel imaging (GRASP)–VIBE.

Materials and Methods

One hundred seventy-three patients indicated for contrast-enhanced neck MRI examination were scanned using 3 T scanners and both CAIPIRINHA-VIBE and GRASP-VIBE with nearly isotropic 3D acquisitions (<1 mm in-plane resolution with analogous acquisition times). Patients' MRI scans were independently rated by 2 radiologists using a 5-grade Likert scale for overall image quality, artifact level, mucosal and lesion conspicuity, and fat suppression degree at separate anatomical regions. Interobserver agreement was calculated using the Cohen κ coefficient. The quality ratings of both sequences were compared using the Mann-Whitney U test. Nonuniformity and contrast-to-noise ratio values were measured in all subjects. Separate MRI scans were performed twice for each sequence in a phantom and healthy volunteer without contrast injection to calculate the signal-to-noise ratio (SNR).

Results

The scores of overall image quality, overall artifact level, motion artifact level, and conspicuity of the nasopharynx, oropharynx, oral cavity, hypopharynx, and larynx were all significantly higher in GRASP-VIBE than in CAIPIRINHA-VIBE (all P's < 0.001). Moderate to substantial interobserver agreement was observed in overall image quality (GRASP-VIBE κ = 0.43; CAIPIRINHA-VIBE κ = 0.59) and motion artifact level (GRASP-VIBE κ = 0.51; CAIPIRINHA-VIBE κ = 0.65). Lesion conspicuity was significantly higher in GRASP-VIBE than in CAIPIRINHA-VIBE (P = 0.005). The degree of fat suppression was weaker in the lower neck regions in GRASP-VIBE (3.90 ± 0.72) than in CAIPIRINHA-VIBE (4.97 ± 0.21) (P < 0.001). The contrast-to-noise ratio at hypopharyngeal level was significantly higher in GRASP-VIBE (6.28 ± 4.77) than in CAIPIRINHA-VIBE (3.14 ± 9.95) (P < 0.001). In the phantom study, the SNR of GRASP-VIBE was 12 times greater than that of CAIPIRINHA-VIBE. The in vivo SNR of the volunteer MRI scan was 13.6 in CAIPIRINHA-VIBE and 20.7 in GRASP-VIBE.

Conclusions

Both sequences rendered excellent images for head and neck MRI scans. GRASP-VIBE provided better image quality, as well as mucosal and lesion conspicuities, with less motion artifacts, whereas CAIPIRINHA-VIBE provided better fat suppression in the lower neck regions.
Third-Generation Cardiovascular Phantom
Authors: McDermott Michael C. , Sartoretti Thomas , Mihl Casper , Pietsch Hubertus , Alkadhi Hatem , Wildberger Joachim E.
Published: June 2022

Objective

Different types of preclinical research tools used in the field of diagnostic imaging such as dynamic flow circulation phantoms have built the foundation for optimization and advancement of clinical procedures including new imaging techniques. The objective was to introduce a third-generation phantom, building on the limitations of earlier versions and unlocking new opportunities for preclinical investigation.

Material and Methods

A third-generation phantom was designed and constructed comprising physiological vascular models from head to toe, including a 4-chamber heart with embedded heart valves and a controllable electromechanical pump. The models include modular segments, allowing for interchangeability between healthy and diseased vessels. Clinical sanity checks were performed using the phantom in combination with a dual-head power injector on a third-generation dual-source computed tomography scanner. Contrast media was injected at 1.5 g I/s, and the phantom was configured with a cardiac output of 5.3 L/min. Measurements of mean transit times between key vascular landmarks and peak enhancement values in Hounsfield units (HUs) were measured to compare with expected in vivo results estimated from literature.

Results

Good agreement was obtained between literature reference values from physiology and measured results. Contrast arrival between antecubital vein and right ventricle was measured to be 13.1 ± 0.3 seconds. Transit time from right ventricle to left ventricle was 12.0 ± 0.2 seconds, from left internal carotid artery to left internal jugular vein 7.7 ± 0.4 seconds, and 2.9 ± 0.2 seconds from aortic arch to aortic bifurcation. The peak enhancement measured in the regions of interest was between 336 HU and 557 HU.

