bluuebunny/crossref_metadata_2025 huggingface dataset:
Limb Lengthening With Precice Intramedullary Lengthening Nails in Children and Adolescents
Authors: Radler Christof , Mindler Gabriel T. , Stauffer Alexandra , Weiß Carina , Ganger Rudolf
Published: November 2021

Background:

The Precice intramedullary bone lengthening nail has been used in our department since 2013. We sought to determine the efficacy and safety of intramedullary limb lengthening with Precice nails in children and adolescents.

Methods:

We retrospectively investigated patients 18 years and younger who underwent lower-limb lengthening using the Precice nail. Radiologic and clinical outcome data were obtained from a prospective database. The minimum postimplantation follow-up was 12 months. Between March 2013 and March 2020, 161 patients underwent limb lengthening with a Precice nail; 76 patients met the inclusion criteria.

Results:

We used 84 nails in 76 patients (68 femurs and 16 tibias). Femoral nails were inserted using an antegrade approach in 57 patients and a retrograde approach in 11. The mean age at surgery was 16 years (range, 9 to 18 y). The mean lengthening was 33 mm (range, 14 to 80 mm) with additional acute axial or rotational malalignment correction in 16 segments. At the last follow-up (mean=2.1, years; range, 1 to 5 y), all regenerates had healed and all patients were mobile with full weight-bearing. Complications that necessitated surgical revision occurred in 6 patients (8%), and the desired lengthening was not achieved in 2 patients. Postlengthening malalignment occurred in 4 patients (5 tibial nails). The weight-bearing index, defined as days from surgery to full weight-bearing/cm of lengthening, was a mean of 45 days (range, 7 to 127 d/cm).

Conclusions:

The Precice nail facilitated reliable and safe bone lengthening and was associated with a low complication rate. Correction of additional malalignment was possible by applying intraoperative acute correction or guided growth.

Level of Evidence:

Level IV—therapeutic study investigating the results of treatment.
Faculty Development Offered by US Medical Schools: A National Survey of Pediatric Educators
Authors: Osman Cynthia , Bradshaw Chanda , Tewksbury Linda
Published: November 2021

Introduction:

There are limited data on the status of faculty development (FD) in the United States. Through a national survey of pediatric educators, we explored the frequency and topics of FD on teaching skills offered at US medical schools, as well as the strategies' schools use to encourage and track participation.

Methods:

Five piloted questions were included in the 2017 Annual Council on Medical Student Education in Pediatrics Survey. We used descriptive statistics.

Results:

Ninety-seven (66%) of the 148 surveyed US medical schools responded to at least one FD question. Ninety-eight percent of respondents reported being offered FD on teaching, with 97% of those respondents reporting that FD occurred at least annually. A variety of FD topics were reported, with feedback and precepting being most common. Incentives included continuing medical education (CME credit) (39%) and being relieved of clinical duties (23%). However, 29% reported little support for FD. Only 20% of schools reported their department tracked FD participation outside the department.

Discussion:

Our data suggest that the majority of medical schools offer FD on teaching skills at least yearly, with a variety of topics. Institutions utilize a variety of incentives for participation. However, a significant minority of respondents reported little support for FD. Further, departments rarely track faculty FD participation.
Attention-Deficit/Hyperactivity Disorder Practice Patterns: A Survey of Kentucky Pediatric Providers
Authors: Trace Marie E. , Feygin Yana B. , Williams Patricia G. , Winders Davis Deborah , Brothers Kyle B. , Sullivan Janice E. , Calhoun Aaron W.
Published: November 2021

Objective:

Kentucky ranks among the highest in the nation for attention-deficit/hyperactivity disorder (ADHD) prevalence in children aged 4 to 17 years. In 2011, the American Academy of Pediatrics (AAP) released a clinical practice guideline based on the DSM-IV. A guideline revision based on the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) was released in October 2019. In this study, we assess and describe pediatric providers' ADHD practices using the 2011 guideline and DSM-5 diagnostic criteria.

Methods:

This was a cross-sectional, survey-based descriptive study. Kentucky Chapter of the AAP (KY AAP) members were anonymously surveyed. The results were examined for trends in routine practice.

Results:

Fifty-eight general pediatricians and pediatric residents responded to the survey, yielding a 38% (58/154) response rate. Among respondents performing routine diagnosis of ADHD (N = 51), 73% (37/51) used DSM-5 criteria. Most providers usually or always initially assessed for coexisting behavioral conditions (96%; 49/51), developmental conditions (78%; 39/51), and adverse childhood experiences (73%; 37/51). Among respondents performing routine management of ADHD (N = 55), only 11% (6/55) of respondents indicated that they titrated stimulant medications every 3 to 7 days. After initiation of medication, 78% of providers scheduled a follow-up visit within 2 to 4 weeks. During subsequent visits, only half indicated discussing behavioral interventions, screening for coexisting conditions, and reviewing follow-up teacher-rated ADHD scales.

