bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Above Average 6-Year Citation Rates in Leading Spine-Specific Medical Journals
Authors: Krivicich Laura M. , VanHorn Trent , Gowd Anirudh , Beck Edward C. , Paul Katlynn , O’Gara Tadhg J.
Published: February 2021

Study Design.

Cross-sectional.

Objective.

To identify predictors of manuscripts achieving 6-year citation rates higher than the mean in spine-specific literature.

Summary of Background Data.

An article's citation rate demonstrates its contribution to academia and its quality. Predictors of citation rates have not yet been studied in spine-specific medical literature.

Methods.

Three leading spine-specific journals were identified by a weighted scoring system comparing various journal metrics. Research articles published in 2014 were evaluated from the following journals: Spine, European Spine Journal, and Journal of Neurosurgery: Spine. Article features analyzed included journal of origin, number of words in article title, author count, degree of first author, conflicts of interest, quantity of contributing academic institutions, country of origin, study topic, study design, level of evidence, sample size, reference count, and citation rate. Multivariate logistic regression was used to determine predictors of above average citation rate at 6 years following publication.

Results.

The final analysis included 1091 articles. Spine had a significantly higher citation rate than European Spine Journal (P = 0.0008); however, no significant differences were observed between Spine and Journal of Neurosurgery: Spine. Regression analysis demonstrated that studies originating in North America (OR:1.44, 95% CI:1.01–2.01, P = 0.04), those with 6 ≥ authors (OR:1.72, 95% CI:1.29–2.30, P < 0.001), sample size >100 (P < 0.001), prospective case series (OR: 2.67, 95% CI: 1.24–5.76), and retrospective case series (OR: 1.99, 95% CI: 1.07–3.73) were independent predictors of achieving above average 6-year citation rates.

Conclusion.

Spine, European Spine Journal, and Journal of Neurosurgery: Spine had the highest 6-year citation rates of the top 10 orthopedic spine journals, with Spine being significantly higher than European Spine Journal. Studies originating in North America, those with six or more authors, sample sizes > 100, and those that are retrospective or prospective case series are independent predictors of greater citation rates at 6 years in orthopedic spine-specific medical literature.

Level of Evidence: 4
Subjective and Objective Change in Cervical Spine Mobility After Single-level Anterior Cervical Decompression and Fusion
Authors: Scholz Christoph , Masalha Waseem , Naseri Yashar , Hohenhaus Marc , Klingler Jan-Helge , Hubbe Ulrich
Published: February 2021

Study Design.

Prospective, observational study.

Objective.

The aim of this study was to collect objective and especially subjective data on changes in cervical spine mobility after single-level anterior cervical decompression and fusion (ACDF) and to investigate the impact on quality of life and activities of daily living (ADLs).

Summary of Background Data.

Although there are several studies dealing with the objective change in mobility after single-level ACDF, there are few data on how spondylodesis of a motion segment affects subjective restriction of cervical spine mobility.

Methods.

Patients undergoing first-time, single-level ACDF for a symptomatic spondylotic process were eligible. Data were collected before surgery, at 3-month, and 1-year follow-up. Patients were assessed via clinical scores (pain intensity, Short-Form 8 [SF-8], among others) and asked for impairment in ADLs due to restriction of cervical spine mobility. The subjective restriction was acquired by a five-step patient-reported score. The range of motion was measured by the CROM device.

Results.

Data of 97 patients could be evaluated. For pain scores and SF-8 there were significant improvements 3 months and 1 year after surgery (P < 0.001). The impairment for most ADLs improved 3 months after surgery and further after 1 year. The subjective restriction showed a significant improvement in general and for all single directions 1 year after surgery. In the objective measurements, a significantly higher total rotation could be found 1 year after surgery compared to preoperatively (101.6° ± 21.2 vs. 93.9° ± 23.4; P = 0.002). There were no significant differences in total flexion-extension and lateral flexion. Increasing age was a significant predictor for objective and subjective restriction.

Conclusion.

The concern of many patients of being severely restricted in their cervical spine mobility after single-level ACDF can be denied. Objectively, the rotation even showed a significant improvement. Regarding the subjective restriction, which is more important for the patients, we found a significant improvement in general and for all directions of movement after surgery.

Level of Evidence: 3
Clinical Outcomes of Minimally Invasive Posterior Decompression for Lumbar Spinal Stenosis with Degenerative Spondylolisthesis
Authors: Kobayashi Yuto , Tamai Koji , Toyoda Hiromitsu , Terai Hidetomi , Hoshino Masatoshi , Suzuki Akinobu , Takahashi Shinji , Hori Yusuke , Yabu Akito , Nakamura Hiroaki
Published: February 2021

Study Design.

Retrospective cohort study.

Objective.

To compare the clinical outcomes 5 years after minimally invasive posterior decompression for lumber spinal stenosis (LSS) between patients with and without degenerative spondylolisthesis (DS).

Summary of Background Data.

Indications for surgical procedures for patients with LSS and DS are still under investigation. Since minimally invasive surgery does not affect most anatomical structures, preoperative DS may not negatively affect the clinical outcomes of minimally invasive posterior decompression.

Methods.

Overall, 198 patients with LSS who underwent microendoscopic or microscopic decompression and were followed up for more than 5 years postoperatively were included in the present study. Patients who showed a segmental kyphosis >5° at the surgical level during flexion were treated with fusion surgery. However, other patients, including those with DS, were treated with posterior decompression. The patients were divided into two groups: the DS group included 82 patients with >3-mm slip and the non-DS group included 112 patients with ≤3-mm slip or without slip. A mixed-effects model adjusted for age and sex was used to compare the improvements in the visual analog scale score for low-back pain and the Japanese Orthopaedic Association score of the two groups. For subgroup analysis (n = 53), the changes in the preoperative physical component summary and the mental component summary of Short Form-36 of the two groups at 5 years after surgery were evaluated.

