bluuebunny/crossref_metadata_2025 huggingface dataset:
A New Tool to Assess Clinician Experience With Patient Care Transitions
Authors: Fekieta Renee , Rosenberg Alana , Jenq Grace Y. , Emerson Beth L.
Published: February 2021

Background and Objectives:

Clinician experience of intrahospital patient care transfers can drive transfer success and safe patient care. Measuring clinician experience can provide insights into opportunities to improve transfer processes that impact patient care. As part of a quality improvement project, we developed a brief survey to gauge clinician experience with patient care transfers that occur within a hospital.

Methods:

The survey framework was built upon a previously identified taxonomy of intrahospital transfers that includes categories of transfer activities: disposition, notification, preparation, communication, and coordination. The survey tool was administered twice to physicians, nurses, and other health professionals across a single hospital. Data were analyzed comparing providers sending patients, and those receiving patients.

Results:

The survey response rate was 33% to 34% across both years. While helpful in demonstrating improving trends in provider experience and engagement with transfer processes, the survey also allowed for differences between the experiences of sending and receiving providers to be revealed. Nurses reported improved preparedness to receive patients and receivers overall reported improved teamwork. Senders' perceptions showed improved trends in all transfer categories. Preliminary data also suggest acceptable reliability across respondent type, item category, and time. Specifically, reliability across sending and receiving clinicians was demonstrated in the categories of timeliness (α = 0.85) and culture (α = 0.72). Responses of sending clinicians were internally consistent within culture (α = 0.82), while responses of receiving clinicians were internally consistent within culture (α = 0.86), timeliness (α = 0.76), notification (α = 0.77), communication (α = 0.73), and teamwork (α = 0.73).

Conclusions:

Overall, the survey was feasible to implement and built to optimize content, construct, and response process validity. Survey results drove practical improvement work, such as informing a verbal transfer protocol to improve nursing preparedness to receive patients on general medicine units. As a practical tool, the survey and its results can help hospital administrators to focus on categories of transfer activities that are most problematic for clinicians and to track trends for quality improvement.
Let's Talk About Lupus. Overview of an Innovative, High-Reach, Online Program to Fill the Education Gaps of Latin Americans Living With Lupus
Authors: Drenkard Cristina , Fuentes-Silva Yurilis , Parente Costa Seguro Luciana , Torres dos Reis-Neto Edgard , Ibañez Soledad , Elera-Fitzcarrald Claudia , Reategui-Sokolova Cristina , Linhares Fernanda Athayde , Bermúdez Witjal , Ferreyra-Garrot Leandro , Acosta Carlota , Caballero-Uribe Carlo V. , Sato Emilia Inoue , Bonfa Eloisa , Pons-Estel Bernardo A.
Published: February 2021

Background/Objective

The Latin American population living with lupus lacks reliable and culturally competent health education resources. We describe a Spanish and Portuguese online program to educate Latin American people about lupus.

Methods

An extensive network of Latin American stakeholders participated in the program design, implementation, dissemination, and evaluation. Patients and rheumatologists selected core topics. Rheumatologists prepared the content using evidence-based data. Adaptations were conducted to meet the audience's health literacy and cultural values. Social media was used to post audiovisual resources and facilitate users' interactions with peers and educators, and a Web site was created to offer in-depth knowledge.

Results

The most massive outreach was through Facebook, with more than 20 million people reached and 80,000 followers at 3 months, between the Spanish and Portuguese pages. Nearly 90% of followers were from Latin America. A high engagement and positive responses to a satisfaction survey indicate that Facebook users valued these resources. The Spanish and Portuguese Web sites accumulated more than 62,000 page views, and 71.7% of viewers were from Latin American.

Conclusions

The engagement of patients and stakeholders is critical to provide and disseminate reliable lupus education. Social media can be used to educate and facilitate interactions between people affected by lupus and qualified health care professionals. Social media–based health education has extensive and scalable outreach but is more taxing for the professional team than the Web site. However, the Web site is less likely to be used as a primary education source by Latin American people because they value social interactions when seeking lupus information.
Validation of Postoperative Angiofibroma Radionuclide Imaging Study (PARIS) Protocol Using PSMA PET/CT—A Proof of Concept Study
Authors: Thakar Alok , Sakthivel Pirabu , Thankarajan Arunraj Sreedharan , Bhalla Ashu Seith , Prashanth Arun , Kumar Rakesh , Sharma Suresh Chandra , Kumar Rakesh
Published: February 2021

Objectives

Juvenile nasopharyngeal angiofibroma (JNA) expresses prostate-specific membrane antigen (PSMA), and PSMA PET/CT scan may be used for its imaging. Also, the precise diagnosis of residual/recurrent JNA after surgical treatment remains difficult with conventional contrast MRI and/or CT; functional imaging with PSMA PET/CT promises greater accuracy in the detection or exclusion of recurrent/residual JNA.

Patients and Methods

In this prospective study, 22 postoperative JNA patients who underwent a PSMA PET/CT scan both preoperatively and postoperatively from January 2018 to September 2020 were included. All patients underwent a low-dose head and neck spot PET/CT imaging. Abnormal postcontrast enhancement of a definite lesion was considered residual/recurrent tumor in contrast-enhanced MRI (CEMRI). In PSMA PET/CT, any abnormal uptake apart from physiological sites in the head and neck was considered as residual lesions. Radiological results were categorized as negative, suspicious for residual lesions, or definite residual/recurrent tumors. PSMA PET/CT findings were considered as the radiological standard, and patients were managed accordingly. The sensitivity, specificity, positive predictive value, and negative predictive value were separately calculated for CEMRI and PSMA PET/CT for diagnosing residual lesions.

