bluuebunny/crossref_metadata_2025 huggingface dataset:
How Wearable Technology Can Facilitate AI Analysis of Surgical Videos
Authors: Pugh Carla M. , Ghazi Ahmed , Stefanidis Dimitrios , Schwaitzberg Steven D. , Martino Martin A. , Levy Jeffrey S.
Published: March 2021

Operative video has great potential to enable instant replays of critical surgical decisions for training and quality review. Recently, artificial intelligence (AI) has shown early promise as a method of enabling efficient video review, analysis, and segmentation. Despite the progress with AI analysis of surgical videos, more work needs to be done to improve the accuracy and efficiency of AI-driven video analysis. At a recent consensus conference held on July 10–11, 2020, 8 research teams shared their work using AI for surgical video analysis. Four of the teams showcased the utility of wearable technology in providing objective surgical metrics. Data from these technologies were shown to pinpoint important cognitive and motor actions during operative tasks and procedures. The results support the utility of wearable technology to facilitate efficient and accurate video analysis and segmentation.
Gene mutations of esophageal squamous cell carcinoma based on next-generation sequencing
Authors: Wang Long , Jia Yi-Meng , Zuo Jing , Wang Yu-Dong , Fan Zhi-Song , Feng Li , Zhang Xue , Han Jing , Lyu Wen-Jing , Ni Zhi-Yu
Published: March 2021

Background

Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive cancers without effective therapy. To explore potential molecular targets in ESCC, we quantified the mutation spectrum and explored the relationship between gene mutation and clinicopathological characteristics and programmed death-ligand 1 (PD-L1) expression.

Methods

Between 2015 and 2019, 29 surgically resected ESCC tissues and adjacent normal tissues from the Fourth Hospital of Hebei Medical University were subjected to targeted next-generation sequencing. The expression levels of PD-L1 were detected by immunohistochemistry. Mutational signatures were extracted from the mutation count matrix by using non-negative matrix factorization. The relationship between detected genomic alterations and clinicopathological characteristics and PD-L1 expression was estimated by Spearman rank correlation analysis.

Results

The most frequently mutated gene was TP53 (96.6%, 28/29), followed by NOTCH1 (27.6%, 8/29), EP300 (17.2%, 5/29), and KMT2C (17.2%, 5/29). The most frequently copy number amplified and deleted genes were CCND1/FGF3/FGF4/FGF19 (41.4%, 12/29) and CDKN2A/2B (10.3%, 3/29). By quantifying the contribution of the mutational signatures to the mutation spectrum, we found that the contribution of signature 1, signature 2, signature 10, signature 12, signature 13, and signature 17 was relatively high. Further analysis revealed genetic variants associated with cell cycle, chromatin modification, Notch, and Janus kinase-signal transducer and activator of transcription signaling pathways, which may be key pathways in the development and progression of ESCC. Evaluation of PD-L1 expression in samples showed that 13.8% (4/29) of samples had tumor proportion score ≥1%. 17.2% (5/29) of patients had tumor mutation burden (TMB) above 10 mut/Mb. All samples exhibited microsatellite stability. TMB was significantly associated with lymph node metastasis (r = 0.468, P = 0.010), but not significantly associated with PD-L1 expression (r = 0.246, P = 0.198). There was no significant correlation between PD-L1 expression and detected gene mutations (all P > 0.05).

Conclusion

Our research initially constructed gene mutation profile related to surgically resected ESCC in high-incidence areas to explore the mechanism underlying ESCC development and potential therapeutic targets.
Evaluation of antihyperalgesic and analgesic effects of 35% nitrous oxide when combined with remifentanil
Authors: Wehrfritz Andreas , Bauer Marcus , Noel Nathalie , Ramirez-Gil Juan Fernando , Ihmsen Harald , Prottengeier Johannes , Schüttler Jürgen , Bessiere Baptiste
Published: March 2021

BACKGROUND

Remifentanil is an effective drug in peri-operative pain therapy, but it can also induce and aggravate hyperalgesia. Supplemental administration of N2O may help to reduce remifentanil-induced hyperalgesia.

OBJECTIVE

To evaluate the effect of 35 and 50% N2O on hyperalgesia and pain after remifentanil infusion.

DESIGN

Single site, phase 1, double-blind, placebo-controlled, randomised crossover study.

SETTING

University Hospital, Germany from January 2012 to April 2012.

PARTICIPANTS

Twenty-one healthy male volunteers.

INTERVENTIONS

Transcutaneous electrical stimulation induced spontaneous acute pain and stable areas of hyperalgesia. Each volunteer underwent the following four sessions in a randomised order: 50 to 50% N2-O2 and intravenous (i.v.) 0.9% saline infusion (placebo); 50 to 50% N2-O2 and i.v. remifentanil infusion at 0.1 μg kg−1 min−1 (remifentanil); 35 to 15 to 50% N2O-N2-O2 and i.v. remifentanil infusion at 0.1 μg kg−1 min−1 (tested drug) and 50 to 50% N2O-O2 and i.v. remifentanil infusion at 0.1 μg kg−1 min−1 (gas active control). Gas mixtures were inhaled for 60 min; i.v. drugs were administered for 30 min.

MAIN OUTCOME MEASURES

Areas of pin-prick hyperalgesia, areas of touch-evoked allodynia and pain intensity on a visual analogue scale were assessed repeatedly for 160 min.