Results.

There was no significant difference in the improvement of preoperative low-back pain visual analog scale score and Japanese Orthopaedic Association score 5 years after surgery between the two groups. Subgroup analysis showed no significant difference between the two groups in the improvement of preoperative physical component summary and mental component summary 5 years after surgery.

Conclusion.

After carefully eliminating patients with segmental instability, DS did not affect the clinical outcomes of minimally invasive decompression surgery.

Level of Evidence: 3
Pain During Sex Before and After Decompressive Surgery for Lumbar Spinal Stenosis
Authors: Holmberg Siril T. , Vangen-Lønne Vetle , Gulati Agnete M. , Nygaard Øystein P. , Solberg Tore K. , Salvesen Øyvind O. , Gulati Sasha
Published: February 2021

Study Design.

Observational multicenter study.

Objective.

The aim of this study was to evaluate changes in pain during sexual activity after surgery for lumbar spinal stenosis (LSS).

Summary of Background Data.

There are limited data available on sexual function in patients undergoing surgery for LSS.

Methods.

Data were retrieved from the Norwegian Registry for Spine Surgery. The primary outcome was change in pain during sexual activity at 1 year, assessed by item number eight of the Oswestry disability index questionnaire. Secondary outcome measures included Oswestry Disability Index, EuroQol-5D, and numeric rating scale scores for back and leg pain.

Results.

Among the 12,954 patients included, 9908 (76.5%) completed 1-year follow-up. At baseline 9579 patients (73.9%) provided information about pain during sexual activity, whereas 7424 (74.9%) among those with complete follow-up completed this item. Preoperatively 2528 of 9579 patients (26.4%) reported a normal sex-life without pain compared with 4294 of 7424 patients (57.8%) at 1 year. Preoperatively 1007 (10.5%) patients reported that pain prevented any sex-life, compared with 393 patients (5.3%) at 1 year. At baseline 7051 of 9579 patients (73.6%) reported that sexual activity caused pain, and among these 3145 of 4768 responders (66%) reported an improvement at 1 year. A multivariable regression analysis showed that having a life partner, college education, and working until time of surgery were predictors of improvement in pain during sexual activity. Current tobacco smoking, pain duration >12 months, previous spine surgery, and complications occurring within 3 months were negative predictors.

Conclusion.

This study clearly demonstrates that a large proportion of patients undergoing surgery for LSS experienced an improvement in pain during sexual activity at 1 year.

Level of Evidence: 2
A Novel Classification of 3D Rib Cage Deformity in Subjects With Adolescent Idiopathic Scoliosis
Authors: Assi Ayman , Karam Mohamad , Skalli Wafa , Vergari Claudio , Vialle Raphael , Pietton Raphael , Bizdikian Aren J. , Kharrat Khalil , Dubousset Jean , Ghanem Ismat
Published: February 2021

Study Design:

This was a multicentric cross-sectional descriptive study.

Objective:

To analyze patterns of 3D rib cage deformity in subjects with adolescent idiopathic scoliosis (AIS) and their relationship with the spinal deformity.

Summary of Background Data:

Subjects with AIS present with rib cage deformity that can affect respiratory functions. The 3D rib cage deformities in AIS and their relationship to the spinal deformity are still unelucidated.

Methods:

A total of 200 AIS and 71 controls underwent low-dose biplanar x-rays and had their spine and rib cage reconstructed in 3-dimensional (D). Classic spinopelvic parameters were calculated in 3D and: rib cage gibbosity, thickness, width, volume and volumetric spinal penetration index (VSPI). Subjects with AIS were classified as: group I with mild rib cage deformity (n=88), group II with severe rib cage deformity (n=112) subgrouped into IIa (high gibbosity, n=48), IIb (high VSPI, n=48), and IIc (both high gibbosity and VSPI, n=16).

Results:

Groups IIa and IIb had a higher Cobb angle (33 vs. 54 degrees and 46 degrees, respectively) and torsion index (11 vs. 14 degrees and 13 degrees, respectively) than group I. Group IIb showed more severe hypokyphosis (IIb=21 degrees; IIa=33 degrees; I=36 degrees; control=42 degrees) with a reduced rib cage volume (IIb=4731 cm3; IIa=4985 cm3; I=5257 cm3; control=5254 cm3) and thickness (IIb=135 mm; IIa=148 mm; I=144 mm; control=144 mm). Group IIa showed an increasingly large local gibbosity descending from proximal to distal levels and did not follow the axial rotation of the spine. Group IIc showed characteristics of both groups IIa and IIb.

