bluuebunny/crossref_metadata_2025 huggingface dataset:
The Function Assessment Scale for Spinal Deformity
Authors: Severijns Pieter , Overbergh Thomas , Ackermans Thijs , Beaucage-Gauvreau Erica , Brumagne Simon , Desloovere Kaat , Scheys Lennart , Moke Lieven
Published: October 2021

Study Design.

Cross-sectional study.

Objective.

The aim of this study was to develop and validate the Function Assessment scale for Spinal Deformity (FASD).

Summary of Background Data.

Spinal malalignment impacts daily functioning. Standard evaluation of adult spinal deformity (ASD) is based on static radiography and patient-reported scores, which fail to assess functional impairments. A clinical scale, quantifying function and balance of patients with ASD, could increase our insights on the impact of ASD on functioning.

Methods.

To develop the FASD, 70 ASD patients and 20 controls were measured to identify the most discriminating items of the Balance Evaluation Systems Test and Trunk Control Measurement Scale. Discussions between experts on the clinical relevance of selected items led to further item reduction. The FASD's discriminative ability was established between 43 patients and 19 controls, as well as between three deformity subgroups. For its responsiveness to treatment, 10 patients were reevaluated 6 months postoperatively. Concurrent validity was assessed through correlation analysis with radiographic parameters (pelvic tilt; sagittal vertical axis [SVA]; pelvic incidence minus lumbar lordosis [PI-LL]; coronal vertical axis) and patient-reported scores [Oswestry Disability Index]; Scoliosis Research Society outcome questionnaire; Falls Efficacy Scale-International). Test–retest and interrater reliability were tested on two groups of ten patients using intraclass correlation coefficients (ICC).

Results.

Patients with ASD, mainly with sagittal malalignment, scored worse compared to controls on FASD (P < 0.001) and its subscales. No significant improvement was observed 6 months postoperatively (P = 0.758). FASD correlated significantly to all patient-reported scores and to SVA and PI-LL. Reliability between sessions (ICC = 0.97) and raters (ICC = 0.93) was excellent. Subscales also showed good to excellent reliability, except FASD 1 on “spinal mobility and balance” between sessions (ICC = 0.71).

Conclusion.

FASD proved to be a valid and reliable clinical scale for evaluation of functional impairments in ASD. Objective information on function and balance might ultimately guide physiotherapeutic treatment toward improved functioning.

Level of Evidence: 2
Minimally Invasive Robotic Lumbar Facet Decortication
Authors: Satin Alexander M. , Albano Joseph , Kisinde Stanley , Lieberman Isador H.
Published: October 2021

Minimally invasive percutaneous pedicle screws (PPS) are placed through muscle sparing paramedian incisions and provide rigid 3 column fixation to promote stability and fusion. Percutaneous pedicle instrumentation is generally performed as adjunctive posterior stabilization after anterior lumbar interbody fusion or lateral lumbar interbody fusion procedures. In these instances, arthrodesis is often achieved through the interbody fusion rather than posterior column fusion. In some cases, the surgeon may choose to perform posterior facet fusion in addition to PPS and anterior interbody. The addition of a minimally invasive facet fusion to PPS and anterior column interbody fusion creates more fusion surface and enables a truly circumferential fusion. While robotic-guided facet decortication has been suggested, there are currently no published techniques. Here, we describe a novel minimally invasive technique to perform percutaneous robotic facet decortication in conjunction with PPS following anterior lumbar interbody fusion or lateral lumbar interbody fusion.
Diagnostic accuracy of dynamic contrast-enhanced magnetic resonance imaging for distinguishing pseudoprogression from glioma recurrence: a meta-analysis
Authors: Qiu Jun , Tao Zhen-Chao , Deng Ke-Xue , Wang Peng , Chen Chuan-Yu , Xiao Fang , Luo Yi , Yuan Shu-Ya , Chen Hao , Huang Huan
Published: October 2021

Background:

It is crucial to differentiate accurately glioma recurrence and pseudoprogression which have entirely different prognosis and require different treatment strategies. This study aimed to assess the diagnostic accuracy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as a tool for distinguishing glioma recurrence and pseudoprogression.

Methods:

According to particular criteria of inclusion and exclusion, related studies up to May 1, 2019, were thoroughly searched from several databases including PubMed, Embase, Cochrane Library, and Chinese biomedical databases. The quality assessment of diagnostic accuracy studies was applied to evaluate the quality of the included studies. By using the “mada” package in R, the heterogeneity, overall sensitivity, specificity, and diagnostic odds ratio were calculated. Moreover, funnel plots were used to visualize and estimate the publication bias in this study. The area under the summary receiver operating characteristic (SROC) curve was computed to display the diagnostic efficiency of DCE-MRI.

