bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Videolaryngoscopy Expertise on First-Attempt Intubation Success in Critically Ill Patients
Authors: Amalric Matthieu , Larcher Romaric , Brunot Vincent , Garnier Fanny , De Jong Audrey , Moulaire Rigollet Valerie , Corne Philippe , Klouche Kada , Jung Boris
Published: August 2020

Objectives:

The use of a videolaryngoscope in the ICU on the first endotracheal intubation attempt and intubation-related complications is controversial. The objective of this study was to evaluate the first intubation attempt success rate in the ICU with the McGrath MAC videolaryngoscope (Medtronic, Minneapolis, MN) according to the operators’ videolaryngoscope expertise and to describe its association with the occurrence of intubation-related complications.

Design:

Observational study.

Setting:

Medical ICU.

Subjects:

Consecutive endotracheal intubations in critically ill patients.

Interventions:

Systematic use of the videolaryngoscope.

Measurements and Main Outcomes:

We enrolled 202 consecutive endotracheal intubations. Overall first-attempt success rate was 126 of 202 (62%). Comorbidities, junior operator, cardiac arrest upon admission, and coma were associated with a lower first-attempt success rate. The first-attempt success rate was less than 50% in novice operators (1–5 previous experiences with videolaryngoscope, independently of airway expertise with direct laryngoscopies) and 87% in expert operators (> 15 previous experiences with videolaryngoscope). Multivariate analysis confirmed the association between specific skill training with videolaryngoscope and the first-attempt success rate. Severe hypoxemia and overall immediate intubation-related complications occurred more frequently in first-attempt failure intubations (24/76, 32%) than in first-attempt success intubations (14/126, 11%) (p < 0.001).

Conclusions:

We report for the first time in the critically ill that specific videolaryngoscopy skill training, assessed by the number of previous videolaryngoscopies performed, is an independent factor of first-attempt intubation success. Furthermore, we observed that specific skill training with the McGrath MAC videolaryngoscope was fast. Therefore, future trials evaluating videolaryngoscopy in ICUs should consider the specific skill training of operators in videolaryngoscopy.
Intradisciplinary Nursing Communication Post Hospital Merger
Authors: Deerhake Ann Margaret , O'Brien Tara Renee
Published: August 2020

After hospital mergers, unit work environments are at risk of being unhealthy due to poor intradisciplinary two-way communication in times of change. This quality improvement project explored the impact a 4-week, social-media–based, intradisciplinary communication strategy had on a postmerger intensive care unit work environment. The sample (N = 14) included 11 bedside nurses and three administrative nurses working in a 22-bed southwestern US ICU. The participants took part in a Facebook closed-group community of practice called Nurse to Nurse, with a total of 25.9% participation rate. Eleven participants completed the pre–Nurse to Nurse survey, a 20.4% completion rate, while eight participants completed the post–Nurse to Nurse survey, a 14.8% completion rate. After the conclusion of Nurse to Nurse, the overall mean skilled communication survey score increased to 3.79, a 1.6% improvement. Question 14, which measured zero-tolerance behavior perception, exhibited a mean of 2.3% improvement, boosting this metric to excellent status. Utilization data revealed 68 comments posted within Nurse to Nurse implementation, with 56 showing horizontal communication (73.5%) and 24 displaying vertical communication (26.5%). A total of 217 bedside nurse views (81.3%) and 50 administrative nurse views (18.7%) were noted. Nurse to Nurse, an online communication-focused community of practice, enhanced communication among bedside and administrative nurses working in a postmerger intensive care unit setting.
Online Cognitive Training
Authors: Cuevas Heather , Carter Sharon
Published: August 2020

Research shows the risk for cognitive impairment and the rate of cognitive decline double after type 2 diabetes mellitus is diagnosed and can make self-management more difficult. Cognitive training has been found to be one way to improve self-management and cognitive function, and this article reports the adaptation of one such intervention to an online format. Ten adults with diabetes participated in an 8-week intervention that combined webinar classes with online computer game training. Perceived memory ability, executive function, self-management, and self-efficacy were measured. Evaluation of recruitment, data collection, and implementation demonstrated good feasibility and reduced barriers to engagement. Although the intervention did not result in significant changes in cognitive function, scores on all surveys improved. Adherence to diet, exercise, and foot care recommendations also improved. Most participants stated they preferred the intervention's online format to “traditional” in-person formats. Online technology in this 8-week intervention helped improve recruitment, retention, participant engagement, and use of cognitive strategies in people with type 2 diabetes mellitus. Overall, participants found the intervention helpful and said it reduced the time and travel burden associated with educational interventions. A larger randomized controlled trial is needed to further explore the intervention's potential impact over a longer period.
Sequencing of Adjuvant Chemoradiation for Advanced Stage Endometrial Cancer
Authors: Arden Jessica D. , Marvin Kimberly , Nandalur Sirisha R. , Al-Wahab Zaid , Field Jayson , Gadzinski Jill , Rakowski Joseph A. , Rosen Barry , Jawad Maha S.
Published: August 2020

Objectives:

Radiation is frequently added to chemotherapy for adjuvant treatment of advanced stage endometrial cancer. Multiple adjuvant therapy sequencing options exist, and little data is available to compare these. We compared outcomes and toxicities after “sandwich” chemoradiation (chemotherapy, then radiation, then chemotherapy) and nonsandwich sequences (chemotherapy then radiation, radiation then chemotherapy, or concurrent chemoradiation).