Results

On postoperative CEMRI evaluation, 12 patients had residual tumors, 2 had normal suspicious scans, and 8 had normal postoperative scans. On PSMA PET/CT, only 7 patients had residual tumors and 15 had normal postoperative scans. In 1 patient with a residual tumor on both scans, a discrepancy was noted concerning tumor extent, and PSMA PET/CT accurately mapped the tumor. The sensitivity, specificity, positive predictive value, and negative predictive value of CEMRI were 100%, 53.33%, 41.67%, and 100%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of PSMA PET/CT were 100% for all parameters.

Conclusions

Because CEMRI is oversensitive and less specific compared with PSMA PET/CT, Postoperative Angiofibroma Radionuclide Imaging Study (PARIS) protocol should be used always. In residual tumors, PSMA PET/CT has an outright advantage over CEMRI in the diagnosis, tumor mapping, decision making, planning stereotactic radiation, and aiding in future follow-ups.
Primary Neuroendocrine Neoplasia of the Liver
Authors: Kaemmerer Daniel , Kunze Almut , Robiller Franz C. , Hommann Merten , Anlauf Martin
Published: February 2021

The presence of primary neuroendocrine tumors in the liver is still a matter of controversy. We present a case of a somatostatin-receptor–positive mass of the liver in the 68Ga-DOTATOC PET/CT. No other primary tumor was found after conventional imaging, endoscopically, and after liver-segment resection. Immunohistochemically, a constellation of findings was found to be compatible with a primary neuroendocrine neoplasm of the liver.
Response to Treatment in IgG4-Related Disease Assessed by Quantitative PET/CT Scan
Authors: Orozco-Gálvez Olimpia , Fernández-Codina Andreu , Simó-Perdigo Marc , Pinal-Fernández Iago , Martínez-Valle Fernando
Published: February 2021

Objective

The aim of this study was to assess disease activity by different PET/CT measurements in IgG4-related disease (IgG4-RD) flares and their correlation with the IgG4-RD responder index (IgG4-RI).

Patients and Methods

Patients were retrospectively recruited from a single center in Barcelona, Spain. They all had IgG4-RD flares with an 18F-FDG PET/CT examination performed within the 2 first weeks of the flare onset and another one after at least 3 months of treatment between 2012 and 2018. Epidemiologic, clinical, laboratory, and therapeutic data were collected at baseline and at follow-up. Semiquantitative and volumetric measurements from PET/CT explorations were recorded. In addition, a 5-point visual scale was (adapted Deauville score) trialed. The IgG4-RI was used as the criterion standard to assess response before and after treatment.

Results

Eighteen patients with a total of 23 flares were included. The median time to second PET/CT examination was 7 months. Remission (complete and partial) according to IgG4-RI was observed in 20 flares (87%). All PET/CT measurements (SUVmax and SUVmean, total lesion glycolysis, MTV, and adapted Deauville score) were statistically significantly lower on the follow-up evaluation, except for the size of the lesion. The correlation of all these parameters with the IgG4-RI was positive except for SUVmean and the size of the lesion.

Conclusions

Semiquantitative, volumetric, and visual parameters in PET/CT scans correlated with response to treatment assessed by IgG4-RI. Volumetric and visual items are less subject to variations and could be used to improve activity scores and treatment strategies.
Response to Concomitant Enzalutamide and 177Lu-PSMA-617 Radioligand Therapy in ATM-Mutated Metastatic Castration Resistant Prostate Cancer
Authors: Satapathy Swayamjeet , Das Chandan Krushna , Parihar Ashwin Singh , Sood Ashwani , Mittal Bhagwant R.
Published: February 2021

Radioligand therapy with 177Lu-PSMA-617 has emerged as a promising treatment modality for patients with mCRPC (metastatic castration resistant prostate cancer). However, genomic defects in DNA damage repair mechanisms have been proposed to affect the radiosensitivity of prostate cancers. Patients harboring such deleterious mutations are, thus, unlikely to respond to 177Lu-PSMA-617 alone and would need a more tailored therapeutic approach. We report the case of a 68-year-old man with ATM mutation–positive mCRPC who showed exceptional response to concomitant administration of enzalutamide with 177Lu-PSMA-617.
Isolated Unilateral Orbital Metastasis From Ewing Sarcoma Detected on FDG PET/CT Scan
Authors: Agarwal Rinky , Khare Abhishek , Gupta Nitin
Published: February 2021

Ewing sarcoma is the second most common primary malignant bone tumor that usually affects diaphysis of long bones during the second decade of life. Isolated unilateral orbital metastasis from this tumor presenting as proptosis is extremely rare. Here we report a case of 11-year-old boy where whole-body FDG PET/CT scan detected primary an Ewing sarcoma site in the left femur and isolated orbital metastasis in the left eye. Follow-up PET/CT scan after 6 cycles of chemotherapy showed resolution of the previously seen lesions.
99mTc-MDP 3-Phase Bone Imaging in 3 Cases of Pigmented Villonodular Synovitis
Authors: Hao Tingting , Xiong Xiaoliang , Wang Libo , Shi Xue , Zhao Yinlong
Published: February 2021