Conclusions:

This new classification of 3D rib cage deformity in AIS shows that the management of cases with high VSPI (groups IIb and IIc) should focus on restoring as much kyphosis as possible to avoid respiratory repercussions. Treatment indications in groups I and IIa would follow the consensual basic principles reported in the literature regarding bracing and surgery.
Novel bone-targeted parathyroid hormone-related peptide antagonists inhibit breast cancer bone metastases
Authors: Ponnapakkam Tulasi , Anbalagan Muralidharan , Stratford Robert E. , Rowan Brian G. , Gensure Robert C.
Published: February 2021

Patients with advanced breast cancer often develop bone metastases. Treatment is limited to palliative care. Parathyroid hormone (PTH)/parathyroid hormone-related peptide (PTHrP) antagonists for bone metastases failed clinically due to short half-life and inadequate concentration in bone. We synthesized two novel PTHrP antagonists fused to an inert bacterial collagen binding domain (CBD) that directs drugs to bone. PTH(7-33)-CBD is an N-terminal truncated PTHrP antagonist. [W2]PTH(1-33)-CBD is an PTHrP inverse-agonist. The aim of this study was to assess PTH(7-33)-CBD to reduce breast cancer bone metastases and prevent osteolytic destruction in mice and to assess both drugs for apoptosis of breast cancer cells in vitro and inhibition of PTH receptor (PTHR1). PTH(7-33)-CBD (1000 µg/kg, subcutaneous) or vehicle was administered 24 h prior to MDA-MB-231 breast cancer cell inoculation into the tibia marrow. Weekly tumor burden and bone density were measured. Pharmacokinetic analysis of PTH(7-33)-CBD in rat serum was evaluated. Drug effect on cAMP accumulation in SaOS-2 osteosarcoma cells and apoptosis of MDA-MB-231 cells was assessed. PTH(7-33)-CBD reduced MDA-MB-231 tumor burden and osteolytic destruction in mice 4–5 weeks post-treatment. PTH(7-33)-CBD (1000 μg/kg i.v. and subcutaneous) in rats was rapidly absorbed with peak concentration 5-min and terminal half-life 3-h. Bioavailability by the subcutaneous route was 43% relative to the i.v. route. PTH(7-33)-CBD was detected only on rat periosteal bone surfaces that stained positive for collagen-1. PTH(7-33)-CBD and [W2]PTH(1-33)-CBD (10−8M) blocked basal and PTH agonist-induced cAMP accumulation in SaOS-2 osteosarcoma cells. Both drugs induced PTHR1-dependent apoptosis of MDA-MB-231 cells in vitro. Novel bone-targeted PTHrP antagonists represent a new paradigm for treatment of breast cancer bone metastases.
The phytochemical p-hydroxycinnamic acid suppresses the growth and stimulates the death in human liver cancer HepG2 cells
Authors: Yamaguchi Masayoshi , Murata Tomiyasu , Ramos Joe W.
Published: February 2021

Hepatocellular carcinoma (HCC) is one of the most prevalent malignant diseases and causes a third of cancer-related death. The prognosis and effective treatment of advanced HCC remains poor in spite of the development of novel therapeutic strategies. In the present study, we investigate anticancer effects of the botanical molecule p-hydroxycinnamic  acid (HCA) in the HepG2 liver cancer model in vitro. Culturing with HCA (10–1000 nM) suppressed colony formation and growth of HepG2 cells. Mechanistically, culturing with HCA decreased levels of Ras, PI3K, Akt, MAPK, NF-κB p65 and β-catenin, which are linked to processes of cell signaling and transcription, and increased levels of retinoblastoma and regucalcin, which are suppressors for carcinogenesis. These alterations may lead to the suppression of cell growth. Furthermore, culturing with HCA (10–1000 nM) stimulated cell death due to increased caspase-3 levels. Interestingly, the effects of HCA on the growth and death of HepG2 cells were inhibited by culturing with CH223191, an antagonist of aryl hydrocarbon receptor (AHR), suggesting that the flavonoid effects are, at least partly, mediated by activation of AHR signaling. Notably, HCA blocked stimulatory effects of Bay K 8644, an agonist of L-type calcium channel, on the growth of HepG2 cells. Thus, our study demonstrates that HCA suppresses the growth and stimulates the death of human liver cancer HepG2 cells in vitro. The botanical molecule HCA may therefore be a useful tool in the treatment of HCC, providing a novel strategy for the therapy of human liver cancers.
Breath-Synchronized Nebulized Surfactant in a Porcine Model of Acute Respiratory Distress Syndrome
Authors: DiBlasi Robert M. , Kajimoto Masaki , Poli Jonathan A. , Deutsch Gail , Pfeiffer Juergen , Zimmerman Joseph , Crotwell David N. , Malone Patrik , Fink James B. , Ringer Coral , Uthamanthil Rajesh , Ledee Dolena , Portman Michael A.
Published: February 2021

Objectives:

Effective treatment options for surfactant therapy in acute respiratory distress syndrome and coronavirus disease 2019 have not been established. To conduct preclinical studies in vitro and in vivo to evaluate efficiency, particle size, dosing, safety, and efficacy of inhaled surfactant using a breath-synchronized, nebulized delivery system in an established acute respiratory distress syndrome model.

Design:

Preclinical study.

Setting:

Research laboratory.

Subjects:

Anesthetized pigs.

Intervention:

In vitro analysis included particle size distribution and inhaled dose during simulated ventilation using a novel breath-synchronized nebulizer. Physiologic effects of inhaled aerosolized surfactant (treatment) were compared with aerosolized normal saline (control) in an adult porcine model (weight of 34.3 ± 0.6 kg) of severe acute respiratory distress syndrome (Pao
2/Fio
2 <100) with lung lavages and ventilator-induced lung injury during invasive ventilation.

