bluuebunny/crossref_metadata_2025 huggingface dataset:
Defining Double Capsules: A Clinical and Histological Study
Authors: Van Slyke Aaron C , Roller Janine M , Alaghehbandan Reza , Carr Nicholas J
Published: March 2021

Background

Macrotextured breast implants are associated with double capsules. There is little agreement as to what defines double capsules, how they present, and whether different degrees of double capsule exist.

Objectives

This study aimed to define double capsules and report an association between double-capsule type and degree of tissue adherence.

Methods

Consecutive aesthetic patients undergoing explantation of Biocell (Allergan, Inc., Irvine, CA) implants between May 2018 and November 2018 were included if they were found to have double capsules intraoperatively. Patient demographics, implant characteristics, explantation reason, implant adherence, and intraoperative findings were recorded. Both adherent and double capsules were histologically examined. Data were analyzed by descriptive statistics.

Results

Eleven patients had 22 Biocell implants explanted during the study period. The average explantation time was 8.0 years. Sixteen implants were found to have some degree of nonadherence, and all areas of nonadherence were associated with double-capsule formation. Double capsules were either partial or complete. The architecture of the inner layer of double capsules varied between an organized capsular layer and a thin area of nascent capsule. Histologically, all capsular specimens demonstrated an overall hypocellular fibrous capsule with scattered chronic inflammatory infiltrates. Synovial metaplasia was present in all capsule types and spaces/cracks in the capsule were disproportionately represented in partially adherent capsules.

Conclusions

This is the first study to identify a clinical and pathological correlation between double capsules and failed tissue adherence. Double capsules represent a spectrum of inner capsule formation ranging between nascent capsular tissue to a mature inner capsular layer.

Level of Evidence: 4
Mid-rotation variation in growth, form and phenology of sycamore (Acer pseudoplatanus L.) provenances in field trials in England
Authors: Whittet Richard , Lopez Gustavo , Rosique-Esplugas Cristina
Published: March 2021

Field trials containing 8–10 sycamore seed sources were established on ‘farm woodland’ sites in 1992 to identify the most productive and adapted seed sources for use in lowland Great Britain. Early results from these trials found little difference among provenances for growth traits. To guide the next steps of sycamore improvement in the British Isles, three of the five original trials have been revisited and assessed for variation in growth and form at 27 years, which is between one-third and half rotation age. There were large differences in growth among sites but differences among provenances were small or non-significant and showed no interaction across sites. Spring phenology evaluation from one of the trials demonstrated that timing of bud burst was negatively associated with latitude which was the only trait providing any evidence of adaptive differentiation among provenances. However, the effect was small and driven by much later flushing of French and German seed sources than British seed sources. Given the lack of clear provenance differentiation and qualitatively similar rankings across sites, we found no justification for subdividing Britain into breeding zones for sycamore at this stage, nor for excluding material from mainland Europe in planned progeny tests.
Remote Delivery of Thrombolytics Prior to Transfer to a Regional Burn Center for Tissue Salvage in Frostbite: A Single-center Experience of 199 Patients
Authors: Carmichael Heather , Michel Samuel , Smith Tyler M , Duffy Patrick S , Wiktor Arek J , Lambert Wagner Anne
Published: March 2021

While much has been published on the efficacy and safety of systemic thrombolytics in the treatment of acute frostbite, there has been limited investigation into administration outside a tertiary care setting. Here, we present a single-center experience with remote initiation of intravenous tissue plasminogen activator (tPA) at referring hospitals prior to transfer to a regional burn center. A modified Hennepin Quantification Score based on tissue involvement was used to determine eligibility for tPA and to quantify the severity of amputation. This is a retrospective review of patients with acute frostbite of the digits admitted to a single verified burn center over a 5-yr period. Of 199 patient admissions, 40 received tPA remotely pre-transfer, 32 received tPA on admission to our institution, and 127 patients did not qualify for tPA therapy according to the protocol. Comparing patients who required any amputation (n = 99, 49.7%) to those who did not, patients who received remote tPA had lower odds of any amputation compared to both those receiving tPA at our institution (OR 0.19, 95% CI 0.05–0.65, P = 0.01) and the group receiving no tPA (OR 0.14, 95% CI 0.05–0.40, P < 0.001) after controlling for confounders. Only one patient receiving pre-transfer tPA according to the protocol (2.3%) had a significant bleeding event requiring transfusion. These results support the protocolized use of thrombolytic therapy for frostbite prior to transfer to a tertiary center.
Anterior leaflet replacement and reconstruction with Admedus Cardiocel™ decellularized pericardial patch in tricuspid valve endocarditis
Authors: Mohamed Saifullah , Patel Akshay J , Mazhar Khurum , Jeeji Ravish , Ridley Paul D , Balacumaraswami Lognathen
Published: March 2021

We present the case of a 28 year-old lady with a history of intravenous drug use who presented to our institution with symptomatic right heart failure secondary to tricuspid valve regurgitation. She presented with infective endocarditis leading to dyspnoea and peripheral oedema secondary to torrential tricuspid regurgitation. Transthoracic echocardiography confirmed right ventricular dysfunction and congestive hepatomegaly. Intra-operatively findings an infected and destroyed anterior leaflet of the tricuspid valve with posterior leaflet prolapse was found to cause severe tricuspid regurgitation. She had complex tricuspid valve reconstruction using anterior leaflet reconstruction using Admedus Cardiocel™ patch, posterior leaflet prolapse correction and commissural reduction with a McGoon imbrication and annuloplasty ring to stabilize the repair. This case demonstrates the importance of reconstructive tricuspid valve surgery in the setting of infective endocarditis. Furthermore, this case demonstrates the possibility of anterior leaflet excision and reconstruction with an excellent durable functional result.
Hemorrhage Following Complete Arteriovenous Malformation Resection With No Detectable Recurrence: Insights From a 27-Year Registry
Authors: Rapaport Sarah , Feghali James , Yang Wuyang , Gami Abhishek , Patel Jaimin , Tamargo Rafael J , Caplan Justin M , Huang Judy
Published: March 2021

BACKGROUND

Although recurrence and de novo formation of arteriovenous malformations (AVMs) have been reported following complete resection, the occurrence of hemorrhage in the same location of an AVM with no detectable lesion (lesion-negative hemorrhage) has not been described after microsurgery.