RESULTS

Data from 20 volunteers were analysed. There were significant treatment and treatment-by-time effects regarding areas of hyperalgesia (P < 0.001). After the treatment period, the area of hyperalgesia was significantly reduced (P < 0.001) in the tested drug and in the gas active control (30.6 ± 9.25 and 24.4 ± 7.3 cm2, respectively) compared with remifentanil (51.0 ± 17.0 cm2). There was also a significant difference between the gas active control and the tested drug sessions (P < 0.001). For the area of allodynia and pain rating, results were consistent with the results for hyperalgesia.

CONCLUSIONS

Administration of 35% N2O significantly reduced hyperalgesia, allodynia and pain intensity induced after remifentanil. It might therefore be suitable in peri-operative pain relief characterised by hyperalgesia and allodynia, such as postoperative pain, and may help to reduce opioid demand.

TRIAL REGISTRATION

EudraCT-No.: 2011-000966-37.
Effect of potassium on DNA methylation of aldosterone synthase gene
Authors: Takeda Yoshimichi , Demura Masashi , Wang Fen , Karashima Shigehiro , Yoneda Takashi , Kometani Mitsuhiro , Aomo Daisuke , Hashimoto Atsushi , Horike Shin-ichi , Meguro-Horike Makiko , Takeda Yoshiyu
Published: March 2021

Background:

Aldosterone synthase gene, CYP11B2 is regulated by potassium and angiotensin II (Ang II). We have reported that Ang II could change the DNA methylation status around transcription factor-binding sites and a transcription start site (TSS) and activate expression of CYP11B2. Similar to Ang II, small increases in extracellular potassium levels also increase CYP11B2 mRNA levels.

Methods and results:

Adrenocortical H295R cells were treated with different doses of potassium. Methylation analysis of CYP11B2 promoter region was done by bisulfite sequencing. CYP11B2 mRNA and protein levels, chromatin accessibility, methylation and demethylation activity were estimated. The transcriptional ability of CYP11B2 promoter with or without methylation was assessed. Potassium stimulation caused DNA demethylation around cyclic AMP responsive element binding protein 1 (CREB1) and nuclear receptor subfamily 4 group A (NR4A) family-binding sites and a TSS; demethylation was accompanied by recruitment of CREB1 and NR4A1 and increased chromatin accessibility of the CYP11B2 promoter. DNA methylation activity decreased in the nucleus. DNA demethylation at CpG1 (Ad1), CpG2 (Ad5) and CpG3 were detected within 2 to 4 days after potassium (16 mmol/l) stimulation. The changes reached a maximum level by day 7. DNA at CpG2 (Ad5) and CpG3 was re-methylated to levels that were similar to those of nontreated cells at day 9. Potassium treatment significantly reduced DNA methylation activity at days 7 and 9. DNA demethylation activity was not changed by potassium.

Conclusion

: Potassium induced reversibly DNA demethylation, which switches the phenotype of CYP11B2 expression from an inactive to an active state.
Skin Cancer in Skin of Color
Authors: Thomley Meredith E. , Roland Damien L. , Noble C. Alexis , Sharma Manoj , Shipley Sonya R. , Nahar Vinayak K.
Published: March 2021

Skin cancer represents the most common type of cancer diagnosed in the United States. Unfortunately, skin cancer is often considered a disease that spares the skin of color. Although skin cancer is less common in Black patients overall, it is typically diagnosed at later stages in this population, which portends a poorer prognosis. Several well-established risk factors for skin cancer do not necessarily apply to Black patients; however, sun exposure is a modifiable behavior that, through public education, can lead to successful prevention. In addition, barriers to adequate resources, including sunscreen and access to care, contribute to the issue of delayed diagnosis. We propose that such barriers should be evaluated further to address the healthcare discrepancy in this patient population. This article explores the importance of both public and provider education regarding the prevention and timely diagnosis of skin cancer in skin of color.
Transition From Pediatric and Adolescent HIV Care to Adult HIV Care and the Patient–Provider Relationship: A Qualitative Metasynthesis
Authors: Barr Emily A. , Raybin Jennifer L. , Dunlevy Hillary , Abuogi Lisa , Jones Jacqueline
Published: March 2021

Approximately 5 million adolescents (ages 15–24 years) living with HIV will transition to adult care in the next decade. Only half are engaged in care 12 months post-transition. This qualitative metasynthesis aimed to answer: What effect did the patient–provider relationship (PPR) have on adolescent living with HIV transition? What strategies were suggested to develop trusting relationships to promote engagement and retention in care? Primary qualitative studies from PubMed, CINAHL, and EBSCO (January 2008 to December 2019) were identified. Data were analyzed using team-based thematic synthesis techniques and international standards. Fourteen articles with 478 participants from eight countries were included. Four themes emerged: the familial nature of the PPR, stigma as a bond and barrier, the provider knowing the patient and getting to know new providers, and recommendations supporting transition. The PPR is integral. Collaborative strategies used to build new relationships will support autonomy, decrease stigma, and facilitate trust.
Elbow arthroplasty complicated by Mycobacterium tuberculosis infection
Authors: Guan Yun , Zeng Zhimin
Published: March 2021

Introduction:

Total elbow arthroplasty (TEA) is an orthopedic procedure that is relatively infrequently performed, but its use has been increasing over time. Infection remains one of the most concerning complications after TEA, although Mycobacterium tuberculosis (TB) as a microbial etiology, is extremely rare. Here, we present a case of M. tuberculosis infection after TEA.