Pigmented villonodular synovitis (PVNS) is a rare proliferative synovial benign disorder, which is characterized by villonodular hyperplasia of joints, tendon sheath, and synovium; invasion of adjacent tissue; and sometimes visible hemosiderin deposition. Studies regarding bone scan findings of PVNS were relatively limited. Here, we report our findings on 99mTc-MDP 3-phase bone scan with SPECT/CT images on delayed phase in 3 patients with joint PVNS.
68Ga-DOTATATE PET/CT Findings of Cervical Esophageal Neuroendocrine Tumor
Authors: Filizoglu Nuh , Ozguven Salih
Published: February 2021

Neuroendocrine tumors (NETs) of the esophagus are extremely rare and aggressive and have a poor prognosis. Because most esophageal cancers occur in the middle and lower parts of the esophagus, cervical esophageal NETs are even rarer. Herein, we present 68Ga-DOTATATE PET/CT findings in a 37-year-old woman who was diagnosed with cervical esophageal NET.
Comparison of 68Ga-FAPI and 18F-FDG PET/CT in the Imaging of Pancreatic Cancer With Liver Metastases
Authors: Deng Maoxue , Chen Yue , Cai Liang
Published: February 2021

A 65-year-old man with suspected pancreatic cancer underwent 18F-FDG PET/CT for initial staging. Mild FDG uptake was observed in the pancreatic mass and bone destruction in the 10th rib on the right. No significant FDG uptake was seen with the multiple hypodense or isodense nodules in the liver. However, 68Ga-FAPI PET/CT revealed intense FAPI uptake in the pancreas and the 10th rib and multiple lesions in the liver. Finally, a biopsy confirmed carcinoma in the head of the pancreas with liver metastasis. This case highlighted that 68Ga-FAPI may outperform 18F-FDG PET/CT in identifying micrometastases of bones and hidden liver metastases.
177Lu-PSMA Therapy for Metastatic Testicular Mixed Germ Cell Tumor
Authors: Has Simsek Duygu , Civan Caner , Ekenel Meltem , Kuyumcu Serkan , Sanli Yasemin
Published: February 2021

Prostate-specific membrane antigen (PSMA) overexpression in various tumors are demonstrated in both in vitro and in vivo studies. Prostate-specific membrane antigen–directed radionuclide therapies are generally used in prostate cancer and could be also useful in PSMA-avid other malignancies. Herein, we present a case of a 46-year-old male patient who had progressive metastatic testicular mixed germ cell tumor, despite repeated operations and treatments. 68Ga-PSMA PET/CT was performed to assess eligibility for 177Lu-PSMA therapy. Patient had intense PSMA uptake in metastatic lesions, and 177Lu-PSMA has been given to control of disease. However, α-fetoprotein level progressed, and mixed therapy response was detected in 68Ga-PSMA PET/CT.
Systemic Air Embolism Complicating Computed Tomography–guided Percutaneous Transthoracic Biopsy of Cavitary Lung Lesions
Authors: Roberts James M. , Chou Frank Y. , Byrne Danielle , Sedlic Anto , Mayo John R.
Published: February 2021

Purpose:

Cavitary lung lesions often pose a diagnostic challenge, and tissue sampling can be required to obtain a confident diagnosis. Many authors contend that a computed tomography–guided percutaneous transthoracic lung biopsy (PTLB) of a cavitary lung lesion places a patient at higher risk for systemic air embolism (SAE) compared with biopsy of a noncavitary lesion.

Materials and Methods:

We reviewed the literature for studies of SAE complicating PTLB. We searched English-language articles indexed through PubMed, Embase, and Ovid Medline and included articles published up to March 31, 2020

Results:

We identified 10 case reports of SAE complicating PTLB, and 3 case-cohort studies comparing cavitary and noncavitary lesion biopsy. Among the case-cohort studies reviewed, 4 SAE occurred among 145 biopsies of cavitary lesions (2.7%), and 65 SAE occurred among 3050 biopsies of noncavitary lesions (2.1%). The pooled odds ratio of PTLB complicating SAE of cavitary lesions compared with noncavitary lesions was 1.29 (95% confidence interval: 0.47-3.60). No deaths following SAE after computed tomography–guided PTLB of cavitary lesions were reported in recent literature.

Conclusions:

On the basis of available evidence, air embolism rates are similar for PTLB of cavitary and noncavitary lesions. Additional research and registry studies are necessary to better understand this topic.
Factors Associated With Late Admission to Facial Plastic Surgery Among Patients With Long-Standing Facial Paralysis
Authors: Hidaka Takeaki , Miyamoto Shimpei , Ogawa Kazuya , Tomioka Yoko , Okazaki Mutsumi
Published: February 2021

Background

Facial plastic surgeons often encounter patients experiencing untreated long-standing facial paralysis who are unaware that their condition can be managed by facial reconstructive procedures. To promote timely admission of patients with facial paralysis for facial plastic surgery, factors associated with late admission should be elucidated.

Methods

A retrospective chart review was conducted on patients admitted to our facial paralysis clinic. Late admission was defined by an onset-to-admission interval longer than the median value. Multivariable logistic regression analysis was used to assess the odds ratio of late admission with age, sex, etiology, referring physician specialty, and the time of first admission.

Results

A total of 199 cases from October 2017 to March 2020 were included. Onset-to-admission interval longer than 21 months (median) was considered late admission. Etiologies involving benign tumors and congenital diseases were significantly associated with late admission (odds ratio [95% confidence interval], 3.9 [1.0–14.4] and 31.7 [4.7–212.6], respectively). Most benign tumor cases were referred from nonplastic surgeons.