OBJECTIVE

To characterize the incidence and properties of lesion-negative hemorrhage following complete microsurgical resection

METHODS

A prospectively maintained registry of AVM patients seen at our institution between 1990 and 2017 was used. Microsurgically treated patients were selected, and the incidence of a lesion-negative hemorrhage was calculated and described with a Kaplan-Meier curve. Baseline characteristics as well as functional outcome at last follow-up were compared between patients with and without a lesion-negative hemorrhage.

RESULTS

From a total of 789 AVM patients, 619 (79%) were treated, and 210 out of 619 patients (34%) underwent microsurgery with or without preoperative embolization or radiosurgery. The microsurgically treated cohort was followed up for a mean of 6.1 ± 3.0 yr after surgery with 5 (2.4%) patients experiencing postresection lesion-negative hemorrhage (3.9 per 1000 person-years) at an average of 8.6 ± 9.0 yr following surgery. Follow-up angiograms after hemorrhage (up to 2 mo posthemorrhage) confirmed the absence of a recurrent or de novo AVM in all cases. All patients with a lesion-negative hemorrhage initially presented with rupture before resection (Fisher P = .066; log-rank P = .057). The occurrence of a lesion-negative hemorrhage was significantly associated with worse modified Rankin scale scores at last follow-up (P = .031).

CONCLUSION

A lesion-negative hemorrhage can occur following complete microsurgical resection in up to 2.4% of patients. Exploration of possible underlying causes is warranted.
Genomics-Informed Multiplex PCR Scheme for Rapid Identification of Rice-Associated Bacteria of the Genus Pantoea
Authors: Kini Kossi , Agnimonhan Raoul , Dossa Rachelle , Silué Drissa , Koebnik Ralf
Published: March 2021

The genus Pantoea forms a complex of more than 25 species, among which several cause diseases of various crop plants, including rice. Notably, strains of Pantoea ananatis and P. stewartii have been repeatedly reported to cause bacterial leaf blight of rice, whereas other authors have observed that P. agglomerans can also cause bacterial leaf blight of rice. The contribution of these and perhaps other species of Pantoea to plant diseases and yield losses of crop plants is currently not well documented, partly due to the lack of efficient diagnostic tools. Using 32 whole-genome sequences of the three major plant-pathogenic Pantoea spp., a set of PCR primers that detect each of the three species P. agglomerans, P. ananatis, and P. stewartii was designed. A multiplex PCR scheme which can distinguish these three species and also detects members of other Pantoea spp. was further developed. Upon validation on a set of reference strains, 607 suspected Pantoea strains that were isolated from rice leaves or seed originating from 11 African countries were screened. In total, 41 P. agglomerans strains from 8 countries, 79 P. ananatis strains from 9 countries, 269 P. stewartii strains from 9 countries, and 218 unresolved Pantoea strains from 10 countries were identified. The PCR protocol allowed detection of Pantoea bacteria grown in vitro, in planta, and in rice seed. The detection threshold was estimated as total genomic DNA at 0.5 ng/µl and heated cells at 1 × 104 CFU/ml. This new molecular diagnostic tool will help to accurately diagnose major plant-pathogenic species of Pantoea. Due to its robustness, specificity, sensitivity, and cost efficiency, it will be very useful for plant protection services and for the epidemiological surveillance of these important crop-threatening bacteria.
Racial Disparities in Surgery
Authors: Azin Arash , Hirpara Dhruvin H. , Doshi Sachin , Chesney Tyler R. , Quereshy Fayez A. , Chadi Sami A.
Published: March 2021

Objective:

To determine if Black race is associated with worse short-term postoperative morbidity and mortality when compared to White race in a contemporary, cross-specialty-matched cohort.

Background:

Growing evidence suggests poorer outcomes for Black patients undergoing surgery.

Methods:

A retrospective analysis was conducted comprising of all patients undergoing surgery in the National Surgical Quality Improvement Program dataset between 2012 and 2018. One-to-one coarsened exact matching was conducted between Black and White patients. Primary outcome was rate of 30-day morbidity and mortality.

Results:

After 1:1 matching, 615,118 patients were identified. Black race was associated with increased rate of all-cause morbidity (odds ratio [OR] = 1.10, 95% confidence interval [CI] 1.08–1.13, P < 0.001) and mortality (OR = 1.15, 95% CI 1.01–1.31, P = 0.039). Black race was associated with increased risk of re-intubation (OR = 1.33, 95% CI 1.21–1.48, P < 0.001), pulmonary embolism (OR = 1.55, 95% CI 1.40–1.71, P < 0.001), failure to wean from ventilator for >48 hours (OR = 1.14, 95% CI 1.02–1.29, P < 0.001), progressive renal insufficiency (OR = 1.63, 95% CI 1.43–1.86, P < 0.001), acute renal failure (OR = 1.39, 95% CI 1.16–1.66, P < 0.001), cardiac arrest (OR = 1.47, 95% CI 1.24–1.76 P < 0.001), bleeding requiring transfusion (OR = 1.39, 95% CI 1.34–1.43, P < 0.001), DVT/thrombophlebitis (OR = 1.24, 95% CI 1.14–1.35, P < 0.001), and sepsis/septic shock (OR = 1.09, 95% CI 1.03–1.15, P < 0.001). Black patients were also more likely to have a readmission (OR = 1.12, 95% CI 1.10–1.16, P < 0.001), discharge to a rehabilitation center (OR = 1.73, 95% CI 1.66–1.80, P < 0.001) or facility other than home (OR = 1.20, 95% CI 1.16–1.23, P < 0.001).

