bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study
Authors: Harrell Shreckengost Constance S. , Foianini Jorge Esteban , Moron Encinas Karen Milenka , Tola Guarachi Hugo , Abril Katrina , Amin Dina , Berkowitz David , Castater Christine Aisha , Douglas J. Miller , Grant April A. , Khullar Onkar Vohra , Lane Andrea Nichole , Lin Alice , Niroula Abesh , Nizam Azhar , Rashied Ammar , Reitz Alexandra W. , Roser Steven M. , Spychalski Julia , Arap Sérgio Samir , Bento Ricardo Ferreira , Ciaralo Pedro Prosperi Desenzi , Imamura Rui , Kowalski Luiz Paulo , Mahmoud Ali , Mariani Alessandro Wasum , Menegozzo Carlos Augusto Metidieri , Minamoto Hélio , Montenegro Fábio Luiz M. , Pêgo-Fernandes Paulo Manoel , Santos Jones , Utiyama Edivaldo Massozo , Sreedharan Jithin K. , Kalchiem-Dekel Or , Nguyen Jonathan , Dhamsania Rohan K. , Allen Kerianne , Modzik Adrian , Pathak Vikas , White Cheryl , Blas Juan , Talal El-Abur Issa , Tirado Gabriel , Yánez Benítez Carlos , Weiser Thomas G. , Barry Mark , Boeck Marissa , Farrell Michael , Greenberg Anya , Miller Phoebe , Park Paul , Camazine Maraya , Dillon Deidre , Smith Randi N.
Published: February 2023

Objectives:

Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either “early” (within 14 d of intubation) or “late” (more than 14 d after intubation).

Design:

International multi-institute retrospective cohort study.

Setting:

Thirteen hospitals in Bolivia, Brazil, Spain, and the United States.

Patients:

Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021.

Interventions:

Not applicable.

Measurements and Main Results:

A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, −16 to −8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, −23 to −9 d; p < 0.001) and 22 days (95% CI, −31 to −12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8−5.2). Differences in 90-day post-admission survival were not identified.

Conclusions:

COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.
Organ Donation From Patients on Extracorporeal Membrane Oxygenation at the Time of Death
Authors: Fainberg Nina A. , Morrison Wynne E. , West Sharon , Hasz Richard , Kirschen Matthew P.
Published: February 2023

OBJECTIVES:

To describe the clinical characteristics and organ donation rate of patients supported by extracorporeal membrane oxygenation (ECMO) at the time of death.

DESIGN:

Retrospective observational study. Pearson chi-square and Fisher exact tests were used in statistical analyses.

SETTING:

One hundred twenty-seven acute care hospitals in New Jersey, Pennsylvania, and Delaware.

PATIENTS:

Adult and pediatric patients who were on ECMO at the time of referral to a large organ procurement organization (OPO) between 2016 and 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Nineteen thousand nine hundred thirty patients were referred to the OPO between November 2016 and September 2020, of which 5,034 were medically suitable potential donors. Of this cohort, 143 patients were supported on ECMO at the time of OPO referral and 141 were included in analyses (median age 47 yr, 60% male). Thirty-three percent (46/141, median age 48 yr, 52% male) donated organs, compared with 50% of non-ECMO patients (p ≤ 0.0005). ECMO and non-ECMO patients had organs recovered but not transplanted at similar rates (11% vs 10%, p = 0.8). There were no significant differences in sex (p = 0.16) or ethnicity (p = 0.50) between organ donor and nondonor groups. Fifty-one percent (21/41) of organ donors donated after circulatory death and 49% (20/41) after brain death. Patients declared dead by neurologic criteria were more likely to donate (51%) than those declared dead by circulatory criteria (21%, p < 0.001). Frequency of cardiac arrest prior to ECMO was similar between donors and nondonors (p = 0.68). Thirty-nine percent (16/41) of donors had an out-of-hospital cardiac arrest (OHCA) and 51% (21/41) were cannulated via extracorporeal cardiopulmonary resuscitation (ECPR). The most common reason patients were not donors was that family declined (57%).

CONCLUSIONS:

One-third of patients referred to the OPO on ECMO at the time of death donated organs. While donation occurred less frequently after ECMO, ECMO and non-ECMO patients had organs used rather than discarded at a similar rate. Patients successfully donated following OHCA and/or ECPR. Clinicians should not consider ECMO a barrier to organ donation.
Nutritional Support in Children Meeting the At-Risk for Pediatric Acute Respiratory Distress Syndrome Criteria
Authors: Pei Theodore T. , Shein Steven L. , Cheifetz Ira M. , Slain Katherine N.
Published: February 2023

IMPORTANCE:

Pediatric acute respiratory distress syndrome (PARDS) is a prevalent condition in the PICU with a high morbidity and mortality, but effective preventative strategies are lacking.

OBJECTIVES:

To examine associations between early enteral nutrition (EN) and PICU outcomes in a cohort of children meeting the 2015 Pediatric Acute Lung Injury Consensus Conference “at-risk” for pediatric acute respiratory distress syndrome (ARF-PARDS) criteria.

DESIGN, SETTING, AND PARTICIPANTS:

This was a single-center, electronic health record-based retrospective chart review. We included children less than or equal to 18 years-old admitted to our mixed medical-surgical PICU from January 2017 to December 2018 who met ARF-PARDS criteria within 48 hours of admission. Children were categorized as receiving “early” EN if feeds were initiated within 48 hours of admission. All others were categorized as “delayed” EN.