Measurements and Main Results:

Mass median aerosol diameter was 2.8 µm. In vitro dose delivered distal to the endotracheal tube during mechanical ventilation was 85% ± 5%. Nebulizers were functional up to 20 doses of 108 mg of surfactant. Surfactant-treated animals (n = 4) exhibited rapid improvement in oxygenation with nearly full recovery of Pao
2/Fio
2 (~300) and end-expiratory lung volumes with nominal dose less than 30 mg/kg of surfactant, whereas control subjects (n = 3) maintained Pao
2/Fio
2 less than 100 over 4.5 hours with reduced end-expiratory lung volume. There was notably greater surfactant phospholipid content and lower indicators of lung inflammation and pathologic lung injury in surfactant-treated pigs than controls. There were no peridosing complications associated with nebulized surfactant, but surfactant-treated animals had progressively higher airway resistance post treatment than controls with no differences in ventilation effects between the two groups.

Conclusions:

Breath-synchronized, nebulized bovine surfactant appears to be a safe and feasible treatment option for use in coronavirus disease 2019 and other severe forms of acute respiratory distress syndrome.
Impact of Blood Product Transfusions on the Risk of ICU-Acquired Infections in Septic Shock*
Authors: Péju Edwige , Llitjos Jean-François , Charpentier Julien , François Anne , Marin Nathalie , Cariou Alain , Chiche Jean-Daniel , Mira Jean-Paul , Lambert Jérôme , Jamme Matthieu , Pène Frédéric
Published: February 2021

OBJECTIVES:

Transfusions of blood products are common in critically ill patients and have a potential for immunomodulation. The aim of this study is to address the impact of transfusion of blood products on the susceptibility to ICU-acquired infections in the high-risk patients with septic shock.

DESIGN:

A single-center retrospective study over a 10-year period (2008–2017).

SETTING:

A medical ICU of a tertiary-care center.

PATIENTS:

All consecutive patients diagnosed for septic shock within the first 48 hours of ICU admission were included. Patients who were discharged or died within the first 48 hours were excluded.

INTERVENTIONS:

RBC, platelet, and fresh frozen plasma transfusions collected up to 24 hours prior to the onset of ICU-acquired infection.

MEASUREMENTS AND MAIN RESULTS:

During the study period, 1,152 patients were admitted for septic shock, with 893 patients remaining alive in the ICU after 48 hours of management. A first episode of ICU-acquired infection occurred in 28.3% of the 48-hour survivors, with a predominance of pulmonary infections (57%). Patients with ICU-acquired infections were more likely to have received RBC, platelet, and fresh frozen plasma transfusions. In a multivariate Cox cause-specific analysis, transfusions of platelets (cause-specific hazard ratio = 1.55 [1.09–2.20]; p = 0.01) and fresh frozen plasma (cause-specific hazard ratio = 1.38 [0.98–1.92]; p = 0.05) were independently associated with the further occurrence of ICU-acquired infections.

CONCLUSIONS:

Transfusions of platelets and fresh frozen plasma account for risk factors of ICU-acquired infections in patients recovering from septic shock. The occurrence of ICU-acquired infections should be considered as a relevant endpoint in future studies addressing the indications of transfusions in critically ill patients.
Patient Perspectives of Sickle Cell Management in the Emergency Department
Authors: Crego Nancy , Masese Rita , Bonnabeau Emily , Douglas Christian , Rains Gary , Shah Nirmish , Tanabe Paula
Published: February 2021

Sickle cell disease (SCD) is a common genetic blood disorder predominantly affecting African Americans in the United States. The objective of this study was to use a multimethods approach to describe how patients with SCD in North Carolina perceive the care they receive in emergency departments (EDs). Fourteen participants completed an interview (n = 10) or 2 focus groups (n = 2 per focus group) and 51 completed surveys. Sixty percent of participants with pain attack “very much” or “quite a bit” avoided going to the ED for care because of prior bad experiences and 50% of participants reported waiting 120 minutes or more in the ED for treatment of their sickle cell pain. Participants reported that stigma associated with provider perception of drug-seeking behavior is a persistent problem in the ED. Participant recommendations warrant further investigation to address persistent SCD quality-of-care concerns in the ED.
The Psychosocial Needs of Families During Critical Illness
Authors: Mahfoodh Mawadah Ali Bin , Alamoudi Manar Ahmed , Aljedaani Mariam Suwad , Alghamdi Walaa Saeed , Babkair Lisa A.
Published: February 2021

Family members of critically ill patients experience significant psychosocial changes during and after exposure to the critical care environment. During the critical care period, providers focus on the patient's critical condition and pay little attention to the family's needs, so they required special care. A cross-sectional design was used to collect data by using an online survey that includes sociodemographic questionnaire and Critical Care Family Needs Inventory. A total of 177 family members participated. Results indicated that the most important psychosocial need was assurance followed by information, comfort, and support. Nurses should identify these needs and help family members cope with the psychosocial aspects of care. Future research should focus on how these needs evolve over time as well as the effectiveness of related coping mechanisms.
Osteoclast-Like Giant Cells: Focus on Entities Relevant to Dermatopathology and Underlying Pathogenesis
Authors: Hamie Lamiaa , Abbas Ossama , Kurban Mazen , Bhawan Jag
Published: February 2021

Osteoclast-like giant cells (OLGCs) resemble osteoclasts with their abundant cytoplasm and well-developed organelles. OLGCs are characteristic features of giant cell tumor of the tendon sheath and giant cell tumor of soft tissue but they have also been described in numerous other cutaneous conditions. The diagnostic and prognostic significance of the presence of OLGCs is unknown. Here, we summarize the clinical entities that can exhibit these cells to avoid a histological overlap, affecting diagnosis and management.
Pudendal Nerve Block in Hemorrhoid Surgery: A Systematic Review and Meta-analysis
Authors: Mongelli Francesco , Treglia Giorgio , La Regina Davide , Di Giuseppe Matteo , Galafassi Jacopo , Majno-Hurst Pietro E. , Christoforidis Dimitrios
Published: February 2021

BACKGROUND:

Postoperative pain represents an important issue in traditional hemorrhoidectomy. Optimal pain control is mandatory, especially in a surgical day care setting.