Conclusions

The third-generation phantom demonstrated the capability of simulating physiologic in vivo conditions with accurate contrast media transport timing, good repeatability, and expected enhancement profiles. As a nearly complete cardiovascular system including a functioning 4-chamber heart and interchangeable disease states, the third-generation phantom presents new opportunities for the expansion of preclinical research in diagnostic imaging.
Impact of Reengineered Discharge Toolkit on Patients Undergoing Total Joint Surgeries
Authors: Mitchell Kathleen
Published: June 2022

Poorly coordinated care transitions account for nearly one fifth of Medicare hospital readmissions within 30 days postdischarge. The primary aim of this pilot project was to determine the impact of the Reengineered Discharge (RED) Toolkit on patient knowledge for self-management, satisfaction with the discharge process, readiness for discharge, discharge time, and 30-day readmission rate following hip or knee joint replacement or revision surgeries. Staff adherence with the RED Toolkit was also measured.

Thirty adult patients received the intervention of the RED Toolkit. Patient knowledge for self-management ranged from 85.2% to 92.6%; satisfaction with the discharge process scores increased from 33% to 59.2%; patient readiness for discharge scores increased from 2% to 64%. Discharge times decreased. On average, patients left the unit 5.67 (±2.52) hours after the written discharge order. The all-cause 30-day readmission rate was reduced to 3.3%. Staff achieved a RED Toolkit adherence rate of 86.8%. Findings provide a basis for developing a coordinated discharge planning process.
Soft Tissue Reconstruction for Upper Extremity Necrotizing Soft Tissue Infections
Authors: Yu Jenny L. , Crowe Christopher S. , Yesantharao Pooja , Kennedy Stephen A. , Keys Kari A.
Published: June 2022

Introduction

One of the main aspects of management for necrotizing soft tissue infection (NSTI) is surgical excision and debridement, which can result in large soft tissue defects. This study examined the reconstructive options and outcomes of patients with upper extremity NSTIs.

Methods

A retrospective chart review was performed on patients from a single institution who were diagnosed with an upper extremity NSTI between 2014 and 2019. Patient characteristics, infectious etiology, surgical debridements, reconstructive procedures, and secondary procedures were analyzed.

Results

There were 99 patients included in the study. The median size of the wound from the initial surgical debridement was 100 cm2 (interquartile range, 300 cm2). The mean number of debridements was 3.4. Seven patients underwent amputations, and 12 patients died. Most wounds were reconstructed via delayed primary closure (15 patients), skin grafting (16 patients), or a combination of the two (30 patients). Three patients underwent reverse radial forearm flaps, 1 patient underwent a groin flap, 3 patients underwent pedicled latissimus muscle flaps, and 2 patients underwent local flexor carpi ulnaris muscle flaps. Seven patients did not undergo any surgical reconstruction, and their wounds were managed with local wound care. Eight patients had complete or partial failure of their initial soft reconstruction requiring an additional operation, and 5 patients had secondary operations for neuromas and/or contractures.

Conclusions

Overall, patients with upper extremity NSTIs survive and undergo successful reconstruction of their wounds. Few patients required additional procedures for reconstructive failure or sequela of their wounds.
Risk Factors Associated With Misdiagnosis of Digital Glomus Tumor
Authors: Xie Yutong , Zhang Feng , Lineaweaver William C. , Zhou Xijie , Chen Hongyu , Yan Hede
Published: June 2022

Objective

Glomus tumors are benign with unique triad of symptoms; however, the delayed diagnosis of these tumors is common. We investigated the possible risk factors for the misdiagnosis of digital glomus tumors, with an aim to treat these patients on time.

Methods

We conducted a retrospective cohort study of 104 patients with digital glomus tumors from October 2009 to February 2021. Data pertaining to sex, age, tumor locations, symptoms, imaging modalities, and clinical departments visited by the patients were extracted and analyzed through logistic regression.

Results

The duration of delayed diagnosis ranged from 3 months to 40 years (mean, 5.5 ± 6.5 years). The total misdiagnosis and recurrence rate are 34.6% and 3.8%, respectively. On the multivariate logistic regression, the misdiagnosis of digital glomus tumor was significantly associated with the clinical departments visited by the patients (P < 0.001). The risk of misdiagnosis of nonhand surgery department visit is 179.741-fold higher than that of hand surgery department visit.

