bluuebunny/crossref_metadata_2025 huggingface dataset:
Upper Quadrant Pain and Disability Associated with a Cross-Sectional Area of Deep and Superficial Neck Muscles
Authors: Radosher Avital , Kalichman Leonid , Moshe Shlomo , Ezra David , Simonovich Azaria , Droujin Jonathan , Alperovitch-Najenson Deborah
Published: July 2021

Study Design.

An analytical cross-sectional computed tomography (CT) study.

Objective.

To investigate the association of the cross-sectional area (CSA) and density of neck muscles (sternocleidomastoid, upper trapezius, levator scapulae, anterior scalene, longus coli, longus capitis) with upper quadrant pain and disability.

Summary of Background Data.

Neck pain, a common condition, causes substantial disability to individuals. The deep cervical flexor muscles are impaired in persons with neck pain. These muscles play a greater role in maintaining stable head postures, whereas, superficial muscles are responsible for peak exertions and reinforcing spinal stability at terminal head postures.

Methods.

Two hundred thirty consecutive individuals suffering from neck pain were referred to CT scans; 124/230 complied with the inclusion and exclusion criteria. Subjects were interviewed and the measurements of the CSA and muscle density were extracted from the scans.

Results.

Muscles associated with quick disability of the arms, shoulders, and hand questionnaire (QDASH) were the lateral posterior group (LPG) CSA C3–C4 on the right side (beta = –0.31, P = 0.029); the sternocleidomastoid (SCM) CSA C3–C4 on the left side (beta = 0.29, P = 0.031); the LPG CSA C3–C4 on the left side (beta = –0.49, P = 0.000); the LCM CSA C5–C6 on the right side (beta = –0.19, P = 0.049); the LPG CSA C5–C6 on the right side (beta = –0.36, P = 0.012); and the LPG CSA C5–C6 on the left side (beta = –0.42, P = 0.002). Further analyses with radiculopathy acting as an augmenting/enhancing variable (moderator), showed an increase in the model strength (r
2 = 0.25) with a stronger prediction of pain and disability. Muscle measurements did not predict neck disability index (NDI) scores.

Conclusion.

By using an accurate measuring tool, we found an association of the deep and superficial neck muscles’ CSA with upper extremities’ pain and disability. When performing manual work, a special load is placed on the shoulders and neck muscles. Future research should focus on examining the effectiveness of exercise-type intervention programs to strengthen the deep neck and upper extremities’ muscles in order to prevent muscle fatigue.

Level of Evidence: 2
Epidemiology of Spine-Related Neurologic Injuries in Professional Baseball Players
Authors: Makhni Melvin C. , Curriero Frank C. , Yeung Caleb M. , Leung Eric , Kvit Anton , Mroz Tom , Ahmad Christopher S. , Lehman Ronald A.
Published: July 2021

Study Design.

A retrospective case series study.

Objective.

To analyze the epidemiology of diagnoses of degenerative cervical and lumbar spinal conditions among Major League Baseball (MLB) and Minor League Baseball (MiLB) players.

Summary of Background Data.

Repetitive high-energy forces in professional baseball players may predispose them to degenerative cervical and lumbar spinal conditions. There is a lack of data concerning the epidemiology of these injuries in professional baseball.

Methods.

Deidentified data on spine injuries were collected from all MLB and MiLB teams from 2011 to 2016 from the MLB-commissioned Health and Injury Tracking System database. Rates of diagnoses of common degenerative spinal conditions as well as their impact on days missed due to injury, necessitation of surgery, and player participation and career-ending status were assessed. Injury rates were reported as injuries per 1000 athlete-exposures in concordance with prior studies.

Results.

Over 2011 to 2016, 4246 days of play were missed due to 172 spine-related injuries. 73.3% were related to the lumbar spine and 26.7% to the cervical spine. There were similar rates of surgery required for these injuries (18.3% of lumbar injuries vs. 13.0% of cervical injuries, P = 0.2164). Mean age of players with cervical injuries was higher compared with the lumbar group (27.5 vs. 25.4, P = 0.0119). Average number of days missed due to lumbar injuries was significantly higher than those due to cervical injuries (34.1 vs. 21.6 d, P = 0.0468). Spine injury rates for pitchers were significantly higher than those of other position players (0.086 per 1000 athlete-exposures vs. 0.037, P < 0.0001).

Conclusion.

Neurologic diagnoses relating to the cervical and lumbar spine lead to substantial disability among MLB and MiLB players as well as days missed from play. Pitchers have over double the rates of injury compared with other position players. Lumbar conditions were associated with significantly higher numbers of days missed from play.

Level of Evidence: 4
Protein Supplement and Enhanced Recovery After Posterior Spine Fusion Surgery
Authors: Khalooeifard Razieh , Oraee-Yazdani Saeed , Keikhaee Mohsen , Shariatpanahi Zahra Vahdat
Published: July 2021

Study Design:

This was a randomized, double-blind clinical trial study.

Objective:

The objective of this study was to evaluate the effect of protein supplementation on vertebral fusion and enhanced recovery after posterior spine fusion (PSF) surgery.

Summary of Background Data:

Nonfusion is one of the most common complications of lumbar spine surgery. It has been shown that protein plays an important role in bone repair; however, its correlation to vertebral fusion following PSF surgery is unknown.

Patients and Methods:

In this randomized, double-blind clinical trial study, the intervention group received a diet with 1.2 g of protein plus high-protein supplement (36 g whey protein), and the control group received a similar diet, except for starch as a placebo from 48 hours before to 1 month after surgery.