OBJECTIVE:

The aim of this study was to investigate the use of pudendal nerve block in patients undergoing hemorrhoidectomy.

DATA SOURCES:

PubMed, Google Scholar, Cochrane Library, and Web of Science databases were searched up to December 2020.

STUDY SELECTION:

Randomized trials evaluating the pudendal nerve block effect in patients undergoing hemorrhoidectomy were selected.

INTERVENTIONS:

Hemorrhoidectomy under general or spinal anesthesia with or without pudendal nerve block was performed.

MAIN OUTCOME MEASURES:

Opioid consumption, pain on the visual analogue scale, length of hospital stay, and readmission rate were the main outcomes of interest and were plotted by using a random-effects model.

RESULTS:

The literature search revealed 749 articles, of which 14 were deemed eligible. A total of 1214 patients were included, of whom 565 received the pudendal nerve block. After hemorrhoidectomy, patients in the pudendal nerve block group received opioids less frequently (relative risk, 0.364; 95% CI, 0.292–0.454, p < 0.001) and in a lower cumulative dose (standardized mean difference, –0.935; 95% CI, –1.280 to –0.591, p < 0.001). Moreover, these patients experienced less pain at 24 hours (standardized mean difference, –1.862; 95% CI, –2.495 to –1.228, p < 0.001), had a shorter length of hospital stay (standardized mean difference, –0.742; 95% CI, –1.145 to –0.338, p < 0.001), and had a lower readmission rate (relative risk, 0.239; 95% CI, 0.062–0.916, p = 0.037). Sensitivity analysis excluded the occurrence of publication bias on the primary end point, and the overall evidence quality was judged “high.”

LIMITATIONS:

Occurrence of publication bias among some secondary end points and heterogeneity are the main limitations of this study.

CONCLUSIONS:

This systematic review and meta-analysis show significant advantages of pudendal nerve block use. A reduction in opioid consumption, postoperative pain, complications, and length of stay can be demonstrated. Despite the limitations, pudendal nerve block in patients undergoing hemorrhoidectomy should be considered.
Trends from 2008 to 2018 in Electricity-dependent Durable Medical Equipment Rentals and Sociodemographic Disparities
Authors: Casey Joan A. , Mango Marriele , Mullendore Seth , Kiang Mathew V. , Hernández Diana , Li Bonnie H. , Li Kris , Im Theresa M. , Tartof Sara Y.
Published: February 2021

Background:

Duration and number of power outages have increased over time, partly fueled by climate change, putting users of electricity-dependent durable medical equipment (hereafter, “durable medical equipment”) at particular risk of adverse health outcomes. Given health disparities in the United States, we assessed trends in durable medical equipment rental prevalence and individual- and area-level sociodemographic inequalities.

Methods:

Using Kaiser Permanente South California electronic health record data, we identified durable medical equipment renters. We calculated annual prevalence of equipment rental and fit hierarchical generalized linear models with ZIP code random intercepts, stratified by rental of breast pumps or other equipment.

Results:

243,559 KPSC members rented durable medical equipment between 2008 and 2018. Rental prevalence increased over time across age, sex, racial–ethnic, and Medicaid categories, most by >100%. In adjusted analyses, Medicaid use was associated with increased prevalence and 108 (95% confidence interval [CI] = 99, 117) additional days of equipment rental during the study period. ZIP code-level sociodemographics were associated with increased prevalence of equipment rentals, for example, a 1 SD increase in percent unemployed and <high school diploma (prevalence ratio [PR] = 1.1, 95% CI = 1.1, 1.1 and PR = 1.1, 95% CI = 1.1, 1.2, respectively). Increased Supplemental Nutrition Assistance Program usage was associated with decreased breast pump rentals (PR = 0.83, 95% CI = 0.78, 0.88).

Conclusions:

We observed some socioeconomic disparities among a growing electricity-dependent population. Our findings are consistent with the hypothesis that reliable electricity access is increasingly required to meet the health needs of medically disadvantaged groups. See video abstract at http://links.lww.com/EDE/B793.
Tacrolimus Measured in Capillary Volumetric Microsamples in Pediatric Patients—A Cross-Validation Study
Authors: Kindem Ingvild Andrea , Bjerre Anna , Åsberg Anders , Midtvedt Karsten , Bergan Stein , Vethe Nils Tore
Published: February 2021

Background:

Therapeutic drug monitoring of tacrolimus (Tac) is mandatory in solid organ transplant (SOT) recipients. Finger-prick microsampling is more flexible and tolerable during the therapeutic drug monitoring of tacrolimus and has been shown to be applicable in adult SOT recipients. In this study, a previously validated method applying volumetric absorptive microsampling (VAMS) to measure Tac in adults was cross-validated in a pediatric population.

Methods:

Patients with SOT scheduled for standard posttransplant follow-up visits were recruited. Blood samples were obtained by trained phlebotomists using standard venipuncture and capillary microsampling, before the morning dose of Tac as well as 2 and 5 hours after dosing. Tac concentrations were quantified using liquid chromatography–tandem mass spectrometry. Concordance between Tac concentrations obtained with venipuncture and VAMS was evaluated using Passing–Bablok regression, calculation of absolute and relative differences, and percentage of samples within ±20% and ±30% difference.