Materials and Methods:

We recorded baseline characteristics, adjuvant treatment details, clinical outcomes, and toxicities for stage III to IVA patients who underwent surgical staging followed by both adjuvant chemotherapy and radiation therapy at our institution. Effects of adjuvant treatment order (sandwich or nonsandwich) on these outcomes were analyzed. Toxicities were graded according to CTCAE v4.0.

Results:

We identified 107 patients with a median follow-up of 3.2 years. Five-year local, regional, and distant recurrence were 7%, 15%, and 33%; disease-free and overall survival were 61% and 68%, respectively. Outcomes did not differ by sequence group. The overall rate of acute toxicity did not differ by sequence group. The overall rate of chronic toxicity was significantly lower for sandwich patients (P<0.001), as were overall rates of chronic genitourinary (P=0.048) and gynecologic (P<0.001) toxicities. There were no grade 4 or 5 acute or chronic toxicities.

Conclusions:

Advanced stage endometrial cancer is an aggressive disease and adjuvant chemotherapy and radiation therapy are indicated. Clinical outcomes were similar amongst the different sequences; however, sandwich therapy led to less chronic toxicity, offering an opportunity for improved quality of life in survivorship.
Ganglion Cysts of the Proximal Tibiofibular Joint: Low Risk of Recurrence After Total Cyst Excision
Authors: Papanastassiou Ioannis D. , Tolis Konstantinos , Savvidou Olga , Fandridis Emmanouil , Papagelopoulos Panayiotis , Spyridonos Sarantis
Published: August 2020

Background

Peroneal nerve neuropathy due to compression from tumors or tumor-like lesions such as ganglion cysts is rare. Few case series have been published and reported local recurrence rates are high, while secondary procedures are frequently employed.

Questions/purposes

(1) What are the demographics of patients with ganglion cysts of the proximal tibiofibular joint, and what proportion of them present with intraneural cysts and peroneal nerve palsy? (2) What Musculoskeletal Tumor Society (MSTS) scores do patients with this condition achieve after decompression surgery with removal of the ganglion cyst, but no arthrodesis of the tibiofibular joint? (3) What proportion of patients experience local recurrence after surgery?

Methods

Between 2009 to 2018, 30 patients (29 primary cases) were treated for chronic peroneal palsy or neuropathy due to ganglion cysts of the proximal tibiofibular joint at two tertiary orthopaedic medical centers with total resection of the cystic lesion. MRI with contrast and electromyography (EMG) were performed preoperatively in all patients. The minimum follow-up for this series was 1 year (median 48 months, range 13 to 120); 14% (4 of 29) were lost to follow-up before that time. The MSTS score was recorded preoperatively, at 6 weeks postoperatively, and at most-recent follow-up.

Results

A total of 90% of the patients were male (26 of 29 patients) and the median age was 67 years (range 20 to 76). In all, 17% (5 of 29) were treated due to intraneural ganglia. Twenty-eight percent (8 of 29) presented with complete peroneal palsy (foot drop). The mean MSTS score improved from 67 ± 12% before surgery to 89 ± 12% at 6 weeks postoperative (p < 0.001) and to 92 ± 9% at final follow up (p = 0.003, comparison with 6 weeks postop). All patients improved their scores. A total of 8% (2 of 25 patients) experienced local recurrence after surgery.

Conclusion

Ganglion cysts of the proximal tibiofibular joint occurred more often as extraneural lesions in older male patients in this small series. Total excision was associated with improved functional outcome and low risk of neurologic damage and local recurrence, and we did not use any more complex reconstructive procedures. Tendon transfers may be performed simultaneously in older patients to stabilize the ankle joint, while younger patients may recover after decompression alone, although larger randomized studies are needed to confirm our preliminary observations.

Level of Evidence

Level IV, therapeutic study.
Minimally Invasive Treatment Options for Managing Spontaneous Intracerebral Hemorrhage
Authors: Kim Michael , Cooper Jared , Al-Mufti Fawaz , Gandhi Chirag , Bowers Christian
Published: August 2020

Spontaneous intracerebral hemorrhage (SICH) is a common stroke subtype, accounting for 10–35% of all stroke. It is the most disabling subtype as well, with disproportionately high rates of morbidity and mortality. Despite numerous advances in neurocritical care and stroke management, the prognosis remains poor, and no medical or surgical interventions have been shown to significantly reduce mortality or improve outcomes. Surgical evacuation of SICH has many theoretical benefits, such as reducing secondary injury, reducing intracranial pressures, and preventing cerebral herniation. However, trials involving open craniotomy for SICH evacuation have not yielded significant clinical benefit, and one thought is that benefit is not seen due to injury to the overlying healthy brain tissue. Therefore, minimally invasive options have increasingly been studied as an option to evacuate the SICH while minimizing injury to healthy tissue. We present here a select review of various minimally-invasive techniques for the evacuation of SICH.
Time to Wake-Up: Extending the Window for Management of Unknown-Onset Strokes
Authors: Fawaz Al-Mufti , Wu Sarah , Viswanathan Divya , Kaur Kavneet , Nuoman Rolla , Nuoaman Halla , Adnan Yasir Ammar , Gandhi Chirag D. , Kurian Christeena , Sahni Ramandeep
Published: August 2020

The term “Wake-Up Stroke” is applied to a patient who displays no symptoms before sleep, but wakes with neurologic deficits suggestive of stroke. The current guidelines for acute ischemic stroke limit intravenous tissue plasminogen activator use to stroke patients in whom symptom onset or last known well is less than 4.5 hours. Approximately one-third of acute ischemic stroke patients present with unknown time of symptom onset and are often not eligible for intravenous reperfusion therapy in clinical practice. This review provides an overview of several earlier trials that used advanced neuroimaging to determine eligibility for reperfusion therapy in patients with unknown stroke onset. The reassuring results of these earlier trials that led to recent thrombolysis trials specifically targeted at “wake-up stroke” patients are discussed in this review. Ongoing studies aim to expand our knowledge regarding the safety and efficacy of thrombolysis in these patients.
A Randomized, Double-Blinded Study Evaluating the Safety and Efficacy of AbobotulinumtoxinA Injections for Oily Skin of the Forehead: A Dose–Response Analysis
Authors: Kesty Katarina , Goldberg David J.
Published: August 2020

BACKGROUND

AbobotulinumtoxinA has been investigated for applications beyond facial rhytides, including the treatment of oily skin.