MAIN OUTCOMES AND MEASURES:

Extracted data included demographics, illness characteristics including primary diagnosis and Pediatric Risk of Mortality (PRISM) III score, respiratory support and oxygenation indices, nutritional data, and PICU length of stay (LOS). The primary outcome of interest was subsequent diagnosis of PARDS.

RESULTS:

Of 201 included children, 152 (75.6%) received early EN. The most common admission diagnoses were pneumonia, bronchiolitis, and influenza. Overall, 21.4% (n = 43) of children developed PARDS. Children receiving early EN had a subsequent diagnosis of PARDS less often then children receiving delayed EN (15.1% vs 40.8%; p < 0.001), an association that persisted after adjusting for patient demographics and illness characteristics, including PRISM III and diagnosis (adjusted odds ratio, 0.24; 95% CI, 0.10–0.58; p = 0.002). Early EN was also associated with a shorter PICU LOS in univariate analysis (2.2 d [interquartile range, 1.5–3.4 d] vs 4.2 d [2.7–8.9 d]; p < 0.001).

CONCLUSIONS AND RELEVANCE:

In this single-center, retrospective cohort study, compared with children with ARF-PARDS who received late EN, those who received early EN demonstrated a reduced odds of subsequent diagnosis of PARDS, and an unadjusted reduction in PICU LOS when compared with delayed EN. Prospective studies should be designed to confirm these findings.
Hospital Strain and Variation in Sepsis ICU Admission Practices and Associated Outcomes
Authors: Anesi George L. , Dress Erich , Chowdhury Marzana , Wang Wei , Small Dylan S. , Delgado M. Kit , Bayes Brian , Barreda Fernando X. , Halpern Scott D. , Liu Vincent X.
Published: February 2023

OBJECTIVES:

To understand how strain-process-outcome relationships in patients with sepsis may vary among hospitals.

DESIGN:

Retrospective cohort study using a validated hospital capacity strain index as a within-hospital instrumental variable governing ICU versus ward admission, stratified by hospital.

SETTING:

Twenty-seven U.S. hospitals from 2013 to 2018.

PATIENTS:

High-acuity emergency department patients with sepsis who do not require life support therapies.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The mean predicted probability of ICU admission across strain deciles ranged from 4.9% (lowest ICU-utilizing hospital for sepsis without life support) to 61.2% (highest ICU-utilizing hospital for sepsis without life support). The difference in the predicted probabilities of ICU admission between the lowest and highest strain deciles ranged from 9.0% (least strain-sensitive hospital) to 45.2% (most strain-sensitive hospital). In pooled analyses, emergency department patients with sepsis (n = 90,150) experienced a 1.3-day longer median hospital length of stay (LOS) if admitted initially to the ICU compared with the ward, but across the 27 study hospitals (n = 517-6,564), this effect varied from 9.0 days shorter (95% CI, –10.8 to –7.2; p < 0.001) to 19.0 days longer (95% CI, 16.7–21.3; p < 0.001). Corresponding ranges for inhospital mortality with ICU compared with ward admission revealed odds ratios (ORs) from 0.16 (95% CI, 0.03–0.99; p = 0.04) to 4.62 (95% CI, 1.16–18.22; p = 0.02) among patients with sepsis (pooled OR = 1.48).

CONCLUSIONS:

There is significant among-hospital variation in ICU admission rates for patients with sepsis not requiring life support therapies, how sensitive those ICU admission decisions are to hospital capacity strain, and the association of ICU admission with hospital LOS and hospital mortality. Hospital-level heterogeneity should be considered alongside patient-level heterogeneity in critical and acute care study design and interpretation.
The Role of Signaling Pathways in Pancreatic Cancer Targeted Therapy
Authors: Zhuo Fangfang , Luo Shuang , He Wei , Feng Zhanhui , Hu Ya’nan , Xu Jingxia , Wang Zejun , Xu Jianwei
Published: February 2023

Signaling pathways play significant roles in the occurrence, development, and treatment of pancreatic cancer (PC). The main treatment options are surgery, chemotherapy, radiotherapy, arterial infusion chemotherapy in interventional therapy, and immunotherapy. Many studies have shown that signaling pathways perform a function in the occurrence and development of PC, for instance, phosphoinositide 3-kinase (PI3K)/AKT, nuclear factor-κB, Ras, interleukin (IL)-17B/IL-17RB, Wnt, and hepatocyte growth factor/c-MET, which play roles in the proliferation, metastasis, invasion, inhibition of apoptosis, promotion of angiogenesis, and drug resistance of PC. Interaction of signaling pathways has an impact on the biological behavior of PC; for example, activation of the neurotensin/NTSR1 pathway, which can activate mitogen-activated protein kinase, nuclear factor-κB, and other pathways related to PC stem cells, play an important role in PC, and an increase in their number is associated with the Wnt/β-catenin and PI3K pathways. Chemotherapy is the main method for the treatment of PC, but drug resistance limits its use. In addition, abnormal activation of IL-17B/IL-17RB signaling pathway is associated with drug resistance. This article discusses the signaling pathways that play different roles in the occurrence and development of PC, as well as current research on signaling pathways in PC treatment.
The Effect of a Home-delivered Protein-rich Meal Service on Quality of Life in Oncological Patients Undergoing Chemotherapy
Authors: IJmker-Hemink Vera E. , Kooijman Nina , Kamm Yvonne J. L. , Koornstra Rutger H. T. , Timmer-Bonte Johanna N. H. , Wanten Geert J. A. , van den Berg Manon G. A.
Published: February 2023

Background:

Patients undergoing oncological treatment may experience a variety of symptoms that interfere with their ability to eat and enjoy meals. This compromises their nutritional status and impairs quality of life (QOL).