Conclusions

Benign tumors and congenital diseases were significantly related to late admission of patients with long-standing facial paralysis. As the majority of benign cases were referred from nonplastic surgeons, spreading awareness on facial plastic surgery as a treatment option may be necessary in promoting timely admission.
Bilateral Reduction Mammaplasty Facilitates Subsequent Weight Loss in Obese Patients (BMI ≥30)
Authors: Kapadia Kailash , Marquez Jocellie , Medrano Christopher , Pamen Larissa , Groves Donald , Singh Gurtej , Huston Tara
Published: February 2021

Background

One of the most commonly discussed benefits of macromastia treatment surgery, bilateral reduction mammaplasty, is the potential for subsequent weight loss. There is limited research examining weight change after reduction mammaplasty and a definitive relationship remains to be established. Our study aims to investigate this relationship and to identify potential preoperative and operative factors associated with postoperative changes in weight.

Methods

A retrospective chart review was performed of all patients who underwent bilateral reduction mammaplasty for symptomatic macromastia at a single academic institution (Stony Brook University Hospital) between January 1, 2000, and January 1, 2016. Patients had 12 months or longer of follow-up to track resultant postoperative weight.

Results

Two hundred and fifty-six patients met our eligibility criteria. The patients were stratified into 2 groups based on preoperative body mass index (BMI). Group 1 consisted of 112 patients (44%) with a BMI less than 30 (ie, nonobese); group 2 consisted of 145 patients (56%) with a BMI of 30 or higher (ie, obese). The mean total weight of bilateral breast tissue resected for each group was 982 and 1719 g for groups 1 and 2, respectively. For both groups, the mean patient age was 38 years, and the mean follow-up period was approximately 5 years. Patients in group 1 (the nonobese group) had a mean preoperative BMI of 26.25 and postoperative BMI of 26.78 (P = 0.108). Postoperatively, these patients demonstrated an overall mean BMI increase of 0.90. Patients in group 2 (the obese group) had a mean preoperative BMI of 34.99 and postoperative BMI of 34.13 (P = 0.045). Postoperatively, they demonstrated an overall mean BMI decrease of 0.20. The difference in change of BMI between the 2 groups was determined to be significant (P = 0.047). There is a significantly larger mean decrease in BMI in the obese group, 3.86 than the nonobese group, 2.01 (P = 0.006).

Conclusions

We found that weight changes after undergoing bilateral reduction mammaplasty are significantly different between obese and nonobese patients. Obese patients (BMI, ≥30) experience greater weight loss than nonobese patients. As the desire for postoperative weight loss and increased physical activity are common reasons to undergo reduction mammaplasty, this study adds valuable data to the discussion.
The Efficacy of Pectoralis Nerve Blockade in Breast Reductions
Authors: Wallace Chelsea C. , Wetzel Margaret E. , Howell Christopher , Vasconez Henry C.
Published: February 2021

Background

Pectoralis nerve (Pecs) blocks have been shown to reduce perioperative opioid consumption in patients undergoing mastectomies, but the effectiveness of these blocks in breast reductions has not been established. This trial aims to evaluate the efficacy of Pecs blocks (I and II) on perioperative pain management in patients undergoing breast reductions.

Methods

Thirty-six patients were enrolled in the randomized controlled trial divided into 2 groups. The treatment group (n = 16) received general anesthesia plus postinduction ultrasound-guided Pecs blocks. The control group (n = 20) received general anesthesia alone. The primary outcomes measured were perioperative narcotic requirements, need for postoperative antiemetics, pain scores, and length of time in the operating room (OR). We measured patient and procedural risk factors including pedicle/skin excision patterns, concurrent liposuction, weight of resection, and additional local anesthesia. Risk factors as well as outcomes were analyzed using Fischer exact and t tests.

Results

No statistically significant difference was shown between the group receiving the Pecs blocks and the control with regard to narcotic requirements, pain scores, and need for antiemetics. Patients undergoing Pecs blocks had a significantly higher OR time before incision (P = 0.0073). Patient and procedural risk factors were well balanced (P > 0.41).

Conclusions

Pectoralis nerve blocks may be a valuable component of a multimodality pain regimen; however, when performed as a solitary adjunct, they do not seem to decrease perioperative narcotic requirements, pain scores, or the need for antiemetic medication in patients undergoing breast reductions. In addition, postinduction Pecs blocks significantly increase OR times.
Anylasis of Nail Bed Injuries
Authors: Gu Ja Hea , Choi Su Hyun , Yoon Jae Hee
Published: February 2021

Background

Although fingertip and nail bed injuries have a high incidence, appropriate management of nail bed injuries remains controversial. This study is the completion of data derived from nail bed injuries with follow-up of a minimum of 6 months to suggest an appropriate treatment.

Methods

In the retrospective study, we analyzed data from 549 nail bed injuries for 6 years and age, type of injury, fractures, treatment methods, and outcomes were reviewed. Results were determined and these were divided to identical to the opposite group, abnormalities based on Zook criteria. Statistical analysis was done according to injury category (type, site, nail substitute, and fracture) and overall final grade.

Results

Over 50% (293 cases) had excellent results. Rates of very good, good, fair, and poor results were 22.6%, 11.3%, 6.2%, and 6.6%, respectively. Poorer results were obtained for fold injuries, crush, and avulsive injuries. The presence of a fracture was associated with poor results.