OBJECTIVE

The authors sought to investigate the optimal number of units and the duration of abobotulinumtoxinA for the treatment of oily skin.

MATERIALS AND METHODS

This randomized, double-blinded, placebo-controlled study included 50 male and female subjects that got either 0, 15, 30, or 45 units of abobotulinumtoxinA injected into their forehead. For the 6 months after treatment, subjects were evaluated for the effectiveness of the treatment in decreasing the oiliness of their skin and the duration of this effect.

RESULTS

Subjects in the treatment groups that received either 30 or 45 units of neurotoxin experienced a significant reduction in oily skin. This effect was present for the 6-month duration of the study. No treatment-related adverse events were reported during this study, and both subjects and investigators reported a high level of satisfaction with the treatment.

CONCLUSION

Thirty or 45 units of abobotulinumtoxinA are safe and effective doses in treating oily skin for improved cosmetic appearance.
Opioid Prescribing Recommendations After Mohs Micrographic Surgery and Reconstruction: A Delphi Consensus
Authors: Donigan Jessica M. , Srivastava Divya , Maher Ian , Abdelmalek Mark , Bar Anna A. , Blalock Travis W. , Bordeaux Jeremy S. , Brodland David G. , Carroll Bryan T. , Council MARTHA Laurin , Duffy Keith , Fathi Ramin , Golda Nicholas , Johnson-Jahangir Hillary , Konda Sailesh , Leitenberger Justin J. , Moye Molly , Nelson Jenny L. , Patel Vishal A. , Shaffer Joseph J. , Soltani-Arabshahi Razieh , Tristani-Firouzi Payam , Tschetter Amanda J. , Nijhawan Rajiv I.
Published: August 2020

BACKGROUND

Prescription opioids play a large role in the opioid epidemic. Even short-term prescriptions provided postoperatively can lead to dependence.

OBJECTIVE

To provide opioid prescription recommendations after Mohs micrographic surgery (MMS) and reconstruction.

METHODS

This was a multi-institutional Delphi consensus study consisting of a panel of members of the American College of Mohs Surgery from various practice settings. Participants were first asked to describe scenarios in which they prescribe opioids at various frequencies. These scenarios then underwent 2 Delphi ratings rounds that aimed to identify situations in which opioid prescriptions should, or should not, be routinely prescribed. Consensus was set at ≥80% agreement. Prescription recommendations were then distributed to the panelists for feedback and approval.

RESULTS

Twenty-three Mohs surgeons participated in the study. There was no scenario in which consensus was met to routinely provide an opioid prescription. However, there were several scenarios in which consensus were met to not routinely prescribe an opioid.

CONCLUSION

Opioids should not be routinely prescribed to every patient undergoing MMS. Prescription recommendations for opioids after MMS and reconstruction may decrease the exposure to these drugs and help combat the opioid epidemic.
Dermatofibrosarcoma Protuberans: A Clinicopathologic and Therapeutic Analysis of 254 Cases at a Single Institution
Authors: Jing Changyou , Zhang Hongtu , Zhang Xinxin , Yu Shengji
Published: August 2020

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade tumor that typically does not metastasize but often recurs. Fibrosarcomatous DFSP (FS-DFSP) is associated with a substantially higher rate of metastasis and a poorer prognosis.

OBJECTIVE

This study sought to investigate the epidemiological, histopathological, and clinical characteristics of DFSP, especially with a particular focus on FS-DFSP.

MATERIALS AND METHODS

Clinical data from 254 patients treated between January 1999 and July 2018 were retrospectively reviewed. Endpoints of the study were the incidence of significant disease-related clinical events.

RESULTS

Follow-up data from 211 patients were available for analysis, with a median follow-up time of 38 months (range: 1–196 months). The 5-year recurrence-free survival rate of patients underwent wide-local excision (WLE) was 97.1%. Patients underwent WLE exhibited a significantly decreased recurrence rate relative to patients treated through local excision (2.9% vs 37.7%; p < .001). Fibrosarcomatous DFSP had significantly higher rates of distant metastasis (66.7% [n = 4] vs 2.0% [n = 4]; p < .001) and long-term mortality (50.0% [n = 3] vs 1.5% [n = 3]; p < .001), compared with classical DFSP (C-DFSP).