Objective:

Compare a home-delivered protein-rich service as a therapeutic measure to patients undergoing chemotherapy with usual care.

Methods:

Randomized clinical trial enrolling patients (n = 148) receiving chemotherapy. The intervention group received 6 protein-rich dishes per day for 3 weeks, the control group maintained their usual diet. QOL, energy and protein intake, nutritional and functional status, physical performance, symptom burden, and caregiver QOL were assessed.

Results:

No difference in QOL was found between the groups but QOL in the gastrointestinal and gynecological tumor groups increased by 8.4 points (95% confidence interval [CI] 1.0-15.8; P < .05) after the intervention, while scores in other tumor groups did not change. Significant effects were observed in energy intake (21%; 95% CI 10.4-32.1) and Short Physical Performance Battery (0.28; 95% CI 0.2-0.8) in the intervention group.

Conclusions:

In patients with cancer undergoing chemotherapy, a home-delivered protein-rich meal service did not improve QOL for the total group but QOL significantly improved in the subpopulation with abdominal cancer.

Implications for Practice:

Future research should focus on vulnerable patients with a high risk for malnutrition and symptoms, such as gastrointestinal and gynecological malignancies, considering the beneficial results in this subgroup.

Foundational:

A home-delivered protein-rich meal service is feasible in patients with cancer while undergoing chemotherapy. QOL increased in gastrointestinal and gynecological cancer patients receiving this meal service.
Different behaviour of target-controlled infusion pumps despite apparently using the same Schnider pharmacokinetic model
Authors: Soehle Martin , Wolter Andreas , Thudium Marcus , Frede Stilla , Coburn Mark
Published: February 2023

BACKGROUND

Target-controlled infusion (TCI) pumps deliver an initial bolus of drug to achieve a preset drug target concentration quickly.

OBJECTIVE

We investigated whether differences exist in the initial bolus dose between different TCI pumps despite apparently using the same pharmacokinetic (PK) model.

DESIGN

Observational study.

SETTING

Laboratory data from a German University Hospital. Experiments were performed between February 2019 and September 2020.

PARTICIPANTS

Four TCI pumps set to the Schnider model in effect-site mode with a target propofol concentration of 3.5 μg ml−1 were studied. The algorithms of two pumps employed a fixed equilibration rate constant (k
e0) of 0.456 min−1 (Perfusor® Space® and Injectomat TIVA Agilia®), while the other two used a fixed time to peak concentration (t
peak) of 1.6 min (Alaris® PK and Syramed® μSP6000). Pump performance was assessed on 13 virtual patients with different combinations of age, sex, height and weight: the initial propofol dose injected was measured on a high precision scale.

MAIN OUTCOME MEASURES

Propofol bolus dose, as if delivered for anaesthesia induction.

RESULTS

A small difference in propofol bolus doses was observed for some simulations: for example, 56.4 ± 1.2 and 59.7 ± 0.2 mg with a Syramed μSP6000 and an Alaris pharmacokinetic pump, respectively, in a virtual 54-year old man with a height of 170 cm and a weight of 74 kg. In contrast, significant differences were found in other simulated patients: for example, 72.0 ± 1.0 and 111.9 ± 1.2 mg (P < 0.001) using a Perfusor Space and an Alaris TCI pump in a virtual 60-year-old, obese man with a height of 182 cm and a weight of 139 kg.

CONCLUSIONS

Discrepancies in the initial bolus dose can be explained by differences in k
e0. Anaesthetists should be aware that differences exist in the implementation of the Schnider model between manufacturers, which could lead to disparities in the initial propofol bolus in some patients.
Inherited genetic effects on arsenic metabolism: A comparison of effects on arsenic species measured in urine and in blood
Authors: Tamayo Lizeth I , Kumarasinghe Yohhan , Tong Lin , Balac Olgica , Ahsan Habibul , Gamble Mary , Pierce Brandon L
Published: February 2023

Inorganic arsenic (iAs) is a carcinogen, and chronic exposure is associated with adverse health outcomes, including cancer and cardiovascular disease. Consumed iAs can undergo two methylation reactions catalyzed by arsenic methyltransferase (AS3MT), producing monomethylated and dimethylated forms of arsenic (MMA and DMA). Methylation of iAs helps facilitate excretion of arsenic in urine, with DMA composing the majority of arsenic species excreted. Past studies have identified genetic variation in the AS3MT (10q24.32) and FTCD (21q22.3) regions associated with arsenic metabolism efficiency (AME), measured as the proportion of each species present in urine (iAs%, MMA%, and DMA%), but their association with arsenic species present in blood has not been examined. We use data from three studies nested within the Health Effects and Longitudinal Study (HEALS)—the Nutritional Influences on Arsenic Toxicity Study, the Folate and Oxidative Stress study, and the Folic Acid and Creatine Trial—to examine the association of previously identified genetic variants with arsenic species in both urine and blood of 334 individuals. We confirm that the genetic variants in AS3MT and FTCD known to effect arsenic species composition in urine (an excreted byproduct of metabolism) have similar effects on arsenic species in blood (a tissue type that directly interacts with many organs, including those prone to arsenic toxicity). This consistency we observe provides further support for the hypothesis the AME SNPs identified to date impact the efficiency of arsenic metabolism and elimination, thereby influencing internal dose of arsenic and the dose delivered to toxicity-prone organs and tissues.
Oral manifestations and management of sickle cell disease: a literature review
Authors: Soualem Hajar , Mainassara Samir , Beenjelloun Laila , Chbicheb Saliha
Published: February 2023