Conclusion:

Pediatricians in the KY AAP adhere to the DSM-5 criteria for diagnosing ADHD. Pediatric providers' practices would benefit from education in improvements in pharmacotherapy titration, surveillance of coexisting conditions associated with ADHD, discussion of psychosocial interventions, and school support strategies.
The Impact of Keeping Indoor Dining Closed on COVID-19 Rates Among Large US Cities
Authors: Schnake-Mahl Alina S. , O’Leary Gabriella , Mullachery Pricila H. , Vaidya Vaishnavi , Connor Gabrielle , Rollins Heather , Kolker Jennifer , Diez Roux Ana V. , Bilal Usama
Published: November 2021

Background:

Indoor dining is one of the potential drivers of COVID-19 transmission. We used the heterogeneity among state government preemption of city indoor dining closures to estimate the impact of keeping indoor dining closed on COVID-19 incidence.

Methods:

We obtained case rates and city or state reopening dates from March to October 2020 in 11 US cities. We categorized cities as treatment cities that were allowed by the state to reopen but kept indoor dining closed or comparison cities that would have kept indoor dining closed but that were preempted by their state and had to reopen indoor dining. We modeled associations using a difference-in-difference approach and an event study specification. We ran negative binomial regression models, with city-day as the unit of analysis, city population as an offset, and controlling for time-varying nonpharmaceutical interventions, as well as city and time fixed effects in sensitivity analysis and the event study specification.

Results:

Keeping indoor dining closed was associated with a 55% (IRR = 0.45; 95% confidence intervals = 0.21, 0.99) decline in the new COVID-19 case rate over 6 weeks compared with cities that reopened indoor dining, and these results were consistent after testing alternative modeling strategies.

Conclusions:

Keeping indoor dining closed may be directly or indirectly associated with reductions in COVID-19 spread. Evidence of the relationship between indoor dining and COVID-19 case rates can inform policies to restrict indoor dining as a tailored strategy to reduce COVID-19 incidence. See video abstract at, http://links.lww.com/EDE/B902.
Tracheal intubation in the critically ill patient
Authors: Russotto Vincenzo , Rahmani Lua S. , Parotto Matteo , Bellani Giacomo , Laffey John G.
Published: November 2021

Tracheal intubation is among the most commonly performed and high-risk procedures in critical care. Indeed, 45% of patients undergoing intubation experience at least one major peri-intubation adverse event, with cardiovascular instability being the most common event reported in 43%, followed by severe hypoxemia in 9% and cardiac arrest in 3% of cases. These peri-intubation adverse events may expose patients to a higher risk of 28-day mortality, and they are more frequently observed with an increasing number of attempts to secure the airway. The higher risk of peri-intubation complications in critically ill patients, compared with the anaesthesia setting, is the consequence of their deranged physiology (e.g. underlying respiratory failure, shock and/or acidosis) and, in this regard, airway management in critical care has been defined as “physiologically difficult”. In recent years, several randomised studies have investigated the most effective preoxy-genation strategies, and evidence for the use of positive pressure ventilation in moderate-to-severe hypoxemic patients is established. On the other hand, evidence on interventions to mitigate haemodynamic collapse after intubation has been elusive. Airway management in COVID-19 patients is even more challenging because of the additional risk of infection for healthcare workers, which has influenced clinical choices in this patient group. The aim of this review is to provide an update of the evidence for intubation in critically ill patients with a focus on understanding peri-intubation risks and evaluating interventions to prevent or mitigate adverse events.
Dexamethasone for the treatment of established postoperative nausea and vomiting
Authors: Czarnetzki Christoph , Albrecht Eric , Desmeules Jules , Kern Christian , Corpataux Jean-Baptiste , Gander Sylvain , van Kuijk Sander M.J. , Tramèr Martin R.
Published: November 2021

BACKGROUND

Dexamethasone is widely used for the prevention of postoperative nausea and vomiting (PONV) but little is known about its efficacy for the treatment of established PONV.

OBJECTIVE

To test the antiemetic efficacy of intravenous dexamethasone for the treatment of established PONV in adults undergoing surgery under general anaesthesia and to determine whether there is dose-responsiveness.

DESIGN

The DexPonv trial is a multicentre, placebo-controlled, randomised, double-blind, dose-finding study. Inclusion of patients was between September 2012 and November 2017. Follow-up for PONV symptoms was for 24 h. Thirty days postoperatively, patients were contacted by study nurses for any information on postoperative bleeding and infection.

SETTING

Four public hospitals in Switzerland.

PATIENTS

A total of 803 adults scheduled for elective surgery without any antiemetic prophylaxis signed the consent form; 714 were included. Among those, 319 had PONV and 281 patients were eventually randomised (intention to treat population and safety set). The per protocol set consisted of 260 patients.

INTERVENTIONS

Patients with PONV symptoms (including retching) were randomised to a single intravenous dose of dexamethasone 3, 6 or 12 mg or matching placebo.

MAIN OUTCOME MEASURES

The primary endpoint was the absence of further nausea or vomiting (including retching), within 24 h after administration of the study drug.

RESULTS

Dexamethasone was ineffective during the first 24 h, whatever the dosage, compared to placebo, even when the model was adjusted for known risk factors (P = 0.170). There were no differences in the time to treatment failure or the quality of sleep during the first night. There was a positive correlation between the dose of dexamethasone and blood glucose concentrations (P < 0.001), but not with bleeding risk, wound infections or other adverse effects.

CONCLUSION

This randomised trial failed to show anti-emetic efficacy of any of the tested intravenous regimens of dexamethasone for the treatment of established PONV in adults undergoing surgery under general anaesthesia.