CONCLUSION

Wide-local excision is an effective means of reducing DFSP recurrence. Rates of metastasis are higher for FS-DFSP than for C-DFSP, with the former having significantly poorer outcomes.
Influence of Neutralization Accelerated by the Soak Method on the Radon Exhalation of Cement-based Materials
Authors: Yang Rong , Zhang Xiaowen , Feng Shengyang , Li Xiangyang
Published: August 2020

Radon is considered a significant contaminant that affects indoor air quality. Neutralization is one of the most important environmental factors in changing pore structure of cement-based materials that may release radon. Therefore, it is necessary to study the radon exhalation of cement-based materials impacted by neutralization, which is extremely lacking. Some concrete blocks were accelerated to neutralization by soaking in sodium bicarbonate solution, and the radon activity concentrations over the blocks were measured to investigate the effect of neutralization on radon exhalation. Controlled experiments were conducted with blocks in the initial dry state and soaked in pure water. The results show that the radon activity concentration exhaled from block is promoted by neutralization, and the promoting role of water is quite limited. The radon surface exhalation rate increases by increasing the sodium bicarbonate solution concentration from 0.5% to saturation.
Evaluating the Cross-Sectional and Longitudinal Relationships Predicting Suicidal Ideation Following Traumatic Brain Injury
Authors: Awan Nabil , DiSanto Dominic , Juengst Shannon B. , Kumar Raj G. , Bertisch Hilary , Niemeier Janet , Fann Jesse R. , Kesinger Matthew R. , Sperry Jason , Wagner Amy K.
Published: August 2020

Objective:

Characterize relationships among substance misuse, depression, employment, and suicidal ideation (SI) following moderate to severe traumatic brain injury (TBI).

Design:

Prospective cohort study.

Setting:

Inpatient rehabilitation centers with telephone follow-up; level I/II trauma centers in the United States.

Participants:

Individuals with moderate to severe TBI with data in both the National Trauma Data Bank and the Traumatic Brain Injury Model Systems National Database, aged 18 to 59 years, with SI data at year 1 or year 2 postinjury (N = 1377).

Main Outcome Measure:

Primary outcome of SI, with secondary employment, substance misuse, and depression outcomes at years 1 and 2 postinjury.

Results:

Cross-lagged structural equation modeling analysis showed that year 1 unemployment and substance misuse were associated with a higher prevalence of year 1 depression. Depression was associated with concurrent SI at years 1 and 2. Older adults and women had a greater likelihood of year 1 depression. More severe overall injury (injury severity score) was associated with a greater likelihood of year 1 SI, and year 1 SI was associated with a greater likelihood of year 2 SI.

Conclusions:

Substance misuse, unemployment, depression, and greater extracranial injury burden independently contributed to year 1 SI; in turn, year 1 SI and year 2 depression contributed to year 2 SI. Older age and female sex were associated with year 1 depression. Understanding and mitigating these risk factors are crucial for effectively managing post-TBI SI to prevent postinjury suicide.
Return to School Following TBI: Educational Services Received 1 Year After Injury
Authors: Lundine Jennifer P. , Todis Bonnie , Gau Jeff M. , McCart Melissa , Wade Shari L. , Yeates Keith Owen , Glang Ann
Published: August 2020

Background:

Many children who experience a traumatic brain injury (TBI) return to school without receiving needed support services.

Objective:

To identify services received and predictors of formal special education services (ie, Individualized Education Plan [IEP]) for students with TBI 1 year after returning to school.

Setting and Participants:

A total of 74 students with TBI recruited from children's hospitals in Colorado, Ohio, and Oregon.

Design:

Secondary analysis of previously reported randomized control trials with surveys completed by caregivers when students returned to school (T1) and 1 year later (T2). This study reports data collected at T2.

Results:

While 45% of students with TBI reported an IEP 1 year after returning to school, nearly 50% of students received informal or no services. Male students, those who sustained a severe TBI, and students whose parents reported domain-specific concerns were more likely to receive special education services at 1 year. In a multivariate model, sex remained the only significant predictor of IEP services at T2.

Conclusions:

Females and students with less severe or less visible deficits were less likely to receive special education services. While transition services may help students obtain special education for the first year after TBI, identifying students with TBI who have subtle or later-developing deficits remains a challenge.
Understanding the Link Between Traumatic Brain Injury Accompanied by Loss of Consciousness and Well-Being: A Sample of UK Military Veterans
Authors: Hendrikx Laura Josephine , Murphy Dominic
Published: August 2020

Objective:

To investigate the association between reported traumatic brain injury plus loss of consciousness (TBI + LOC) and a range of demographic, military, and physical and mental health factors among a sample of UK veterans seeking support for mental health difficulties.

Design:

The present study was a cross-sectional study.

Participants:

Clinical records were used to identify a sample of treatment-seeking UK veterans (N = 3335), of which a total of 403 took part.

Main Measures:

Information on demographic characteristics, military experiences, and a range of physical and mental health difficulties was collected.

Results:

Almost half of the sample (48%) reported a TBI + LOC, which was most strongly associated with drug use and childhood adversity. More modest associations also emerged with earlier service termination, likelihood of unemployment, as well as chronic pain and poor mobility.

Conclusion:

The findings suggested that TBI + LOC may not specifically be associated with symptoms of posttraumatic stress in a sample of treatment-seeking veterans. The demonstrated links between TBI + LOC and adverse childhood, drug use, physical health, and employment may be useful in improving the assessment and rehabilitation of veterans with TBI + LOC.
Lifetime History of Traumatic Brain Injury With Loss of Consciousness and the Likelihood for Lifetime Depression and Risk Behaviors: 2017 BRFSS North Carolina
Authors: Waltzman Dana , Daugherty Jill , Sarmiento Kelly , Proescholdbell Scott
Published: August 2020

Objective:

Because of the growing concern about the potential effects of traumatic brain injuries (TBIs) on a child's developing brain and the potential impact of lifetime depression and risk behaviors associated with TBI, further exploration is warranted.

Setting and Participants:

Data (N = 4917) from the 2017 North Carolina Behavioral Risk Factors Surveillance System (BRFSS).