Conclusions

The misdiagnosis rate of digital glomus tumor was closely related to the clinical departments visited by the patients. Hand surgeons are the first choice for the treatment of the tumor.
Inhibition of Nitrosative Stress Attenuates Myocardial Injury and Improves Outcomes after Cardiac Arrest and Resuscitation
Authors: Wang Fulin , Yuan Qiuhuan , Cao Shengchuan , Li Ruochuan , Zhang Jian , Yang Kehui , Xu Feng , Chen Yuguo
Published: June 2022

Objectives:

Nitrosative stress is widely involved in cell injury via inducing the nitration modification of a variety of proteins. This study aimed to investigate whether inhibition of nitrosative stress attenuated myocardial injury and improved outcomes in a rat model of cardiac arrest (CA) and cardiopulmonary resuscitation (CPR).

Methods:

Adult male Wistar rats were subjected to asphyxia-induced cardiac arrest and subsequently resuscitation. One minute after return of spontaneous circulation (ROSC), rats were randomized and administered the nitrosative stress inhibitor, FeTMPyP (1 or 3 mg/kg), or normal saline as a placebo. 3-Nitrotyrosine (3-NT), mean arterial pressure (MAP), heart rate (HR), mortality, electrocardiogram (ECG), left ventricular ejection fraction (EF) and fractional shortening (FS), and levels of myocardial apoptosis were evaluated. The concentrations of lactate, creatine kinase MB isoenzyme (CK-MB), and angiotensin II (Ang II), were measured in blood samples.

Results:

3-NT level was significantly increased in the heart after ROSC. Administration of FeTMPyP (1 or 3 mg/kg) attenuated the increase of 3-NT in the myocardium. Inhibition of nitrosative stress improved survival and attenuated CA/CPR-induced reperfusion injury by maintaining the stability of MAP and HR, and reducing the accumulation of lactic acid. Post-cardiac arrest rats had higher serum CK-MB and Ang II than healthy rats, while EF and FS were lower in healthy rats. Inhibition of nitrosative stress not only alleviated ischemic heart injury but also reduced the occurrence of CA/CPR-induced of arrhythmias. Moreover, nitrosative stress mediated the upregulation of Cleaved caspase-3 and downregulation Bcl-2, which was abolished by FeTMPyP.

Conclusions:

Inhibition of nitrosative stress is a novel molecular target to alleviate myocardial injury and improve outcomes in a rat model of CA/CPR.
Association Between Surgeon and Anesthesiologist Sex Discordance and Postoperative Outcomes
Authors: Wallis Christopher J. D. , Jerath Angela , Kaneshwaran Kirusanthy , Hallet Julie , Coburn Natalie , Wright Frances C. , Conn Lesley Gotlib , Bischof Danielle , Covelli Andrea , Klaassen Zachary , Zlotta Alexandre R. , Kulkarni Girish S. , Luckenbaugh Amy N. , Armstrong Kathleen , Lim Kelvin , Bass Barbara , Detsky Allan S. , Satkunasivam Raj
Published: June 2022

Objective:

The aim of this study was to examine the effect of surgeon-anesthesiologist sex discordance on postoperative outcomes.

Summary Background Data:

Optimal surgical outcomes depend on teamwork, with surgeons and anesthesiologists forming two key components. There are sex and sex-based differences in interpersonal communication and medical practice which may contribute to patients’ perioperative outcomes.

Methods:

We performed a population-based, retrospective cohort study among adult patients undergoing 1 of 25 common elective or emergent surgical procedures from 2007 to 2019 in Ontario, Canada. We assessed the association between differences in sex between surgeon and anesthesiologists (sex discordance) on the primary endpoint of adverse postoperative outcome, defined as death, readmission, or complication within 30 days following surgery using generalized estimating equations.

Results:

Among 1,165,711 patients treated by 3006 surgeons and 1477 anesthesiologists, 791,819 patients were treated by sex concordant teams (male surgeon/male anesthesiologist: 747,327 and female surgeon/female anesthesiologist: 44,492), whereas 373,892 were sex discordant (male surgeon/female anesthesiologist: 267,330 and female surgeon/male anesthesiologist: 106,562). Overall, 12.3% of patients experienced >1 adverse postoperative outcomes of whom 1.3% died. Sex discordance between surgeon and anesthesiologist was not associated with a significant increased likelihood of composite adverse postoperative outcomes (adjusted odds ratio 1.00, 95% confidence interval 0.97–1.03).