Conclusions

The cause of poor results is thought to be multifactorial. Although, overall outcomes were good, nail splitting, nail roughness, and nail adherence can cause dirtiness, catching, bending, and various cosmetic problems. Thus, careful suture and replacement of nail to nail fold are important to reach good results.
Blepharoplasty Approach to the Orbital Rim: A Novel Approach for Select Patients Presenting for Gender Affirming Facial Plastic Surgery
Authors: Ostrom Jonnae Y. , Teixeira Jeffrey C. , Nuara Michael J.
Published: February 2021

Background:

Gender affirming facial surgery is a valuable option for patients with gender dysphoria. Traditionally, procedures for the upper third of the face focus on hairline position and contour of bony prominences via a coronal or trichophytic incision. These traditional approaches require large incisions and extensive dissection, which is not desirable for many patients and potentially avoidable in specific situations.

Method:

We utilized a standard blepharoplasty approach to access the superior orbital rim in patients who desired isolated lateral orbital contouring as part of their gender affirming facial surgery.

Conclusion:

A subset of patients who require bony contouring of the orbital rim as part of their treatment for gender dysphoria will benefit from a less invasive approach to the upper face. A standard blepharoplasty incision is safe and effective to access the orbital rims in select patients, with decreased recovery and comparable results to traditional approaches.
Mucomuscular Elastic Flap for Lower Lip Vermilion Reconstruction: Experience in a Series of Cases in Pediatric Patients
Authors: Giugliano Carlos , Graf Stephanie , Graf Nicole
Published: February 2021

The mucocutaneous line and the lip vermilion are important structures from an esthetic standpoint but also in relation to the functionality of the mouth. In the literature, several types of flaps have been described for reparation of labial defects in adults. In this study, the authors analyze results of surgical reconstruction of the lower lip in the pediatric population using unilateral or bilateral mucomuscular elastic flaps for labial reconstruction. A retrospective analysis of 10 patients operated between 2003 and 2018 at our institution was made. The following demographic and clinical data were collected: age, sex, diagnosis, type of flap, follow-up, results, and complications. The Strasser scale was chosen for assessment of postoperative photographic results. Average age was 8.1 years (range 3–18). The most frequent etiology was arteriovenous malformation seen in 60% of cases. All cases corresponded to a defect of the lower lip. The average percentage of lip compromised was 44% and the largest length of compromise observed was 60% of the lip. Follow-up was on average 2.4 years. Esthetic results according to the Strasser method were as follows: 1 patient presented an excellent esthetic result, 5 good, 4 regular, and 0 poor.

Considering the esthetic outcomes and low incidence of complications of the mucomuscular elastic flap, it is an acceptable and recommended technique of choice for lip vermilion reconstruction.
Retropharyngeal Abscess in an Adult With Pneumonia During COVID-19 Outbreak
Authors: Wang Tianyu , Liu Haibin , Liang Caiquan , Zhang Hang , Liao Jianchun , Liu Huanhai
Published: February 2021

Background:

Retropharyngeal abscesses are rarely reported in adults and occur mostly in patients with immunocompromised or as a foreign body complication. Admittedly, the treatment of retropharyngeal abscesses frequently involves surgical drainage to achieve the best results. However, when retropharyngeal abscesses occurred in a highly suspected patient with COVID-19, the managements and treatments should be caution to prevent the spread of the virus.

Clinical Presentation:

On February 13, a 40-year-old male with retropharyngeal abscesses turned to our department complaining dyspnea and dysphagia. In addition, his chest CT scan shows a suspected COVID-19 infection, thus making out Multiple Disciplinary Team determine to perform percutaneous drainage and catheterization through left anterior cervical approach under the guidance of B-ultrasound. Finally, the patient recovered and was discharged from the hospital on February 27 after 14 days of isolation. There was no recurrence after half a year follow-up.

Conclusions:

By presenting this case, we aim at raising awareness of different surgical drainage methods and summarizing our experience in the management of retropharyngeal abscesses during the outbreak of COVID-19.
An Updated Look at Television-Related Pediatric Head and Neck Injuries: Safer Products and a Shifting Paradigm
Authors: Oleck Nicholas C. , Berlin Ryan S. , Leverant Elizabeth , Paskhover Boris
Published: February 2021

Television tip-over injuries have been designated a top-five hidden home hazard by the United States Consumer Product Safety Commission. In this study the authors utilize the National Electronic Injury Surveillance System (NEISS) Database to provide an updated look at television-related head and neck injuries in the United States pediatric population. The NEISS Database was accessed for all television-related head and neck injury reports from January 2000 to December 2018 in patients under 18 years of age. Demographic data including age, sex, and race were also obtained. Narrative descriptions of each injury were also individually reviewed and categorized by specific type of injury. Miscoded reports were excluded. Between January 2000 and December 2018, 5944 NEISS reports of television-related injuries met inclusion criteria, corresponding to an estimated total of 159,785 injuries nationally during this period. The average patient age at time of evaluation was 4.11 years with a male predominance of 61.3%. Total number of injuries — and weighted national estimates — remained relatively stable between 2000 and 2006, peaking in 2009 (450 reported cases, 12,004 estimated national total). Between 2009 and 2018 the number of reported injuries, and corresponding national estimates, saw a 75.8% and a 72.1% decrease, respectively. Television-related head and neck injuries have declined dramatically in the United States since 2009. The underlying cause of this decline is likely multifactorial, and additional steps to improve the safety of these products are necessary to continue to ensure the safety of all children in the United States.
Exploratory Qualitative Analysis of Early Literacy Engagement in Latinx Parents of a Child With a Cleft
Authors: Johns Alexis , Wallace Erin , Thach Jenny , Ola Cindy , Gallagher Emily , Gutierrez Yvonne , Collett Brent
Published: February 2021