Patient concerns:

A 45-year-old woman underwent TEA for severe traumatic arthritis of the elbow following failure of conservative treatment. Four months after TEA, the patient experienced progressive elbow pain and swelling, without other external signs of infection such as a sensation of local heating and erythematous alterations.

Diagnosis:

Pulmonary computed tomography showed stable pulmonary TB in the right upper lobe. The T-SPOT, TB, and purified protein derivative test results were positive, and M. tuberculosis exhibited growth on cultures. The final diagnosis was periprosthetic infection of M. tuberculosis.

Interventions:

The patient was treated with debridement with submission of deep tissue cultures. According to these cultures and suggestions of a bacteriologist, anti-TB treatment was administered for 12 months.

Outcomes:

The symptoms of the infection were controlled, and the prosthesis was retained. At the time of writing this case report, the elbow prosthesis had survived for more than 2 years, and no recurrent infection had been observed.

Conclusion:

The diagnosis of TB infection after TEA is difficult to confirm due to its nonspecific signs and symptoms. Despite the extremely low incidence, failure to consider this possibility for diagnosis can lead to delayed treatment. Proper diagnosis allows for antitubercular therapy with retention of a prosthesis.
Excising the neovagina due to introital atresia and closed neovaginal loop after sigmoid vaginoplasty
Authors: Wang Rui , Su Qi , Yan Zhaopeng
Published: March 2021

Introduction:

Vaginal agenesis is a congenital disorder, which can be managed by nonsurgical dilation or surgical reconstruction of the vagina. The sigmoid vaginoplasty procedure is a popular approach, which pulls down part of the sigmoid colon to form a neovagina. One complication of this procedure is introital stenosis.

Patient concerns:

A 55-year-old woman presented to the outpatient general surgery department with severe, persistent abdominal pain. The patient was diagnosed with congenital absence of uterus and vagina, and a sigmoid vaginoplasty was performed 34 years ago.

Diagnosis:

A pelvic MRI and an abdominal enhanced CT scan were performed, finding that the uterus was absent, and the os of the vagina was closed, forming a closed loop full of fluid. Introital atresia and closed loop of neovaginal colon conduit were diagnosed.

Interventions:

Based on our conclusions and the patient's consent we surgically removed the neovagina.

Outcomes:

After surgery, the abdominal pain was relieved, and the patient reported full recovery during a 6-month follow-up appointment.

Conclusion:

Introital stenosis is one of the long-term complications of sigmoid vaginoplasty procedure. Introital stenosis, leading to introital atresia, is rare but may occur. Surgical removal of neovagina can relieve the pain in patients who do not have the demand of sexual intercourse.
Prevalence of inflammatory bowel disease in young Greek Army male recruits from 2006 to 2018: a 13-year retrospective study from a tertiary center
Authors: Kyriakos Nikolaos , Papaefthymiou Apostolis , Giakoumis Marios , Galanopoulos Michail , Galanis Petros , Mylonas Iordanis , Karatzas Pantelis , Mantzaris Gerasimos , Liatsos Christos
Published: March 2021

Background

The prevalence and incidence of inflammatory bowel diseases (IBDs) vary among countries. Data regarding prevalence of IBD in Greece are limited or outdated.

Methods

We reviewed the medical records of IBD patients from a population of 551,808 Greek Army recruits in a 13-year period (2006–2018). Study population consisted of males 18–37 of age from Northwest, Central Greece (including Attica), Peloponnese, and Aegean Sea Islands. Age, disease distribution, pharmaceutical treatment and IBD-related surgery at the time of patients’ admission were recorded.

Results

The prevalence of IBD among male recruits during the studied period was 0.15% (839/551 808, 95% confidence interval 0.14–0.16%). Of these, 448 (53.4%) had Crohn’s disease (CD) and 391 (46.6%) ulcerative colitis (UC). Although 32.1% of CD patients had been treated with biologics, most often infliximab (60% of them), azathioprine was the most common as monotherapy (27% of patients). Among UC patients, mesalamine was the most often prescribed treatment (64.2%), whereas treatment with biologics as monotherapy or in combination with azathioprine was used in a ratio 1:2 compared to CD patients. A gradual reduction in steroid use was noted from 2006 to 2018, coinciding with the advent and increasing use of biologics. IBD-related surgery had been performed in 8% and 2.8% of CD and UC patients, respectively.

Conclusion

The prevalence of IBD in Greek male recruits was 0.15% with a slight CD predominance. Remarkable changes in therapeutic trends were noted with an increasing use of biologics and reduced prescription of steroids, especially for CD.
Statins for treatment of chronic liver disease
Authors: Marrache Mohamad Kareem , Rockey Don C.
Published: March 2021

Purpose of review

Statins are a class of lipid lower medications used primarily in patients with high-risk cardiovascular disease. Since their development, statins have been considered to be harmful in patients with liver disease, and many of the prescribing information labels consider them to be contraindicated in patients with active liver disease. However, recent studies have shown the contrary, warranting further investigation and discussion. This review aims to describe the latest literature on the mechanism, safety profile and potential benefits of statins use on the natural history of chronic liver disease (CLD) progression and its complications.