Sickle cell disease (SCD) is an autosomal recessive hematological disorder that results in defective red blood cells (RBCs). These RBCs become sickled in shape, have a shortened lifespan leading to vascular occlusion and ischemia resulting in damaging effect on many organs throughout the body. There are numerous oral manifestations of SCD, although some may not be specific to SCD, it is important to recognize these clinical presentations and have a good understanding of the disease process to help in management of SCD from an oral health care perspective. The oral care of sickle cell patients requires specific precautions such as good management of local anaesthetics, rigorous anti-infective prophylaxis as well as controlled prescription of analgesics.
Willingness and associated factors of comprehensive abortion services provision by health care professionals in selected public health facilities of Addis Ababa, Ethiopia
Authors: Sahile Addisu T. , Bekele Getabalew E. , Bibiso Kidist , Gebremariam Zewdu M.
Published: February 2023

Background:

Globally, abortion-related maternal deaths significantly decreased, but the opposite was true for Sub-Saharan Africa, where there was a significant increment in abortion-related maternal deaths. Health care providers are in constant conflict with the legalization of abortion, for viewing induced abortion as immoral.

Objective:

To assess the willingness and associated factors of comprehensive abortion care among health care professionals in Public health facilities of Bole Sub-City, Addis Ababa, Ethiopia, 2021.

Methods:

An institution-based cross-sectional study was undertaken among 367 health care professionals from April 1 to August 30, 2021. Willingness was measured as willing and not willing, as well as the level of agreement to provide abortion care under justifiable conditions. The data were collected by a structured and pretested self-administered questionnaire. Binary (bivariate and multivariate) logistics regression was used for the identification of predictors of willingness with its respective 95% CI and a P-value of <0.05 statistically significant levels. The finding was presented in texts and tables.

Findings:

A total of 367 study participants were involved in the study giving a response rate of 100%. The overall level of willingness was 42.3% (95% CI: 37.25%–47.35%). Being male [adjusted odds ratio (AOR): 1.987, 95% CI: 1.111–3.551, P<0.05], having a lower weekly religious attendance (AOR: 2.88; 95% CI: 1.687–4.930, P<0.001), and perceiving unsafe abortion as a health problem (AOR: 6.15; 95% CI: 3.79–9.97; P<0.05) were predictors associated with an increased level of willingness.

Conclusions and Recommendations:

A low level of willingness to provide comprehensive abortion was observed in the study. Being male, having a lower religious attendance, and having the perception that unsafe abortion is a health problem were predictors associated with an increased level of willingness to provide comprehensive abortion care. Stakeholders, government, and policymakers were recommended to work on the identified predictors of willingness in the study settings.
Observational analysis of criteria for a difficult airway alert
Authors: Milne Andrew D. , Dobson Gregory R. , Forbes Stewart J.
Published: February 2023

Introduction:

Difficult airway alerts are a tool used to document difficulties encountered with the patient’s airway and assist with future management. There is no universally accepted criterion as to who should get a difficult airway alert and the indication for these alerts may be changing with the proliferation of videolaryngoscopes. The purpose of this study was to characterize the airway events that were encountered in patients who had been assigned a difficult airway alert by staff anesthesiologists.

Methods:

This retrospective study analyzed the airway details of patients who were assigned a difficult airway letter at an academic teaching institution between November 2011 and January 2016. Electronic records of intraoperative airway management and difficult airway letters were reviewed for the methods used, difficulties encountered, and what recommendations were provided for future airway management.

Results:

A cohort of 107 adult patients (62 males and 45 females) issued difficult airway letters identified for analysis. The mean age (SD) of the cohort was 57 (±13) years, and the mean body mass index was 31 (±7) kg/m2. Direct laryngoscopy failed in 68 of 89 cases, with 77 reported grade III views and 9 grade IV views. Videolaryngoscopy (VL) was used successfully in 63 cases, with 8 documented VL failures. Ten patients were intubated awake with a flexible bronchoscope (FB), and 6 cases were managed using an asleep FB technique. The most common methods suggested for future airway management were VL (57 cases) or either awake or asleep FB (31 cases).

Conclusions:

Patients with difficult direct laryngoscopy were predominant in this cohort who were assigned a difficult airway alert. Many of the difficult airways were successfully managed using VL, however, FB was required in some cases. Staff preferentially recommended VL over flexible bronchoscopy for future management of the known difficult airway.
Autoimmune Neutropenias: Update on Clinical and Biological Features in Children and Adults
Authors: Fioredda Francesca , Dufour Carlo , Höglund Petter , Papadaki Helen A , Palmblad Jan
Published: February 2023