Results:

The intervention group showed a significantly higher rate of vertebral fusion compared with the control group (P=0.019). Surgical site infection and pain were significantly lower in the intervention group. A significant difference was found in the wound healing rate in favor of the intervention group. The rates of decrease in serum high-sensitivity C-reactive protein levels and increase in serum levels of insulin-like growth factor 1, albumin, total protein, and alkaline phosphatase were greater in the intervention group than in the control group (P<0.001).

Conclusions:

Increased protein intake improves vertebral fusion and enhances recovery in patients undergoing PSF. This was the first study to investigate the effect of protein on fusion and healing factors; as a result, further clinical trials are needed to confirm the current results.
Hypophysitis secondary to pembrolizumab: a case report and review of the literature
Authors: Montero Pérez Olalla , Sánchez Escudero Laura , Guzmán Ramos María Isabel , Aviñó Tarazona Victoria
Published: July 2021

Pembrolizumab is a mAb against the programmed cell death protein-1 (PD-1). It has been approved for the treatment of advanced melanoma (unresectable or metastatic) in adults. Side effects associated with the use of anti-PD-1 are usually considered well tolerated; nevertheless, there are immune-related adverse events that may require treatment discontinuation. A 79-year-old man diagnosed with stage IV right scapular melanoma experienced unspecific symptoms and alterations of the hypothalamus–hypophysis axis after six cycles with pembrolizumab. The case was compatible with immune-related hypophysitis. Autoimmune thyroiditis and primary hypophysitis were excluded and toxicity due to pembrolizumab was considered the cause of hypophysitis. Pembrolizumab was discontinued and toxicity was managed with corticosteroids and hormonal replacement therapy (HRT). After 7 months of follow-up, symptoms were controlled with HRT but thyrotropin and corticotropin hormones had not recovered. It was decided not to reintroduce immunotherapy. Although endocrine disorders are common with the use of anti-PD-1, hypophysitis is very rare. However, clinical signs and symptoms can be nonspecific, therefore, it has probably been underdiagnosed. Monitoring hormones before and during the treatment is important for an early diagnosis and also to replace the alterations with HRT to control the symptoms. Hormonal function does not always recover, but it does not mean immunotherapy cannot be restarted and it should be evaluated in every case.
Atractylenolide III induces apoptosis by regulating the Bax/Bcl-2 signaling pathway in human colorectal cancer HCT-116 Cells in vitro and in vivo
Authors: Zhang Dan , Li Xiaofang , Song Daqiang , Chen Siwei , Zhang Zhuo , Cao Shousong , Liu Minghua
Published: July 2021

Atractylodes is the dry root of atractylodes macrocephala koidz and has been commonly used as a traditional Chinese medicine (TCM). Atractylenolide III, a main component of atractylodes, has displayed significant effects on anti-inflammation and anticancer. However, the effects of atractylenolide III on growth inhibition and apoptosis induction in colon cancer remain unclear. The results showed that atractylenolide III significantly inhibited the cell growth and induce cellular apoptosis in HCT-116 cells in a concentration dependence manner in vitro. Mechanistic studies further showed that atractylenolide III could regulate the Bax/Bcl-2 apoptotic signaling pathway through promoting the expression of proapoptotic related gene/proteins Bax, caspase-9 and caspase-3 but inhibiting the expression of antiapoptotic related gene/protein Bcl-2 in HCT-116 cells. Furthermore, atractylenolide III also significantly inhibited the tumor growth of HCT-116 tumor xenografts bearing in nude mice through inducing apoptosis by upregulation of the expressions of Bax, cleaved caspase-3 and p53 but downregulation of the expressions of Bcl-2 in HCT-116 tumor tissues in vivo. The studies may provide the scientific rationale for the understanding of the anticancer effect of atractylenolide III. Therefore, atractylenolide III may have the potential to be developed as a promising novel anticancer agent for the treatment of colorectal cancer clinically.
“How long does crizotinib work? a rare case of recurrent inflammatory myofibroblastic tumor”
Authors: Albayrak Haluk Cihad , Gürler Fatih , Sütçüoğlu Osman , Akyürek Nalan , Özet Ahmet
Published: July 2021

Inflammatory myofibroblastic tumors (IMTs) are mesenchymal solid tumors, in which anaplastic lymphoma kinase (ALK) gene rearrangement might be detected. A 48-year-old female presented with IMT of lung, treated with surgery. After a 39-month disease-free survival metastatic recurrence was occurred involving soft tissues both infra- and supradiaphragmatic regions. The biopsies obtained from metastatic regions confirmed the recurrence with ALK rearrangement in immunohistochemistry. Initial partial response observed early in treatment course remained as a stable disease with crizotinib treatment. Although an excellent outcome with overall survival of 57 months was observed in our case, there is not enough information about survivals with crizotinib and the treatment options beyond progression. Therefore, every individual case has a unique value paving the way for more effective treatment.
Norcantharidin counteracts acquired everolimus resistance in renal cell carcinoma by dual inhibition of mammalian target of rapamycin complex 1 and complex 2 pathways in Vitro
Authors: Chen Xinglu , Cai Xiangsheng , Zheng Dianpeng , Huang Xiuya , Chen Ying , Deng Tanggang , Mo Lijun , Li Hongwei , Li Jinlong , Chen Sansan
Published: July 2021