Recent findings

A number of recently published studies have added to the existing body of literature supporting the concept that statins are safe and likely to be beneficial for treating patients with CLD. Patients with CLD including hepatitis B virus infection, hepatitis C virus infection, nonalcoholic fatty liver disease and alcohol on statins have been shown to have a lower rate of decompensating events, lower incidence of hepatocellular cancer, a lower rate of infections, and increased survival. However, the majority of the available literature supporting statin use in patients with liver disease comes from retrospective observational studies with high potential for bias.

Statins appear to be safe in patients with compensated cirrhosis, and evidence suggests that they may reduce fibrosis, even in patients with advanced fibrosis and cirrhosis. Further high-quality research on this topic is needed to fully delineate the effect of statins in patients with liver disease.
Methods to quantify endothelial cell front-rear polarity in vivo and in vitro
Authors: Pena Andreia , Ouarné Marie , Franco Cláudio Areias
Published: March 2021

Purpose of review

Endothelial cell (EC) front-rear (axial) polarization in response to chemokines and shear stress is fundamental for angiogenesis. This review provides an overview of the in vitro and in vivo methods that are currently available to quantify EC axial polarity.

Recent findings

Innovative methodologies and new animal models have been developed to evaluate EC axial polarity. Micropatterning, wound healing and microfluidic assays allow interrogation of signalling mechanisms in vitro. Mouse and zebrafish transgenic lines, in combination with advances in imaging techniques and computational tools, enable interrogation of physiological functions of EC axial polarity in vascular biology during development and in pathology in vivo.

We present a literature-based review of the methods available to study EC polarity. Further refinement of quantitative methods to analyse EC axial polarity using deep learning-based computational tools will generate new understanding on the aetiology of vascular malformations.
Effect of a Vein Imaging Device and of Fist Clenching on Determination of an Appropriate Vein and on Catheter Placement Time in Patients Receiving Chemotherapy
Authors: Eren Handan , Caliskan Nurcan
Published: March 2021

Background

As the vein structure gets damaged in patients receiving chemotherapy treatment, placement of peripheral intravenous catheter becomes difficult. To increase the success of peripheral intravenous catheter placement, a vein imaging device and fist clenching can be used.

Objective

The aim of this study was to determine the effect of using a vein imaging device or fist clenching on the determination of an appropriate vein and successful catheter placement time in adult patients receiving chemotherapy.

Methods

One hundred thirty-five patients receiving chemotherapy were randomly assigned to either the vascular imaging device group (n = 45), the fist clenching group (n = 45), or the control group (n = 45). In the vascular imaging group, a vascular imaging device was used to determine the appropriate vein; in the fist clenching group, the patients were asked to open and close their palms to determine the appropriate vein; and in the control group, no interventions except for the process steps were applied and the same nurse carried out the catheter insertion.

Results

The durations of determining the appropriate vein and successful peripheral intravenous catheter insertion were shorter in the device group at a significant level (P < .05) compared with the control group. The satisfaction levels of the patients and the nurse were higher in the device group at a significant level (P < .05) compared with the control group.

Conclusion

The vascular imaging device was effective in determining the proper vein and in successful intravenous catheter insertion time in patients who were receiving chemotherapy.

Implications for Practice

The use of vein imaging device will have positive results for patients and nurses.
Self-care Experiences of Advanced Prostate Cancer Survivors Who Underwent Androgen Deprivation Therapy
Authors: Chien Ching-Hui , Huang Xuan-Yi
Published: March 2021

Background

Androgen deprivation therapy is the primary treatment for advanced cases of prostate cancer, but its adverse effects may decrease prostate cancer survivors’ quality of life.

Objective

The aim of this study was to understand the self-care experiences of prostate cancer survivors before and while receiving androgen deprivation therapy.

Methods

A qualitative study design with inductive content analysis was used. Semistructured interviews were conducted with 13 prostate cancer survivors in Taiwan treated with androgen deprivation therapy. Data collection and analysis proceeded simultaneously until data saturation was reached.

Results

The survivors’ self-care experiences were categorized into generic categories: physical impacts, psychosocial impacts, lack of supporting information, changing lifestyle habits, coping with physical symptoms, relieving stress, and acquiring disease-related knowledge. These generic categories were then organized into 2 main categories: impacts and adjustments.

Conclusions

This article describes the experiences of prostate cancer survivors in terms of the impacts of disease and its treatment and adjustments in self-care before and while receiving treatment. It was found that the information acquired by survivors and the adjustment strategies they used were not entirely appropriate or adequate.

Implications for Practice

Healthcare providers should continually assess the self-care experiences of prostate cancer survivors receiving androgen deprivation therapy, provide them with appropriate information, and clarify their understanding. This will improve survivors’ disease care–related knowledge, increase the success of their experience of self-care, alleviate their emotional distress, and strengthen their ability to adjust their self-care to cope with the impacts of the disease and its treatment.
Do COVID-19–Related Treatment Changes Influence Fear of Cancer Recurrence, Anxiety, and Depression in Breast Cancer Patients?
Authors: Kim Soo Yeon , Kim Sue
Published: March 2021

Background

The worldwide spread of the coronavirus disease 2019 (COVID-19) has impacted the treatment of cancer patients. Treatment changes can negatively affect patients’ prognosis and may be psychologically burdensome.

Objective

The aim of this study was to explore whether COVID-19–related treatment changes (delays, cancellations, changes) influenced fear of cancer recurrence, anxiety, and depression in breast cancer patients.