The definition of autoimmune neutropenias (AIN) has been based on the demonstration of autoantibodies directed to various epitopes on blood neutrophils. However, this definition is probably too limited and excludes neutropenias (NPs) with a negative autoantibody test but with other phenomena that indicate an underlying autoimmune process. Examples of such AINs may be complete or incomplete systemic lupus erythematosus or other autoimmune diseases where NP is common but patients may not fulfill formal diagnostic criteria for a rheumatic disease. Recently, various inherited immune-dysregulation syndromes, such as those related to variants in, for example, TACI, BAFFR, ACKR1/DARC, LRBA, CTLA 4 genes, with dysregulated B- and T-lymphocyte functions, have been associated with concomitant AINs. Cellular immune mechanisms may also play a prominent role in the development of NP, in the presence or not of autoantibodies, in cases of large granular lymphocyte syndromes of T- and NK-cell types or in chronic idiopathic NP, particularly in adults with T-cell clonal populations. The course of AIN may differ according to age, being transient and rather uncomplicated in children, and chronic with treatment requirement in adolescents and adults. This review discusses current knowledge of AINs, including diagnostic procedures, treatments, and prognosis.
Steroid hormone regulation of immune responses in cancer
Authors: Anderson Ana C. , Acharya Nandini
Published: February 2023

Steroid hormones are derived from cholesterol and can be classified into sex hormones (estrogens, androgens, progesterone) that are primarily synthesized in the gonads and adrenal hormones (glucocorticoids and mineralocorticoids) that are primarily synthesized in the adrenal gland. Although, it has long been known that steroid hormones have potent effects on the immune system, recent studies have led to renewed interest in their role in regulating anti-tumor immunity. Extra-glandular cells, such as epithelial cells and immune cells, have been shown to synthesize glucocorticoids and thereby modulate immune responses in the tumor microenvironment. Additionally, new insight into the role of androgens on immune cell responses have shed light on mechanisms underpinning the observed sex bias in cancer survival outcomes. Here, we review the role of steroid hormones, specifically glucocorticoids and androgens, in regulating anti-tumor immunity and discuss how their modulation could pave the way for designing novel therapeutic strategies to improve anti-tumor immune responses.
Multiple Cases of Facial Disfigurement From Filler Use and One Injector
Authors: Parikh Alomi O. , Conger Jordan R. , Sibug Saber Maria E. , Samimi David , Burnstine Michael A.
Published: February 2023

Purpose:

To present a case of facial disfigurement from an injectable permanent filler and describe the consequences to patients exposed to the same injector (common source outbreak).

Methods:

Case report and discussion of a common source outbreak after a group of persons developed complications years after permanent filler given by one injector.

Results:

A 39-year-old transgender model underwent polymethylmethacrylate (Artefill) facial filler injections to the lips, cheeks, and chin in 2018. A year later, the patient presented to the emergency room with severe facial swelling and difficulty breathing. Treatments have included 4 surgeries to remove filler and scar tissue and chronic low-dose oral steroid therapy. Upon questioning the patient, 6 additional people suffered from similar facial swelling years after injection by the same injector. The injector cannot be located.

Conclusions:

Care must be taken in giving all facial fillers, particularly permanent ones. When one source patient is identified, questioning the patient’s knowledge of others affected is critical to help manage an epidemic problem and to report a rogue injector. Physicians have a duty to investigate and report such cases.
Severity stages of chronic nodular prurigo: analysis of associated itch intensity and quality of life impairment
Authors: Zeidler Claudia , Pereira Manuel P. , Storck Michael , Suer Aysenur , Ständer Sonja
Published: February 2023

Introduction:

Chronic nodular prurigo (CNPG) is a pruritic neuroinflammatory skin disease characterized by the presence of multiple pruriginous nodules. Previous psychometric analyzes showed the presence of moderate to severe pruritus and a considerable impairment of quality of life. A detailed study of these parameters in relation to the severity of the disease defined by the number of lesions is lacking.

Methods:

A total of 131 adult patients with CNPG were included. The number of pruriginous lesions and disease stage was determined by using the Prurigo Activity and Severity (PAS) scale and the prurigo-specific Investigator’s Global Assessment (IGA) scale. Patient-reported outcomes comprised pruritus intensity (worst itch intensity of the previous 24 h using the numerical rating scale; WI-NRS/24 h) and the impairment of quality of life (ItchyQol, Dermatology Life Quality Index; DLQI).

Results:

The counted and estimated number of pruriginous nodules correlated strongly with each other (r=0.82; P<0.001), moderately with the WI-NRS/24 h (counted number: r=0.44, P<0.001; estimated number: r=0.45, P<0.001) and with the DLQI score (counted number: r=0.40, P<0.001; estimated number: r=0.38, P<0.001). The severity groups of the CNPG, as defined by the IGA scale, correlated strongly with the WINRS/24 h and DLQI scores. With increasing severity of CNPG, increasing pruritus intensity and DLQI/ItchyQoL scores were recorded.

Conclusion:

The correlation between objective (disease stage) and subjective (itch intensity, quality of life) CNPG disease parameters argues for a representative disease severity characterization via physician assessments using either PAS or IGA.
Wavefront-guided PRK treatment of myopia using a refractive aberrometer
Authors: Hofmeister Elizabeth M. , Cason John B. , Murdoch Donna M. , Yau Irene W. , Wang Ying , Parizadeh Dari D. , Janakiraman Devi Priya , Kasthurirangan Sanjeev
Published: February 2023

Purpose:

To evaluate the safety, effectiveness, and patient-reported outcomes of wavefront-guided photorefractive keratectomy (PRK) for the correction of myopic refractive errors with and without astigmatism.

Setting:

U.S. multicenter study.

Design:

Prospective, nonrandomized clinical investigation.