Results:

In the present meta-analysis, a total of 11 studies covering 616 patients were included. The results showed that the pooled sensitivity, specificity, and diagnostic odds ratio were 0.792 (95% confidence interval [CI] 0.707–0.857), 0.779 (95% CI 0.715–0.832), and 16.219 (97.5% CI 9.123–28.833), respectively. The value of the area under the SROC curve was 0.846. In addition, the SROC curve showed high sensitivities (>0.6) and low false positive rates (<0.5) from most of the included studies, which suggest that the results of our study were reliable. Furthermore, the funnel plot suggested the existence of publication bias.

Conclusions:

While the DCE-MRI is not the perfect diagnostic tool for distinguishing glioma recurrence and pseudoprogression, it was capable of improving diagnostic accuracy. Hence, further investigations combining DCE-MRI with other imaging modalities are required to establish an efficient diagnostic method for glioma patients.
Computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction for bone sarcomas: long-term outcomes
Authors: Xu Li-Hui , Zhang Qing , Zhao Hai-Tao , Yu Feng , Niu Xiao-Hui
Published: October 2021

Background:

Computed tomography (CT) and magnetic resonance imaging (MRI) data can be fused to identify the tumor boundaries. This enables surgeons to set close but tumor-free surgical margins and excise the tumor more precisely. This study aimed to report our experience in performing computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction to treat bone sarcoma in the diaphysis and metaphysis of the femur and tibia.

Methods:

Between September 2008 and December 2015, 24 patients with bone sarcomas underwent surgical resection and joint-sparing reconstruction under image-guided computer navigation. The cohort comprised 16 males and eight females with a median age of 19.5 years (range: 12–48 years). The tumor location was the femoral diaphysis in three patients, distal femur in 19, and proximal tibia in two. The tumors were osteosarcoma (n = 15), chondrosarcoma (n = 3), Ewing sarcoma (n = 3), and other sarcomas (n = 3). We created a pre-operative plan for each patient using navigation system software and performed navigation-aided resection before reconstructing the defect with a custom-made prosthesis with extracortical plate fixation.

Results:

Pathological examination verified that all resected specimens had appropriate surgical margins. The median distance from the tumor resection margin to the joint was 30 mm (range: 13–80 mm). The median follow-up duration was 62.5 months (range: 24–134 months). Of the 24 patients, 21 remain disease free, one is alive with disease, and two died of the disease. One patient developed local recurrence. Complications requiring additional surgical procedures occurred in six patients, including one with wound hematoma, one with delayed wound healing, one with superficial infection, one with deep infection, and two with mechanical failure of the prosthesis. The mean Musculoskeletal Tumor Society score at the final follow-up was 91% (range: 80%–100%). The 5- and 10-year implant survival rates were 91.3% and 79.9%, respectively.

Conclusions:

Computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction with extracortical plate fixation is a reliable surgical treatment option for bone sarcoma in the diaphysis and metaphysis of the femur and tibia.
Discharge heart rate and 1-year clinical outcomes in heart failure patients with atrial fibrillation
Authors: Xing Fuwei , Zheng Xin , Zhang Lihua , Hu Shuang , Bai Xueke , Hu Danli , Li Bing , Li Jing
Published: October 2021

Background:

The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF level.

Methods:

In this analysis, we enrolled 1760 hospitalized HF patients with AF from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure study from August 2016 to May 2018. Patients were categorized into three groups with low (<65 beats per minute [bpm]), moderate (65–85 bpm), and high (≥86 bpm) heart rate measured at discharge. Cox proportional hazard models were employed to explore the association between heart rate and 1-year primary outcome, which was defined as a composite outcome of all-cause death and HF rehospitalization.

Results:

Among 1760 patients, 723 (41.1%) were women, the median age was 69 (interquartile range [IQR]: 60–77) years, median discharge heart rate was 75 (IQR: 69–84) bpm, and 934 (53.1%) had an LVEF <50%. During 1-year follow-up, a total of 792 (45.0%) individuals died or had at least one HF hospitalization. After adjusting for demographic characteristics, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the groups with low (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05–1.68, P = 0.020) and high (HR: 1.34, 95% CI: 1.07–1.67, P = 0.009) heart rate were associated with a higher risk of 1-year primary outcome compared with the moderate group. A significant interaction between discharge heart rate and LVEF for the primary outcome was observed (P for interaction was 0.045). Among the patients with LVEF ≥50%, only those with high heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.38, 95% CI: 1.01–1.89, P = 0.046), whereas there was no difference between the groups with low and moderate heart rate. Among the patients with LVEF <50%, only those with low heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.46, 95% CI: 1.09–1.96, P = 0.012), whereas there was no difference between the groups with high and moderate heart rate.