Results:

A total of 39 SOT patients aged 4–18 years (22 male) were included. The median (range) predose venous blood concentration was 4.8 (2.6–13.6) mcg/L, with a difference between VAMS and venous blood samples of −0.2 ± 0.7 mcg/L. The relative mean difference was −1.3% [95% confidence interval (CI), −5.9% to 3.4%]. Ninety-two percent and 97% of the sample pairs demonstrated differences within ±20% and ±30%, respectively. Postdose (2 hours and/or 5 hours, n = 17) median concentration in venous blood was 7.9 (4.8–19.2) mcg/L. The difference between VAMS and venous blood samples was 0.1 ± 1.0 mcg/L, with a relative mean difference of −2.5% (95% confidence interval, −8.8% to 3.8%). Eighty-eight percent of the postdose sample pairs were within ±20% difference, and all were within ±30% difference.

Conclusions:

Tac concentrations can be accurately measured using VAMS technology in pediatric SOT recipients. This makes home-based Tac monitoring feasible in the pediatric population.
Safety of Copolyamide Filler Injection for Breast Augmentation
Authors: Nomoto Shunichi , Hirakawa Keiko , Ogawa Rei
Published: February 2021

Background:

Although injections with copolyamide fillers (Aquafilling/Los Deline and Aqualift/Activegel) are currently used widely for breast augmentation, many complications have been reported. A recent position statement by a Korean aesthetic/reconstructive breast surgery society indicated these fillers are the same as polyacrylamide gel (PAAG), which is widely prohibited due to complications. To test this statement, this retrospective cohort study examined the clinical complications after breast augmentation with copolyamide fillers. Nuclear magnetic resonance (NMR) analysis of copolymer and PAAG fillers was also conducted.

Methods:

All consecutive patients with concerns about or sequelae from copolyamide fillers who visited our hospital in 2018–2020 were identified. The injected formulation, complications, and intraoperative findings were recorded. Copolyamide fillers were compared with PAAG and 2 PAAG fillers (Amazingel and Aquamid) by NMR.

Results:

Of the 29 patients (all women; average age, 42 years), 17 complained of breast deformity. Eight had puncture site infections and mammary gland inflammation. Five exhibited induration (single large/small lumps). In 4 cases, the filler had migrated outside of the breast, including to the back and vulva; these cases had severe symptoms. NMR showed that the copolyamide and PAAG fillers bore all of the characteristic peaks of PAAG.

Conclusions:

Our clinical/intraoperative and NMR findings showed, respectively, that copolyamide fillers cause the same complications as PAAG fillers and have the same composition. Thus, the risks of copolyamide fillers for breast augmentation are equivalent to those for PAAG fillers. It is strongly recommended not to use copolyamide fillers until their long-term safety is established.
A Novel Technique for Single-stage Reconstruction of Nipple-Areola Complex following Central Lumpectomy
Authors: Huang Yinglai , Jogeland Karin , Ivanova Mariya
Published: February 2021

Several oncoplastic techniques have been proposed for subareolar breast cancer, some of which may require contralateral operation for symmetry, or more than one operation for delayed reconstruction of the nipple-areola complex (NAC). We herein developed a simple and effective oncoplastic approach following central quadrantectomy, aiming to achieve the following: (1) preservation of breast shape and contour for patients who are not accepting of a notably smaller breast or bilateral operation; (2) single procedure with advantages of single anesthetic and the ability to reconstruct a breast that has not yet been affected by radiation; (3) no autologous grafts with disadvantage of an extra donor site; (4) creation of natural neo-NAC with only incision within the region of the areola complex; and (5) maintaining long-term nipple projection. In this technique, the medial and lateral peri-areolar flap was advanced and rotated to restore partial neo-NAC, and to fill the defect after central tumor and NAC resection. The whole neo-NAC margin was created using the “round block” technique. Additionally, the nipple reconstruction was performed at the mitten of the neo-areola area using the C-V nipple flaps with an internal strut of rolled dermal grafts harvested from excised skin during the round block procedures. Lastly, a purse-string suture is placed in the outer skin margin for control of areola diameter and project. Six patients with central tumors of the breast were treated in this easily achieved approach. Patient satisfaction was noted as high, and the cosmetic results were evaluated as good to excellent.
Function-preserving Surgery for Femoral Sarcoma by “In Situ Preparation” Technique with a Free Flap
Authors: Uemura Kazuhisa , Kanno Seiji , Shimoe Takashi , Kojima Fumiyoshi , Murata Shinichi , Kusuhara Hirohisa , Wada Yoshitaka , Asamura Shinichi
Published: February 2021

Resection of soft-tissue sarcomas near important tissues (major blood vessels, nerves, bones) is challenging. “In situ preparation” (ISP) technique enables the function of the affected limb to be maintained by preserving the tissue as much as possible. The technique is based on evaluation of the margin of resection of important tissues near the tumor during surgery. Postoperative fractures are known to frequently occur, however, in cases where bones were preserved and periosteum has been resected by the ISP. We present the case of a 51-year-old woman who required treatment for soft-tissue sarcoma close to the femur. During surgery, femoral periosteum was included in the tumor side and the femur was preserved by the ISP. We covered the femur using a vascularized latissimus dorsi free flap instead of periosteum. The flap survived completely, and 5 years after surgery, there has been no recurrence or postoperative complications and the lower limb is functional. This is the first reported case of successful combined use of the bone ISP and the vascularized latissimus dorsi free flap to preserve the function of the limb affected by femoral sarcoma suspected of bone infiltration.
Reset Neurectomy for Cutaneous Nerve Injuries
Authors: Eberlin Kyle R. , Pickrell Brent B. , Hamaguchi Ryoko , Hagan Robert R.
Published: February 2021