Conclusion and Relevance:

This contemporary matched analysis demonstrates an association with increased morbidity, mortality, and readmissions for Black patients across surgical procedures and specialties.
A Comparison of Endoscopic Versus Surgical Creation of a Cystogastrostomy to Drain Pancreatic Pseudocysts and Walled-Off Pancreatic Necrosis in 5500 Patients
Authors: Suggs Patrick , NeCamp Timothy , Carr John Alfred
Published: March 2021

Objective:

To determine the success, morbidity, and mortality rates of endoscopic and surgical creation of pancreatic cystenterostomies for the drainage of peripancreatic fluid collections, pseudocysts with necrotic debris, and walled-off pancreatic necrosis.

Summary Background Data:

Endoscopic methods of cystenterostomy creation to drain pancreatic pseudocysts (with and without necrotic debris) and infected peripancreatic fluid collections are perceived to be less morbid than surgery. Contemporary reports document a very high complication rate with endoscopic methods.

Methods:

A meta-analysis of 5500 patients.

Results:

Open and laparoscopic surgical techniques to drain chronic pancreatic pseudocysts, infected pancreatic fluid collections, and walled-off pancreatic necrosis are more successful with less morbidity and mortality than endoscopic methods.

Conclusions:

In regards to a surgical step-up approach to treat chronic infected pancreatic fluid collections or walled-off pancreatic necrosis, surgical creation of a cystenterostomy is more successful with fewer complications than endoscopic methods and should be given priority if less invasive or conservative methods fail.
Management of Acute Subaxial Trauma and Spinal Cord Injury in Professional Collision Athletes
Authors: Patel Parthik D. , Divi Srikanth N. , Canseco Jose A. , Donnally Chester J. , Galetta Matthew , Vaccaro Alexander , Schroeder Gregory D. , Hsu Wellington K. , Hecht Andrew C. , Dossett Andrew B. , Dhanota Arsh S. , Prasad Srivinas K. , Vaccaro Alexander R.
Published: March 2021

Sports-related acute cervical trauma and spinal cord injury (SCI) represent a rare but devastating potential complication of collision sport injuries. Currently, there is debate on appropriate management protocols and return-to-play guidelines in professional collision athletes following cervical trauma. While cervical muscle strains and sprains are among the most common injuries sustained by collision athletes, the life-changing effects of severe neurological sequelae (ie, quadriplegia and paraplegia) from fractures and SCIs require increased attention and care. Appropriate on-field management and subsequent transfer/workup at an experienced trauma/SCI center is necessary for optimal patient care, prevention of injury exacerbation, and improvement in outcomes. This review discusses the epidemiology, pathophysiology, clinical presentation, immediate/long-term management, and current return-to-play recommendations of athletes who suffer cervical trauma and SCI.
Blood pressure, glycemic status and advanced liver fibrosis assessed by transient elastography in the general United States population
Authors: Ciardullo Stefano , Monti Tommaso , Grassi Guido , Mancia Giuseppe , Perseghin Gianluca
Published: March 2021

Objective:

Few studies investigated the role of different predictors of advanced liver fibrosis in unselected populations. Here, we estimate the prevalence of steatosis and fibrosis in the general United States population by means of transient elastography and evaluate the impact of blood pressure (BP) and diabetes on disease severity.

Methods:

This is a cross-sectional study of United States adults participating in the 2017–2018 cycle of the National Health and Nutrition Examination Survey. Participants underwent a transient elastography examination, and liver steatosis and fibrosis were estimated through the controlled attenuation parameter (CAP) score and liver stiffness measurement (LSM), respectively.

Results:

Four thousand, three hundred and seventy-one participants had reliable transient elastography and BP readings. Steatosis (CAP ≥ 248 dB/m), advanced fibrosis (LSM ≥ 9.6 kPa) and cirrhosis (LSM ≥ 13 kPa) were present in 56.9, 5.5 and 2.9% of participants, respectively. After controlling for potential confounders, risk of steatosis increased proportionally going from participants with optimal (reference) to those with normal [odds ratio (OR) 1.24, 95% confidence interval (CI) 0.83–1.86], high normal (OR 1.41, 95% CI 1.01–1.97) and elevated BP (OR 1.64, 95% CI 1.21–2.21), whereas no significant association was found between BP status and liver fibrosis. Conversely, presence of diabetes increased the risk of both steatosis (OR 2.15, 95% CI 1.49–3.11) and advanced fibrosis (OR 2.25, 95% CI 1.36–3.72).

Conclusion:

Liver steatosis and fibrosis are highly prevalent in the multiethnic United States adult population, raising concerns for future incidence of cirrhosis and its complications. BP status was associated with a progressively higher risk of steatosis, whereas obesity and diabetes were consistently associated with both steatosis and fibrosis.
Reverse dipping and subclinical cardiac organ damage: a meta-analysis of echocardiographic studies
Authors: Cuspidi Cesare , Tadic Marijana , Sala Carla , Carugo Stefano , Mancia Giuseppe , Grassi Guido
Published: March 2021

Aim:

Available evidence on the association between reverse dipping pattern and subclinical cardiac damage is scanty. We performed a systematic meta-analysis of echocardiographic studies in order to provide an updated and comprehensive information on this issue.