Conclusions:

Among the overall HF patients with AF, both low (<65 bpm) and high (≥86 bpm) heart rates were associated with poorer outcomes as compared with moderate (65–85 bpm) heart rate. Among patients with LVEF ≥50%, only a high heart rate was associated with higher risk; while among those with LVEF <50%, only a low heart rate was associated with higher risk as compared with the group with moderate heart rate.

Trail Registration:

Clinicaltrials.gov; NCT02878811.
Impact of conventional vs. goal-directed fluid therapy on urethral tissue perfusion in patients undergoing liver surgery
Authors: Chirnoaga Dragos , Coeckelenbergh Sean , Ickx Brigitte , Van Obbergh Luc , Lucidi Valerio , Desebbe Olivier , Carrier François Martin , Michard Frederic , Vincent Jean-Louis , Duranteau Jacques , Van der Linden Philippe , Joosten Alexandre
Published: October 2021

BACKGROUND

Although fluid administration is a key strategy to optimise haemodynamic status and tissue perfusion, optimal fluid administration during liver surgery remains controversial.

OBJECTIVE

To test the hypothesis that a goal-directed fluid therapy (GDFT) strategy, when compared with a conventional fluid strategy, would better optimise systemic blood flow and lead to improved urethral tissue perfusion (a new variable to assess peripheral blood flow), without increasing blood loss.

DESIGN

Single-centre prospective randomised controlled superiority study.

SETTING

Erasme Hospital.

PATIENTS

Patients undergoing liver surgery.

INTERVENTION

Forty patients were randomised into two groups: all received a basal crystalloid infusion (maximum 2 ml kg−1 h−1). In the conventional fluid group, the goal was to maintain central venous pressure (CVP) as low as possible during the dissection phase by giving minimal additional fluid, while in the posttransection phase, anaesthetists were free to compensate for any presumed fluid deficit. In the GDFT group, patients received in addition to the basal infusion, multiple minifluid challenges of crystalloid to maintain stroke volume (SV) variation less than 13%. Noradrenaline infusion was titrated to keep mean arterial pressure more than 65 mmHg in all patients.

MAIN OUTCOME MEASURE

The mean intra-operative urethral perfusion index.

RESULTS

The mean urethral perfusion index was significantly higher in the GDFT group than in the conventional fluid group (8.70 [5.72 to 13.10] vs. 6.05 [4.95 to 8.75], P = 0.046). SV index (ml m−2) and cardiac index (l min−1 m−2) were higher in the GDFT group (48 ± 9 vs. 33 ± 7 and 3.5 ± 0.7 vs. 2.4 ± 0.4, respectively; P < 0.001). Although CVP was higher in the GDFT group (9.3 ± 2.5 vs. 6.5 ± 2.9 mmHg; P = 0.003), intra-operative blood loss was not significantly different in the two groups.

CONCLUSION

In patients undergoing liver surgery, a GDFT strategy resulted in a higher mean urethral perfusion index than did a conventional fluid strategy and did not increase blood loss despite higher CVP.

TRIAL REGISTRATION

NCT04092608.
Teleconsultation for preoperative evaluation during the coronavirus disease 2019 pandemic
Authors: Wienhold Jan , Mösch Lucas , Rossaint Rolf , Kemper Ilka , Derwall Matthias , Czaplik Michael , Follmann Andreas
Published: October 2021

BACKGROUND

During the surge in coronavirus disease 2019 (COVID-19) infections in early 2020, many medical organisations began developing strategies for implementing teleconsultation to maintain medical services during lockdown and to limit physical contact. Therefore, we developed a teleconsultation preoperative evaluation platform to replace on-site preoperative meetings.

OBJECTIVE

This study assessed the feasibility of a teleconsultation for preoperative evaluation and procedure-associated adverse events.

DESIGN

Implementation study.

SETTING

A tertiary care university hospital in Germany from April 2020 to October 2020.

PATIENTS

One hundred and eleven patients scheduled for elective surgery.

INTERVENTION

Patients were assigned to receive teleconsultation for preoperative evaluation and to complete a subsequent survey.