Diffuse cutaneous nerve injuries, often caused by a crush mechanism, are challenging for the nerve surgeon. Discrete nerve transections and focal neuromas are easier to identify and have a more distinct treatment algorithm. Following crush injury to a noncritical sensory nerve, a successful local anesthetic block proximal to the injury may help determine the possibility of surgical intervention. In these cases, we describe a technique of “reset neurectomy” whereby a neurectomy is performed proximal to the zone of injury, and immediate repair or reconstruction (with or without a nerve graft) is performed. This technique may be useful in cases of diffuse, nontransection nerve injuries in which neuropathic pain is the primary symptom.
Anterior Neck-scar Contracture Reconstruction Using a Long Skin-pedicled Flap
Authors: Kondo Akatsuki , Dohi Teruyuki , Izumi Nikki , Ochi Tomohiro , Ogawa Rei
Published: February 2021

We previously reported cases of anterior-neck reconstruction using super-thin and perforator-supercharged skin-pedicled flaps harvested from the pectoral area and back. Here, we reconstructed a neck-scar contracture with a long skin-pedicled flap from the pectoral area that survived without congestion despite not being supercharged with a perforator, as planned. The patient, a 67-year-old man, was admitted to our hospital due to neck-scar contracture after a chemical burn 3 years previously. During surgery, the scar was resected above the platysma. A large, 19 × 6-cm skin-pedicled flap was elevated from the left pectoral area. We planned to supercharge the flap by anastomosing the second intercostal perforator to the flap periphery but could not confirm the perforator intraoperatively. To promote flap survival, we did not elevate the flap pedicle more than absolutely necessary and then manipulated the flap very carefully. The flap survived fully and the contracture was effectively released. Thin flaps are useful for reconstructing exposed areas such as the face, neck, and dorsum of the hands that require good outcomes in terms of both function and aesthetics. However, if the flap is too large, ischemia/congestion could arise in the periphery unless the blood flow is stabilized by attaching a perforator. In our case, supercharging was not possible and we had to resort to careful intraoperative maneuvers to ensure flap survival. This approach was successful and suggests that although supercharging of thin and large flaps is preferred, unexpectedly unsuperchargeable flaps can be rescued by careful and finely tuned surgical judgment and techniques.
Two-way Revascularization to Manage Celiac Artery Stenosis during Pancreaticoduodenectomy: A Case Report
Authors: Takasu Hiroyuki , Kuramoto Yasuyo , Yokoyama Shigekazu , Ota Hideo , Yagi Sasagu , Hisamoto Sawa , Furukawa Soichi , Shimomura Yutaka
Published: February 2021

Celiac artery (CA) occlusion, or stenosis, is not uncommon, and most cases are asymptomatic. If the CA is occluded, collateral circulation from the superior mesenteric artery (SMA) is maintained through the pancreaticoduodenal arcade. However, the pancreaticoduodenal arcade is removed if pancreaticoduodenectomy (PD) is performed, which results in ischemia of the liver, stomach, and residual pancreas. Thus, these patients require CA revascularization, which can include antegrade endovascular reconstruction and retrograde reconstruction using vascular anastomosis from the SMA system to the CA system. Both methods carry risks of restenosis or anastomotic thrombosis. We report a technique that involves a combination of both revascularization methods in an 89-year-old man who underwent PD for lower bile duct cancer. Preoperative endovascular stent placement in the CA preserved antegrade blood flow to the liver, and intraoperative vascular anastomosis of the jejunal artery and right gastroepiploic artery achieved retrograde blood flow. Although we confirmed both stent and anastomosis patency and blood circulation in our case, obstruction of 1 of these revascularization pathways would not likely lead to ischemia of the liver. Thus, our 2-way revascularization technique for managing celiac artery stenosis during PD may reduce the risk of organ ischemia.
Minor Improvement in Activity and Participation and Decline in Physical Activity Motivation After Cardiac Rehabilitation Discharge
Authors: Kim Young Joo , Crane Patricia A. , Houmard Joseph A. , Swift Damon L. , Wu Qiang
Published: February 2021

Purpose:

To investigate the changes in activities and participation, and mental and physical functions for 9 mo after cardiac rehabilitation (CR) among adults with chronic cardiac conditions.

Methods:

Twenty-five adults with chronic cardiac conditions scheduled for discharge from CR were assessed at four different times: within 2-wk window of CR discharge date, 1 mo, 3 mo, and 9 mo after CR discharge. Nine assessments according to the International Classification of Functioning, Disability and Health were used to track the changes post-CR.

Results:

Participants showed significant changes in the Cognitive Instrumental Activities of Daily Living adequacy of Performance Assessment of Self-Care Skills-Clinic (F = 8.10, P = .017) and improvements in the applied cognitive domain of the Activity Measure for Post-Acute Care Outpatient Short Form (F = 4.493, P = .016). Participants also showed significant decline in the CogState Detection test (F = 3.307, P = .045), the Physical Activity and Leisure Motivation Scale (PALMS) (F = 4.749, P = .005), and the affiliation subscale of the PALMS (F = 5.316, P = .002), and improvements in the 6-min walk test (F = 9.000, P = .011). Lastly, participants showed depressive symptoms for 3 mo post-CR. No other significant changes were detected among other outcome measures.