TRIAL REGISTRATION

clinicaltrials.gov (NCT01975727).
Peri-interventional outcome study in the elderly in Europe
Authors:   POSE-Study group∗
Published: November 2021

OBJECTIVES

The aim of this study was to describe the 30-day mortality rate of patients aged 80 years and older undergoing surgical and nonsurgical procedures under anaesthesia in Europe and to identify risk factors associated with mortality.

DESIGN

A prospective cohort study.

SETTING

European multicentre study, performed from October 2017 to December 2018. Centres committed to a 30-day recruitment period within the study period.

PATIENTS

Nine thousand four hundred and ninety-seven consecutively recruited patients aged 80 years and older undergoing any kind of surgical or nonsurgical procedures under anaesthesia.

MAIN OUTCOME MEASURES

The primary outcome was all-cause mortality within 30 days after procedure described by Kaplan–Meier curves with 95% CI. Risk factors for 30-day mortality were analysed using a Cox regression model with 14 fixed effects and a random centre effect.

RESULTS

Data for 9497 patients (median age, 83.0 years; 52.8% women) from 177 academic and nonacademic hospitals in 20 countries were analysed. Patients presented with multimorbidity (77%), frailty (14%) and at least partial functional dependence (38%). The estimated 30-day mortality rate was 4.2% (95% CI 3.8 to 4.7). Among others, independent risk factors for 30-day mortality were multimorbidity, hazard ratio 1.87 (95% CI 1.26 to 2.78), frailty, hazard ratio 2.63 (95% CI 2.10 to 3.30), and limited mobility, hazard ratio 2.19 (95% CI 1.24 to 3.86). The majority of deaths (76%) occurred in hospital. Mortality risk for unplanned ICU admission was higher, hazard ratio 3.57 (95% CI 2.38 to 5.26) than for planned ICU admission, hazard ratio 1.92 (95% CI 1.47 to 2.50). Compared with other studies, the in-hospital complication rates of 17.4 and 3.9% after discharge were low. Admission to a unit with geriatric care within 30 days after the intervention was associated with a better survival within the first 10 days.

CONCLUSIONS

The estimated 30-day mortality rate of 4.2% was lower than expected in this vulnerable population.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03152734, https://clinicaltrials.gov.
Adverse drug reactions to herbal medicines
Authors: Routledge Philip A. , Bracchi Robert
Published: November 2021

Herbal medicines may cause adverse drug reactions (ADRs) due to effects of known constituent(s), substitution with other herbal ingredients, or contamination or adulteration with additional substances. Healthcare professionals (HCPs) should always take a full medicines history, including use of herbal medicines and other complementary products (e.g., food supplements and other dietary supplements).

A range of resources are available to inform HCPs and the public/patients/ carers about possible ADRs associated with herbal medicines. HCPs and the public/patients also need to be made aware of the importance of reporting suspected ADRs to the appropriate regulatory agency. Good safety surveillance systems can thus help to ensure that those who choose to take herbal medicines are able to do so with acceptable safety.
Barriers and Facilitators in the Clinical Implementation of Beta-Lactam Therapeutic Drug Monitoring in Critically Ill Patients: A Critical Review
Authors: Abdulla Alan , van den Broek Puck , Ewoldt Tim M. J. , Muller Anouk E. , Endeman Henrik , Koch Birgit C. P.
Published: November 2021

Background:

With increasing knowledge of beta-lactam pharmacodynamics and interpatient and intrapatient variability in pharmacokinetics, the usefulness of therapeutic drug monitoring (TDM) is becoming increasingly clear. However, little research has been conducted to identify potential barriers and facilitators in the clinical implementation of beta-lactam TDM. This study provides an overview of the current practices of beta-lactam TDM and barriers and facilitators in its implementation.

Methods:

A systematic search was conducted using the Ovid MEDLINE database in April 2021, without restrictions on the publication date. All studies reporting the implementation of beta-lactam antibiotic TDM in critically ill patients through questionnaires or surveys were included in this review.

Results:

Six eligible studies were identified from 215 records, all of which were cross-sectional. All studies identified barriers and facilitators in the implementation of beta-lactam TDM in critically ill patients. The main barriers were insufficient knowledge about various aspects regarding the implementation of beta-lactam TDM and the unavailability of assays. Furthermore, a delay in the acquisition of TDM results reduces the probability of physicians altering drug dosages. Finally, doubts about the cost-effectiveness and clinical effectiveness of beta-lactam TDM in critically ill patients hinder broad implementation. Moreover, to improve the willingness of physicians to use beta-lactam TDM, collaboration between physicians and clinical pharmacists and clinical microbiologists should be strengthened.