Methods

A convenience sample (n = 154) of patients who were diagnosed with breast cancer no longer than 2 years ago was obtained from an online community and social network site. The survey content included COVID-19–related treatment experiences and psychological status. The data were analyzed using descriptive statistics, χ
2 test, independent t test, and analysis of variance.

Results

Twenty-nine patients (18.8%) had experienced COVID-19–related treatment changes, and changes of the treatment plan had a significant correlation with depression (t = 2.000, P = .047). Fear of cancer recurrence was high (mean score, 84.31 ± 24.23). Fifteen percent had moderate to severe levels of anxiety, and 24.7% had moderate to severe levels of depression. Narrative reports also identified COVID-19–related unforeseen costs.

Conclusion

In the midst of the COVID-19 pandemic, breast cancer patients experienced treatment changes, and changes in treatment plans were significantly associated with depression. Fear of recurrence, anxiety, and depression were found at high levels.

Implications for Practice

Oncology nurses should assess the psychological status of cancer patients in the early survivorship phase who appear to be especially vulnerable during the COVID-19 pandemic. Oncology nurses can also monitor whether patients are receiving timely supportive care to alleviate fears and anxiety and assess financial needs for COVID-19–related costs.
Association Between Acute Kidney Injury Duration and Outcomes in Critically Ill Children*
Authors: Alobaidi Rashid , Anton Natalie , Burkholder Shauna , Garros Daniel , Garcia Guerra Gonzalo , Ulrich Emma H. , Bagshaw Sean M.
Published: March 2021

OBJECTIVES:

Acute kidney injury occurs frequently in children during critical illness and is associated with increased morbidity, mortality, and health resource utilization. We aimed to examine the association between acute kidney injury duration and these outcomes.

DESIGN:

Retrospective cohort study.

Settings:

PICUs in Alberta, Canada.

PATIENTS:

All children admitted to PICUs in Alberta, Canada between January 1, 2015, and December 31, 2015.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

In total, 1,017 children were included, and 308 (30.3%) developed acute kidney injury during PICU stay. Acute kidney injury was categorized based on duration to transient (48 hr or less) or persistent (more than 48 hr). Transient acute kidney injury occurred in 240 children (77.9%), whereas 68 children (22.1%) had persistent acute kidney injury. Persistent acute kidney injury had a higher proportion of stage 2 and stage 3 acute kidney injury compared with transient acute kidney injury and was more likely to start within 24 hours from PICU admission. Persistent acute kidney injury occurred more frequently in those with higher illness severity and in those admitted with shock, sepsis, or with a history of transplant. Mortality varied significantly according to acute kidney injury status: 1.8% of children with no acute kidney injury, 5.4% with transient acute kidney injury, and 17.6% with persistent acute kidney injury died during hospital stay (p < 0.001). On multivariable analysis adjusting for illness and acute kidney injury severity, transient and persistent acute kidney injury were both associated with fewer ventilation-free days at 28 days (–1.28 d; 95% CI, –2.29 to –0.26 and –4.85 d; 95% CI, –6.82 to –2.88), vasoactive support–free days (–1.07 d; 95% CI, –2.00 to –0.15 and –4.24 d; 95% CI, –6.03 to –2.45), and hospital-free days (–1.93 d; 95% CI, –3.36 to –0.49 and –5.25 d; 95% CI, –8.03 to –2.47), respectively.

CONCLUSIONS:

In critically ill children, persistent and transient acute kidney injury have different clinical characteristics and association with outcomes. Acute kidney injury, even when its duration is short, carries significant association with worse outcomes. This risk increases further if acute kidney injury persists longer independent of the degree of its severity.
Toys and Toy Accessories Strike Back
Authors: Vega Carolina , Kannikeswaran Nirupama , Farooqi Ahmad , Arora Rajan
Published: March 2021

Objective

The aim of the study was to examine age-associated injury trends and severe injury proportions for plush toys, toy figurines, and doll and toy accessories. We hypothesized that the proportion of severe injuries would be highest in the younger than 3-year and 3- to 5-year age groups.

Methods

We analyzed injury patterns from plush toys, toy figurines, and doll and toy accessories for ages of 0 to 18 years from 2010 to 2018 using the Consumer Product Safety Commission National Electronic Injury Surveillance System. Exclusion criteria included unspecified toy categories, adult or pet involvement, or unspecified disposition. National estimates were calculated with National Electronic Injury Surveillance System sample weights. Outcome of interest was severe injury proportions per age and toy category. Severe injury was defined as life- or limb-threatening injuries or injuries requiring admission. χ2 test was used to analyze the distribution of categorical variables.

Results

We analyzed 1360 injuries. The majority occurred in female (n = 771, 56.7%) and ages of 3 to 5 years (n = 580, 42.7%). Annual injury frequency remained stable. One fifth of injuries were severe (n = 321, 23.6%), with a national estimate of 9304.7. The majority of both total (n = 778, 57.2%) and severe injuries (n = 182, 56.7%) resulted from toy figurines. Life-threatening injury secondary to foreign body aspiration or ingestion with a risk for asphyxiation was the most common severe injury. Severe injuries were significantly more common in the younger than 3-year group (odds ratio, 3.59; 95% confidence interval, 2.40–5.36) and 3- to 5-year age group (odds ratio, 2.97; 95% confidence interval, 2.01–4.39) than the older than 5-year age group.