Literacy interventions are needed for children born with orofacial clefts, particularly for Latinx children who may experience multiple risk factors. To collect formative data for intervention design, focus groups and interviews were completed with 18 Latinx parents of children ages 13 to 49 months with orofacial clefts. Interviews focused on literacy experiences and practices. Six themes were identified through inductive qualitative analysis: child reading skills were highly valued; parents were motivated to improve on their childhood reading experiences; bilingualism was a goal for all parents; parents noted challenges in building child reading skills; reading engagement was broadly defined; and impact of cleft diagnosis was wide-reaching. Implications for intervention include a bilingual strength-based approach incorporating cleft-specific speech concerns, play, parallel online programming, behavioral strategies, and social support options. Use of telephone and online intervention with mailed materials can also help address family resource and time limitations.
Postoperative Clinical Outcomes Using Standard Variables Following Levator-Mullerectomy Advancement Blepharoptosis Surgery
Authors: Dryden Stephen C. , Rho Jonathan E. , Fowler Samuel C. , Gannon Edwin W. , Houser Kourtney H. , Fleming James C. , Fowler Brian T.
Published: February 2021

The Muller muscle-conjunctival resection is a common technique used to treat blepharoptosis, but there is variability with the target surgical resection and expected postoperative outcomes measured by marginal reflex distance-1 (MRD1). A Levator-Mullerectomy is a novel surgical approach described by Morris et al to incorporate the levator palpebrae superioris in the same incision as the classic Muller muscle-conjunctival resection in the treatment of blepharoptosis. This a retrospective study of patients who underwent Levator-Mullerectomy for ptosis repair showing the clinical outcomes based on MRD1. Statistical analysis was performed using analysis of variance and a nonparametric Kruskal–Wallis test. One hundred-twelve eyes of 83 patients (29 bilateral cases) with a mean age 64.6 years (7–92 years) were included. The types and prevalence of blepharoptosis were involutional (83%), neurogenic (8.0%), traumatic (3.6%), apraxia (2.7%), and congenital (2.7%). There was no significant difference in clinical outcome based on type of blepharoptosis (P = 0.7). Target resection lengths of 8 mm, 10 mm, and 12 mm were compared with postoperative MRD1 change. The mean change in MRD 1 between 8 mm and 10 mm was found to be statistically significant (P = 0.001 for both) but was not statistically significant for the 12 mm resection (P = 0.8). In patients with blepharoptosis and a positive response to 2.5% phenylephrine can benefit from Levator-Mullerectomy with either an 8 mm or 10 mm resection. This novel surgical approach allows surgeons to produce a more predictable and consistent clinical outcome.
Anatomical Variants, Pneumatization Classification, and Volumetric Studies of the Sphenoid Sinus With High-Resolution Computed Tomography
Authors: Yan Yujia , Guo Fang , Liu Jiayu , Yu Meng , Huang Ying
Published: February 2021

Objectives:

Aimed to explore the correlation between the volume of the sphenoid sinuses (SS) and sex, age, pneumatization and its anatomical variant types.

Material and Methods:

Retrospectively evaluated high-resolution computed tomography images of 170 individuals; were studied by ITK-SNAP software to measure the volume of SS.

Results:

The average volume of SS was a significant difference between the gender, the volume of SS in the elderly group (≥65 years old) showed a downward trend. The volume of the SS in the variants of the anterior clinoid processes, pterygoid processes, greater wings, and clivus were significantly higher than in the nonvariants (P < 0.05). With the expansion of pneumatization, the optic nerve (CNII) type 3-4, the internal carotid artery (ICA) type 2-3 and the septal insertion on the ICA have a larger volume, while the occurrence of septal insertion on only the CNII was not correlated with the volume (P > 0.05).

Conclusions and Significance:

The volume of SS is closely related to age, sex, the type of pneumatization and anatomical variation. High-resolution computed tomography can facilitate a precise study of anatomical variations and adjacent structures and help ensure the safety of an operation.
Membrane Permeant Inhibitor of Myosin Light Chain Kinase Worsens Survival in Murine Polymicrobial Sepsis
Authors: Sun Yini , Oami Takehiko , Liang Zhe , Miniet Ashley A. , Burd Eileen M. , Ford Mandy L. , Coopersmith Craig M.
Published: February 2021

Sepsis-induced intestinal hyperpermeability is mediated by disruption of the epithelial tight junction, which is closely associated with the peri-junctional actin-myosin ring. Genetic deletion of myosin light chain kinase (MLCK) reverses intestinal hyperpermeability and improves survival in a murine model of intra-abdominal sepsis. In an attempt to determine whether these findings could be translated using a more clinically relevant strategy, this study aimed to determine if pharmacologic inhibition of MLCK using the membrane permeant inhibitor of MLCK (PIK) improved gut barrier function and survival following sepsis. C57BL/6 mice underwent cecal ligation and puncture to induce sepsis and were then randomized to receive either PIK or vehicle. Unexpectedly, PIK significantly worsened 7-day survival following sepsis (24% vs. 62%). The three pathways of intestinal permeability were then interrogated by orally gavaging septic mice with creatinine (6Å), FD-4 (28Å), and rhodamine70 (120Å) and assaying their appearance in the bloodstream. PIK led to increased permeability in the leak pathway with higher levels of FD-4 in the bloodstream compared to septic mice given vehicle. In contrast, no differences were detected in the pore or unrestricted pathways of permeability. Examination of jejunal tight junctions for potential mechanisms underlying increased leak permeability revealed that mice that received PIK had increased phosphorylated MLC without alterations in occludin, ZO-1, or JAM-A. PIK administration was not associated with significant differences in systemic or peritoneal bacterial burden, cytokines, splenic or Peyer's Patches immune cells or intestinal integrity. These results demonstrate that pharmacologic inhibition of MLCK unexpectedly increases mortality, associated with worsened intestinal permeability through the leak pathway, and suggest caution is required in targeting the gut barrier as a potential therapy in sepsis.
Cannabinoid Receptor 1 and 2 Signaling Pathways Involved in Sepsis
Authors: Leite-Avalca Mariane C.G. , Zampronio Aleksander , Lehmann Christian
Published: February 2021