Everolimus, an oral mammalian target of rapamycin complex 1 (mTORC1) inhibitor, presents a therapeutic option in metastatic renal cell carcinoma (RCC) patients who were intolerant to, or previously failed, immune- and vascular endothelial growth factor-targeted therapies. However, the onset of drug resistance limits its clinical use. One possible mechanism underpinning the resistance is that inhibiting mTORC1 by everolimus results in mTORC2-dependent activation of v-Akt murine thymoma viral oncogene (AKT) and upregulation of hypoxia-inducible transcription factors (HIF). Norcantharidin (NCTD) is a demethylated derivative of cantharidin with antitumor properties which is an active ingredient of the traditional Chinese medicine Mylabris. In this study, everolimus-resistant RCC cells (786-O-R) obtained by chronic everolimus treatment revealed higher level of HIF2α and over-activated mTORC2 pathway and NCTD inhibits cell proliferation in both everolimus-resistant and -sensitive RCC cells by arresting cell cycle in G0/G1 phase and reducing cell cycle-related proteins of C-Myc and cyclin D. Furthermore, NCTD shows synergistic anticancer effects combined with everolimus in everolimus-resistant 786-O-R cells. Mechanically, NCTD repressed both mTORC1 and mTORC2 signaling pathways as well as downstream molecular signaling pathways, such as p-4EBP1, p-AKT, HIF1α and HIF2α. Our findings provide sound evidence that combination of NCTD and everolimus is a potential therapeutic strategy for treating RCC and overcoming everolimus resistance by dual inhibition of mTORC1 and mTORC2.
Achieving the Most Effective Hanging Points at the Lower End of the Face for Thread Lifting: Quantitative Measurement of Tissue Resistance in Different Facial Layers
Authors: Rungsawang Chalermquan , Tansatit Tanvaa , Fasunloye Liz Kenny , Uruwan Sukanya
Published: July 2021

The thread lift procedure is a minimally invasive alternative to facelift surgery. The hanging point, which the terminal end of the thread is hooked into, is an important component. If it is loose and cannot stabilize the passage when the inserted thread is pulled, the lifting effect will fail. Therefore, the aim of this study was to elucidate the ability of the tissue to support the thread attachment in the different facial layers while performing this procedure. Twenty hemi-faces of 10 soft cadavers, which were divided into 45 blocks, were used to measure the tissue resistance in the midface area. The resistance of the soft tissue in the four facial layers in each block was measured while a 22G cannula connected with a force gauge was passed through it. The results showed that the tissue resistance in the sub-SMAS was higher than the SMAS and subcutaneous layers in the blocks located in the nasolabial and perioral regions. This was also significantly greater than the resistance in the subcutaneous layer in the three medial blocks below the oral commissure (P < 0.05). However, the low resistance of the sub-SMAS was found in the blocks located in the buccal and lower parotidomasseteric regions. Thus, it was preferable that the hanging point was based in the deep plane (sub-SMAS and SMAS layers) of the nasolabial, perioral, and upper parotidomasseteric regions. Moreover, the sub-SMAS layer within the buccal and lower parotidomasseteric regions should be avoided due to the loose attachment in the buccal capsule and subplatysmal fat.
Method for Flushing Surgical Drains Using a Butterfly Needle
Authors: Becker Hilton , Abadi Kevin , Slutsky Hanna , Vazquez Oscar Adrian
Published: July 2021

Surgical drains placed during breast surgery can become blocked by clots or other debris, which may lead to infection of the prosthetic and seroma or hematoma formation from improper drainage. Current methods involve stripping the drain, which does not clear the pores inside the cavity, or flushing the drain at the opposite end using a syringe with the debris going into the cavity being drained. The authors propose an easily available flushing option using a butterfly needle inserted at an angle that provides a sterile and efficient method for flushing the drain near the body cavity and clearing blockages. This creates a self-sealing valve that can be reinforced with Tegaderm and allows for the use of antibiotics or hemostatic agents through it. The primary author has performed this technique in-office in multiple patients undergoing breast augmentation, mastopexy/mammaplasty, breast reconstruction after mastectomy, and breast revision surgeries requiring implants or expanders with satisfactory results and no complications. This method is limited in that it must be performed by a health care professional, but it is easy to perform.
Utility of urinary albumin excretion as an index for stratifying the residual cardiovascular risk in patients undergoing antihypertensive agents treatment
Authors: Kikuchi Yawara , Tanaka Fumitaka , Nakamura Motoyuki , Tanno Kozo , Onoda Toshiyuki , Ohsawa Masaki , Sakata Kiyomi , Omama Shinichi , Ogasawara Kuniaki , Yonekura Yuki , Itai Kazuyoshi , Kuribayashi Toru , Ishigaki Yasushi , Okayama Akira , Asahi Koichi
Published: July 2021

Background:

Patients treated with antihypertensive medication, even those with well controlled blood pressure (BP), are at higher risk for the development of atherosclerotic cardiovascular disease (ASCVD) in comparison to nonhypertensive individuals with optimal risk levels. We hypothesized that this residual risk could be stratified based on urinary albumin excretion (UAE).

Methods:

A total of 13 082 middle-aged and older individuals with SBP/DBP of less than 160/100 mmHg and urinary albumin-to-creatinine ratios (UACRs) of less than 300 mg/g, and who were free from ASCVD events, were followed to investigate the incidence of ASCVD. The baseline BP was classified into four categories: normal BP (BP1), high normal BP (BP2), elevated BP (BP3), and grade 1 hypertension (BP4) based on the 2019 Japanese Society of Hypertension guidelines.