Conclusions:

Although the evidence for application of beta-lactam TDM continues to grow, its clinical implementation remains limited. To enable optimal implementation of these antibiotics in critically ill patients, several barriers need to be overcome regarding logistics, equipment availability, clinical evidence, and proof of cost-effectiveness.
Impact of Sodium-glucose Cotransporter-2 Inhibitor Initiation in a Safety-net Hospital
Authors: Wienkers Stephanie , Boka Adrian , Krantz Mori J.
Published: November 2021

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are antihyperglycemic medications with cardiovascular disease and renal protective properties. While clinical trials supporting their efficacy, the utility among safety-net health system patients with low health literacy has not been evaluated. We sought to assess appropriate monitoring, safety and effectiveness of GLT2i initiation at a safety-net hospital. From May 2017 to July 2020, 150 patients were newly initiated on an SGLT2i therapy. We evaluated appropriate initiation, laboratory monitoring, impact on urine microalbumin, mean hemoglobin A1c (HbA1c), and systolic blood pressure (SBP). We also analyzed primary care versus subspecialty prescriber patterns. All patients did not have prohibitive renal dysfunction based on Food and Drug Administration labeling and the majority (N = 101, 67%) had renal function testing completed before initiation. Improvement in cardiovascular disease surrogate markers including SBP (mean, –3.12 mm Hg), albuminuria (mean, –3.98 mg/dL), and HbA1c (mean, –1.06%) were observed. A total of 94% of the cohort had serum chemistry panels drawn, yet only 4% were performed within the protocol-specified (14-day) period. Primary care and cardiology providers were the sole prescribers; despite the known renoprotective properties, no patients were initiated on SGLT2i therapy by a nephrologist. In conclusion, the benefits of SGLT2i drugs reducing SBP, albuminuria, and HbA1c observed in clinical trials were duplicated in our safety-net population. Therefore, ongoing education and promotion to providers to ensure broadened utilization and timely renal function monitoring appear warranted.
“Elimination of Hepatitis by 2030”: Present Realities and Future Projections
Authors: Akbar Sheikh Mohammad Fazle , AL-Mahtab Mamun , Khan Sakirul , Yoshida Osamu , Hiasa Yoichi
Published: November 2021

Each year, viral hepatitis and its complications affect millions of patients and cause one-and-a-half million deaths. To deal with this immense public health burden, international organizations have, as part of their sustainable development goals, set up the plan “Elimination of Hepatitis by 2030,” which has been ratified by most countries. The plan's aims include the prevention of different hepatitis viruses and the treatment of existing patients. However, a mid-term analysis revealed that lest novel maneuvers are adopted, some of the plan's objectives may not be attained. While new infections seem to be contained by vaccines and other public health measures, the persistent reservoir of chronic hepatitis viruses –hepatitis B virus (HBV) and hepatitis C virus (HCV) – may not be properly addressed. Although antiviral therapy against chronic HCV infection is promising, chronic-HBV-infected persons may not be properly handled. There are about 296 million chronic hepatitis B (CHB) patients in the world, and only 10% of them are aware of their infection. Thus, the undetected CHB patients should be found, and a proper approach should be devised to address this issue, especially in developing countries that harbor the main bulk of CHB patients. In addition, there is no finite therapy for CHB patients, and the safety and efficacy of the existing drugs are also questionable. This indicates the need for novel drugs for CHB patients. In light of this, this study aimed to offer measures that could discover the millions of undetected patients and address the need for developing innovative drugs for CHB patients and thus substantiate the “Elimination of Hepatitis by 2030” plan.
Genome Sequencing and Apoptotic Markers to Assess Treatment Response of Lacrimal Gland Adenoid Cystic Carcinoma to Intra-Arterial Cytoreductive Chemotherapy
Authors: Yu Michael D. , Men Clara J. , Do Huy , Colevas A. Dimitrios , Lin Jonathan H. , Egbert Peter R. , Tse David T. , Kossler Andrea L.
Published: November 2021

Adenoid cystic carcinoma of the lacrimal gland is an aggressive, malignant epithelial neoplasm. We report the case of a 30-year-old male with lacrimal gland adenoid cystic carcinoma treated with neoadjuvant intra-arterial chemotherapy through the internal carotid artery, followed by orbital exenteration and chemoradiation. Treatment response was evaluated using a novel combination of pre- and posttreatment genome sequencing coupled with immunohistochemical evaluation, which showed diffuse tumor apoptosis. A posttreatment decrease in variant allele frequency of the NOTCH1 mutation, and robust tumor cytoreduction on imaging, supports exploration of NOTCH1 analysis as a potential marker of cisplatin sensitivity. The use of genome sequencing and immunohistochemical evaluation could provide a more targeted therapeutic assessment of neoadjuvant intra-arterial chemotherapy in the management of lacrimal gland adenoid cystic carcinoma.
Evidence for engagement of the nucleus of the solitary tract in processing intestinal chemonociceptive input irrespective of conscious pain response in healthy humans
Authors: Beckers Abraham B. , van Oudenhove Lukas , Weerts Zsa Zsa R.M. , Jacobs Heidi I.L. , Priovoulos Nikos , Poser Benedikt A. , Ivanov Dimo , Gholamrezaei Ali , Aziz Qasim , Elsenbruch Sigrid , Masclee Ad A.M. , Keszthelyi Daniel
Published: November 2021