Sepsis is defined as a life-threatening organ dysfunction, caused by a dysregulated host response to an infection and can progress to septic shock, which represents a major challenge in critical care with a high mortality rate. Currently, there is no definitive treatment available for the dysregulated immune response in sepsis. Therefore, a better understanding of the pathophysiological mechanisms may be useful for elucidating the molecular basis of sepsis and may contribute to the development of new therapeutic strategies. The endocannabinoid system is an emerging research topic for the modulation of the host immune response under various pathological conditions. Cannabinoid receptors include the cannabinoid type 1 receptor (CB1) and the cannabinoid type 2 receptor (CB2). This review addresses the main functionality of CB1 and CB2 in sepsis, which can contribute to a better understanding about the pathophysiology of sepsis. Specifically, we discuss the role of CB1 in the cardiovascular system which is one of the biological systems that are strongly affected by sepsis and septic shock. We are also reviewing the role of CB2 in sepsis, specially CB2 activation, which exerts anti-inflammatory activities with potential benefit in sepsis.
Association of Opioid Type With Opioid Consumption After Surgery
Authors: Zikovich Shannon , Gunaseelan Vidhya , Englesbe Michael , Waljee Jennifer , Brummett Chad M.
Published: February 2021

Objective:

This study was designed to test the hypothesis that patients prescribed hydrocodone consume a similar number of tablets as those prescribed oxycodone after surgery.

Summary of Background Data:

In October 2017, the Michigan Opioid Prescribing Engagement Network released opioid prescribing guidelines for surgeries. For each procedure, these guidelines recommended prescribing 50% more tablets of hydrocodone than tablets of oxycodone to adjust for potency differences. These guidelines were simplified in January 2019 to recommend the same number of 5 mg hydrocodone tablets as 5 mg oxycodone tablets for each procedure.

Methods:

Retrospective, observational analysis of opioid-naïve adults who underwent surgical procedures across 64 hospitals in Michigan and were prescribed 5 mg tablets of hydrocodone or oxycodone between January 1, 2018 and May 31, 2019. The primary outcome was number of tablets consumed. We defined a meaningful difference in consumption as 5 pills a priori. Secondary outcomes included self-reported pain, satisfaction, and opioid refills.

Results:

A total of 6842 patients were included. Adjusting for covariates, patients prescribed hydrocodone consumed 7 tablets (95% confidence interval 6.79–7.18) while patients prescribed oxycodone consumed 6 tablets (95% confidence interval 5.58–6.40.) Comparing patients prescribed oxycodone with those prescribed hydrocodone, there were no differences in satisfaction, pain, or refills.

Conclusions:

Although patients prescribed hydrocodone consumed more tablets than patients prescribed oxycodone, this difference was not clinically significant and did not result in differences in satisfaction, pain, or refills. Perioperative opioid prescribing guidelines may recommend the same number of 5 mg oxycodone and hydrocodone tablets without sacrificing patient-reported outcomes.
Renoportal Anastomosis During Liver Transplantation in Patients With Portal Vein Thrombosis
Authors: Azoulay Daniel , Quintini Cristiano , Rayar Michel , Salloum Chady , Llado Laura , Diago Teresa , D’Amico Giuseppe , Ramos Emilio , Fabregat Joan , Eshkenazy Rony , Bardou-Jacquet Edouard , Camus Christophe , Compagnon Philippe , Vibert Eric , Lim Chetana
Published: February 2021

Objective:

To evaluate the short- and long-term outcomes of RPA in a large multicentric series.

Summary Background:

The current knowledge on RPA for portal reconstruction during LT in patients with diffuse PVT and a large splenorenal shunt is poor and limited to case reports and small case series.

Methods:

All consecutive LTs with RPA performed in 5 centers between 1998 and 2020 were included. RPA was physiological provided it drained the splanchnic venous return through a large splenorenal shunt (≥ 1 cm diameter). Complications of PHT, long-term RPA patency, and patient and graft survival were assessed. RPA success was achieved provided the 3 following criteria were all fulfilled: patients were alive with patent RPA and without clinical PHT.

Results:

RPA was attempted and feasible in 57 consecutive patients and was physiological in 51 patients (89.5%). Ninety-day mortality occurred in 5 (8.5%) patients, and PHT-related complications occurred in 42.9% of patients. With a median follow-up of 63 months, the 1-, 3- and 5-year patient and graft survival rates were 87%, 83%, and 76% and 82%, 80%, and 73%, respectively. The primary and primary-assisted patency rates at 5 years were 84.5% and 94.3%, respectively. Success was achieved in 90% (27/30) of patients with a follow-up ≥5 years.