Conclusions

Injury frequency remained stable. The greatest proportion of injuries were in ages up to 5 years, with most injuries occurring in the 3- to 5-year age category, and a significant proportion of injuries were severe.
A Case Series of Life-Threatening Complications of Central Venous Catheter Insertion
Authors: Akkuzu Emine , Sincar Şahin , Kalkan Gökhan
Published: March 2021

Central venous catheters are commonly used in emergency department and the intensive care units for the treatment of critically ill patients. Reports on the rate of mechanical complications of catheter insertion are around 1%. Mechanical complications related with the insertion of the catheter mainly depend on the anatomic location, the use of ultrasound, and experience of the operator. The rate of complication is higher in places where central lines are not routinely inserted as in emergency department. Here, we report a case series of 4 patients who had life-threatening complications of central venous catheter insertion, including venous intimal injury leading to pleural effusion, kinked central venous catheter in the superior vena cava, knotted guidewire with the separation of coil and core, and a missed guidewire with their respective insertion history and imaging. Increasing the awareness of and developing strategies to prevent these rare but potentially fatal conditions may have impact on patient outcomes.
Upper Extremity Strengthening for an Individual With Dyskinetic Cerebral Palsy: A Case Report
Authors: Graber Laura , Senesac Claudia
Published: March 2021

Purpose:

The purpose of this case is to describe an exercise program designed for an individual with athetoid cerebral palsy who had difficulties with fine motor control and shoulder girdle stability.

Summary of Key Points:

ET is a 19-year-old man with dyskinetic-type cerebral palsy with rapidly fluctuating muscle tone and movements that preclude trunk and extremity control necessary for the effective performance of functional activities. The participant underwent a 6-week intense physical therapy program aimed at strength and stability at the shoulder girdle and fine motor movements of the hand.

Conclusions:

ET had improvements on the Performance of Upper Limb Scale, myometry, and from family report after 6 weeks.

Recommendations:

A progressive exercise program aimed at improving proximal stability and fine motor function might be an appropriate intervention for persons with athetoid cerebral palsy.

Video Abstract:

For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A315.
Predictive Value of Time–Space Clusters for HIV Transmission in Washington State, 2017–2019
Authors: Erly Steven J. , Naismith Kelly , Kerani Roxanne , Buskin Susan E. , Reuer Jennifer R.
Published: March 2021

Background:

Pillar 4 of the United States' End the HIV Epidemic plan is to respond quickly to HIV outbreaks, but the utility of CDC's tool for identifying HIV outbreaks through time–space cluster detection has not been evaluated. The objective of this evaluation is to quantify the ability of the CDC time–space cluster criterion to predict future HIV diagnoses and to compare it to a space–time permutation statistic implemented in SaTScan software.

Setting:

Washington State from 2017 to 2019.

Methods:

We applied both cluster criteria to incident HIV cases in Washington State to identify clusters. Using a repeated-measures Poisson model, we calculated a rate ratio comparing the 6 months after cluster detection with a baseline rate from 24 to 12 months before the cluster was detected. We also compared the demographics of cases within clusters with all other incident cases.

Results:

The CDC criteria identified 17 clusters containing 192 cases in the 6 months after cluster detection, corresponding to a rate ratio of 1.25 (95% confidence interval: 0.95 to 1.65) relative to baseline. The time–space permutation statistic identified 5 clusters containing 25 cases with a rate ratio of 2.27 (95% confidence interval: 1.28 to 4.03). Individuals in clusters identified by the new criteria were more likely to be of Hispanic origin (61% vs 20%) and in rural areas (51% vs 12%).

Conclusions:

The space–time permutation cluster analysis is a promising tool for identification of clusters with the largest growth potential for whom interruption may prove most beneficial.
Effects of Mandibular Distraction Osteogenesis on Three-Dimensional Upper Airway Anatomy in Newborns Affected by Isolated Pierre Robin Sequence
Authors: Mao Zhe , Ye Liang
Published: March 2021

Background:

Effective airway management is critical to Pierre Robin Sequence treatment. The goal of this study is to assess the three-dimensional changes in airway size and shape in 117 newborns with isolated Pierre Robin sequence who underwent mandibular distraction osteogenesis.

Methods:

During the study period (11/29/2016 to 11/26/2019), 117 newborns affected by isolated Pierre Robin sequence met the inclusion criteria for the present study. All 117 included patients underwent linear distraction. Demographic variables were recorded and analyzed. Cone-beam computed tomography were performed before and after mandibular distraction osteogenesis. A systemic quantitative three-dimensional analysis of size and shape of upper airway was performed.

Results:

The mean age was 71 day (range 12 to 213). The mean weight was 3.9 kg (range 2.3–6.8). A total of 53 patients are female and 64 are male. When the distraction device was removed, the upper and lower jaws were symmetrically aligned. Pre- and post-distraction comparison clearly showed osteogenesis. For the size of the upper airway, airway volume, anteroposterior dimension of the retroglossal airway, lateral dimension of retroglossal airway, minimum retropalatal area, minimum retroglossal area, average cross-sectional area and minimum cross-sectional area increased significantly after mandibular distraction osteogenesis (P < 0.001). However, the airway length did not change significantly (P > 0.05). For the shape of the upper airway, the lateral/anteroposterior ratio in the retroglossal region and the ratio of the retropalatal airway diameter to the retroglossal airway diameter significantly decreased after mandibular distraction osteogenesis (P < 0.001). The airway uniformity significantly increased after mandibular distraction osteogenesis (P < 0.001).