Conclusions:

We did not demonstrate an association between intraoperative surgeon and anesthesiologist sex discordance on adverse postoperative outcomes in a large patient cohort. Patients, clinicians, and administrators may be reassured that physician sex discordance in operating room teams is unlikely to clinically meaningfully affect patient outcomes after surgery.
Effect of Nrf2 on Phenotype Changes of Macrophages in the Anterior Vaginal Wall of Women With Pelvic Organ Prolapse
Authors: Liu Peng , Liu Dongxia , Chen Fei , Luo Lin , Jin Yuxi , Peng Juan , Yu Hang , Wei Mengyan , Shi Xiaojing , Wang Luwen
Published: June 2022

Objective

The aim of this study was to observe the effect of nuclear factor-erythroid 2-related factor 2 (Nrf2) on the phenotype changes of macrophages in the anterior vaginal wall of patients with pelvic organ prolapse (POP).

Methods

The tissues of the anterior vaginal wall of the control group (n = 30) and POP groups (n = 60) were collected during operation. The expressions of Nrf2, iNOS (representative factor of M1 macrophages), and CD206 (representative factor of M2 macrophages) were determined by immunohistochemical staining and Western blot. Morphological changes and collagen distribution of the anterior vaginal wall were observed by hematoxylin-eosin staining and Masson trichrome staining.

Results

Compared with the control group, the expression levels of Nrf2 and CD206 protein in the anterior vaginal wall tissues of the POP groups were significantly decreased (P < 0.05), and were negatively proportional to the degree of prolapse (P < 0.05). The expression of iNOS was significantly increased and was directly proportional to the degree of prolapse (P < 0.05). Hematoxylin-eosin staining and Masson trichrome staining showed that the collagen fibers are more sparsely arranged and disordered in the POP group than the control.

Conclusions

In patients with POP, the expression of antioxidant factor Nrf2 is reduced in the vaginal anterior wall tissues and the antioxidant capacity is weakened, leading to the blocked polarization of macrophages and the accumulation of a large number of M1 macrophages in the tissue, affecting the occurrence and development of POP.
Are Formal Voiding Trials Necessary After Posterior Compartment Reconstructive Surgery?
Authors: Askew Amy L. , Margulies Samantha L. , Sakai Nozomi , Schroeder Michelle N. , Chu Christine M. , Wu Jennifer M. , Willis-Gray Marcella
Published: June 2022

Importance

Posterior compartment surgery is considered a risk factor for postoperative urinary retention because of the impact of postoperative pain on the pelvic floor; however, few studies have examined the association between posterior compartment reconstructive surgery and urinary retention.

Objective

The aim of the study was to compare rates of urinary retention in patients undergoing vaginal reconstructive surgery, without hysterectomy, in the posterior compartment only versus any apical and/or anterior compartment (with or without posterior compartment).

Study Design

In this retrospective cohort study, we evaluated patients who underwent surgery, without hysterectomy, in the posterior compartment only versus any apical and/or anterior compartment (with or without posterior compartment) from January 2015 to November 2020. Our primary outcome was rate of postoperative urinary retention, defined as a failed voiding trial before discharge. Secondary outcome was days of catheterization. Multivariable logistic regression was performed to assess variables associated with a failed voiding trial.

Results

Of 362 patients, 141 (39.0%) underwent surgery in the posterior compartment only and 221 (61.0%) underwent vaginal apical and/or anterior compartment surgical procedures. Rate of retention was significantly lower in the posterior compartment only group (9.9% vs 41.6%, P < 0.001). The median numbers of days of catheterization were significantly fewer in the posterior compartment only group (0 [0,0] vs 0 [0,3], P < 0.001). In multivariable logistic regression, posterior compartment only surgery was associated with passing the voiding trial (odds ratio, 6.0; 95% confidence interval, 2.97–12.03).

Conclusions

Rates of postoperative urinary retention after surgery in the posterior compartment are low, and these patients may not require formal voiding trials after surgery.
Nonarteritic Anterior Ischemic Optic Neuropathy After Cataract Surgery: A Systematic Review and Meta-Analysis
Authors: Shew William , Wang Michael T. M. , Danesh-Meyer Helen V.
Published: June 2022

Background:

Nonarteritic anterior ischemic optic neuropathy (NAION) has been reported to occur after cataract surgery. It is not clearly established whether cataract surgery increases the risk of NAION over baseline.