Conclusions:

Adults with chronic cardiac conditions discharged from site-based CR maintained their activity and participation level following discharge with little improvement. They also showed depressive symptoms and decreased motivation for physical activity post-CR.
Current Nutrition Practice in Cardiac Rehabilitation Programs
Authors: Kocanda Lucy , Schumacher Tracy L. , Kerr Jane , May Jennifer , Rollo Megan E. , Neubeck Lis , Brown Leanne J.
Published: February 2021

Purpose:

This study sought to determine current practice regarding nutrition care within cardiac rehabilitation (CR) programs, including perceived barriers and facilitators to providing nutrition care in this setting.

Methods:

A cross-sectional survey was conducted in October and November 2019. Potential participants were program coordinators, identified through the Australian Cardiovascular Health and Rehabilitation Association program directory and invited to participate via e-mail.

Results:

Forty-nine respondents (response rate: 13%) are included in this analysis. Programs provided group (n = 42, 86%) and/or individual (n = 25, 51%) nutrition education, and most were supported by a dietitian (63%). However, the availability of dietitians and nutrition care provided at CR was variable. For example, individual education was consistently provided at 13 programs and usually by health professionals other than dietitians. Eight programs (16%) used a formal behavior change framework for nutrition care. Generally, respondents were positive about the role of nutrition; CR coordinators perceived nutrition as a valuable component of the program, and that they had good nutrition knowledge. An identified barrier was the financial resources available to support the provision of nutrition care.

Conclusions:

To ensure that patients receive the benefits of evidence-based nutrition care, program staff may require additional support, particularly regarding the use of evidence-based behavior change techniques. Key facilitators that may be leveraged to achieve this include the high value and priority that CR program coordinators place on nutrition care.
High Rates of SARS-CoV-2 Family Transmission in Children of Healthcare Workers During the First Pandemic Wave in Madrid, Spain
Authors: Méndez-Echevarría Ana , Sainz Talía , de Felipe Beatriz , Alcolea Sonia , Olbrich Peter , Goycochea-Valdivia Walter A. , Escosa-García Luis , Cobo Lorena , Calvo Cristina , Neth Olaf
Published: February 2021

Background:

Data on SARS-CoV-2 transmission among children living with healthcare workers (HCWs) are scarce.

Methods:

A cross-sectional study was performed at a tertiary Hospital in Madrid, including children of HCW who suffered from SARS-CoV-2 infection between March and May 2020. Children underwent enzyme-linked immunosorbent serological study for detecting SARS-CoV-2 antibodies: VIRCELL IgG assay.

Results:

One hundred thirteen children from 69 HCWs with confirmed SARS-CoV-2 infection were recruited: 47 children had positive IgG (41.6%). Children secondary attack rate was 43.7% (25% if both parents have had asymptomatic infection; 39.5% if one parent was symptomatic; and 47% when both parents had symptoms). Having a positive sibling was associated with a positive IgG result (odds ratio = 12.2; 95% confidence interval: 4.4–33.7, P < 0.001). Median age was higher in IgG positive children (P = 0.022). Children who referred anosmia presented higher IgG titles (P < 0.04).

Conclusions:

We observed a very high SARS-CoV-2 transmission in children of HCW during the first pandemic wave, especially when both parents were symptomatic. Having a positive sibling was associated with seroconversion, supporting the important role of family clusters in the transmission of SARS-CoV-2.
Lacrimal Intrasaccal Polyp With Inspissated Mucopeptide Concretions
Authors: Ali Mohammad Javed , Joshi Anamika , Pattnaik Monalisa , Jakati Saumya
Published: February 2021

Lacrimal sac mucopeptide concretions are not uncommon and usually identified following the lacrimal sac marsupialization during a dacryocystorhinostomy. A 39-year-old female presented with epiphora and discharge of 8 months duration and was diagnosed as primary acquired nasolacrimal duct obstruction. During the endoscopic dacryocystorhinostomy, a large intrasaccal polyp arising from the posterosuperior wall of the lacrimal sac with multiple inspissated mucopeptide concretions was noted. The lesion was excised, and the mucopeptide concretions were removed. Histopathology was suggestive of an intrasaccal polypoidal granuloma. To the best of the authors’ knowledge, this is the first report of an intrasaccal polyp-like lesion secondary to a granulomatous response to a lacrimal sac mucopeptide concretion. It is important to be aware of this entity. The retrieval of mucopeptide concretion or lacrimal sac dacryoliths should prompt the surgeon to initiate an intraoperative endoscopic assessment of the sac before proceeding with the surgery.
Primary Synovial Sarcoma of the Orbit: A Case Report and Update on Diagnostic Techniques
Authors: Gervasio Kalla A. , Ramesh Sathyadeepak , Sivalingam Meera D. , Markovitz Michele , Milman Tatyana
Published: February 2021

Synovial sarcoma is a malignant mesenchymal tumor that most commonly occurs in the deep soft tissue of the extremities in adolescents and young adults. Primary periocular synovial sarcoma is extremely rare with only 11 previously reported cases. We describe a 23-year-old woman who presented with a 1-year history of painful, progressive right upper eyelid swelling. She was subsequently found to have a superomedial orbital mass on CT scan. Pathologic evaluation revealed a spindle cell neoplasm with SS18 (SYT) rearrangement by fluorescence in situ hybridization studies, consistent with a monophasic synovial sarcoma. This case describes the clinical, radiographic, histopathologic, and molecular cytogenetic features of this rare orbital neoplasm, with an emphasis on the emerging diagnostic techniques and novel therapies.