Neuroimaging studies have revealed important pathomechanisms related to disorders of brain–gut interactions, such as irritable bowel syndrome and functional dyspepsia. More detailed investigations aimed at neural processing in the brainstem, including the key relay station of the nucleus of the solitary tract (NTS), have hitherto been hampered by technical shortcomings. To ascertain these processes in more detail, we used multiecho multiband 7T functional magnetic resonance imaging and a novel translational experimental model based on a nutrient-derived intestinal chemonociceptive stimulus. In a randomized cross-over fashion, subjects received duodenal infusion of capsaicin (the pungent principle in red peppers) and placebo (saline). During infusion, functional magnetic resonance imaging data and concomitant symptom ratings were acquired. Of 26 healthy female volunteers included, 18 were included in the final analysis. Significantly increased brain activation over time during capsaicin infusion, as compared with placebo, was observed in brain regions implicated in pain processing, in particular the NTS. Brain activation in the thalamus, cingulate cortex, and insula was more pronounced in subjects who reported abdominal pain (visual analogue scale > 10 mm), as compared with subjects who experienced no pain. On the contrary, activations at the level of the NTS were independent of subjective pain ratings. The current experimental paradigm therefore allowed us to demonstrate activation of the principal relay station for visceral afferents in the brainstem, the NTS, which was engaged irrespective of the conscious pain response. These findings contribute to understanding the fundamental mechanism necessary for developing novel therapies aimed at correcting disturbances in visceral afferent pain processing.
Chlorhexidine in the treatment of microsporidial stromal keratitis and the effect of host immunity: A case series and literature review
Authors: Yeh Tsai-Chu , Kuo Yih-Shiuan , Wang Lei-Chi , Tai Tzu-Yang , Lin Pei-Yu
Published: November 2021

Microsporidial stromal keratitis is an increasingly well-known vision-threatening disease. A large proportion of cases are initially misdiagnosed as herpes simplex keratitis and treated with topical steroids. In most of such cases, medical treatment failed, and corneal transplantation was required. This study reported the results of 0.02% topical chlorhexidine used to treat three cases of microsporidial stromal keratitis and reviewed the literature on the outcomes of microsporidial stromal keratitis treatment. In the first case, histopathology of a specimen from penetrating keratoplasty (PK) revealed severe chronic inflammation involving the entire stromal layer but no microorganism activity after the application of topical chlorhexidine for 10 months. The second case exhibited complete resolution of keratitis after topical chlorhexidine. The patient in the third case did not respond to medical treatment, and therapeutic PK was performed. Histopathological examination revealed numerous microsporidial spores that had colonized in the mid and deep stroma, where few inflammatory cells were observed. These findings explain the variable microsporidial susceptibility to chlorhexidine, suggesting the crucial role of host immunity. In cases of host immunity, topical chlorhexidine may represent a promising option for the treatment of microsporidial stromal keratitis.
Design and Production of Low-Cost 3D-Printed Transtibial Prosthetic Sockets
Authors: van der Stelt Merel , Verhulst Arico , Slump Cornelis H. , Papenburg Marco , Grobusch Martin P. , Brouwers Lars , Maal Thomas J.J.
Published: November 2021

Introduction

Only 5% to 15% of individuals with amputation living in low- and middle-income countries (LMICs) have access to proper prostheses. Mainly, prosthetic costs are too high, and facilities are not within reach. Measurement and production of traditional prosthetic sockets are time-consuming, labor-intensive, and highly dependent on the experience and skills of the personnel involved.

Materials and Methods

This report describes the workflow to produce low-cost patella tendon bearing transtibial prosthetic sockets. Using computer-aided design (CAD) and computer-aided manufacturing (CAM), transtibial prostheses can be easily produced in rural areas. The size of the residual limb was scanned with a handheld 3D-scanner (Einscanner Pro Plus), and the sockets were printed using fused filament fabrication (FFF) with an Ultimaker S5. The foot was made locally, and the other prosthetic parts were imported. The 3D-printed socket costs US $20 (excluding value-added tax [VAT]). The total material cost of the prosthesis, including the other prosthetic materials, amounts to approximately US $100 (excluding VAT). Assuming the asset cost of the devices, the costs of one local employee, overhead expenses, a profit margin, and the VAT included, a 3D-printed prosthesis could be sold for US $170.

Conclusions

This report provides a blueprint to produce low-cost 3D-printed transtibial prosthetic sockets. Further research will be conducted to replace the imported prosthetic parts for local products and to automatize the digital design process.

Clinical Relevance

With this workflow, prosthetic sockets can be produced consistently, which makes it a suitable method in LMICs.
Classification of Muscle Inertial Motion and Electromyographic Activity Integration to Improve Accuracy in Pattern Recognition
Authors: Arantes Ana Paula Bittar Britto , Bressan Nadja
Published: November 2021

Introduction

Over the years, several studies have been published reporting the use of distinct sources of information used for pattern recognition that can be translated into commands to control human-machine interface system, for example, electromyography (EMG), pressure sensors, and accelerometers. Studies using muscle motion patterns and its combination with EMG in the context of pattern recognition for evaluation of the muscles and human-machine interface system in able-bodied individuals and limb-absent subjects are scarce.

Material and Methods

In this context, this research presents the assessment of the classification of patterns formed by features extracted from both muscle motion and electromyographic signals. Data sets were collected from both arms of five unilateral transradial limb-absent subjects and seven able-bodied subjects in the control group. The features from the EMG and the muscle motion such as amplitude, frequency, predictability, and variability of the signals were estimated.

Results

The results were presented in terms of the sensitivity, specificity, precision, and accuracy of the classifier. The combination of both measurements, EMG and muscle motion, defined the six basic movements for limb-absent subjects within an accuracy of 98% ± 1% for the sound forearm against 96% ± 4% for the amputated forearm.