Methods:

The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search English-language articles published from January from the inception up to 31 July 2020. Studies were identified by using MeSH terms and crossing the following search items: ‘reverse dipping’, ‘nondipping’, ‘inverted dipping’, ‘ambulatory blood pressure’, ‘cardiac damage’, ‘hypertensive heart disease’, ‘left ventricular mass’, ‘left ventricular hypertrophy’, and ‘echocardiography’.

Results:

Data from 14 studies including 1429 patients with reverse dipping, 2584 dippers and 3508 nondippers were considered. Left ventricular (LV) mass index and relative wall thickness were greater in reverse dippers than in dippers (SMD: 0.40 ± 0.04 g/m2, P < 0.0001; 0.31 ± 0.07, P < 0.0001) and nondippers (SMD: 0.25 ± 0.04 g/m2, P < 0.0001; 0.21 ± 0.07, P = 0.004). The reverse dipping group had an increased risk of LV hypertrophy compared with dipping (OR = 1.85, CI 1.47–2.32, P < 0.0001) and nondipping group (OR = 1.45, CI 1.19–1.78, P < 0.0001). A significant progressive reduction in the E/A ratio, paralleled by an increase in left atrium diameter occurred from dippers, to nondippers and reverse dippers.

Conclusion:

The present meta-analysis provides a novel piece of information about the unfavourable association between the reverse dipping pattern and subclinical cardiac alterations and suggests that the detection of this blood pressure phenotype may identify individuals at increased risk for subclinical organ damage.
Subsyndromal Delirium in Cardiac Surgery Patients
Authors: Mailhot Tanya , Cossette Sylvie , Maheu-Cadotte Marc-André , Fontaine Guillaume , Denault André Y.
Published: March 2021

Background

Subsyndromal delirium (SSD), a subthreshold form of delirium, is related to longer length of stay and increased mortality rates among older adults. Risk factors and outcomes of SSD in cardiac surgery patients are not fully understood.

Objective

The aim of this study was to assess and describe the characteristics and outcomes related to trajectories of SSD and delirium in cardiac surgery patients.

Methods

In this secondary analysis of a retrospective case-control (1:1) cohort study, SSD was defined as a score between 1 and 3 on the Intensive Care Delirium Screening Checklist paired with an absence of diagnosis of delirium on the day of assessment. Potential risk factors (eg, age) and outcomes (eg, mortality) were identified from existing literature. Patients were grouped into 4 trajectories: (1) without SSD or delirium, (2) SSD only, (3) both, and (4) delirium only. These trajectories were contrasted using analysis of variance or χ2 test.

Results

Among the cohort of 346 patients, 110 patients did not present with SSD or delirium, 62 presented with only SSD, 69 presented with both, and 105 presented with only delirium. In comparison with patients without SSD or delirium, patients with SSD presented preoperative risk factors known for delirium (ie, older age, higher European System for Cardiac Operative Risk Evaluation II) but underwent less complicated surgical procedures, received fewer transfusions postoperatively, and had a lower positive fluid balance postoperatively than patients who presented with delirium. Patients with both SSD and delirium had worse outcomes in comparison with those with delirium only.

Conclusion

This study stresses the importance for healthcare professionals to identify SSD and prevent its progression to delirium.
Efficacy and safety of Guizhi-Shaoyao-Zhimu decoction in the treatment of rheumatoid arthritis
Authors: Ye Jing , Li Renliang , Hu Ziyi , Zhang Ping , Liu Liangji
Published: March 2021

Background:

Rheumatoid arthritis (RA) is a significant public health problem associated with a substantial burden of functional disability. The Guizhi-Shaoyao-Zhimu decoction (GSZD), a traditional medicine, has been used in China for a long time to treat RA. This study aimed to systematically investigate the efficacy and safety of GSZD in the treatment of RA.

Methods:

We will search the electronic databases of PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, the Chongqing VIP Chinese Science and Technology Periodical Database, Wanfang Database, and China Biomedical Literature Database, and also manually search the Chinese Clinical Trial Register and unpublished studies or references, with the establishment up to February 2021. According to the inclusion and exclusion criteria, we will screen the literature, and the data are extracted independently by the 2 researchers. We will collect RCTs of GSZD in the treatment of RA. RevMan5.3 will be used for statistical analysis. According to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE), we will appraise each outcome quality evidence.

Results:

We will publish the results in a peer-reviewed journal.

Conclusion:

We will evaluate the efficacy and safety of GSZD in treating RA.

Unique INPLASY number:

INPLASY2020120147.
Two AOS genes attributed to familial exudative vitreoretinopathy with microcephaly
Authors: Tao Zhiyan , Bu Shaochong , Lu Fang
Published: March 2021

Rationale:

Familial exudative vitreoretinopathy (FEVR) is an inherited disorder, which is mostly reported to be associated with the mutation of genes involved in the Wnt signaling pathway related to β-catenin. To the best of our knowledge, the involvement of Adams-Oliver syndrome (AOS) genes in FEVR patients have not been reported before.

Patient concerns:

Two patients with FEVR presented with microcephaly. One of them showed slight scarring of the scalp vertex which is a typical manifestation of AOS. The whole exon sequencing confirmed the diagnosis of AOS with 2 AOS-gene mutations at DOCK6 and ARHGAP31. Further clinical examination revealed that their parents with the same mutations showed FEVR-like vascular anomalies.

Diagnosis:

Both patients were diagnosed with AOS through whole exon sequencing, and they presented with some FEVR-like retinopathy including retinal detachment.

Interventions:

Both patients received vitrectomy for tractional retinal detachment with proliferative vitreoretinopathy. During the follow-up, 1 patient received additional laser photocoagulation for tractional retinal detachment.