Methods:

334 eyes (167 patients) underwent wavefront-guided PRK with the STAR S4 IR Excimer Laser System. Patients had preoperative myopic refractive errors with sphere up to −8.00 diopters (D) and cylinder up to −4.00 D with a maximum spherical equivalent (SE) of −10.00 D. All eyes were targeted for emmetropia, and treatment plans were derived from the iDESIGN system wavefront measurements.

Results:

At 6 months, the point of refractive stability, 99.4% of eyes achieved 20/20 or better uncorrected distance visual acuity (UDVA), 92% of eyes achieved 20/16 or better UDVA, 85.5% of eyes achieved manifest refraction SE (MRSE) within 0.50 D of target, mean SE was −0.06, and less than 1% of eyes lost more than 2 lines of corrected distance visual acuity. Glare and halos occurred with similar or lower frequencies at 6 months vs preoperative. Results from the National Eye Institute Refractive Error Quality of life questionnaire showed statistically significant improvements at 6 months vs preoperative across most measures of vision-related functioning and well-being. Approximately 98% of patients reported high satisfaction with their overall vision at 6 months.

Conclusions:

Wavefront-guided PRK with the iDESIGN aberrometer was safe, effective, and predictable for the correction of low to moderate myopia with and without astigmatism and led to high patient satisfaction.
Development and Implementation of a Practical Onboarding Curriculum for Physician Quality and Safety Leaders
Authors: Naureckas Li Caitlin , Leya Gregory A. , Mort Elizabeth , Aaronson Emily , Gartland Rajshri M.
Published: February 2023

Physicians are increasingly asked to assume quality and safety (Q&S) leadership roles; prior experience varies, and onboarding training is limited. Semistructured interviews were completed with physician Q&S leaders; interview responses were analyzed using 2-step rapid analysis. Interview learnings informed development of a 2-day onboarding training and complementary digital resource repository. Attendees were surveyed to evaluate the training. Thirteen semistructured interviews with physician leaders from 6 academic medical centers demonstrated 61.5% had no formal Q&S training before assuming their role. Respondents identified a range of knowledge gaps. A 2-day virtual onboarding training and complementary digital repository were created. Attendee surveys demonstrated 96% (73/76) believed the training would be “extremely” or “moderately” helpful to others. Subject-matter familiarity across all content areas improved after the training. Using front-line stakeholder input, a pilot onboarding curriculum for Q&S leaders was created. Future work includes ongoing implementation and iterative improvement.
Capillary Malformation-Arteriovenous Malformation Type 2, A Report of 6 Cases and Main Differential Diagnosis
Authors: Cordisco Maria Rosa , El-Feghaly Jinia , Prezzano James C. , Lanöel Agustina , Torres Natalia , Persico Susana , Requejo Flavio , Sierre Sergio , Fiandrino María José , Luna Laura , Maccario Maria Fernanda , Brouillard Pascal , Vikkula Miikka
Published: February 2023

Objectives:

Capillary malformation-arteriovenous malformation (CM-AVM) is a rare disorder characterized by multifocal CMs associated with AVMs. While the phenotype of CMAVM1 has been well established in the literature, there are limited published reports documenting the clinical features of CMAVM2. Our aim is to highlight this phenotype, and the distinctive features of CMAVM2 compared with CMAVM1 and hereditary hemorrhagic telangiectasia, as prompt recognition is crucial to screen for fast-flow vascular malformations, which, if left untreated, can sometimes be life-threatening.

Methods:

This is a retrospective review of cases seen at multiple tertiary care centers in the United States and Argentina.

Results and Conclusions:

We report 6 pediatric patients with CMAVM2 presenting with diffuse multifocal cutaneous CMs, telangiectases favoring the lips, perioral area and upper trunk, and Bier spots. Three patients had epistaxis. One patient had an extracranial AVM and 1 patient had Parkes Weber syndrome. EPHB4 pathogenic variants were identified in all patients. CMAVM2 remains an underrecognized condition. Genetic testing and imaging studies are recommended to guide management.
Spontaneous thrombolysis of an unruptured intracranial aneurysm with spontaneous thrombosis
Authors: Xia Junyang , Pan Haojun , Jiang Xin , Liu Peipei
Published: February 2023

Background:

Spontaneous thrombolysis of unruptured intracranial aneurysm with spontaneous thrombosis is rare and its significance remains unclear. To date, there are no published reports of spontaneous thrombolysis prior to growth of unruptured intracranial aneurysm with spontaneous thrombosis.

Methods:

We described a 65-year-old man with a chief complaint of mild weakness and numbness in the left limbs. He had a smoking history of 20 years. Then he was diagnosed having unruptured intracranial aneurysm with spontaneous thrombosis. His cerebrovascular digital subtraction angiography conducted 30 days after his first onset revealed spontaneous thrombolysis of the unruptured intracranial aneurysm. And his following brain computed tomography scan conducted 36 days after his first onset revealed growth of the unruptured intracranial aneurysm.

Results:

The diagnosis of unruptured right fetal-type posterior cerebral artery aneurysm with spontaneous complete thrombosis was established based on the preliminary physical examination and the imaging findings. The patient underwent embolization of the aneurysm and parent artery. We followed up with the patient for 12 months after his embolization of the aneurysm and parent artery. He experienced neither aneurysm recurrence nor cerebral infarction during this period, but his were not alleviated.