MAIN OUTCOME MEASURES

Primary endpoints were medical and technical feasibility, user satisfaction and time savings.

RESULTS

For 100 out of 111 patients, telepreoperative consultations allowed for adequate perioperative risk assessment, patient education and also for effective collection of legal signatures. For six patients (5.4%), consultations could not be started because of technical issues, whereas for five patients (4.8%), clearance for surgery could not be granted because of medical reasons. A clear majority of anaesthetists (93.7%) rated the telepreoperative evaluations as equivalent to on-site meetings. The majority of the patients considered teleconsultation for preoperative evaluation as convenient as an on-site meeting (98.2%) and would choose a teleconsultation again (97.9%). Median travel time saved by patients was 60 min (Q1 40, Q3 80). We registered one adverse event: we detected atrial fibrillation in one patient only immediately prior to surgery.

CONCLUSION

Telepreoperative evaluations are medically and technically feasible, yielding high satisfaction rates on both sides. However, regarding patient safety, not every patient is equally well suited. Overall, implementation of teleconsultation for preoperative evaluation into clinical routine could help maintain medical care during the COVID-19 pandemic.

TRIAL REGISTRATION

NCT04518514, ClinicalTrials.gov
The Impossible Anastomosis: Intima-to-adventitia Suture Technique for Microanastomosis of Severely Calcified Arteries
Authors: Cai Aijia , Horch Raymund E. , Arkudas Andreas
Published: October 2021

Microsurgery in patients with advanced atherosclerosis is challenging. Calcified vessels can hinder microanastomosis, which precludes free flap reconstruction in those patients. We present a case of a female patient with stage 4 peripheral artery disease who had undergone mastectomy because of invasive breast cancer. During autologous breast reconstruction with a muscle-sparing transverse rectus abdominis free flap, we experienced difficulties during microanastomosis due to complicated plaques in an extremely calcified inferior epigastric artery. Also, the intima presented completely detached from the media, leading to a collapse of the vessel lumen. To prevent curling of the intima and prolapse of the atherosclerotic plaques into the vessel lumen, the intima was sutured to the adventitia by interrupted stitches. This maneuver led to eversion of the intima and facilitated the otherwise unfeasible anastomosis. The reconstructed breast showed adequate perfusion during the postoperative course. We present a technique to facilitate microanastomosis in severely calcified and fragile arteries.
Bilateral Outpatient Breast Reconstruction with Stacked DIEP and Vertical PAP Flaps
Authors: Martinez Carlos A. , Fairchild Berry , Secchi-del Rio Roberto , Boutros Sean G.
Published: October 2021

Background:

Stacking free flaps for breast reconstruction is far from novel, even in the case of a deep inferior epigastric perforator (DIEP) plus profunda artery perforator (PAP) configuration, where the latter is always described in the traditional transverse configuration. We present a series of consecutive patients undergoing bilateral breast reconstruction with stacked DIEP and vertical PAP flaps.

Methods:

Patients with inadequate abdominal donor tissue were offered the possibility of a stacking breast reconstruction. The DIEP flap was harvested via microfascial incisions, whereas the vertical PAP flap was harvested in the lithotomy position, following the course of the gracilis muscle.

Results:

In total, 28 consecutive patients with a mean BMI of 24.9 underwent bilateral breast reconstruction with stacked DIEP and vertical PAP flaps. The internal mammary artery and vein were used as recipient vessels in all 56 stacked flaps. Fifty-three PAP flaps were anastomosed to the distal portion of the (primary) DIEP flaps utilizing a sequential flap anastomosis technique, and one DIEP flap was anastomosed to the distal portion of the (primary) PAP flap. Hospitalization for the initial eight patients averaged 35 hours, whereas the following 20 patients were discharged within 23 hours. There were no postoperative takebacks or vascular complications.

Conclusions:

Stacked DIEP/PAP flaps offer an excellent option for patients who require more volume than available from DIEP flaps alone. When compared with transverse PAP flaps, the vertical PAP offers excellent variability of volume and ease of shaping to allow for excellent results, while minimizing donor site tension in the seated position and preserving the gluteal fold.
Association Between Telecommuting Environment and Low Back Pain Among Japanese Telecommuting Workers
Authors: Matsugaki Ryutaro , Muramatsu Keiji , Tateishi Seiichiro , Nagata Tomohisa , Tsuji Mayumi , Hino Ayako , Ikegami Kazunori , Fujino Yoshihisa , Matsuda Shinya
Published: October 2021

Objectives:

We evaluated the relationship between telecommuting environment and low back pain (LBP) among desk-based workers in Japan.