Outcomes:

The 2 patients remained stable in the latest follow up after the treatment.

Lessons:

Microcephaly could be associated with some form of retinopathy. We proposed that mutation of DOCK6 and ARHGAP31 genes could be the possible cause of FEVR associated with microcephaly. Our study suggested that these genes may be candidate genes of FEVR.
Spiritual and Emotional Experience With a Diagnosis of Breast Cancer
Authors: Leão Diva Cristina M. R. , Pereira Eliane R. , Silva Rose Mary C. R. A. , Rocha Renata Carla N. P. , Cruz-Quintana Francisco , García-Caro María Paz
Published: March 2021

Background

The breast cancer diagnosis causes a high level of suffering and distress in patients who experience difficulties in coping. There is a need to improve knowledge of emotional and spiritual coping in response to the stressful situation of women who must face this diagnosis.

Objectives

The aims of this study were to map women's spiritual and emotional coping experiences reported after a breast cancer diagnosis and examine the proposed interventions and suggestions for clinical practice.

Methods

A scoping review was performed by searching the Scientific Electronic Library Online, Scopus, Cumulative Index to Nursing and Allied Health Literature, Latin American & Caribbean Health Sciences Literature, Medical Literature Analyses and Retrieval System Online, Spanish Bibliographic Index of Health Sciences, PSYCINFO, and Google Scholar databases using Medical Subject Headings terms. Additional pertinent studies were identified by reviewing the bibliographies of the included studies. Twenty articles were included according to the recommendations for scoping reviews.

Results

Study findings regarding emotional and spiritual coping with the diagnosis and proposed interventions were synthesized. A thematic list of interventions and recommendations for clinical practice is also provided.

Conclusions

The studies demonstrated that women with breast cancer are challenged by their emotions and experiences. The review highlights the importance of spiritual coping for redefining women's meaning in life. In clinical practice, caring for women's inherent needs when they are coping with a diagnosis is important to establish integral care.

Implications for Practice

Nurses can evaluate coping strategies, offer support for adaptation to the disease, provide qualified listening, help women in their search for significance while coping with cancer, and help them identify ways to overcome this stressful situation. Similarly, they can encourage patients to find spiritual comfort and emotional support.
Clinical Presentation of Toddlers With New Intracranial Space-Occupying Lesions
Authors: Khan Abdullah , Azadian Moosa , Richter David , Young Timothy P. , Kuntz Heather M.
Published: March 2021

Objective

Intracranial space occupying lesions (ICSOLs) like tumors and abscesses can be life-threatening conditions. It can be especially difficult to diagnose these conditions in toddlers. We aimed to describe symptoms and signs present in a sample of toddlers with ICSOLs.

Methods

We performed a retrospective chart review of 15 toddlers with intracranial tumors, abscesses, or infected cysts. We collected data on the presence of various signs and symptoms on presentation to the emergency department.

Results

Eight toddlers (53%) presented with vomiting. A change in behavior was the second most common symptom (6, 40%). Seven children (47%) had motor weakness, and 5 (33%) had ataxia. Eleven of the 12 children with tumors (92%) had documented abnormal neurologic signs on initial physical examination.

Conclusions

Vomiting, a change in behavior, and an abnormal neurologic examination were common signs and symptoms in our sample of toddlers with ICSOLs. An accurate history and appropriate neurologic examination can help physicians make this challenging diagnosis in this age group.
A Workplace Procedure Training Cart to Augment Pediatric Resident Procedural Learning
Authors: Goldman Michael P. , Palladino Lauren E. , Malik Rabia N. , Powers Emily M. , Rudd Alexis V. , Aronson Paul L. , Auerbach Marc A.
Published: March 2021

Objective

Our primary aim was to describe pediatric residents' use of a workplace procedural training cart. An exploratory aim was to examine if the cart associated with increased resident procedural experiences with real patients.

Methods

Guided by the procedural training construct of “Learn, See, Practice, Prove, Do, Maintain,” we created a novel workplace procedural training cart with videos (learn and see) and simulation equipment (practice and prove). An electronic logbook recorded resident use data, and a brief survey solicited residents' perceptions of the cart's educational impact. We queried our electronic medical record to compare the proportion of real procedures completed by residents before and after the intervention.

Results

From August 1 to December 31, 2019, 24 pediatric residents (10 interns and 14 seniors) rotated in the pediatric emergency department. Twenty-one cart encounters were logged, mostly by interns (67% [14/21]). The 21 cart encounters yielded 32 learning activities (8 videos watched and 24 procedures practiced), reflecting the residents' interest in laceration repair (50% [4/8], 54% [13/24]) and lumbar puncture (38% [3/8], 33% [8/24]). All users agreed (29% [6/21]) or strongly agreed (71% [15/21]) the cart encouraged practice and improved confidence in independently performing procedures. No changes were observed in the proportion of actual procedures completed by residents.

Conclusions

A workplace procedural training cart was used mostly by pediatric interns. The cart cultivated residents' perceived confidence in real procedures but was not used by all residents or influenced residents' procedural behaviors in the pediatric emergency department.
Pain in Adults With Cerebral Palsy After Single-Event Multilevel Surgery
Authors: Götze Marco , Geisbüsch Andreas , Thielen Mirjam , Döderlein Leonhard , Wolf Sebastian I. , Dreher Thomas , Putz Cornelia
Published: March 2021

Objective

The aim of the investigation was to assess the contribution of pain to functional, social, and health-related quality-of-life outcomes in adults with cerebral palsy.