Conclusions

For future work, it is expected that the strategy of classification and the combination of inertial and electromyographic activity will be used in actual scenarios for the controlling of artificial limbs and other applications related to human-machine interaction.

Clinical Relevance

The use of inertial sensors may increase the usability and accuracy of systems used for diagnosing, training, therapy, or controlling devices such as orthoses and prostheses.
Impact of Vulvar Cancer Surgery on Quality of Sex Life: A Review of Literature
Authors: Zeitoun Jeremie , Calvary Marjolaine , Bonneau Claire , Rouzier Roman
Published: November 2021

Objectives

Vulvar cancer is a gynecological cancer for which posttreatment morbidity must be known to propose the appropriate medical strategy. The objectives of this article were to review and to summarize the available studies evaluating the impact of vulvar surgery on the quality of sex life.

Materials and Methods

We searched MEDLINE abstracts (source PubMed) and included all studies published between 1990 and 2020 that evaluated the impact of vulvar surgery on the patients’ sex life. Articles were selected in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. We evaluated the quality of the studies using the “study quality assessment tools” established by the National Heart Lung and Blood Institute and the health-related quality-of-life score. Summary statistics were used to report the results of the studies selected.

Results

A total of 41 articles were screened, and 15 studies were included in this review. Two questionnaires, that is, European Organization for Research and Treatment of Cancer QLC C30 and Female Sexual Function Index, were used in 60% of the studies. The quality of the studies was heterogeneous. None of them had a high level of evidence. Eleven of the 16 studies reported an impairment of quality of sex life, mainly related to the size of the initial lesion and the type of surgery performed. Preoperative sexual status, that is, active sex life, age, and morbidity seemed to be important factors.

Conclusions

None of the studies had a high level of evidence, and their methodological quality was heterogeneous. More powerful studies using validated questionnaires are necessary. Because this is essential surgery, patients should be informed that if it impacts their sexual life, management strategies will be part of their postoperative care.
Fabrication and Characterization of Tissue-Mimicking Phantoms for Ultrasound-Guided Cannulation Training
Authors: Jafary Rezan , Armstrong Sophie , Byrne Timothy , Stephens Andrew , Pellegrino Vincent , Gregory Shaun D.
Published: November 2021

Tissue-mimicking materials (TMMs) have been investigated and used for decades as imaging phantoms in various medical applications. They are designed and fabricated to replicate certain biological tissue characteristics, a process often dictated by the target application. Moreover, TMMs have been utilized in some medical procedural training requiring the use of imaging modalities. One potential application for TMMs is ultrasound-guided cannulation training. Cannulation is a procedure that requires a level of dexterity to gain vascular access using ultrasound guidance while avoiding complications like vessel laceration and bleeding. However, an ideal phantom for this application is yet to be developed. This work investigates the development and characterization of high-fidelity phantoms for cannulation training. The mechanical (shore hardness, elastic modulus, and needle-interaction forces) and acoustic (B-mode ultrasound scans) properties of candidate materials were quantitatively compared with biological tissue. The evaluated materials included ballistic gel, plasticized polyvinyl chloride (PVC), silicone, gelatin, agar, and polyvinyl alcohol (PVA)- cryogel. Mechanical testing demonstrated that each material could replicate the Shore hardness and elasticity characteristics of different biological tissues (skin, fat, and muscle), with PVA and PVC showing tunability by varying composition or fabrication processes. Shore hardness (OO-range) for PVA ranged between 6.3 ± 1.0 to 59.3 ± 2.6 and PVC from 4.8 ± 0.7 to 14.6 ± 0.8. Ultrasound scans of PVA were the closest to human scans, both qualitatively (based on experts’ opinion) and quantitatively (based on pixel intensity measurements). Modified mixtures of PVA are found to best serve as high-fidelity cannulation phantoms. Alternatively, PVC can be used to avoid troublesome fabrication processes of PVA.
Left Ventricular Assist Device Reinsertion for Recurrence of End-Stage Heart Failure Eleven Years after Device Removal: Case Report
Authors: Akay Mehmet H. , Salas De Armas Ismael , Patel Manish K. , Nathan Sriram , Kar Biswajit , Gregoric Igor D.
Published: November 2021

After demonstrated myocardial recovery in patients with durable left ventricular assist device (LVAD) support, the device may occasionally be explanted. A 38-year-old female with nonischemic cardiomyopathy underwent implantation of an LVAD as a bridge-to-transplant therapy. After one year, the patient demonstrated sufficient myocardial recovery allowing the LVAD to be explanted. A Teflon felt strip plug was created and placed within the apical sewing ring to occlude the opening into the left ventricle. Eleven years later, the patient presented with recurrence of severe heart failure. Due to morbid obesity, the patient was not a heart transplant candidate. Therefore, a second LVAD was implanted with a concomitant gastric sleeve procedure. When the plug was surgically removed from the sewing ring, no thrombus was observed; however, the ventricular surface was completely endothelialized. The patient recovered without any complications, was discharged from the hospital, and is currently listed for a heart transplant. This case demonstrates remission from heart failure lasting for more than a decade. If a second LVAD is needed due to exacerbation of severe heart failure, it can be safely introduced through the previous sewing ring after removing the Teflon plug.
Neglected analytes in the 24-h urine: ammonium and sulfate
Authors: Asplin John R.
Published: November 2021

Purpose of review

Evaluation of the kidney stone patient includes measurement of 24 h urine chemistries. This review summarizes the application of physiologic principles to the interpretation of urine chemistries, using sulfate and ammonium to estimate diet acid load, and the renal response.