Conclusion:

Mandibular distraction osteogenesis for isolated Pierre Robin sequence improved size and shape of the upper airway, further confirming mandibular osteogenesis distraction as an effective surgical modality to address the airway obstruction in newborns affected by isolated Pierre Robin sequence. Cone-beam computed tomography scanning and analysis can serve as a safe and effective examination modality for upper airway applications of PRS newborns.
Telemedicine for Sports-Related Injuries
Authors: Tam Anson , Plotsker Ethan , Kim Minji , Thaller Seth R.
Published: March 2021

Background:

Telemedicine use has expanded rapidly since the COVID-19 pandemic in order to adhere to social distancing protocols and has been met with much enthusiasm. However, less is known about the use of telemedicine in sports and exercise medicine (teleSEM) and its utility to treat emergent craniofacial injuries. Given how common facial trauma is among athletes and its possible complications, incorporation of telemedicine in sports-related injuries may prove to be quintessential for athletes and coaches.

Methods:

A comprehensive literature search of the MEDLINE, PubMed, Google Scholar, EMBASE, and Cochrane Central Register of Controlled Trials was conducted for studies published through December 2020 with multiple search terms related to telemedicine in sports and trauma care.

Results:

Overall, teleSEM is appreciated by both patients and physicians alike. Studies show that the satisfaction rate among patients and physicians are high. Sports-related telemedicine visits can help improve resource utilization and total costs. Facial trauma studies also reveal that the level of concurrency of treatment options between telemedicine visits and in-person consultations is almost perfect. Further, there are many additional ways that teleSEM can be implemented in treating injured athletes, including possible collaboration between athletic coaches and physicians as well as mobile device applications. Telemedicine may be particularly useful in treating acute injuries in low-resourced areas with limited equipment and training.

Conclusion:

Telemedicine has been widely employed for sports-related injuries and in traumatic care. Patients and providers alike have noted its utility over other methods of communication with physicians. Our findings suggest that telemedicine has a significant potential in treating sports-related injuries and improving the efficiency of diagnoses and treatments. It may enhance outcomes for participants in athletic events. This may become a key aspect of determining whether a player can return to immediate competition.
Corneal Neurotization in the Setting of Facial Paralysis: A Comprehensive Review of Surgical Techniques
Authors: Ziai Kasra , Thomas Sydnie , Weller Christopher , Lighthall Jessyka G.
Published: March 2021

Neurotrophic keratopathy is characterized by decreased corneal sensitivity, decreased reflex tearing, and poor corneal healing resulting in corneal injury. Without proper sensory innervation, the cornea undergoes continuous epithelial injury, ulceration, infection and eventually results in vision loss. In situations where patients have concomitant facial paralysis, such as after resection of a large vestibular schwannoma, the ocular health is further impaired by paralytic lagophthalmos with decreased eye closure and blink reflex, decreased tearing, and potential lower eyelid malposition. In patients with a dual nerve injury, the ocular surface is in significant danger, as there is increased environmental exposure in conjunction with the inability to sense damage when it occurs. Immediate recognition and care of the eye are critical for maintaining ocular health and preventing irreversible vision loss. The first modern corneal neurotization procedure was described in 2009. The ultimate goal in corneal neurotization is to establish sub-basal plexus regeneration via transferring a healthy nerve to the corneo-limbal region. Corneal neurotization can be achieved either via a direct transfer of healthy nerve (direct approach) or via nerve graft interpositions (indirect approach). This is an emerging concept in the treatment of neurotrophic/exposure keratitis and over the past decade multiple direct and indirect approaches have been described in the attempt to restore corneal sensation and to prevent the devastating outcomes of neurotrophic keratitis. Knowledge of these techniques, their advantages, and disadvantages is required for proper management of patients suffering from neurotrophic keratitis in the setting of facial paralysis.
Association of Surgeon Representation on NIH Study Sections With Receipt of Funding by Surgeon-scientists
Authors: Lewit Ruth A. , Black Caitlin M. , Camp Lauren , Brott Nathan , Cottrell J. Macy , Herman Timothy , Holden Kylie W. , Matthews Lynley , Schneider Elizabeth , Goldstein Allan M. , Matthews Jeffrey B. , Emamaullee Juliet , Gosain Ankush
Published: March 2021

Objective:

Our goal was to evaluate the relationship between surgeon representation on NIH study sections and success in grant funding.

Summary of Background Data:

NIH funding for surgeon-scientists is declining. Prior work has called for increased surgeon participation in the grant review process as a strategy to increase receipt of funding by surgeon-scientists.

Methods:

A retrospective review of surgeon (primary department: General, Urology, Orthopedic, Ophthalmology, Otolaryngology, Neurosurgery) representation on NIH study sections and receipt of funding was performed using NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) and 2019 Blue Ridge Institute for Medical Research data. NIH chartered study section panels and ad hoc reviewers for each 2019 review date were also obtained.