Design:

Cross-sectional.

Main Measures:

Examine whether a lifetime history of TBI with loss of consciousness (LOC) or having a history of TBI with LOC prior to 18 years of age was associated with a greater likelihood of lifetime depression, current binge drinking, and current cigarette and e-cigarette smoking.

Results:

Respondents with a history of TBI with LOC had 2.1 (95% CI, 1.6-2.8) times higher odds of lifetime depression and 1.7 to 1.8 (95% CI, 1.02-2.97) times higher odds of all risk behaviors than those without a lifetime history of TBI with LOC. There were no statistical differences between age of first TBI with LOC and lifetime depression, binge drinking, cigarette smoking, and e-cigarette use after controlling for key demographics.

Conclusion:

These findings underscore the importance of increasing awareness among healthcare providers of the prevalence of lifetime depression and risk behaviors among individuals with a history of TBI and the need for improved screening and referrals to evidence-based services.
Use of Corneas From Septic Donors for Descemet Membrane Endothelial Keratoplasty
Authors: Vasiliauskaitė Indrė , de Jong Maloeke , Quilendrino Ruth , van der Wees Jacqueline , Oellerich Silke , Melles Gerrit R. J.
Published: August 2020

Purpose:

To evaluate the suitability of corneas from septic donors for transplantation by analyzing the discard rate in the eye bank and the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) using organ-cultured corneal grafts from septic versus nonseptic donors.

Methods:

This retrospective study included 1554 corneas of which 456 corneas (29%) were from septic and 1072 corneas (69%) from nonseptic donors [for 26 corneas (2%) sepsis status was unknown]. The clinical outcome at 6 months after DMEK was evaluated for 82 grafts (26 from septic and 56 from nonseptic donors). Outcome measures were endothelial cell density, central corneal thickness, and postoperative complications.

Results:

Primary discard rates were higher for corneas from septic than from nonseptic donors (32.9% vs. 24.5%, P = 0.001). The main discard reason was poor endothelial cell quality for both septic (13.8%) and nonseptic (11.8%) donor corneas. Eye bank contamination rates for septic and nonseptic donor corneas were 1.1% and 1.7%, respectively (P = 0.102). After DMEK, donor endothelial cell density at 6m postoperatively was comparable between grafts from septic and nonseptic donors (1410 ± 422 cells/mm2 vs. 1590 ± 519 cells/mm2, P = 0.140). No differences in 6m central corneal thickness and in the rebubbling rate were observed between the 2 groups (P = 0.780 and P = 0.396, respectively). None of the cases had graft rejection nor endophthalmitis in both groups.

Conclusions:

Provided strict adherence to donor screening and evaluation protocols, the use of organ-cultured corneas from septic donors for DMEK does not seem to increase the risk for recipients and allows for expansion of the donor pool for corneal tissue.
Ex Vivo Safety and Efficacy of Paired Peripheral Incisions in Descemet's Membrane Endothelial Keratoplasty Grafts to Facilitate Unscrolling
Authors: de la Presa Martin , Bedard Peter , Justin Jeff J. , Hansen Mark S. , Hou Joshua H.
Published: August 2020

Purpose:

To evaluate the ex vivo safety and efficacy of using paired peripheral incisions to achieve a triple scroll conformation that facilitates unscrolling in Descemet membrane endothelial keratoplasty (DMEK).

Methods:

The safety of adding paired peripheral incisions to DMEK grafts was evaluated by assessing endothelial cell loss (ECL) and risk of tearing. ECL was measured using calcein-AM staining after incisions. The risk of tearing was evaluated by comparing incision lengths before and after simulated DMEK surgery using cadaveric eyes. Efficacy was evaluated by comparing the scrolling pattern and the width of grafts with different incision lengths (0.0 mm, 0.5 mm, and 1.0 mm). Surgical unscrolling times in simulated DMEK surgery by a novice DMEK surgeon were evaluated to determine whether incisions facilitate unscrolling in DMEK surgery.

Results:

The mean ECL after adding incisions was 0.78% ± 0.23%. There was no significant change in incision length after simulated DMEK surgery (P = 0.6). In donor grafts aged less than or equal to 65 years, 60% (6/10) achieved a stable triple scroll with 0.5 mm incisions and 80% (8/10) achieved a stable triple scroll with 1.0 mm incisions. In donor grafts aged greater than 65 years, 0% (0/4) achieved a stable triple scroll. Mean graft width increased significantly after forming a triple scroll (5575 μm ± 1128 μm) compared with baseline (1563 μm ± 428 μm) (P < 0.001). In the hands of a novice DMEK surgeon, the mean unscrolling time was significantly shorter with incisions (2.61 min ± 1.41 min) versus without incisions (5.44 min ± 3.17 min) (P = 0.02).