Results:

After an average 10.6 ± 2.6 years of follow-up, the multivariable hazard ratio for the development of ASCVD (n = 994) was already increased in medicated hypertensive patients with BP1 in comparison with untreated individuals with BP1; however, among medicated hypertensive patients, this risk was separated between the UAE groups, which were classified according to the median UACR (male, 15.4 mg/g; female, 19.0 mg/g). In medicated hypertensive patients with any category of BP1-BP3, the adjusted risk of the development of ASCVD in those with lower and higher UACRs was comparable to that observed in untreated individuals in the BP1 and BP4 categories, respectively.

Conclusion:

In medicated patients with well controlled hypertension, UAE is useful for stratifying the residual risk of developing ASCVD in comparison to nonhypertensive individuals with optimal risk levels.
Cataract surgery in herpes simplex virus ocular disease
Authors: Al-Ani Haya H. , Lu Lucy M. , Meyer Jay J. , Niederer Rachael L.
Published: July 2021

Purpose:

To investigate the outcomes and complications associated with cataract surgery in eyes with herpes simplex virus (HSV)-related anterior segment ocular disease.

Setting:

Public tertiary center in Auckland, New Zealand.

Design:

Retrospective observational cohort study.

Methods:

Clinical records of patients diagnosed with HSV-related keratitis and/or anterior uveitis who underwent subsequent cataract surgery in the affected eye were reviewed. Main outcomes measured were visual outcome, complications, and recurrence.

Results:

37 eyes of 37 patients were included. Intraoperative complications occurred in 1 patient (2.7%) with iris prolapse. Keratitis or uveitis recurred postoperatively in 17 patients (45.9%) 8 patients (22.5%); 22.5% experienced recurrences in the first year postoperatively. 1 case (2.7%) of postoperative cystoid macular edema and 1 (2.7%) postoperative endophthalmitis occurred. Corrected distance visual acuity at 3 months was >20/50 in 21 patients (70.0%), 20/50 to 20/200 in 4 patients (12.9%), and ≤20/200 in 6 patients (19.4%). Vision improved in 26 eyes (83.9%) and worsened in only 1 eye (3.2%). Risk for recurrent inflammation was associated with a greater number of recurrences prior to surgery (hazard rate [HR] 1.31), time quiescent prior to surgery (HR 0.48), and iris transillumination defect at preoperative assessment (HR 57.66).

Conclusions:

Cataract surgery in eyes with previous HSV disease may improve visual acuity for most of the eyes but, overall, carries a guarded prognosis, particularly in eyes with corneal scarring. There is a significant risk for recurrent inflammation in the first year postoperatively. If possible, surgeons should ensure a period of disease quiescence prior to surgery.
Treatment with angiotensin receptor neprilysin inhibitor for Taiwan heart failure patients: Rationale and baseline characteristics of the TAROT-HF study
Authors: Lin Wen-Yu , Chung Fa-Po , Liao Chia-Te , Huang Jin-Long , Liang Huai-Wen , Lee Ying-Hsiang , Lin Po-Lin , Chiou Wei-Ru , Hsu Chien-Yi , Chang Hung-Yu
Published: July 2021

Background:

This study used a real-world database to investigate the prescription patterns of sacubitril/valsartan (Sac/Val) among Taiwanese patients with heart failure with reduced ejection fraction (HFrEF).

Methods:

The Treatment with Angiotensin Receptor neprilysin inhibitor fOr Taiwan Heart Failure patients (TAROT-HF) study is a principal investigator–initiated, multicenter, observational, retrospective study on Taiwanese HFrEF patients. A total of 1772 patients with HFrEF (mean age 62.5 years, 75.3% male, mean left ventricular ejection fraction [LVEF] 29.3%) who received Sac/Val at 10 hospitals between 2017 and 2018 were enrolled at the date of Sac/Val initiation. Among these patients, 585 (33%) initially received Sac/Val during acute decompensated heart failure (HF) hospitalization (TAROT-AHF arm), whereas 1187 (67%) initially received the same at the outpatient clinic (TAROT-CHF arm).

Results:

A total of 1343 (75.8%) patients received an initial dose of 50 mg twice daily or fewer, whereas 422 (23.8%) received the standard initiation dose (100 mg twice daily). During outpatient Sac/Val initiation, the mean dosages were significantly higher than that following hospitalization (117 ± 55 mg vs 109 ± 57 mg; p = 0.014). Multivariate analysis identified younger age, higher systolic blood pressure, higher LVEF, prior use of renin-angiotensin system inhibitors, use of ivabradine, and a history of diabetes mellitus as independent factors for initiating a standard Sac/Val dose. Over a follow-up period of 18 months, incidences of cardiovascular death or first unplanned HF hospitalization were 18.69 and 33.11 per 100-person years for the TAROT-CHF and TAROT-AHF arms, respectively.

Conclusion:

The TAROT-HF study provided an opportunity to describe the clinical features of patients with HFrEF who received Sac/Val, assess the real-world utilization and efficacy of Sac/Val, and compare these patients with those included in prior registries.
Influential factors of surgical decompression for ulnar nerve neuropathy in Guyon’s canal
Authors: Huang Chen-Wen , Yin Cheng-Yu , Huang Hui-Kuang , Chen Tung-Ming , Hsueh Kuang-Kai , Yang Chen-Yuan , Huang Yi-Chao , Chang Ming-Chau , Wang Jung-Pan
Published: July 2021

Background:

Guyon’s canal syndrome is nerve compressive pathology which can lead to sensory and/or motor function deficits. This problem is usually difficult to distinguish from cubital tunnel syndrome and relatively less common than cubital tunnel syndrome. This study evaluated the functional results and patient-reported outcomes following decompression of the ulnar nerve in Guyon’s canal.