Methods:

This cross-sectional study included 3663 desk-based, telecommuting workers. LBP was assessed using a 0 to 10 numerical rating scale. The telecommuting environment was evaluated using subjective questions. Mixed-effects logistic regression analysis was used to evaluate this association.

Results:

The results of mixed-effects logistic model revealed that not having a place or room to concentrate on work, desk not well-lit enough for work, lack of space on the desk to work, not having enough legroom, and uncomfortable temperature and humidity conditions in the workspace were significantly associated with higher odds of LBP.

Conclusions:

Our findings suggest that telecommuting environment is associated with the prevalence of LBP.
Transeustachian Middle Ear Endoscopy Using a Steerable Distal-Camera Tipped Endoscope
Authors: Freeman Michael H. , Gafford Joshua B. , Fichera Loris , Noble Jack , Webster Robert J. , Labadie Robert F.
Published: October 2021

Objective:

Demonstrate the ability of a novel steerable distal chip endoscope to traverse the Eustachian tube and provide diagnostic quality images of the human middle ear.

Patients:

Three cadaveric temporal bone specimens were used in this work.

Intervention:

Diagnostic transeustachian endoscopy of the middle ear was performed.

Main Outcome Measure:

Diagnostic image quality.

Results:

A novel 1.62 mm steerable endoscope successfully cannulated the Eustachian tube of three human cadaveric temporal bone specimens to reveal intact middle ear anatomy with high optical clarity.

Conclusions:

A steerable endoscope can be designed to traverse the human Eustachian tube and provide diagnostic quality images of middle ear anatomy.
Comparison of Bivalirudin Versus Unfractionated Heparin for Anticoagulation in Adult Patients on Extracorporeal Membrane Oxygenation
Authors: Sheridan Erica A. , Sekela Michael E. , Pandya Komal A. , Schadler Aric , Ather Ayesha
Published: October 2021

Extracorporeal membrane oxygenation (ECMO) contributes to coagulopathy, necessitating systemic anticoagulation to prevent thrombosis. Traditionally, unfractionated heparin (UFH) has been the anticoagulant of choice, however, due to many inadequacies new evidence suggests benefit with the use of direct thrombin inhibitors. This retrospective cohort sought to evaluate the safety and efficacy of bivalirudin compared to UFH in ECMO patients. Primary endpoints included incidence of bleeding and thrombosis. Percent time in therapeutic range (TR), time to achieve TR and number of dose titrations required to maintain TR were calculated to assess efficacy of institutional protocols. Overall incidence of thrombosis was low, with one event in the bivalirudin group and no events in the UFH group. No difference was found in rates of bleeding between groups (6% vs. 10%, P = 0.44). Bivalirudin yielded higher percent time in TR (86% vs. 33%, P < 0.001), faster time to TR (2 vs. 18 hr, P < 0.001) and required fewer dose adjustments to maintain TR (2 vs. 11, P < 0.001) compared to UFH. These results suggest bivalirudin and UFH are associated with similar rates of bleeding and thrombosis in patients requiring ECMO support. Our results demonstrate the favorable pharmacokinetic profile of bivalirudin, and its ability to consistently maintain TR when compared to UFH.
Impact of glomerular filtration rate estimation on cardiovascular events in elderly patients undergoing coronary angiography
Authors: Aker Amir , Eitan Amnon , Saliba Walid , Jaffe Ronen , Zafrir Barak
Published: October 2021

Background

Estimation of kidney function by glomerular filtration rate (eGFR) is affected by age and is important for decision making regarding treatment and prognosis of patients with cardiovascular disease. We investigated the impact of eGFR on long-term cardiovascular outcomes in an elderly population undergoing coronary angiography for evaluation or treatment of coronary artery disease.

Methods

GFR was estimated according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in 3690 elderly patients (aged 70–100 years) undergoing coronary angiography. Patients receiving maintenance dialysis were excluded. The association between eGFR and major adverse cardiovascular events (MACE) including myocardial infarction, ischemic stroke or death, was investigated. GFR was further calculated according to modification of diet in renal disease (MDRD) and the Cockcroft–Gault equations, and compatibility between estimations was analyzed.