Evidence Acquisition:

Medline, PubMed, Embase, and Cochrane Central registers were systematically searched for eligible studies reporting on postcataract surgery NAION (psNAION) within 1 year. All peer-reviewed publications with events n ≥ 10 were included. Pooled incidence and odds/hazard ratios and 95% confidence intervals (CIs) were extracted and calculated using random effect models for early and delayed psNAION. Time to event data were pooled for temporal analysis of psNAION events within the first year. This systematic review was registered (PROSPERO CRD42021274383).

Results:

Nine articles met the selection criteria with five studies suitable for meta-analysis. A total of 320 psNAION cases, 1,307 spontaneous NAION (sNAION) cases, 1,587,691 cataract surgeries, and 1,538,897 noncataract surgery controls were included. Pooling of 63,823 cataract surgeries and 161,643 controls showed a hazard ratio of 4.6 (95% CI 2.7–7.8) of psNAION within 1 year of surgery. Pooled unadjusted incidence of psNAION within 2 months was 99.92 (95% CI 38.64–161.19) per 100,000/year, psNAION within 1 year was 32.36 (95% CI 9.38–55.34) per 100,000/year, and sNAION was 8.87 (95% CI 2.12–15.62) per 100,000/year. psNAION cases were older by a mean of 7.6 years; otherwise, pooled odds ratios for baseline risk factors in psNAION vs. sNAION cases were not statistically significant. psNAION within the first year peaked within 72 hrs and at 6 weeks after the surgery with 73% of cases occurring within 6 months.

Conclusion:

The risk of NAION after cataract surgery is four times greater within the first year and usually occurs within 6 months. However, the absolute risk remains low at 1 in 1,000–3,100 surgeries and is unlikely to warrant extra mention for consenting.
High-frequency ultrasound exposure improves depressive-like behavior in an olfactory bulbectomized rat model of depression
Authors: Yamauchi Tsugumi , Yoshioka Toshinori , Yamada Daisuke , Hamano Takumi , Ikeda Maika , Kamei Masato , Otsuki Takaya , Sato Yasuo , Nii Kyoko , Suzuki Masashi , Iriyama Satoshi , Yoshizawa Kazumi , Nishino Shoichi , Ichikawa Hiroko , Miyazaki Satoru , Saitoh Akiyoshi
Published: June 2022

Objectives

According to previous studies, ultrasound exposure appears to be a noninvasive method for modulating brain activity related to cognition and consciousness; however, its effects on emotional states remain unclear. Therefore, an animal model is required in which the effects and effect mechanisms of ultrasound exposure can be investigated. Thus, we used olfactory bulbectomized rats as an animal model of depression and investigated their emotional state following ultrasound exposure.

Methods

In male Wistar/ST olfactory bulbectomized rats, hyperemotionality was evaluated according to hyperemotionality scoring and the scores before and after 24-h ultrasound exposure were compared. Elevated plus maze (EPM) tests were also conducted after 24-h ultrasound exposure, and blood samples were collected in which plasma corticosterone concentrations were measured.

Results

Following exposure to high-frequency (~50 kHz) ultrasound vocalizations (USVs) associated with the pleasant emotions of rats, the hyperemotionality scores of olfactory bulbectomized rats were significantly reduced. Additionally, the latency of the first entry into the open arm of the EPM was significantly decreased in USV-exposed olfactory bulbectomized rats, as were their plasma corticosterone levels. Furthermore, artificial ultrasound (50 kHz) at a similar frequency to that of USV also significantly decreased the hyperemotionality score of olfactory bulbectomized rats.