Design

This monocentric, prospective study included long-term data for ambulant adults with cerebral palsy and at levels I–III in the Gross Motor Function Classification System who had received orthopedic multilevel surgery in adulthood and in whom preoperative and postoperative three-dimensional gait analysis was conducted, including the Gait Profile Score. A questionnaire including the Visual Analog Scale, Oswestry Disability Index, and European Quality of Life 5 Dimensions 3 Level was analyzed.

Results

Twenty-four adults at a mean age of 38.0 yrs were included. Sixteen patients (66.7%) indicated that they experienced pain and 10 patients (41.7%) had pain for more than 6 mos. Overall, 13 patients (54%) experienced both pain and anxiety. There was no correlation of the Gait Profile Score with pain, Gross Motor Function Classification System, and Oswestry Disability Index. The Oswestry Disability Index showed a positive correlation with the Gross Motor Function Classification System (r = 0.39, P = 0.05) and pain (r = 0.57, P = 0.004).

Conclusions

Pain and anxiety represent relevant comorbidities in adults with cerebral palsy. The occurrence of pain correlates with the Oswestry Disability Index and is higher than in children with cerebral palsy.
Community Space, Community Groups, and Incident HIV Infection Among Adolescent Girls and Young Women in Rural South Africa: A Longitudinal Analysis of HIV Prevention Trials Network 068 Data
Authors: Bhushan Nivedita L. , Stoner Marie C. D. , Twine Rhian , Kahn Kathleen , Lippman Sheri A. , Pettifor Audrey E.
Published: March 2021

Background:

As adolescent girls and young women (AGYW) transition to adulthood, their interaction with their social context becomes a critical consideration for HIV prevention interventions. Few studies have examined what types of community groups and community spaces might be protective for AGYW HIV acquisition and related sexual behaviors.

Methods:

Data were obtained from HIV Prevention Trials Network 068, a longitudinal study of AGYW (age 13–20 years) in rural South Africa. Survival analyses and generalized estimating equations were used to assess whether community group membership and time spent in community spaces were associated with HIV incidence and sexual behaviors (unprotected sex, transactional sex, and having an older partner).

Results:

A total of 2245 AGYW were followed up for up to 4 years. Membership in church groups [adjusted hazard ratio (aHR): 0.75, 95% confidence interval (CI): 0.53 to 0.91] and dance groups (aHR: 0.89, 95% CI: 0.80 to 0.98) and spending time at church (aHR: 0.88, 95% CI: 0.79 to 0.98) were protective for HIV infection. Conversely, spending time at taverns was associated with higher HIV incidence (aHR: 1.27, 95% CI: 1.15 to 1.41). Membership in church groups and spending time at a family member's home and at church were protective for all 3 sexual behaviors. Spending time at a boyfriend's home and taverns was risky for all 3 sexual behaviors.

Conclusions:

The results suggest that community spaces and community groups that include an element of adult supervision are potentially protective, whereas spaces and groups that provide an opportunity for AGYW to interact unsupervised with boyfriends or meet new partners are potentially risky.
COVID-19 Testing and the Impact of the Pandemic on the Miami Adult Studies on HIV Cohort
Authors: Tamargo Javier A. , Martin Haley R. , Diaz-Martinez Janet , Trepka Mary Jo , Delgado-Enciso Ivan , Johnson Angelique , Mandler Raul N. , Siminski Suzanne , Gorbach Pamina M. , Baum Marianna K.
Published: March 2021

Background:

Socioeconomic disadvantages and potential immunocompromise raise particular concerns for people living with HIV (PLWH) and other marginalized communities during the COVID-19 pandemic. In this study, we explored COVID-19 testing and the impact of the pandemic among participants from the Miami Adult Studies on HIV cohort, predominantly composed of low-income minorities living with and without HIV.

Methods:

Between July and August 2020, a telephone survey was administered to 299 Miami Adult Studies on HIV participants to assess COVID-19 testing, prevention behaviors, and psychosocial stressors. Health care utilization, antiretroviral adherence, food insecurity, and substance use during the pandemic were compared with those of their last cohort visit (7.8 ± 2.9 months earlier).

Results:

Half of surveyed participants had been tested for COVID-19, 8 had tested positive and 2 had been hospitalized. PLWH (n = 183) were 42% times less likely than HIV-uninfected participants to have been tested. However, after adjustment for age, employment, COVID-19 symptoms, mental health care, and substance use, the effect of HIV status was no longer significant. PLWH were more likely to have seen a health care provider, use face coverings, and avoid public transportation and less likely to be food insecure and drink hazardously. There were significant changes in substance use patterns during the pandemic when compared with those before.

Conclusion:

PLWH, compared with their HIV-uninfected peers, were more likely to engage in preventive measures and health care during the pandemic, potentially reducing their exposure to COVID-19. There were no reported changes in antiretroviral adherence or health care utilization, but there were changes in substance use; these need to be monitored as this crisis progresses.
Characterization of Ascending Aortic Flow in Patients With Degenerative Aneurysms
Authors: Ramaekers Mitch J.F.G. , Adriaans Bouke P. , Juffermans Joe F. , van Assen Hans C. , Bekkers Sebastiaan C.A.M. , Scholte Arthur J.H.A. , Kenjeres Sasa , Lamb Hildo J. , Wildberger Joachim E. , Westenberg Jos J.M. , Schalla Simon
Published: March 2021

Objectives

Degenerative thoracic aortic aneurysm (TAA) patients are known to be at risk of life-threatening acute aortic events. Guidelines recommend preemptive surgery at diameters of greater than 55 mm, although many patients with small aneurysms show only mild growth rates and more than half of complications occur in aneurysms below this threshold. Thus, assessment of hemodynamics using 4-dimensional flow magnetic resonance has been of interest to obtain more insights in aneurysm development. Nonetheless, the role of aberrant flow patterns in TAA patients is not yet fully understood.