Recent findings

There has been increased recognition of the need to measure urine ammonium excretion in the clinical setting in order to understand renal acid excretion. Some 24 h urine kidney stone panels include ammonium measurements, providing an opportunity to apply this measurement to clinical practice. In order to better interpret ammonium excretion, one needs an estimate of dietary acid load to understand the driving forces for ammonium excretion. Sulfate is also included in some kidney stone panels and functions as an estimate of diet acid load. Combining these analytes with urine pH, the clinician can quickly estimate dietary stone risk as well as potential bowel disease, acidification disorders, and the presence of urease producing bacteria; all of which can affect stone risk.

Measurement of ammonium and sulfate excretion along with urine pH provide important insights into the acid/alkali content of diet, presence and severity of bowel disease, presence of renal acidification disorders, and urinary infection.
Cardiovascular risk stratification in the noncardiac solid organ transplant candidate
Authors: Truby Lauren K. , Mentz Robert J. , Agarwal Richa
Published: November 2021

Purpose of review

Solid organ transplantation (SOT) has become a widely accepted therapy for end-stage disease across the spectrum of thoracic and abdominal organs. With contemporary advances in medical and surgical therapies in transplantation, candidates for SOT are increasingly older with a larger burden of comorbidities, including cardiovascular disease (CVD). CVD, in particular, is a leading cause of morbidity and mortality in SOT candidates with end-stage disease of noncardiac organs [1].

Recent findings

Identification of coronary artery disease (CAD), heart failure, and valvular disease are important in noncardiac SOT to ensure both appropriate peri-transplant management and equitable organ allocation. Although the American College of Cardiology (ACC) and the American Heart Association (AHA) have published guidelines and recommendations for the perioperative cardiovascular evaluation of patients undergoing noncardiac surgery, the implications of both symptomatic and asymptomatic CVD differ in patients with end-stage organ failure being considered for SOT when compared to the general population.

Herein, we review the epidemiology, diagnosis, and evidence for the management of CVD in kidney and liver transplantation, combining current guidelines from the 2012 ACC/AHA scientific statement on cardiac disease evaluation in SOT with more contemporary evidenced-based algorithms.
Quantum Mechanics and Surgical Pathology: A Brief Introduction
Authors: AbdullGaffar Badr
Published: November 2021

Quantum mechanics (QM) and surgical pathology might seem totally unrelated fields of science. Because QM or particle physics explains the very basic structure and function of nature, there are growing interconnections between the fundamentals and applications of QM and biologic sciences. QM is not only applied to the structure of atoms but also probes the structure of biologic molecules, explains their mutational changes and has provided an insight into the basic mechanisms of many different biologic systems. Many of the current applications in biologic sciences, medicine, and surgical pathology rely on the principles of QM. Because surgical pathology uses quantum phenomena such as light and studies disease’s alterations that are ultimately governed by quantum changes at nanoscale levels, QM will have potential future implications for the progress of surgical pathology. These might include quantum-enhanced refinements in light, ancillary tools, and interpretation assistance computerized systems. The future of applying the concepts, discoveries, and tools of QM in surgical pathology might create something analogous to quantum biology; that is, quantum pathology or “QuPath.”
Bizarre Chorionic-type Trophoblast in Second-trimester and Third-trimester Placentas
Authors: Murdock Tricia A. , Varghese Aaron , Xing Deyin , Schoolmeester J. Kenneth , Alexander Caitlin , Baergen Rebecca N. , Dahoud Wissam , Hopkins Mark R. , Askin Frederic , Vang Russell
Published: November 2021

Bizarre (atypical/symplastic) cells have been described in various gynecologic normal tissues and benign neoplasms. This type of bizarre cytologic change is usually an incidental finding and is regarded as a benign process. We describe 17 cases of bizarre chorionic-type trophoblast in second-trimester and third-trimester placentas that created concern for an underlying/undersampled or incipient intraplacental trophoblastic neoplasm, predominantly found in intervillous trophoblastic islands (11/17), placental septae (6/17), chorionic plate (1/17), and/or the chorion layer of fetal membranes (2/17). The bizarre trophoblastic cells exhibited sheet-like or nested architecture, had a multifocal/patchy distribution, and/or were present as individual cells within hyaline stroma; they were characterized by large nuclei with smudgy chromatin and occasional intranuclear pseudoinclusions. The degree of atypia was classified as mild (0/17), moderate (3/17), or severe (14/17). Mitotic figures and necrosis were not identified. A dual immunohistochemical stain for trophoblast (hydroxyl-delta-5-steroid dehydrogenase) and a proliferation marker (Ki-67), performed in 15 cases, demonstrated 0% to very low proliferative activity within the bizarre trophoblast (0% to 2% [10/15], 3% to 8% [5/15]). Immunohistochemical stains for fumarate hydratase showed intact/retained expression in the bizarre cells in 7 of 7 cases. Clinical follow-up ranged from 1 to 45 months, and all patients were alive and well without subsequent evidence of a gestational trophoblastic or other neoplasms. We conclude that bizarre chorionic-type trophoblast in second-trimester or third-trimester placentas have the potential to mimic an intraplacental trophoblastic neoplasm but are likely a benign degenerative change. This study expands the spectrum of bizarre cells that occur in the gynecologic tract.
RASGRF1-rearranged Cutaneous Melanocytic Neoplasms With Spitzoid Cytomorphology
Authors: Goto Keisuke , Pissaloux Daniel , Fraitag Sylvie , Amini Mona , Vaucher Richard , Tirode Franck , de la Fouchardière Arnaud
Published: November 2021