Results

Cardiovascular comorbidities were more prevalent with the reduction in kidney function as was the proportion of patients presenting with acute coronary syndromes. The adjusted hazard ratio (95% confidence interval) for MACE during a mean follow-up of 5 years was 0.95 (0.77–1.16), 1.04 (0.84–1.29), 1.56 (1.16–1.84), 2.22 (1.65–2.97) and 3.74 (2.20–6.38) in patients with eGFR 60-89, 45–59, 30–44, 15–29 and <15 ml/min/1.73m2, respectively, compared to >90 ml/min/1.73m2. Reclassification of eGFR stages by MDRD (upward 23.8%, downward 0.4%) and Cockcroft–Gault (upward 4.3%, downward 28.1%) compared to CKD-EPI estimation, was noted. However, the association between eGFR stages and MACE was similar between equations.

Conclusions

Kidney function, as manifested by eGFR, has a graded inverse association with the burden of cardiovascular comorbidities and long-term adverse events in elderly patients undergoing coronary angiography.
Impact on the long-term prognosis of FDG PET/CT in luminal-A and luminal-B breast cancer
Authors: Urso Luca , Quartuccio Natale , Caracciolo Matteo , Evangelista Laura , Schirone Alessio , Frassoldati Antonio , Arnone Gaspare , Panareo Stefano , Bartolomei Mirco
Published: October 2021

Purpose

The aim of the present study was to explore the prognostic role of 2- deoxy-2-[18F]fluoro-D-glucose PET (FDG PET)/CT in recurrent luminal A and luminal B breast cancer.

Materials and methods

From two institutional databases, we retrospectively retrieved data about breast cancer patients undergoing FDG PET/CT between 2011 and 2018 for the assessment of recurrency. Molecular subtypes of breast cancer were defined based on the expression of estrogen, progesterone, human epidermal growth factor receptor 2 (HER2)-b receptors and proliferation index. Overall survival (OS, intended as the time from PET/CT and the time of death) was registered for each patient, by checking the medical charts. Parametric and survival analyses were computed.

Results

Data of 179 patients were retrieved. Sixty-three patients had luminal A, 88 luminal B and 28 luminal B/He breast cancer. At the time of PET/CT scan, cancer antigen (CA) 15.3 levels was within the normal range in 119 patients, whereas it was increased in 60 patients. FDG PET/CT results were suggestive for disease recurrence in 114 (63.7%) patients. The median time lapse from the FDG PET/CT scan to the last clinical follow-up visit was 51 months (1–192 months). Patients with evidence of a PET/CT scan suggestive for disease recurrence showed a significantly shorter OS (P < 0.001) compared to patients with no PET/CT evidence of recurrence, in each subset of luminal breast cancer. Moreover, PET/CT was able to stratify the prognosis of patients independently from the level of tumor marker.

Conclusion

These data suggest that FDG PET/CT may be an attractive prognostic tool in recurrent breast cancer. Our study supports its prognostic role both in luminal A and B-type molecular subtypes, regardless of the CA 15.3 levels.
Surgical treatment options for benign prostatic obstruction: beyond prostate volume
Authors: Deyirmendjian Claudia , Elterman Dean , Chughtai Bilal , Zorn Kevin C. , Bhojani Naeem
Published: October 2021

Purpose of review

Many surgical treatment options are available for patients who present with benign prostatic obstruction (BPO). This article reviews the current treatment options available and distinguishes them based on five clinical considerations: antithrombotic therapy, sexual function preservation, ambulatory procedures, anesthesia-related risks and duration of catheterization.

Recent findings

A comprehensive review of the literature was performed on 10 BPO procedures. Laser enucleation of the prostate (LEP), bipolar plasma transurethral vaporization of the prostate and photoselective vaporization (PVP) of the prostate reduces the risk of bleeding, which is recommended for anticoagulated men. Ejaculatory function is more likely to be preserved following transurethral incision of the prostate, Rezūm, Aquablation, UroLift and iTind. Same-day discharge is possible for LEP, PVP and prostatic arterial embolization (PAE). For patients with high anesthesia-related risks, procedures compatible with local anesthesia (UroLift, Rezūm, iTind and PAE) should be favored. Catheterization duration is shorter with UroLift, PVP and LEP.

BPO treatment options are growing rapidly. The optimal procedure for a given patient is based on factors such as associated risks, recovery and expected outcomes. Besides prostate volume, the clinical considerations in the present article can help elucidate the best surgical BPO treatment option for each patient based on their values, preferences, and risk tolerance.
The Mathematical Knowledge for Teaching Model as a Pedagogical Framework for Clinical Nursing Educators
Authors: Huber Stacy W.
Published: October 2021

Background:

Clinical education is essential to the development of nursing students and future nursing practice. However, research often focuses on pedagogies used in the classroom and not in the clinical environment.

Problem:

Presently, there is no framework in nursing education to describe the subject matter and pedagogical knowledge educators draw upon when teaching in the clinical setting.