Conclusion:

Spontaneous thrombolysis after spontaneous thrombosis of unruptured intracranial aneurysm is an urgent indication for isolation of the aneurysm, as it may foreshadow the growth of unruptured intracranial aneurysm.
The efficacy and safety of acupuncture and related therapies for postpartum osteitis condensans llii
Authors: Ji Haiyang , Zhang Ke , Xu Kun , Qu Yao , Shi Lechen , Zhang Tong
Published: February 2023

Background:

Osteitis condensans illi often leads to low back pain in postpartum women. At present, physical therapy and non-steroidal anti-inflammatory drugs are often used for osteitis condensans illi. Acupuncture and its related therapies have significant clinical efficacy in the treatment of osteitis condensans illi has been reported in many studies. The purpose of this study is to evaluate the efficacy and safety of acupuncture in the treatment of osteitis condensans illi, and to provide the latest evidence for clinical application.

Methods:

We will search PubMed, Web of Science, EMBASE, Cochrane Library, China Knowledge Resource Integrated Database, Weipu Database for Chinese Technical Periodicals, SinoMed, and Wanfang Database, conference papers and grey literature. All relevant randomized controlled trial using acupuncture and related therapies for osteitis condensans illi will be included. Two reviewers will independently search and screen date. Systematic review and meta-analysis will be completed by RevMan5.3 software (Cochrane St Albans House 57-59 Haymarket, London, United Kingdom).

Results:

This study will provide comprehensive evidence of high quality of acupuncture and related therapies for osteitis condensans illi from visual analog scale, numerical rating scale, Japanese Orthopaedic Association low back pain scale, Quality of Life Scale, and adverse reactions.

Conclusion:

This systematic review and meta-analysis will provide a reliable for evaluating the efficacy and safety of acupuncture and related therapies in treatment postpartum osteitis condensans illi.
Association Between Perioperative Costs and Induction Immunosuppression in Pediatric Liver Transplant Recipients
Authors: Ewing Caroline B. , Farnan Sheila , Squires James E. , Raghu Vikram K.
Published: February 2023

Objectives:

The objectives of this study was to describe variation in induction regimen, identify predictors of induction immunosuppression (IS) choice, and examine the impact of induction IS regimen on length of stay (LOS) and total perioperative costs in pediatric liver transplant recipients.

Methods:

We analyzed liver transplant utilization data in the Pediatric Health Information System database. Patients were divided into 3 induction IS groups: (1) steroids only, (2) T-cell depleting antibody (TDA), and (3) non-TDA. We identified predictors of induction IS regimen and examined associations between each outcome and choice of induction IS.

Results:

We analyzed 4905 liver transplant recipients (50% female, 80% under age 13 years, 42% non-Hispanic White). Most patients (3162, 64%) received steroids only induction, and about twice as many patients received a non-TDA regimen (1093, 22%) versus a TDA regimen (650, 13%). Median total perioperative costs were highest for the TDA group [$146,438 (interquartile range $113,461–$195,575)] versus the non-TDA group [$129,307 ($102,632–$173,953)] and the steroids only group ($127,049 ($98,814–$181,053)]. Compared to steroids only induction, TDA was associated with increased LOS (+2 days, P = 0.017) with no difference in cost. Non-TDA induction was associated with a decreased LOS (−3 days, P < 0.001) and increased cost (+$42,542; P < 0.001) independent of LOS.

Conclusions:

Compared to a steroids only induction IS regimen, non-TDA induction was associated with increased total perioperative costs, even after adjustments for LOS. Future work will combine cost and outcome data to provide decision-making support in pediatric liver transplant recipients.
Intraoperative assessment of bone viability through improved analysis and visualization of dynamic contrast-enhanced fluorescence imaging: technique report
Authors: Elliott Jonathan Thomas , Jiang Shudong , Henderson Eric R. , Slobogean Gerard P. , O'Hara Nathan N. , Xu Cao , Xin Jing , Han Xinyue , Christian Melanie L. , Gitajn Ida Leah
Published: February 2023

Bone devitalization is believed to be a critical determinant of complications such as infection or nonunion. However, intraoperative assessment of bone devitalization, particularly in open fractures and infections, remains highly subjective resulting in variation in treatment. Optical imaging tools, particularly dynamic contrast-enhanced fluorescence imaging, can provide real-time, intraoperative assessment of bone and soft tissue perfusion, which informs the tissues' ability to heal and fight infection. We describe a novel technique to apply indocyanine green–based fluorescence imaging, using a device that is frequently used in the operating room to assess skin or flap perfusion in plastic surgery, to assess bone and deep tissue perfusion in three pertinent cases: (1) a chronic infection/nonunion after a Gustilo type 3A tibia fracture (patient 1), (2) an acute Gustilo type 3C tibia open fracture with extensive degloving/soft tissue stripping (patient 2), and (3) an atrophic nonunion of the humerus (patient 3). In all three cases, fluorescence imaging (both time-specific fluorescence and maximum fluorescence) and derived kinetic maps of time-to-peak, ingress slope, and egress slope demonstrated clear spatial variation in perfusion that corresponded to the patient pathogenesis. The impact of this information on patient outcome will need to be evaluated in future clinical trials; however, these cases demonstrate in principle that optical imaging information has the potential to inform surgical practice, reduce the variation in treatment, and improve outcomes observed in these challenging patients.
Hearing Results, Quality of Life, Patient Satisfaction, and Postoperative Complications of Day-case Versus Inpatient Stapes Surgery for Otosclerosis in Adults: A Randomized Controlled Trial
Authors: Derks Laura S. M. , Borgstein Isabelle , Kamalski Digna M. A. , Thomeer Hans G. X. M. , Tange Rinze A. , Grolman Wilko , Stokroos Robert J. , Wegner Inge
Published: February 2023

Objective:

To investigate the effect of day-case stapes surgery on hearing results, quality of life, patient satisfaction, and complications rates, compared with inpatient stapes surgery.