Methods:

Patients who were diagnosed with Guyon’s canal syndrome confirmed by electrodiagnostic studies and underwent nerve decompression surgery were included in this study. The functional improvement by examining the Froment’s sign, Wartenberg’s sign, static two-point discrimination, and Semmes Weinstein monofilament examination as physical examination scores was evaluated. The visual analogue scale of satisfaction and the disabilities of the arm, shoulder, and hand questionnaire were used for the postoperative patient-reported outcome evaluation.

Results:

From 2003 to 2019, 38 cases had been enrolled with a mean age of 53 years, ranging from 19 to 85 years. There were seven patients with comorbidity of diabetes mellitus and 28 patients who received additional neurolysis combined with the Guyon’s release procedure. There were 19 patients with a good response to surgery and 10 patients with a poor surgical outcome due to persistent paresthesia or weakness. After statistical analysis, it was revealed that several influential factors could have been related to a compromised functional outcome, including a symptom duration of more than 3 months, combination with additional neurolysis of ipsilateral extremity, and/or comorbidity with diabetes mellitus.

Conclusion:

It was concluded that promising functional outcomes after surgical release of ulnar neuropathy in Guyon’s canal could be achieved if the patients did not need additional neurolysis or the symptom duration was within 3 months.
The Role of the Physical Environment in Shaping Interruptions and Disruptions in Complex Health Care Settings
Authors: Bayramzadeh Sara , Anthony Mary K. , Sterling Madeline , O’Donnell Kayla
Published: July 2021

Interruptions and disruptions in complex healthcare environments, such as trauma rooms, can lead to compromised workflow and safety issues due to the physical environment’s characteristics. This scoping review investigated the impact of the physical environment on interruptions and disruptions and the associated outcomes in complex environments, as they relate to the components of the Systems Engineering Initiative for Patient Safety. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to conduct the scoping review. CINAHL, Web of Science, and PubMed databases were searched. After removing duplicates and eligibility screening, quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). Of 1,158 articles found, 20 were selected. Poor layout configurations, tripping hazards, and technology integration were common examples. More research must be conducted to unveil the impact of the physical environment on interruptions and disruptions.
Erector Spinae Plane Block
Authors: Sharp Ashley , Mudda Galaxy , Braehler Matthias R. , Gesthalter Yaron B.
Published: July 2021

Background:

Anesthesia and analgesia for thoracic procedures, specifically pleuroscopy, present unique challenges given the spectrum of underlying pulmonary disease and susceptibility to respiratory complications. This study describes efforts to reduce postoperative pain and minimize opioid analgesia after thoracoscopic procedures through the use of erector spinae plane block (ESPB).

Methods:

This is a single center, retrospective case series of all patients who underwent rigid pleuroscopy with ESPB plus monitored anesthesia care (MAC) from November 2018 through September 2020. The primary outcome measures were postoperative pain scores and analgesic medication requirements.

Results:

Twenty-six patients underwent pleuroscopy with ESPB plus MAC. Average intraoperative and postoperative opioid consumption in oral morphine equivalents were 18.4±15.8 and 11.2±19.6 mg, respectively. There was no significant difference between average preoperative and postoperative subjective numerical pain scores (P=0.221). There were no complications associated with ESPB.

Conclusion:

This case series demonstrates the feasibility of utilizing single shot ESPB in combination with MAC as the primary anesthetic for thoracoscopic procedures.
The Effect of Infectious Complications During Ventricular Assist Device Use on Outcomes of Pediatric Heart Transplantation
Authors: Auerbach Scott. R. , Cantor Ryan S. , Bradford Tamara T. , Bock Matthew J. , Skipper Eric R. , Koehl Devin A. , Butler Kathleen , Alejos Juan. C. , Edens R. Erik , Kirklin James K.
Published: July 2021

To describe the impact of infectious adverse events (IAEs) during ventricular assist device (VAD) support on graft loss, infection, and rejection after pediatric heart transplant (HT). Pedimacs data were linked to Pediatric Heart Transplant Society (PHTS) data for patients receiving a VAD followed by HT between September 2012 and December 2016. Linked patients were categorized into IAE on VAD (group A) and no IAE on VAD (group B). Infectious adverse event locations included nondevice, device (external or internal), and sepsis. Post-HT outcomes for analysis were graft loss, infection, and rejection. Time-dependent analysis included Kaplan–Meier and multiphase parametric hazard function analysis. We linked 207 patients (age 9.4 ± 6.3 years). Post-HT follow-up was 19.4 patient-months (<8 days–4.1 years). Group A included 42 patients (20%) with 62 IAEs. Group B included 165 patients without an IAE. Group A patients were younger (7.4 ± 6.1 vs. 9.5 ± 6.3 years; p = 0.03), waited longer for HT (5.3 ± 4.1 vs. 2.9 ± 2.5 months; p = 0.0005), and were hospitalized longer post-HT (42 ± 59 vs. 23 ± 22 days; p = 0.05). VAD-related IAEs were rare (N = 11). Groups A and B had similar freedom from first post-HT infection, rejection, and graft loss (all p > 0.1). However, patients with VAD-related IAE were somewhat more likely to experience rejection (p = 0.03) and graft loss (p = 0.01). Children with an IAE on VAD who survive to HT are younger, wait longer for HT, and remain hospitalized longer than those without an IAE on VAD. Overall, IAE on VAD did not impact post-HT outcomes, but VAD-related IAE may be associated with graft loss and rejection.
3D Holographic Virtual Surgical Planning for a Single Right Ventricle Fontan Patient Needing Heartmate III Placement
Authors: Szugye Nicholas A. , Zafar Farhan , Villa Chet , Lorts Angela , Morales David L. S. , Moore Ryan A.
Published: July 2021