Approach:

This article describes how the mathematical knowledge for teaching framework was applied to nursing education to examine clinical educators' subject matter and pedagogical knowledge.

Outcomes:

By applying the framework, facets of subject and pedagogical knowledge used by clinical educators were identified, defined, and described.

Conclusions:

Applying the mathematical knowledge for teaching framework to clinical education may be an initial step to describe the types of knowledge that nursing educators draw upon in the clinical setting. It may also be used in the design of professional development and mentoring programs for nurse educators.
Impact of the COVID-19 Pandemic on Centers for Disease Control and Prevention–Funded Sexually Transmitted Disease Programs
Authors: Wright Shauntā S. , Kreisel Kristen M. , Hitt Jeffrey C. , Pagaoa Melissa A. , Weinstock Hillard S. , Thorpe Phoebe G.
Published: October 2021

The COVID-19 pandemic impacted sexually transmitted disease (STD) services. Of 59 US-funded STD programs, 91% reported a great deal to moderate impact from staff reassignment in April 2020, with 28% of respondents reporting permanent reassignment of disease intervention specialist staff. Telemedicine was implemented in 47%. Decreases in STD case reports were reported by most jurisdictions.
Ten Common Structures and Processes of High-Performing Primary Care Practices
Authors: Nguyen Ann M. , Paul Margaret M. , Shelley Donna R. , Albert Stephanie L. , Cohen Deborah J. , Bonsu Pam , Wyte-Lake Tamar , Blecker Saul , Berry Carolyn A.
Published: October 2021

Structures (context of care delivery) and processes (actions aimed at delivery care) are posited to drive patient outcomes. Despite decades of primary care research, there remains a lack of evidence connecting specific structures/processes to patient outcomes to determine which of the numerous recommended structures/processes to prioritize for implementation. The objective of this study was to identify structures/processes most commonly present in high-performing primary care practices for chronic care management and prevention. We conducted key informant interviews with a national sample of 22 high-performing primary care practices. We identified the 10 most commonly present structures/processes in these practices, which largely enable 2 core functions: mobilizing staff to conduct patient outreach and helping practices avoid gaps in care. Given the costs of implementing and maintaining numerous structures/processes, our study provides a starting list for providers to prioritize and for researchers to investigate further for specific effects on patient outcomes.
Immobilization-Related Hypercalcemia in a COVID-19 Patient With Prolonged Intensive Care Unit Stay
Authors: Mesland Jean-Baptiste , Collienne Christine , Laterre Pierre-François , Hantson Philippe
Published: October 2021

Immobilization-related hypercalcemia is an uncommon finding in patients admitted to intensive care unit. We report a case of severe hypercalcemia in a COVID-19 patient admitted to intensive care unit for hypoxemic respiratory failure. He developed an acute kidney injury requiring continuous renal replacement therapy with regional citrate anticoagulation. Citrate chelates ionized calcium and stop the coagulation cascade locally, preventing filter clotting. Calcium is then given intravenously to a specific target (normocalcemia). It is only when calcium infusion has been stopped that bone resorption and hypercalcemia were unmasked.
Early Life Adversity and Blunted Cardiovascular Reactivity to Acute Psychological Stress: The Role of Current Depressive Symptoms
Authors: Keogh Tracey M. , Howard Siobhán , Gallagher Stephen
Published: October 2021

Objective

The pathways underlying the early life adversity and cardiovascular reactivity association remain unclear. The current study examined the role of current depressive symptoms on this relationship.

Methods

Mediation analyses were conducted using data from 639 participants drawn from the Midlife Development in the United States 2 Biomarker Project. Responses were derived from the Childhood Trauma Questionnaire and Center for Epidemiologic Studies Depression Scale. Participants had their systolic and diastolic blood pressure (SBP, DBP) and heart rate monitored throughout a standardized stress testing protocol.

Results

The association between early life adversity and reactivity was mediated by current depressive symptoms; all adversity factors were linked to higher levels of current depressive symptoms, which, in turn, were associated with lower cardiovascular reactivity. For emotional abuse, this was noted for SBP (β = −0.06 [95% confidence interval {CI}, −0.13 to −0.01]) and DBP (β = −0.04 [−0.07 to −0.01]), physical abuse (SBP: β = −0.05 [−0.11 to −0.01]; DBP: β = −0.03 [−0.06 to −0.01]), sexual abuse (SBP: β = −0.04 [−0.09 to −0.01]; DBP: β = −0.02 [−0.05 to −0.01]), emotional neglect (SBP: β = −0.04 [−0.09 to −0.01]; DBP: β = −0.02 [−0.05 to −0.01]), physical neglect (SBP: β = −0.09 [−0.17 to −0.02]; DBP: β = −0.05 [−0.09 to −0.02]), and total Childhood Trauma Questionnaire score (SBP: β = −0.02 [−0.03 to −0.00]; DBP: β = −0.01 [−0.02 to −0.00]).