Conclusions

Ultrasound exposure improved depressive-like behavior in olfactory bulbectomized rats and reduced their plasma corticosterone levels. Thus, we recommend the use of olfactory bulbectomized rats as an animal model for investigating the effects and effect mechanisms of ultrasound exposure.
Effectiveness of Triclosan-Coated Sutures Compared with Uncoated Sutures in Preventing Surgical Site Infection after Abdominal Wall Closure in Open/Laparoscopic Colorectal Surgery
Authors: Miyoshi Norikatsu , Fujino Shiki , Nishimura Junichi , Suzuki Yozo , Ueda Masami , Uemura Mamoru , Fujii Matkoto , Murata Kohei , Doki Yuichiro , Eguchi Hidekazu ,   for the Clinical Study Group of Osaka University, Colorectal Cancer Treatment Group (CSGOCG)
Published: June 2022

BACKGROUND:

Previous randomized trials have assessed the effectiveness of triclosan-coated sutures in fascia closure after midline laparotomy in preventing surgical site infections (SSIs); however, available evidence remain inconclusive. We aimed to evaluate the effectiveness of triclosan-coated sutures in abdominal fascia closure to prevent postoperative SSIs.

STUDY DESIGN:

This study was a multicenter prospective trial conducted within 24 Japanese secondary and tertiary care centers and a propensity score (PS)–matched analysis. Patients 20 years of age or older who underwent elective surgery for colorectal cancer (CRC) were included. Between July 2016 and July 2019, 2,207 patients were prospectively enrolled into the triclosan-coated sutures or uncoated sutures groups. The per-protocol population comprised 2,195 patients. The PS matching was performed for 1,579 patients: 926 patients in the coated group and 653 patients in the uncoated group. The abdominal fascia after midline laparotomy was closed with triclosan-coated or uncoated sutures depending on group. The primary endpoint was the incidence of an SSI. Secondary endpoints were length of hospital stay and surgical complication rates.

RESULTS:

The recorded SSI rates were 4.2% in the triclosan-coated group and 6.74% in the uncoated suture group (p = 0.028). There were no serious adverse events in the groups. The final logistic regression model showed that several variables affected the occurrence of SSI. Our meta-analysis included six phase-III trials, and our study evaluated 4,797 patients. The results show a significant superiority of triclosan-coated sutures over uncoated suture material.

CONCLUSION:

Triclosan-coated sutures reduce the incidence of SSI after elective CRC surgery.
Appendiceal Cancer in the National Cancer Database: Increasing Frequency, Decreasing Age, and Shifting Histology
Authors: Salazar Michelle C , Canavan Maureen E , Chilakamarry Sitaram , Boffa Daniel J , Schuster Kevin M
Published: June 2022

BACKGROUND:

Nonoperative management of acute appendicitis is increasingly common. However, small studies have demonstrated high rates of appendiceal cancer in interval appendectomy specimens. Therefore, we sought to identify national trends in appendiceal cancer incidence and histology.

STUDY DESIGN:

The National Cancer Database was queried for patients 18 years or older, diagnosed with a right-sided colon cancer (including appendiceal) from 2004 to 2017 who had undergone surgery. Outcomes included trends in appendiceal cancer compared with right-sided colon cancers and trends in appendiceal cancer histology. Logistic regression was used to assess trends over time while adjusting for patient age, insurance, income, area of residence, and comorbidity. Predicted probabilities of the outcomes were derived from the logistic regression models.

RESULTS:

Of 387,867 patients with right-sided colon cancer, 19,570 had appendiceal cancer and of those 5,628 had a carcinoid tumor. Odds of appendiceal cancer, relative to other right-sided colon cancers, increased from 2004 to 2017 (odds ratio [OR] 2.56, 95% CI 2.35–2.79). The increase occurred in all age groups; however, it was more markedly increased in patients 40–49 years old (2004: 10%, 95% CI 9–12 to 2017: 18%, 95% CI 16–20; pairwise comparisons p < 0.001). Odds of appendiceal carcinoid, relative to other appendiceal histologies, increased from 2004 to 2017 (OR 1.70, 95% CI 1.40–2.07) with the greatest increase in probability of a carcinoid in patients younger than 40 years old (2004: 24%, 95% CI 15–34 to 2017: 45%, 95% CI 37–53; pairwise comparisons p < 0.001).