Materials and Methods

A total of 25 TAA patients and 22 controls underwent time-resolved 3-dimensional phase contrast magnetic resonance imaging with 3-directional velocity encoding (ie, 4-dimensional flow magnetic resonance imaging). Hemodynamic parameters such as vorticity, helicity, and wall shear stress (WSS) were calculated from velocity data in 3 anatomical segments of the ascending aorta (root, proximal, and distal). Regional WSS distribution was assessed for the full cardiac cycle.

Results

Flow vorticity and helicity were significantly lower for TAA patients in all segments. The proximal ascending aorta showed a significant increase in peak WSS in the outer curvature in TAA patients, whereas WSS values at the inner curvature were significantly lower as compared with controls. Furthermore, positive WSS gradients from sinotubular junction to midascending aorta were most prominent in the outer curvature, whereas from midascending aorta to brachiocephalic trunk, the outer curvature showed negative WSS gradients in the TAA group. Controls solely showed a positive gradient at the inner curvature for both segments.

Conclusions

Degenerative TAA patients show a decrease in flow vorticity and helicity, which is likely to cause perturbations in physiological flow patterns. The subsequent differing distribution of WSS might be a contributor to vessel wall remodeling and aneurysm formation.
Craniofacial Measurements: A History of Scientific Racism, Rethinking Anthropometric Norms
Authors: Ching Ann Hui , Kang Gavin Chun Wui , Lim Gale Jue Shuang
Published: March 2021

Craniofacial measurements have been used in attempt to create racial categories. This article discusses the history of this practice and the potential implications this has for patients.
Double-Layered Closuring to Repair an Oroantral Fistula Using Septal Cartilage and Buccal Fat Pad
Authors: Aksakal Ceyhun , Akti Serdar , Aksakal Betül Subaşi
Published: March 2021

Oroantral fistula (OAF) is a pathological connection between the maxillary sinus and oral cavity, and it usually occurs after tooth extraction. Proper repair of OAF is important for the prevention of recurrences. The present case offers a technique of OAF repair using septal cartilage and buccal fat pad for the repair of the defect after excision of fistula tract. This double-layered closure is a new technique that could be used to repair chronic OAF.
Pandemic Recovery: Persistent Disparities in Access to Elective Surgical Procedures
Authors: Lin Joseph A. , Braun Hillary J. , Schwab Marisa E. , Pierce Logan , Sosa Julie A. , Wick Elizabeth C.
Published: March 2021

Objective:

To examine potential disparities in patient access to elective procedures during the recovery phase of the COVID-19 pandemic.

Summary of Background Data:

Elective surgeries during the pandemic were limited acutely. Access to surgical care was restored in a recovery phase but backlogs and societal shifts are hypothesized to impact surgical access.

Methods:

Adults with electronic health record orders for procedures (“procedure requests”), from March 16 to August 25, 2019 and March 16 to August 25, 2020, were included. Logistic regression was performed for requested procedures that were not scheduled. Linear regression was performed for wait time from request to scheduled or completed procedure.

Results:

The number of patients with procedure requests decreased 20.8%, from 26,789 in 2019 to 21,162 in 2020. Patients aged 36–50 and >65 years, those speaking non-English languages, those with Medicare or no insurance, and those living >100 miles away had disproportionately larger decreases. Requested procedures had significantly increased adjusted odds ratios (aORs) of not being scheduled for patients with primary languages other than English, Spanish, or Cantonese [aOR 1.60, 95% confidence interval (CI) 1.12–2.28]; unpartnered marital status (aOR 1.21, 95% CI 1.07–1.37); uninsured or self-pay (aOR 2.03, 95% CI 1.53–2.70). Significantly longer wait times were seen for patients aged 36–65 years; with Medi-Cal insurance; from ZIP codes with lower incomes; and from ZIP codes >100 miles away.

Conclusions:

Patient access to elective surgeries decreased during the pandemic recovery phase with disparities based on patient age, language, marital status, insurance, socioeconomic status, and distance from care. Steps to address modifiable disparities have been taken.
A multicenter investigation of the hemodynamic effects of induction agents for trauma rapid sequence intubation
Authors: Leede Emily , Kempema James , Wilson Chad , Rios Tovar Alejandro J. , Cook Alan , Fox Erin , Regner Justin , Richmond Robyn , Carrick Matt , Brown Carlos V.R. ,   Texas Trauma Study Group (Frank Buchanan, MBA, Andrew Kolodziej, LaDonna Allen, RN, Victoria E. Herrick, Natalie Tully, MD)
Published: March 2021

BACKGROUND

Several options exist for induction agents during rapid sequence intubation (RSI) in trauma patients, including etomidate, ketamine, and propofol. These drugs have reported variable hemodynamic effects (hypotension with propofol and sympathomimetic effects with ketamine) that could affect trauma resuscitations. The purpose of this study was to compare the hemodynamic effects of these three induction agents during emergency department RSI in adult trauma. We hypothesized that these drugs would display a differing hemodynamic profile during RSI.

METHODS

We performed a retrospective (2014–2019), multicenter trial of adult (≥18 years) trauma patients admitted to eight ACS-verified Level I trauma centers who underwent emergency department RSI. Variables collected included systolic blood pressure (SBP) and pulse before and after RSI. The primary outcomes were change in heart rate and SBP before and after RSI.