Conclusions:

Despite a high rate of PHT-related complications, excellent long-term patient and graft survival could be achieved. RPA could be considered successful in the vast majority of patients. The expanded use of RPA is warranted.
Impact of Lymph Node Dissection on Survival After Neoadjuvant Chemoradiotherapy for Locally Advanced Esophageal Squamous Cell Carcinoma
Authors: Guo Xufeng , Wang Zhexin , Yang Hong , Mao Teng , Chen Yuping , Zhu Chengchu , Yu Zhentao , Han Yongtao , Mao Weimin , Xiang Jiaqing , Chen Zhijian , Liu Hui , Yang Haihua , Wang Jiaming , Pang Qingsong , Zheng Xiao , Yang Huanjun , Li Tao , Zhang Xu , Li Qun , Wang Geng , Lin Ting , Liu Mengzhong , Fu Jianhua , Fang Wentao
Published: February 2021

Objective:

To clarify whether systemic LND influences the safety of surgery and the survival of patients with locally advanced esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (nCRT).

Summary of Background Data:

Prognostic impact of systemic lymphadenectomy during surgery after nCRT for ESCC is still uncertain and requires clarification.

Methods:

This is a secondary analysis of NEOCRTEC5010 trial which compared nCRT followed by surgery versus surgery alone for locally advanced ESCC. Relationship between number of LND and perioperative, recurrence, and survival outcomes were analyzed in the nCRT group.

Results:

Three-year overall survival was significantly better in the nCRT group than the S group (75.2% vs 61.5%; P = 0.011). In the nCRT group, greater number of LND was associated with significantly better overall survival (hazard ratio, 0.358; P < 0.001) and disease-free survival (hazard ratio, 0.415; P = 0.001), but without any negative impact on postoperative complications. Less LND (<20 vs ≥20) was significantly associated with increased local recurrence (18.8% vs 5.2%, P = 0.004) and total recurrence rates (41.2% vs 25.8%, P = 0.027). Compared to patients with persistent nodal disease, significantly better survival was seen in patients with complete response and with LND ≥20, but not in those with LND <20.

Conclusions:

Systemic LND does not increase surgical risks after nCRT in ESCC patients. And it is associated with better survival and local disease

control. Therefore, systemic lymphadenectomy should still be considered as an integrated part of surgery after nCRT for ESCC.
The Influence of Cognitive Impairment on Postoperative Outcomes
Authors: Blair Emilie M. , Levine Deborah A. , Hu Hsou Mei , Langa Kenneth M. , Kabeto Mohammed U. , Waljee Jennifer
Published: February 2021

Objective:

To examine differences in rates of elective surgery, postoperative mortality, and readmission by pre-existing cognitive status among Medicare beneficiaries undergoing surgery.

Background:

MCI is common among older adults, but the impact of MCI on surgical outcomes is understudied.

Methods:

We conducted a retrospective cohort study of individuals ≥65 who underwent surgery between 2001 and 2015 using data from the nationally-representative Health and Retirement Study linked with Medicare claims. Cognitive status was assessed by the modified telephone interview for cognitive status score and categorized as normal cognition (score: 12–27), MCI (7–11), and dementia (<7). Outcomes were 30- and 90-day postoperative mortality and readmissions. We used Cox proportional hazard models to estimate the risk of each outcome by cognition, adjusting for patient characteristics.

Results:

In 6,590 patients, 69.9% had normal cognition, 20.1% had MCI, and 9.9% had dementia. Patients with MCI (79.9%) and dementia (73.6%) were less likely to undergo elective surgery than patients with normal cognition (85.9%). Patients with MCI had similar postoperative mortality and readmissions rates as patients with normal cognition. However, patients with dementia had significantly higher postoperative 90-day mortality (5.2% vs 8.4%, P = 0.002) and readmission rates (13.9% vs 17.3%, P = 0.038).

Conclusion:

Patients with self-reported MCI are less likely to undergo elective surgery but have similar postoperative outcomes compared with patients with normal cognition. Despite the variability of defining MCI, our findings suggest that MCI may not confer additional risk for older individuals undergoing surgery, and should not be a barrier for surgical care.
Cardio-oncology: rationale, aims and future directions
Authors: Pan Jiliu , Garza Felipe , Lyon Alexander R.
Published: February 2021

Purpose of review

Cardiovascular comorbidity among cancer patients is a growing clinical problem with the dramatic improvements in cancer survival. Cardio-oncology has developed as a new medical field dedicated to addressing the complex issues faced by patients who have both cancer and cardiovascular disease. This article explains to the reader what cardio-oncology services provide and the nature of cardiovascular problems caused by the growing array of modern cancer therapies.

Recent findings

The list of potentially cardiotoxic cancer therapeutic agents is ever growing and dedicated cardio-oncology experts are required to tackle cardiovascular complications with minimal delay to necessary cancer therapy. Cardio-oncology services originated in academic centres but are now being set up around the world in all hospitals and clinics that provide care to cancer patients. Cardio-oncology plays an increasingly active role at every stage of cancer therapy including baseline risk assessment pretreatment, surveillance and prevention during treatment, response to acute complications and assessment in survivors post cardiotoxic treatments. New treatment strategies exist to optimize cancer treatment so it can be completed safely.

In the present review, we explore the rationale, aims and roles of cardio-oncology, as well as future directions, which will certainly require multidisciplinary international collaboration.