CONCLUSION:

Appendiceal cancer has increased over time, and the increase appears to be driven by a rise in carcinoids, most prevalent in patients 49 years of age or younger. When nonoperative management of acute appendicitis is undertaken, close follow-up may be appropriate given these findings.
Submucosal Tunneling Endoscopic Resection for Submucosal Tumors in the Proximal Esophagus
Authors: Chen Tao , Wang Guo-Xiang , Lian Jing-Jing , Xu Ai-Ping , Leng Zhu-Yun , Zhang Li , Li Sheng-Xi , Wang Xiao-Yun , Xu Mei-Dong
Published: June 2022

BACKGROUND:

Submucosal tunneling endoscopic resection (STER) is widely applied for treatment of gastrointestinal submucosal tumors (SMTs) originating from the muscularis propria layer. However, the tumor location within the proximal esophagus makes STER a challenge for the endoscopists. The aim of this study was to summarize the technique skill and evaluate the outcomes of proximal esophageal STER.

STUDY DESIGN:

A total of 72 patients with SMTs in the proximal esophagus undergoing STER were included from February 2019 to March 2021. Imaging 3-dimensional reconstruction was used for patients with large SMTs. Clinicopathological, endoscopic, and follow-up data were collected and analyzed.

RESULTS:

In this study, all the tumors were removed completely and no gross disease was remaining. The en bloc resection was achieved in 90.28% of patients, and the complications rate was 6.95%. Three-dimensional reconstruction was used for 30 patients (41.67%) with large SMTs (transverse diameter >2.0 cm). Based on statistical analysis, tumors with irregular shape and larger size were the significant contributors to piecemeal resection. Larger tumors increase the risk of long operation time, and irregular tumor shapes increase the risk of complications. The median hospitalization time was 4 days. All of the complications were cured by conservative treatment. A median follow-up of 12 months was available, and all patients were free from local recurrence or distant metastasis during the study period.

CONCLUSIONS:

STER is an effective and safe methodology for the resection of proximal esophageal SMTs. Tumor size and shape mainly impact the piecemeal resection rate, STER-related complications, and procedural difficulty.
Ethical Care of the Traumatized: Conceptual Introduction to Trauma-Informed Care for Surgeons and Surgical Residents
Authors: Bliton John N , Zakrison Tanya L , Vong Gerard , Johnson Dwane A , Rattan Rishi , Hanos Dustin S , Smith Randi N
Published: June 2022

Trauma-informed care (TIC) is a set of principles and practices designed to improve the ways professionals treat people who have been traumatized. This study reviews fundamental concepts of TIC and applies them to the work of surgeons. TIC is described in relation to fundamental medical ethical concepts, and evidence for TIC-based intervention is reviewed. Implementation of TIC in medical education is also described, and recommendations for practice changes are made.
Contemporary Practice of General Surgery in the US: Analysis of American Board of Surgery Diplomate Case Logs
Authors: Cortez Alexander R , Ibáñez Beatriz , Jones Andrew T , Valentine R James , Potts John R
Published: June 2022

BACKGROUND:

The demographics and operative experience of general surgeons certified by the American Board of Surgery were last examined a decade ago. This study examines the contemporary workforce and scope of practice of general surgeons.

STUDY DESIGN:

Applications of diplomates seeking American Board of Surgery recertification from 2013 to 2017 were reviewed. Demographic data and case logs from the year before submission were analyzed. Total operative volume was examined, as were total volumes for 13 operative domains and 11 abdominal and alimentary tract subdomains.

RESULTS:

There were 4,735 general surgeons certified by the American Board of Surgery with a mean ± SD age of 53 ± 8 years and included 19% women and 14% international graduates. Regions of practice were 22% Northeast, 31% Southeast, 20% Midwest, 20% West, and 7% Southwest. Practice settings were 86% urban, 9% large rural, 4% small rural, and 1% isolated. Forty-one percent were 10 years, 35% were 20 years, and 24% were 30 years since initial certification. On average, general surgeons performed 417 ± 338 procedures per year, with abdominal, alimentary tract, and endoscopy being the most common. On multivariable analysis, male sex and being midcareer or late career were positively associated with being a high-volume (top quartile) surgeon, whereas age and practicing in either the Northeast or West demonstrated a negative association.

CONCLUSIONS:

The demographics of general surgeons have remained stable over time, except for an increased proportion of female surgeons. The overall operative experience is similar to years past but is widely variable between surgeons. Periodic analysis of these data is important for education and certification purposes.
Outcomes of Telemedicine-Based Consultation among Rural Patients Referred for Abdominal Wall Reconstruction and Hernia Repair
Authors: Bray Jordan O , Sutton Thomas L , Akhter Mudassir S , Iqbal Emaad , Orenstein Sean B , Nikolian Vahagn C
Published: June 2022

BACKGROUND:

Perioperative telemedicine use has increased as a result of the COVID-19 pandemic and may improve access to surgical care. However, studies assessing outcomes in populations at risk for digital-health disparities are lacking. We sought to characterize the pre- and postoperative outcomes for rural patient populations being assessed for hernia repair and abdominal wall reconstruction with telehealth.