Study Design:

A single-center, nonblinded, randomized controlled trial in a tertiary referral center.

Methods:

One hundred twelve adult patients planned for primary or revision stapes surgery were randomly assigned to either the day-case or inpatient treatment group. The effect on hearing outcomes (primarily), hearing benefits, quality of life, patient satisfaction, postoperative complications, and causes of crossover or readmission (secondarily) were assessed using auditory evaluations, questionnaires, and patients’ charts over a follow-up period of 1 year.

Results:

Audiometric measurements and postoperative success rates were not different between the inpatient and day-case group. There were no statistically significant differences between both groups regarding the overall quality of life (QoL) (HUI3), disease-specific QoL (GHSI), change in postoperative health status (GBI), and postoperative complications rate. We found a high patient satisfaction toward the day-case approach. Six patients allocated to the inpatient group requested same-day discharge. Of the day-case patients, there was a crossover rate to inpatient care of 38% (20 patients), mainly due to postoperative nausea and vomiting (25%), vertigo (20%), or dizziness (40%).

Conclusion:

We found no significant differences in outcomes of audiometric measurements, QoL, patient satisfaction and postoperative complications following day-case, and inpatient stapes surgery. Therefore, stapes surgery in a day-case setting seems to be a feasible approach in terms of postoperative outcome, safety, and desirability when taking patient selection and surgical planning into account. Besides this, the familiarity with a day-case approach of both patient and the surgical team, will increase the acceptance and feasibility of day-case stapes surgery.
Trends in Spontaneous Cerebrospinal Fluid Leak Repairs in the United States, 2009–2018
Authors: Totten Douglas J. , Schueth Elizabeth , Saltagi Mohamad Z. , Rabbani Cyrus , Harris Alyssa Hartsell , Tressman Dani , Hohmann Samuel F. , Nelson Rick F.
Published: February 2023

Background:

Rates of spontaneous cerebrospinal fluid leak (sCSF) repairs have increased in recent decades in line with increases in obesity rates.

Objectives:

To determine if the national rate of sCSF leak has continued to rise in recent years and to identify associated risk factors utilizing a comprehensive national database comprising most academic medical centers.

Methods:

A retrospective review from 2009 to 2018 was performed using the Vizient Clinical Database (CDB) of 105 leading academic medical centers in the United States. Patients who underwent CSF leak repair in the CDB database using ICD-9 and ICD-10 diagnostic and procedure codes. Patients with epidural hematomas over the same time frame were used as a control. National rates of craniotomy for sCSF leak repair each quarter were assessed and sCSF leak patient characteristics (age, gender, obesity, hypertension, diabetes) were calculated.

Results:

The rate of craniotomy for all sCSF leak repairs increased by 10.2% annually from 2009 to 2015 (P < 0.0001). There was no statistically significant change in the rate of epidural hematomas over the same period. The rate of lateral sCSF leak repair increased on average by 10.4% annually from 2009 (218 cases/year) to 2018 (457 cases/year) (P < 0.0001). A statistically significant increase was observed across all regions of the United States (P ≤ 0.005). sCSF leak patients had an average (standard deviation) age of 55.0 (13.2) years and 67.2% were female. Obesity was the only demographic factors that increased significantly over time. Likely due to comorbid factors, Black patients comprise a disproportionately large percentage of lateral sCSF leak repair patients.

Conclusions:

The rate of craniotomy for spontaneous CSF leaks continues to rise by approximately 10% annually.
Systematic Review of Otologic and Neurotologic Surgery Using the 3-dimensional Exoscope
Authors: Chiang Harry , Ledbetter Leila , Kaylie David M.
Published: February 2023

Objective:

The 3D exoscope is an emerging technology that has been met with success in neurosurgery and is now increasingly used in otologic and neurotologic surgery. There is currently no consensus on its safety, efficiency, and utility, compared to the traditional microscope for these procedures. This systematic review aims to evaluate the use of the 3-dimensional (3D) exoscope for otologic and neurotologic surgery.

Databases Reviewed:

MEDLINE/PubMed, Web of Science, Scopus, and EMBASE.

Methods:

A systematic search of the databases was conducted for otologic and neurotologic surgery using the 3D exoscope. English language papers with no limit on the date of publication were considered. Inclusion criteria: full articles studying otologic or neurotologic/skull base surgery using exoscopes. Exclusion criteria: non-otologic surgery and non-neurotologic/skull base surgery, exclusive use of the traditional microscope, editorials, video reports, and letters. Two authors independently reviewed papers for inclusion; discrepancies were settled by consensus. Extracted variables included: number of patients, types of surgical procedures, operative and postoperative complications, setup and operative time, and visualization and ergonomic rating.

Results:

Six articles containing 128 surgical cases (103 exoscopic and 25 microscopic) were analyzed. Of the exoscopic cases, 21% were surgeries for chronic ear disease, 5% were cochlear implants, and 74% were lateral skull base procedures encompassing a wide variety of approaches.

Conclusion:

Based on preliminary studies, the exoscope appears to be comparable in safety, visualization, and efficiency compared to the operating microscope, with the potential for increased comfort and ease of use.