Spitz neoplasms, according to 2018 WHO Blue Book, are morphologically defined by spindled and/or epithelioid melanocytes and genetically by either HRAS mutations or kinase gene fusions. The terminology “spitzoid” refers to lesions with similar morphology but with alternate or undefined genetic anomalies. Herein, we present 3 melanocytic neoplasms with a spitzoid cytomorphology, variable nuclear atypia, and harboring undescribed fusions involving RASGRF1. Two cases presented as unpigmented papules on the heel of a 26-year-old female (case 1) and the forearm of a 13-year-old boy (case 2). They were classified as low-grade melanocytomas (WHO 2018). The third case appeared as a pigmented ulcer on the sole of a 72-year-old female (case 3) that displayed diagnostic features of an invasive melanoma (Breslow thickness 6 mm, Clark level V). A wide skin reexcision identified an epidermotropic metastasis, and sentinel lymph node biopsy displayed multiple subcapsular metastatic deposits. RNA sequencing revealed CD63::RASGRF1, EHBP1::RASGRF1, and ABCC2::RASGRF1 fusions in cases 1 to 3, respectively. They were confirmed by a RASGRF1 break-apart fluorescence in situ hybridization technique. Translocations of RASGRF1, a gene coding a guanine nucleotide exchange factor but not a kinase, have rarely been reported in tumors. While all these cases showed spitzoid cytomorphology, it is too early to tell if they are true Spitz neoplasms as currently defined.
Adolescent Male Receptivity of and Preferences for Sexual Health Interventions in the Emergency Department
Authors: Chernick Lauren S. , Wallace Brendan K. , Potkin Maxmoore T. , Bell David L. , Dayan Peter S.
Published: November 2021

Objective

Male adolescents frequently present to the emergency department (ED) and many participate in behaviors increasing their risk of sexually transmitted infections and unintended pregnancies. Although the ED visit may represent an intervention opportunity, how best to design and deliver a sexual health intervention matching the preferences of adolescent male users is unclear. Our objective was to explore receptivity to and preferences for sexual health interventions among adolescent male ED patients.

Methods

In this qualitative study, we asked sexually active male ED patients aged 14 to 21 years about their attitudes toward ED-based sexual health interventions and preferences for intervention modalities. Participants interacted with an early prototype of a digital intervention to gather specific feedback. Enrollment continued until saturation of key themes. Interviews were recorded, transcribed, and coded based on thematic analysis using NVivo.

Results

Participants (n = 42) were predominantly 18 to 21 years (63%) and Hispanic (79%). Although most (71%) had sex in the prior 3 months, 45% did not use a condom at last intercourse and 17% had impregnated a partner. Participants viewed the ED visit as unused time without distracting influences, suitable for educational sexual health interventions. They considered ED-based digital interventions a reliable and confidential source of information. Engaging interventions allowed user control and provided novel and relatable content.

Conclusions

Adolescent male ED patients are receptive to ED-based digital sexual health interventions. These identified preferences should be considered when designing future user-informed sexual health interventions for the ED setting.
Serum Albumin Level as a Predictor of Outcome in Patients Admitted to Pediatric Intensive Care Units
Authors: Bekhit Osama E. , Yousef Remon M. , Abdelrasol Hoiyda A. , Mohammed Mohammed A.
Published: November 2021

Objective

The aim of this study was to assess serum albumin level on admission to the pediatric intensive care unit (PICU) as a prognostic indicator.

Methods

A prospective study was conducted in Fayoum University Children's Hospital. The study subjects' demographics and clinical and laboratory data were recorded. Pediatric Risk of Mortality III (PRISM-III) score was calculated. Serum albumin level was assessed within 24 hours from admission. Outcomes included mortality, PICU and hospital stay, need and duration of mechanical ventilation, and inotrope use.

Results

The incidence of admission hypoalbuminemia was 26%. The study subjects had a significantly higher mortality rate than subjects with normal albumin levels (42.3% vs 17.6%, respectively, P = 0.011). Each unit of increase in serum albumin decreased the risk of mortality by 28.9% (odds ratio, 0.289; confidence interval, 0.136–0.615, P = 0.001). Serum albumin showed a fair discriminatory power (area under the curve, 0.738). At a cutoff point of ≤3.7 g/dL, albumin had a 79.2% sensitivity, 67.1% specificity, 43.2% positive predictive value, and 91.1% negative predictive value. Incorporation of serum albumin with PRISM-III score was more predictive of mortality than either predictors alone (area under the curve, 0.802). No significant difference was found between the 2 groups regarding either PICU and hospital stay as well as the need and duration of ventilation.

Conclusions

In PICUs, admission hypoalbuminemia is a good predictor of mortality. Further studies to confirm the value of adding serum albumin to PRISM-III score are recommended.