A 15 year old female with hypoplastic left heart syndrome status post Norwood with Sano modification, bidirectional Glenn and extracardiac conduit Fontan developed severe right ventricular (RV) systolic dysfunction. Due to symptomatic heart failure, she underwent assessment for ventricular assist device (VAD) placement as a bridge-to-cardiac transplantation strategy. To evaluate her atypical anatomy, a chest computed tomography (CT) was uploaded into an EchoPixel True3D (Santa Clara, CA) view portal along with an accurately scaled 3D surface model of the HeartMate III (HM3) device. The surgeon then manipulated the position of the HM3 to evaluate multiple potential device positions in relation to anatomic features such as the intraventricular septum, tricuspid valve annulus, and RV muscle bundles. The patient was taken to the operating room and the HM3 device was placed just anterior to the RV apex as virtually planned. She had an uneventful postoperative course, underwent cardiac transplantation on postoperative day (POD) 63 and is doing well now 19 months post-transplantation.
Does Cardiac Catheterization Facilitate Hemodynamic Optimization of Pediatric Patients on Continuous-Flow Ventricular Assist Devices?
Authors: Lahiri Subhrajit , Choudhry Swati , Denfield Susan W. , Price Jack F. , Cabrera Antonio G. , Dreyer William J. , Spinner Joseph A. , Loar Robert W. , Elias Barb , McMullen Jason , Qureshi Athar M. , Adachi Iki , Tunuguntla Hari Priya
Published: July 2021

Understanding optimal ventricular assist device (VAD) parameters for pediatric patients is valuable given the inherent issue of patient-device size mismatch and heterogeneous cardiac anatomy in children. We evaluated our center’s experience of continuous-flow VAD (CF-VAD) optimization using cardiac catheterization. We performed a retrospective analysis of all patients on CF-VAD support who underwent hemodynamic heart catheterization from 2013 to 2018. Fifteen patients had 16 hemodynamic catheterizations performed. The indications for hemodynamic optimization by catheterization included clinical signs of heart failure while on CF-VAD (9 of 16, 56%), pretransplant evaluation of pulmonary hypertension (2 of 16, 13%), or assessment of myocardial recovery (5 of 16, 31%). The median age at catheterization was 12 years (interquartile range: 8–16). Median baseline speed of device was 2333 ± 253 rotations per minute. The goal was to find the speed at which optimal hemodynamics were achieved, defined by low wedge pressure with an acceptable central venous pressure. Of the 16 catheterizations, there were 9 (56%) speed increases to achieve optimal hemodynamics and 5 (33%) speed decreases for hemodynamic optimization or for potential explant. The speed was not changed in 2 (13%) catheterizations as the patients were determined to be at an optimal hemodynamic state. Overall, VAD settings were optimized in 75% (14 of 16) of hemodynamic catheterizations. There were no adverse events related to catheterization. Thus, we conclude that catheterization-based hemodynamic assessment is safe and effective for optimizing VAD speed and provides guidance on medical management in children supported on CF-VAD.
Extracorporeal Life Support in Accidental Hypothermia with Cardiac Arrest—A Narrative Review
Authors: Swol Justyna , Darocha Tomasz , Paal Peter , Brugger Hermann , Podsiadło Paweł , Kosiński Sylweriusz , Puślecki Mateusz , Ligowski Marcin , Pasquier Mathieu
Published: July 2021

Severely hypothermic patients, especially suffering cardiac arrest, require highly specialized treatment. The most common problems affecting the recognition and treatment seem to be awareness, logistics, and proper planning. In severe hypothermia, pathophysiologic changes occur in the cardiovascular system leading to dysrhythmias, decreased cardiac output, decreased central nervous system electrical activity, cold diuresis, and noncardiogenic pulmonary edema. Cardiac arrest, multiple organ dysfunction, and refractory vasoplegia are indicative of profound hypothermia. The aim of these narrative reviews is to describe the peculiar pathophysiology of patients suffering cardiac arrest from accidental hypothermia. We describe the good chances of neurologic recovery in certain circumstances, even in patients presenting with unwitnessed cardiac arrest, asystole, and the absence of bystander cardiopulmonary resuscitation. Guidance on patient selection, prognostication, and treatment, including extracorporeal life support, is given.
Left Ventricular Assist Device Support-Induced Alteration of Mechanical Stress on Aortic Valve and Aortic Wall
Authors: Kainuma Atsushi , Itatani Keiichi , Hayashi Hideyuki , Kaku Yuji , Wu Isaac Y. , Colombo Paolo C. , Ferrari Giovanni , Kurlansky Paul , Yuzefpolskaya Melana , Takeda Koji , Naka Yoshifumi , Akiyama Koichi , Takayama Hiroo
Published: July 2021