METHODS:

Patients undergoing telehealth evaluation from March 2020 through May 2021 were identified. Rurality was identified by zip code of residence. Rural and urban patients were compared based on demographics, diagnosis, treatment plan, and visit characteristics and outcomes. Downstream care use related to supplementary in-person referral, and diagnostic testing was assessed.

RESULTS:

Three hundred-seventy-three (196 preoperative, 177 postoperative) telehealth encounters occurred during the study period (rural: 28% of all encounters). Rural patients were more likely to present with recurrent or incisional hernias (90.0 vs 72.7%, p = 0.02) and advanced comorbidities (American Society of Anesthesiologists status score > 2: 73.1 vs 52.1%, p = 0.009). Rural patients derived significant benefits related to time saved commuting, with median distances of 299 and 293 km for pre- and postoperative encounters, respectively. Downstream care use was 6.1% (N = 23) for additional in-person evaluations and 3.4% (N = 13) for further diagnostic testing, with no difference by rurality.

CONCLUSIONS:

Perioperative telehealth can safely be implemented for rural populations seeking hernia repair and may be an effective method for reducing disparities. Downstream care use related to additional in-person referral or diagnostic testing was minimally impacted in both the preoperative and postoperative settings. These findings suggest that rurality should not deter surgeons from providing telemedicine-based surgical consultation for hernia repair.
Opioid-Free Anesthesia and Same-Day Surgery Laparoscopic Hiatal Hernia Repair
Authors: Hoffman Clarissa , Buddha Mrinalini , Mai Megan , Sanjeevi Srinivas , Gutierrez Rigoberto , O’ Neill Colleen , Miller Andre , Banki Farzaneh
Published: June 2022

BACKGROUND:

Laparoscopic hiatal hernia repair is commonly performed with a 1 to 2 night hospitalization. Our aim was to compare the feasibility and short-term outcomes of same-day surgery (SDS) laparoscopic hiatal hernia repair with an opioid-based anesthesia protocol (OBAP) vs an opioid-free anesthesia protocol (OFAP).

STUDY DESIGN:

Outcomes and pharmacy costs of repairs with OBAP were compared with OFAP. Values were expressed as median (interquartile range) and costs as means.

RESULTS:

There were 244 primary laparoscopic repairs. OBAP was used in 191 of 244 (78.3%) vs OFAP in 53 of 244 (21.7%). The length of stay was 1 day (0 to 2) vs 0 days (0 to 1), p = 0.006. There was no difference between the percentage of patients requiring analgesics and dosage between the 2 groups. SDS was planned in 157 and performed in 74 of 122 (60.7%) vs 33 of 35 (94.3%), p < 0.001. The age was 56 years (45 to 63) vs 60 years (56 to 68), p = 0.025. There were more type I hiatal hernia in SDS-OBAP and more type III and IV in SDS-OFAP, p = 0.031. American Society of Anesthesiologists Physical Status was II (II–III) vs III (II–III), p = 0.045. SDS was not performed in 50 of 157 (31.8%), 48 of 122 (39.3%) vs 2 of 35 (5.7%), p < 0.001. Out of 157 planned SDS, nausea/retching were causes of transition in 19 of 122 (15.6%) vs 0 of 35 (0%), p = 0.020. Multivariable logistic regression showed the odds of SDS were 8.21 times (95% CI 3.10 to 21.71; p < 0.001) greater in OFAP compared with OBAP, adjusting for sex, age, body mass index, American Society of Anesthesiologists Physical Status, type of hiatal hernia, type of procedure, and duration of the operation. Patients with opioid medication after SDS discharge were 74 of 74 (100%) vs 22 of 33 (66.7%), p < 0.001.

CONCLUSIONS:

Opioid-free anesthesia increases the feasibility of SDS hiatal hernia repair with less perioperative nausea and comparable pain control and pharmacy cost.