Conclusions:

Paired peripheral incisions are safe and effective for inducing a triple scroll in DMEK grafts with donor age less than or equal to 65 years. Adding incisions may facilitate unscrolling for inexperienced DMEK surgeons.
Early changes in brain network topology and activation of affective pathways predict persistent pain in the rat
Authors: Sperry Megan M. , Granquist Eric J. , Winkelstein Beth A.
Published: August 2020

Adaptations in brain communication are associated with multiple pain disorders and are hypothesized to promote the transition from acute to chronic pain. Despite known increases in brain synaptic activity, it is unknown if and how changes in pathways and networks contribute to persistent pain. A tunable rat model that induces transient or persistent temporomandibular joint pain was used to characterize brain network and subcircuit changes when sensitivity is detected in both transient and persistent pain groups and later when sensitivity is present only for the persistent pain group. Brain activity was measured by 18F-FDG positron emission tomography imaging and used to construct intersubject correlation networks; network connectivity distributions, diagnostics, and community structure were assessed. Activation of subcircuits was tested by structural equation modeling. Findings reveal differences in the brain networks at day 7 between the persistent and transient pain groups, a time when peripheral sensitivity is detected in both groups, but spontaneous pain occurs only in the persistent pain group. At day 7, increased (P ≤ 0.01) clustering, node strength, network segregation, and activation of prefrontal-limbic pathways are observed only in the group that develops persistent pain. Later, increased clustering and node strength are more pronounced with persistent pain, particularly within the limbic system, and decrease when pain resolves. Pretreatment with intra-articular etanercept to attenuate pain confirms that these adaptations are associated with pain onset. Results suggest that early and sustained brain changes can differentiate persistent and transient pain, implying they could be useful as prognostic biomarkers for persistent pain and in identifying therapeutic targets.
Nociceptor-localized cGMP-dependent protein kinase I is a critical generator for central sensitization and neuropathic pain
Authors: Wang Fei , Ma Sui-Bin , Tian Zhi-Cheng , Cui Ya-Ting , Cong Xiang-Yu , Wu Wen-Bin , Wang Fu-Dong , Li Zhen-Zhen , Han Wen-Juan , Wang Tao-Zhi , Sun Zhi-Chuan , Zhang Fan-Liang , Xie Rou-Gang , Wu Sheng-Xi , Luo Ceng
Published: August 2020

Patients with neuropathic pain often experience exaggerated pain and anxiety. Central sensitization has been linked with the maintenance of neuropathic pain and may become an autonomous pain generator. Conversely, emerging evidence accumulated that central sensitization is initiated and maintained by ongoing nociceptive primary afferent inputs. However, it remains elusive what mechanisms underlie this phenomenon and which peripheral candidate contributes to central sensitization that accounts for pain hypersensitivity and pain-related anxiety. Previous studies have implicated peripherally localized cGMP-dependent protein kinase I (PKG-I) in plasticity of nociceptors and spinal synaptic transmission as well as inflammatory hyperalgesia. However, whether peripheral PKG-I contributes to cortical plasticity and hence maintains nerve injury–induced pain hypersensitivity and anxiety is unknown. Here, we demonstrated significant upregulation of PKG-I in ipsilateral L3 dorsal root ganglia (DRG), no change in L4 DRG, and downregulation in L5 DRG upon spared nerve injury. Genetic ablation of PKG-I specifically in nociceptors or post-treatment with intervertebral foramen injection of PKG-I antagonist, KT5823, attenuated the development and maintenance of spared nerve injury–induced bilateral pain hypersensitivity and anxiety. Mechanistic analysis revealed that activation of PKG-I in nociceptors is responsible for synaptic potentiation in the anterior cingulate cortex upon peripheral neuropathy through presynaptic mechanisms involving brain-derived neurotropic factor signaling. Our results revealed that PKG-I expressed in nociceptors is a key determinant for cingulate synaptic plasticity after nerve injury, which contributes to the maintenance of pain hypersensitivity and anxiety. Thereby, this study presents a strong basis for opening up a novel therapeutic target, PKG-I, in nociceptors for treatment of comorbidity of neuropathic pain and anxiety with least side effects.
Tapentadol vs oxycodone for postoperative pain treatment the first 7 days after total knee arthroplasty: a randomized clinical trial
Authors: Rian Torbjørn , Skogvoll Eirik , Hofstad Janne , Høvik Lise , Winther Siri B. , Husby Vigdis Schnell , Klaksvik Jomar , Egeberg Tarjei , Sand Kari , Klepstad Pål , Wik Tina Strømdal
Published: August 2020

Pain after total knee arthroplasty is a prevalent condition. This study compared the effectiveness of tapentadol extended-release (ER) 50 mg × 2, oxycodone controlled-release (CR) 10 mg × 2, and placebo, as added to a multimodal analgesic regime both in-hospital and at home the first week after total knee arthroplasty. The study was randomized and blinded for investigators, staff, outcome assessors, and patients. Follow-up included pain intensity on mobilization, pain at rest, worst pain in the previous 24 hours, and adverse effects measured on 0 to 10 numerical rating scales. A total of 134 patients in 3 study groups received their allocated intervention and were included in the analysis. The primary outcome pain on mobilization the 7 first postoperative days reported as area under the curve was 528.1 (SD 267.5, interquartile range (IQR) 356.6-665.4) for placebo, 427.2 (SD 203.9, IQR 303.6-544.3) for tapentadol ER, and 507.9 (SD 243.7, IQR 292.4-686.8) for oxycodone CR (P = 0.12). With the exception of constipation being less prevalent in the tapentadol ER group (P = 0.02), we found no significant differences between treatment groups for the secondary outcomes. Tapentadol ER as an add-on to multimodal analgesia did not significantly improve pain relief when compared to oxycodone CR or placebo. Constipation was lowest in the tapentadol ER group.
The role of cyclin-dependent kinase 5 in neuropathic pain
Authors: Gomez Kimberly , Vallecillo Tissiana G.M. , Moutal Aubin , Perez-Miller Samantha , Delgado-Lezama Rodolfo , Felix Ricardo , Khanna Rajesh
Published: August 2020