RESULTS

There were 2,092 patients who met criteria, 85% received etomidate (E), 8% ketamine (K), and 7% propofol (P). Before RSI, the ketamine group had a lower SBP (E, 135 vs. K, 125 vs. P, 135 mm Hg, p = 0.04) but there was no difference in pulse (E, 104 vs. K, 107 vs. P, 105 bpm, p = 0.45). After RSI, there were no differences in SBP (E, 135 vs. K, 130 vs. P, 133 mm Hg, p = 0.34) or pulse (E, 106 vs. K, 110 vs. P, 104 bpm, p = 0.08). There was no difference in the average change of SBP (E, 0.2 vs. K, 5.2 vs. P, −1.8 mm Hg, p = 0.4) or pulse (E, 1.7 vs. K, 3.5 bpm vs. P, −0.96, p = 0.24) during RSI.

CONCLUSION

Contrary to our hypothesis, there was no difference in the hemodynamic effect for etomidate versus ketamine versus propofol during RSI in trauma patients.

LEVEL OF EVIDENCE

Therapeutic, Level IV.
Unraveling the Genomic Architecture of the CYP3A Locus and ADME Genes for Personalized Tacrolimus Dosing
Authors: Yoon Jihoon G. , Song Seung Hwan , Choi Sungkyoung , Oh Jaeseong , Jang In-Jin , Kim Young Jin , Moon Sanghoon , Kim Bong-Jo , Cho Yuri , Kim Hyo Kee , Min Sangil , Ha Jongwon , Shin Ho Sik , Yang Chul Woo , Yoon Hye Eun , Yang Jaeseok , Lee Min Goo , Park Jae Berm , Kim Myoung Soo
Published: March 2021

Background.

Tacrolimus (TAC) is an immunosuppressant widely prescribed following an allogenic organ transplant. Due to wide interindividual pharmacokinetic (PK) variability, optimizing TAC dosing based on genetic factors is required to minimize nephrotoxicity and acute rejections.

Methods.

We enrolled 1133 participants receiving TAC from 4 cohorts, consisting of 3 with kidney transplant recipients and 1 with healthy males from clinical trials. The effects of clinical factors were estimated to appropriately control confounding variables. A genome-wide association study, haplotype analysis, and a gene-based association test were conducted using the Korea Biobank Array or targeted sequencing for 114 pharmacogenes.

Results.

Genome-wide association study verified thatCYP3A5*3 is the only common variant associated with TAC PK variability in Koreans. We detected severalCYP3A5andCYP3A4rare variants that could potentially affect TAC metabolism. The haplotype structure ofCYP3A5stratified byCYP3A5*3 was a significant factor forCYP3A5rare variant interpretation.CYP3A4rare variant carriers among CYP3A5 intermediate metabolizers displayed higher TAC trough levels. Gene-based association tests in the 61 absorption, distribution, metabolism, and excretion genes revealed thatCYP1A1are associated with additional TAC PK variability:CYP1A1rare variant carriers among CYP3A5 poor metabolizers showed lower TAC trough levels than the noncarrier controls.

Conclusions.

Our study demonstrates that rare variant profiling ofCYP3A5andCYP3A4, combined with the haplotype structures ofCYP3Alocus, provide additive value for personalized TAC dosing. We also identified a novel association betweenCYP1A1rare variants and TAC PK variability in the CYP3A5 nonexpressers that needs to be further investigated.
An Open-label Randomized Controlled Parallel-group Pilot Study Comparing the Immunogenicity of a Standard-, Double-, and Booster-dose Regimens of the 2014 Seasonal Trivalent Inactivated Influenza Vaccine in Kidney Transplant Recipients
Authors: Odongo Fatuma Catherine Atieno , Braga Patrícia Emília , Palacios Ricardo , Miraglia João Luiz , Sartori Ana Marli Christovam , Ibrahim Karim Yaqub , Lopes Marta Heloisa , Caiaffa-Filho Helio Hehl , Timenetsky Maria do Carmo Sampaio Tavares , Agena Fabiana , Fonseca de Azevedo Luiz Sergio , David-Neto Elias , Precioso Alexander Roberto , Pierrotti Lígia Camera
Published: March 2021

Background.

Immunogenicity of influenza vaccine in transplant recipients is suboptimal and alternative vaccination regimens are necessary.

Methods.

We compared the immunogenicity of a standard-dose trivalent inactivated influenza vaccination (SDTIIV), double-dose trivalent inactivated influenza vaccination (DDTIIV), and booster-dose trivalent inactivated influenza vaccination (BDTIIV) of the 2014 seasonal trivalent inactivated influenza vaccine in kidney transplant recipients. We randomized 176 participants to SDTIIV (59), DDTIIV (59), and BDTIIV regimens (58). Antibody titers were determined by hemagglutination inhibition at enrollment and 21 d postvaccination. Seroprotection rates (SPRs), seroconversion rates (SCRs), and geometric mean ratios (GMRs) were analyzed separately for participants with low (<1:40) and high (≥1:40) prevaccination antibody titers.

Results.

Vaccination was confirmed for 172 participants. Immunogenicity analysis was done for 149 participants who provided postvaccination blood samples. In the subgroup with high prevaccination antibody titers, all vaccination regimens induced SPR > 70% to all antigens, but SCR and GMR were below the recommendations. In the subgroup with low prevaccination antibody titers, DDTIIV and BDTIIV regimens induced adequate SCR > 40% and GMR > 2.5 for all antigens, whereas SDTIIV achieved the same outcomes only for influenza B. SPRs were >70% only after DDTIIV (A/H1N1—77.8%) and BDTIIV (A/H3N2—77.8%). BDTIIV regimen independently increased seroprotection to A/H1N1 (PR = 2.58; P = 0.021) and A/H3N2 (PR = 2.21; P = 0.004), whereas DDTIIV independently increased seroprotection to A/H1N1 (PR = 2.59; P = 0.021).

Conclusions.

Our results suggest that DDTIIV and BDTIIV regimens are more immunogenic than SDTIIV, indicating the need for head-to-head multicenter clinical trials to further evaluate their efficacy.