The aim of this study was to evaluate the fluid dynamics in the aortic valve and proximal aorta during continuous-flow left ventricular assist device (LVAD) support using epiaortic echocardiography and vector flow mapping technology. A total of 12 patients who underwent HeartMate 3 implantation between December 2018 and February 2020 were prospectively examined. The wall shear stress (WSS) on the ascending aorta, aortic root, and aortic valve was evaluated before and after LVAD implantation. The median age of the cohort was 62 years and 17% were women. The peak WSS on the ascending aorta (Pre 1.48 [0.86–1.69] [Pascal {Pa}] vs. Post 0.33 [0.21–0.58] [Pa]; p = 0.002), aortic root (Pre 0.46 [0.31–0.58] (Pa) vs. Post 0.18 [0.12–0.25] (Pa); p = 0.001), and ventricularis of the aortic valve (Pre 1.76 [1.59–2.30] (Pa) vs. Post 0.30 [0.10–0.61] (Pa); p = 0.001) was significantly lower after LVAD implantation. No difference in WSS was observed on the fibrosa of the aortic valve (Pre 0.36 [0.22–0.53] (Pa) vs. Post 0.38 [0.38–0.52] (Pa); p = 0.850) before and after implantation. The WSS on the ascending aorta, aortic root, and ventricularis of the aortic valve leaflets was significantly altered by LVAD implantation, providing preliminary data on the potential contribution of fluid dynamics to LVAD-induced aortic insufficiency and root thrombus.
Neurological Outcome According to the Site of Cannulation in Septic Children Supported by Venoarterial Extracorporeal Membrane Oxygenation
Authors: Chenouard Alexis , Liet Jean-Michel , Maminirina Pierre , Denis Manon , Tonna Joseph , Rycus Peter , Joram Nicolas , Bourgoin Pierre
Published: July 2021

The impact of cervical cannulation on neurologic outcome has not been yet studied among children receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the context of severe sepsis or septic shock. A retrospective cohort study was performed using the extracorporeal life support organization (ELSO) registry. A total of 559 children weighing less than 20 kg with a primary or secondary diagnosis of severe sepsis, septic shock or toxic shock syndrome were included between January 1, 2010, and December 31, 2019. Cervical cannulation was performed in 485 children (87%) and central cannulation in 74 children (13%). The prevalence of acute neurologic event (ANE) was 32%, including clinical and/or electroencephalographic seizures, cerebral infarction, cerebral hemorrhage, and/or brain death. In multivariable analysis, we did not find an association between cervical cannulation and greater/lesser odds of ANE during ECMO (adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] 0.72–2.65; P = 0.326). Only pre-ECMO acidosis was independently associated with the development of ANE (pH < 6.99; aOR = 2.71, 95% CI 1.34–5.49; P = 0.006; pH 6.99 to <7.12; aOR = 2.57, 95% CI 1.37–4.82; P = 0.003). Thus, the site of cannulation appears not as a modifiable neurologic risk factor in this young septic population.
Advances in management of hepatorenal syndrome
Authors: Khemichian Saro , Francoz Claire , Nadim Mitra K.
Published: July 2021

Purpose of review

Hepatorenal syndrome (HRS) is encountered frequently in patients with end-stage liver disease and remains an important cause of morbidity and mortality in this patient population. This review will focus and provide updates on pathophysiology, assessment of kidney function, new definitions, and treatment and prevention of HRS.

Recent findings

Pathophysiology of HRS has been elucidated more recently and in addition to hemodynamic changes, the role of systemic inflammatory response contributes significantly to this process. Assessment of kidney function in patients with liver cirrhosis remains challenging. Novel glomerular filtration rate equations have been developed in patients with liver disease to better estimate kidney function and changes made in the definition of acute kidney injury (AKI), which are more aligned with KDIGO criteria for AKI. Vasoconstrictors, especially terlipressin, along with albumin remain the mainstay of pharmacological treatment of HRS-AKI. Biomarkers have been useful in differentiating ATN from HRS at an early stage.

HRS remains a significant cause of morbidity and mortality for patients with end-stage liver disease. Newer understanding of mechanisms in development and pathophysiology of HRS have helped with elucidation of the disease process.
Emerging non-pharmacological interventions in ADPKD: an update on dietary advices for clinical practice
Authors: Meijer Esther , Gansevoort Ron T.
Published: July 2021

Purpose of review

Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) reach kidney failure at a median age of 58 years. There has been a strong interest in medical interventions to improve prognosis. With increasing understanding of the underlying pathophysiology, there is also a rationale for non-pharmaceutical interventions. However, these have received little attention. This review, therefore, focuses on dietary interventions in ADPKD.

Recent findings

Recent studies regarding salt, protein and water intake, caloric restriction, BMI, caffeine and alcohol are discussed in this review. In general, these studies suggest that advices do not need to be different from those in chronic kidney disease (CKD). On the basis of research in the general population and CKD, these advices will likely decrease cardiovascular morbidity and mortality. With respect to delaying ADPKD progression, evidence for salt restriction is growing. For increasing water intake and targeting glucose metabolism by intermittent fasting, preclinical studies are promising. Long-term randomized human intervention studies are, however, lacking.

In ADPKD, advices regarding dietary interventions can, in general, be the same as in CKD to decrease cardiovascular morbidity and mortality. Whether these interventions also delay disease progression needs further study.
Paediatric polyposis syndromes: burden of disease and current concepts
Authors: Phen Claudia , Rojas Isabel
Published: July 2021

Purpose of review

Polyposis syndromes are rare but significant entities that often present during childhood and adolescence. Polyposis syndromes should remain high on the differential diagnoses for any child presenting with rectal bleeding, protein-losing enteropathy or intussusception in the setting of multiple polyps in the gastrointestinal tract. There are three primary paediatric polyposis syndromes: Juvenile polyposis syndrome (JPS), Familial adenomatous polyposis (FAP) and Peutz-Jeghers syndrome (PJS). This review will cover recent guidelines for these conditions and advances in genetic testing.