The chronification of pain can be attributed to changes in membrane receptors and channels underlying neuronal plasticity and signal transduction largely within nociceptive neurons that initiate and maintain pathological pain states. These proteins are subject to dynamic modification by posttranslational modifications, creating a code that controls protein function in time and space. Phosphorylation is an important posttranslational modification that affects ∼30% of proteins in vivo. Increased phosphorylation of various nociceptive ion channels and of their modulators underlies sensitization of different pain states. Cyclin-dependent kinases are proline-directed serine/threonine kinases that impact various biological and cellular systems. Cyclin-dependent kinase 5 (Cdk5), one member of this kinase family, and its activators p35 and p39 are expressed in spinal nerves, dorsal root ganglia, and the dorsal horn of the spinal cord. In neuropathic pain conditions, expression and/or activity of Cdk5 is increased, implicating Cdk5 in nociception. Experimental evidence suggests that Cdk5 is regulated through its own phosphorylation, through increasing p35's interaction with Cdk5, and through cleavage of p35 into p25. This narrative review discusses the molecular mechanisms of Cdk5-mediated regulation of target proteins involved in neuropathic pain. We focus on Cdk5 substrates that have been linked to nociceptive pathways, including channels (eg, transient receptor potential cation channel and voltage-gated calcium channel), proteins involved in neurotransmitter release (eg, synaptophysin and collapsin response mediator protein 2), and receptors (eg, glutamate, purinergic, and opioid). By altering the phosphoregulatory “set point” of proteins involved in pain signaling, Cdk5 thus appears to be an attractive target for treating neuropathic pain conditions.
Cross-Cultural Adaptation, Validity, and Reliability of the Arabic Version of the Self-care of Hypertension Inventory Scale Among Older Adults
Authors: Alsaqer Khitam , Bebis Hatice
Published: August 2020

Background

Self-care is considered as the best method of blood pressure control. Because the prevalence of hypertension in Arab countries is high and continuously increasing through the years, more attention is needed to evaluate patients' self-care for hypertension, to enable further studies to develop the appropriate intervention. The Self-care of Hypertension Inventory (SC-HI) is a scale that has been developed to measure the maintenance, monitoring, and management of a person with hypertension.

Objective

The aim of this study was to assess the psychometric properties of the Arabic version of the SC-HI scale among older adults.

Methods

A cross-cultural adaptation process was used, where structural validity was assessed through factor analysis and interobserver agreement using Cohen κ. The reliability of internal consistency was determined through Cronbach's α and scale item correlation. Test-retest examined the interclass correlation and was tested by paired t test.

Results

The mean age of our sample is 63 ± 7.8 years, and most were educated (illiterate patients, 14%). Some modification was done for the scale items. Item-level content validity index ranged between 0.85 and 1, and average scale-level content validity was 0.96. Interobserver adjustment showed high agreement. Cronbach's α was 0.89. Test-retest reliability showed no differences (t = −0.298, P = 0,767), and interclass correlation was 0.85 (95% confidence interval, 0.078–0.90; P < .01). Factor analysis extracted 2, 3, and 1 signal factors for maintenance, management, and confidence subscales, respectively.

Conclusion

The adapted Arabic version of SC-HI scale is shown to be valid and reliable among older adults. Further studies are need for further reliability analyses among large groups from various Arab countries.
Fruit and Vegetable Consumption and High-Density Lipoproteins in Overweight or Obese Individuals
Authors: Arnotti Karla , Bamber Mandy
Published: August 2020

Background

Overweight and obesity are associated with low levels of high-density lipoprotein (HDL). The occurrence of cardiovascular disease is strongly predicted by HDL. Increased HDL reduces the risk of cardiovascular disease and stroke. Increased fruit and vegetable consumption (FVC) has been proposed to increase HDL in overweight and obesity; however, research outcomes are inconclusive on the effects of FVC on HDL in this population.

Objective

The purpose of this study was to examine the effect of weight loss FVC interventions on HDL in overweight or obese individuals.

Methods

We conducted a meta-analysis using a random-effects model to analyze the results of 6 primary studies. Secondarily, we conducted moderator analyses to explore the effects based on participants, methods, intervention, and source characteristics.

Results

We found a small standardized mean difference of FVC on HDL (d = 0.18; 95% confidence interval, 0.06–0.29; z = 3.04, P < .01), minimal heterogeneity (Q = 6.10, P = .30, I
2 = 18.05%), and possible publication bias. Moderator analyses indicated that masking of data collectors (Z = 3.73, P = .05) and intention-to-treat analysis (Z = 3.73, P = .05) significantly moderated the overall summary effect. Given that only 1 research team reported masking and intention to treat, these results should be interpreted with caution.

Conclusions

There was a small increase in HDL across studies (d = 0.18) in overweight and obese individuals. The effect size may be limited because of the small number of studies included in this meta-analysis. Nonetheless, obese and overweight individuals should be encouraged to increase their FVC to improve HDL and lower cardiovascular risk factors.
No Observed Effect Level (NOEL) for Systemic Inflammation by Copper and Zinc in Welding Fumes
Authors: Brand Peter , Beilmann Viktor , Krichel Thomas , Merizian Johanna , Schmidt Katrin , Kraus Thomas , Krabbe Julia
Published: August 2020

Copper and zinc containing welding fumes are able to induce systemic inflammation in healthy subjects. In this study the no observed effect levels (NOEL) for welding fumes containing either copper or zinc were assessed.

Fifteen healthy male volunteers participated in an exposure. Each subject was exposed to two different concentrations of both, copper and zinc containing welding fumes. Exposure was performed in the Aachen Workplace Simulation Lab.

The NOEL was found at metal concentrations between 0.2 and 0.3 mg/m3 for copper and between 0.8 and 1.2 mg/m3 for zinc.