Results:

In 2019, 9239 individuals reviewed in at least 1 of the 168 study sections [190 (2.1%) surgeons, 64 (0.7%) standing members, 126 (1.4%) ad-hoc]. Most surgeons on study sections were male (65%) professors (63%). Surgeons most commonly served on bioengineering, technology, and surgical sciences (29.6% surgeons), diseases and pathophysiology of the visual system (28.3%), and surgery, anesthesiology and trauma (21%). In 2019, 773 surgeons received 1235 NIH grants (>$580 M) out of a total of 55,012 awards (2.2%). Funded surgeons were predominantly male (79%), White (68%), non-Hispanic (97%), full professors (50%), and 43% had additional advanced degrees (MPH/PhD/MBA). surgery, anesthesiology and trauma, diseases and pathophysiology of the visual system, and bioengineering, technology, and surgical sciences were the most common study sections that reviewed funded grants to surgeon-scientists. Ninety-two surgeons both received grant funding and served on study section. Study sections with higher surgeon representation were more likely to fund surgeon-scientists (P < 0.001).

Conclusions:

Surgeon representation on NIH study sections is strongly associated with receipt of funding by surgeon-scientists. Increasing NIH study section representation by surgeons may help to preserve the surgeon-scientist phenotype.
Effects of Advanced Practice Providers on Single-specialty Surgical Practice
Authors: Hollenbeck Brent K. , Kaufman Samuel R. , Oerline Mary , Modi Parth K. , Caram Megan E. V. , Shahinian Vahakn B. , Ellimoottil Chad
Published: March 2021

Objective:

To assess the effects of adding advanced practice providers to surgical practices on surgical complications, readmissions, mortality, episode spending, length of stay, and access to care.

Summary Background Data:

There has been substantial growth in the number of nurse practitioners and physician assistants (ie, advanced practice providers) in the United States. The extent to which advanced practice providers have been integrated into surgical practice, and their impact on surgical outcomes and access is unclear.

Methods:

Using a 20% sample of national Medicare claims, we performed a retrospective cohort study of fee-for-service beneficiaries undergoing one of 4 major procedures (coronary artery bypass graft, colectomy, major joint replacement, and cystectomy) between 2010 and 2016. We limited our study population for each procedure to patients treated by single-specialty surgical groups to ensure that the advanced practice providers have direct interactions with its surgeons and patients. All outcomes were measured at the practice level for the year before and the year after the addition of the first advanced practice provider. Outcomes included: complications, readmission, mortality, episode payments, length of stay. Models were adjusted for age, race, sex, comorbidity, socioeconomic class and procedure type. Secondary outcome: practice-level office visits by surgical group type.

Results:

The number of advanced practice providers increased by 13%, from 6713 to 7596 between 2010 and 2016. The largest relative increases occurred in general (46.9%) and urologic (27.6%) surgical practices. The year after an advanced practice provider was added to a surgical practice, the odds of complications were 17% and 16% lower at 30- and 90-days postprocedure, respectively. Additionally, 90-day readmissions were 18% less likely and length of stay was 0.33 days shorter (a 7.1% reduction). Average 30-day and

90-day episode spending was $1294.73 and $1427.76 lower, respectively (P < 0.001). General surgical, orthopedic, and urology practices realized increases of 49.0 (95% CI 13.5–84.5), 112.0 (95% CI 83.0–140.5), and 205.0 (95% CI 117.5–292.0) in-office visits per surgeon, respectively.

Conclusions:

The addition of advanced practice providers to single-specialty surgical groups is associated with improvements in surgical outcomes and access. Future work should clarify the mechanisms by which advanced practice providers within surgical practices contribute to health outcomes to identify best practices for deployment.
Angiotensin II Type 1 Receptor Antibody-mediated Rejection Following Orthotopic Heart Transplant: A Single-center Experience
Authors: Moreno Jonathan D. , Verma Amanda K. , Kopecky Benjamin J. , Dehner Carina , Kostelecky Nicolas , Vader Justin M. , Lin Chieh-Yu , Schilling Joel D.
Published: March 2021

Background.

Antibody-mediated rejection (AMR) following orthotopic heart transplant (OHT) causes significant morbidity and mortality. There are limited data on antibodies to the angiotensin II type 1 receptor antibody (AT1R-Ab) causing rejection following OHT.

Methods.

This is a retrospective, single-center study that presents our 2-y experience with a series of 11 patients with evidence of nonspecific graft dysfunction and pathologic levels of AT1R-Ab. The clinical outcomes and treatments were compared to a group of 10 patients, also with evidence of nonspecific graft dysfunction, but who had nonsignificant AT1R-Ab titers.

Results.

The mean age of the AT1R-Ab cohort was 52% and 73% were bridged to transplant with an left ventricular assist device. The average left ventricular ejection fraction at presentation was 45%, and most were not on an angiotensin receptor blocker (ARB). Endomyocardial biopsies in those with elevated AT1R-Ab levels frequently showed reactive endothelium/endocardium without C4d or intravascular CD68 staining. Ten patients (91%) were started on an ARB. Other therapies included plasmapheresis and IVIg (64%), with 4 patients also receiving rituximab. Most patients had symptom improvement, but minimal change in graft function at an average 6 mo of follow-up.

Conclusions.

The role of AT1R-Ab-mediated rejection in OHT recipients remains poorly understood. More than half of patients at our center who presented with graft dysfunction in the absence of acute cellular rejection or AMR were found to have elevated AT1R-Ab titers. Empiric AMR treatment in conjunction with ARB therapy may improve patient outcomes. Future studies are needed to better define the optimal treatment modalities for ATR1-Ab-mediated AMR.