Recent findings

The first set of paediatric guidelines were released in 2019 by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) for FAP, JPS and PJS. Even with advances in genetic testing, a significant proportion of patients with polyposis syndromes have no identifiable genetic mutations. Recent research has shown that polyps behave differently in patients with and without disease-causing variants, emphasizing the role of genetic testing in the diagnosis and management of polyposis syndromes.

Polyposis syndromes in the paediatric population are growing due to increased recognition and advances in genetic testing. A timely diagnosis and surveillance of a paediatric polyposis syndrome are pivotal for the management of disease burden and early identification of cancers within the gastrointestinal tract and beyond. Paediatricians, paediatric gastroenterologists, paediatric oncologists and paediatric surgeons should be familiar with the presentation and comorbidities of polyposis syndromes in children and adolescents. Further research into genotype-phenotype correlations is needed to tailor the care for paediatric patients with polyposis syndromes.
Electrosurgery or laser for benign prostatic enlargement: trumpcard or pitfalls
Authors: Pallauf Maximilian , Herrmann Thomas , Oswald David , Törzsök Peter , Deininger Susanne , Lusuardi Lukas
Published: July 2021

Purpose of review

To summarize and comment on publications of the last 2 years in the field of endoscopic surgery for benign prostatic enlargement, focusing on similarities and differences of laser and electrosurgery.

Recent findings

Because of good hemostasis and safety, invasive endoscopic surgery has evolved to a choice of treatment for vulnerable patients with ongoing antithrombotic medication and in same-day surgery. Recent publications show a good perioperative course and no deterioration in the postoperative outcome. Furthermore, alterations to the original surgical techniques of resection, enucleation, and vaporization have increased the preservation rate for antegrade ejaculation, advancing them to an appealing choice of treatment for sexually active men. Favorable outcomes can be achieved in both laser and electrosurgery. Only the choice of the surgical technique determines the outcome.

Various invasive endoscopic surgical techniques are available, offering different advantages and disadvantages for the patient. All of them can be performed with laser and electrosurgery. Therefore, focusing on the proper choice of surgical technique instead of the energy source will guarantee the patient to benefit most.
Tissue engineering: recent advances and review of clinical outcome for urethral strictures
Authors: Saad Sanad , Osman Nadir I. , Chapple Christopher R.
Published: July 2021

Purpose of review

Urethrotomy remains the first-line therapy in the treatment of a urethral stricture despite data showing no real chance of a cure after repeated urethrotomies. An anastomotic or an augmentation urethroplasty using oral mucosa can be offered to patients following failed urethrotomy. The potential for a tissue engineered solution as an alternative to native tissue has been explored in recent years and is reviewed in this article.

Recent findings

More than 80 preclinical studies have investigated a tissue-engineered approach for urethral reconstruction mostly using decellularized natural scaffolds derived from natural extracellular matrix with or without cell seeding. The animal models used in preclinical testing are not representative of disease processes seen with strictures in man. The available clinical studies are based on small noncontrolled series.

There is a potential role for tissue engineering to provide a material for substitution urethroplasty and work has demonstrated this. Further work will require a rigorous basic science programme and adequate evaluation of the material prior to its introduction into clinical practice. The research with tissue engineering applied to the urethra has not yet been resulted in a widely available material for clinical use that approaches the efficacy seen with the use of autologous grafts.
State of the art on stress incontinence management after benign prostatic obstruction surgery
Authors: Sabbagh Paul , Dupuis Hugo , Cornu Jean-Nicolas
Published: July 2021

Purpose of review

Stress urinary incontinence (SUI) is mostly seen after prostate surgery (radical prostatectomy or benign prostatic obstruction [BPO] relief). As new surgical techniques (laser, endoscopic enucleation) have been dramatically expanded in the past decade, a focus on postoperative SUI is necessary to provide the best management in this iatrogenic situation.

Recent findings

Surgery is the main option for curative management of SUI after BPO as no oral medication is recommended. Preoperative work-up is mandatory to assess concomitant bladder dysfunction. All available surgical options (peri-urethral injections, periurethral balloons, various male slings, and artificial urinary sphincter) have been studied, but the level of evidence is very low. In this setting, SUI after BPO management is widely inspired from post-PR SUI management, mainly based on clinical experience.

The available literature regarding persistent SUI after BPO relief is very scarce and further studies are warranted in this specific population.
Validity and Usefulness of an Electronic Health Care Record-Generated Mobility Ambulation Tool
Authors: Kawar Lina Najib , Crawford Cecelia L. , Mendoza Rosalina G. , Harrison Staci J. , Thibodeaux Mariaelena Washington , Spicer Jerry E.
Published: July 2021

Background:

Mobility is a vital function of human life. Nurses have an essential role in preventing hospitalized patient complications through movement and ambulation.

Purpose:

This study examined the integration, accuracy, and precision of a paper-based mobility/ambulation tool into an electronic health record (EHR) to assess inpatient mobility/ambulation status.

Methods:

This multisite mixed-methods study was a time-series correlational evaluation of a mobility/ambulation tool into the EHR.

Results:

Sustainability data revealed strong correlations between nurse responses and EHR levels (r = 0.602; scores r = 0.624). Cronbach's α values were 0.737 and 0.761. Nurses' anecdotes supported the findings.

Conclusion:

Findings revealed that the EHR-Mobility Ambulation Tool is a valid, reliable, and stable tool. EHR-generated scores can assist in reducing charting burden, care planning, and inform the interdisciplinary health team at all patient care stages. Tool adoption could potentially assist nurses plan interventions suitable to maintain or increase hospitalized patients' mobility status and contribute to discharge planning.