The NOEL identified in this study was about a factor of 10 higher than the German workplace threshold limit values (TLV). However, TLV in other countries was in the same range or even higher than the NOEL indicating a considerable risk for workers.
Injury, Illness, and Mental Health Risks in United States Domestic Mariners
Authors: Lefkowitz Rafael Y. , Null Dawn B. , Slade Martin D. , Redlich Carrie A.
Published: August 2020

Objective:

Describe health conditions and injury and illness rates in a population of United States mariners, an understudied workforce vital to economic security.

Methods:

In this survey study, mariner health data was collected and analyzed to provide injury and illness rates (including mental health conditions) and associated risk factors.

Results:

In this mariner population of highly tenured vessel masters and pilots, hypertension, obesity, sleep disorders, smoking, alcohol consumption, and symptoms of depression and anxiety were common. BMI ≥35 was associated with increased likelihood of work injury (OR 5.7; 95%CI 1.01, 32.59).

Conclusions:

The mariners were in poor overall health, raising public health and safety concerns in this population of essential transportation workers. Follow-up studies including a wider distribution of domestic mariners (deck hands, engineers) would further characterize occupational risks.
The Impact of an Urban Scrapyard Fire on Respiratory-Related Pediatric Emergency Department Visits
Authors: Li Jonathan C. , Casher Danielle
Published: August 2020

Objective:

In Philadelphia, a scrapyard fire generated PM2.5 concentrations >1000 μg/m3. We assessed whether this was associated with pediatric emergency department visits for respiratory diagnoses.

Design/Methods:

Retrospective observational study using electronic health record data from a local, academic pediatric hospital.

Results:

Compared to the two-week period before the fire, patients living directly north of the fire (downwind) had a significant difference in all asthma diagnoses (OR = 3.02, P = 0.03); asthma and upper respiratory infection (OR = 17.3, P = 0.01); overall admissions (OR = 3.04, P = 01); asthma admissions (OR = 4.45, P = .01); and asthma and upper respiratory infection admissions (OR = 15.0, P = 0.01). We did not observe any significant differences among visits or admissions from patients residing in other adjacent zip codes.

Conclusion:

A localized, transient increase in PM2.5 was associated with increased pediatric emergency department visits for asthma among patients living downwind of the fire.
Association of Sickness Absence With Severe Psychiatric Outcomes in a Brazilian Health Workforce
Authors: Szlejf Claudia , Kumow Aline , Dadão Rafael , Duim Etienne , Assalim Vanessa Moraes
Published: August 2020

Objectives:

To investigate the association of sickness absence with severe psychiatric outcomes in the workforce of a health institution.

Methods:

This cross-sectional analysis included 16,890 employees from a health institution. The association of all-cause sick-leave spells and mental sick-leave spells with a composite outcome (psychiatric hospital admission and/or suicidality) was investigated with logistic regression, adjusted for age, sex, education, and job position.

Results:

There were 18,855 sick-leave spells among 6428 employees and 8.2% were mental sick-leaves. All-cause sick-leave was associated with the composite outcome (OR = 6.81; 95% CI = 2.99–15.52). This association was driven by mental-sick leave (OR = 100.52; 95% CI = 41.26–244.91), and the odds were higher among men.

Conclusion:

Health promotion interventions on workers with mental sick-leave should be implemented to minimize the impact of mental disorders in this high-risk group.
The Post Hurricane Harvey Respiratory Protection Training Program
Authors: Li Yiyao , Bakos-Block Christine , Rammah Amal , Magal Rotem , Adekanye Joel , Esquenazi Shari , McDaniel Michelle R. , Zhang Kai , Symanski Elaine , Perkison William B.
Published: August 2020

Objectives:

This study evaluated the effectiveness of an outreach program which included safety training and the distribution of personal protection kits in the Houston area in the aftermath of Hurricane Harvey.

Methods:

Outreach: 71 volunteers conducted training sessions at 19 different sites and distributed a total of 1187 kits. Follow-up study: We conducted telephonic interviews to collect data on respiratory symptoms and obtain perceptions of the quality of the safety training provided among 83 participants.

Results:

Participants reported an increase in airway symptoms four weeks after Hurricane Harvey. Outreach efforts were felt to be effective by a majority of participants.

Conclusion:

Future studies may adopt some of the best practices from our training efforts in terms of utilizing a combination of verbal demonstrations and written training guidelines on proper respirator usage.
Effort-Reward Imbalance, Mental Health and Burnout in Occupational Groups That Face Mental Stress
Authors: Diekmann Katharina , Böckelmann Irina , Karlsen Håvard R. , Lux Anke , Thielmann Beatrice
Published: August 2020

Objective:

The aim of this study was to investigate the interactions between mental health, effort-reward imbalance, intrinsic overcommitment and burnout in occupational groups that face mental stress.

Methods:

Three hundred forty-six people aged 43.8 ± 9.9 years in professions characterized by mental strain (medical assistants, nurses, bank employees, teachers) were surveyed. The Effort-Reward Imbalance Questionnaire, overcommitment, General Health Questionnaire and Maslach Burnout Inventory were used.

Results:

There were occupational group-specific differences. Nurses showed the highest effort-reward imbalance, the highest impaired mental health and risk of burnout. The intrinsic overcommitment was highest among teachers. Gender and work experience had no influence, but there were some differences in age.

Conclusions:

The occupational groups we studied experience stress differently. They would benefit from the establishment of general conditions to improve the management of stress in the workplace. The focus should be on improving mental health.