Conclusions

The present findings extend research and demonstrate that depression is an underlying mechanism linking early life adversity and blunted cardiovascular reactivity.
Self-Perceived Psychological Stress and Risk of First Stroke in Treated Hypertensive Patients
Authors: Li Huan , He Panpan , Zhang Yuanyuan , Lin Tengfei , Liu Chengzhang , Xie Di , Liang Min , Wang Guobao , Nie Jing , Song Yun , Liu Lishun , Wang Binyan , Zhang Yan , Li Jianping , Huo Yong , Wang Xiaobin , Hou Fan Fan , Xu Xiping , Qin Xianhui
Published: October 2021

Objective

We aimed to investigate the prospective association between self-perceived psychological stress and first stroke, and to examine possible effect modifiers among adults with hypertension.

Methods

A total of 20,688 hypertensive adults with information on self-perceived psychological stress at baseline were included from the China Stroke Primary Prevention Trial. Participants were randomly assigned to a double-blind treatment of receiving a single tablet daily with either 10 mg enalapril and 0.8 mg folic acid or 10 mg enalapril alone. Follow-up visits occurred every 3 months after randomization. Psychological stress was measured with a one-item 3-point rating scale. The primary outcome was first stroke (fatal or nonfatal).

Results

The median treatment period was 4.5 years. Compared with participants with low levels of psychological stress, those with high psychological stress had a significantly higher risk of first stroke (adjusted hazard ratio = 1.40, 95% confidence interval = 1.01 to 1.94) or first ischemic stroke (adjusted hazard ratio = 1.45; 95% confidence interval = 1.01 to 2.09). Moreover, a stronger positive relationship between psychological stress and first stroke was found in participants with time-averaged mean arterial pressure <101 mm Hg (median; p-interaction = .004) during the treatment period. However, our study did not find a significant association between psychological stress and first hemorrhagic stroke.

Conclusions

Higher psychological stress was associated with an increased risk of first stroke among treated hypertensive patients, especially in those with lower mean arterial pressure during the treatment period.
Intracorporeal Versus Extracorporeal Anastomosis in Robotic Right Colectomy
Authors: Dohrn Niclas , Yikilmaz Helin , Laursen Magnus , Khesrawi Faisal , Clausen Frederik Bjerg , Sørensen Frederik , Jakobsen Henrik Loft , Brisling Steffen , Lykke Jakob , Eriksen Jens Ravn , Klein Mads Falk , Gögenur Ismail
Published: October 2021

Objective:

To determine if minimally invasive right colectomy with intra-corporeal anastomosis improves postoperative recovery compared to extra-corporeal anastomosis.

Background:

Previous trials have shown that intracorporeal anastomosis improves postoperative recovery; however, it has not yet been evaluated in a setting with optimized perioperative care or with patient-related outcome measures.

Methods:

This was a multicenter, triple-blind, randomized clinical trial at two high-volume colorectal centers with strict adherence to optimized perioperative care pathways. The patients underwent robotic right colectomy with either intracorporeal or extracorporeal anastomosis. The primary outcome was patient-reported postoperative recovery measured using the “Quality of Recovery–15” questionnaire. ClinicalTrials.gov NCT03130166.

Results:

A total of 89 patients were randomized and analyzed according to the “Intention-to-treat”-principle. We found no statistically significant differences in patient-reported recovery between the groups. Postoperative pain, nausea, time to ambulation, time to first passage of flatus/stool, length of hospital stay, and pathophysiological tests showed no differences either. The duration of time to create the anastomosis was significantly longer with intracorporeal anastomosis (17 vs 13 min,P= 0.003), while all other intraoperative, postoperative, and pathology variables showed no difference.

Conclusion:

There were no significant differences in postoperative recovery between the two groups.
Not so FAST—Chest ultrasound underdiagnoses traumatic pneumothorax
Authors: Santorelli Jarrett E. , Chau Harrison , Godat Laura , Casola Giovanna , Doucet Jay J. , Costantini Todd W.
Published: October 2021

BACKGROUND

Ultrasonography for trauma is a widely used tool in the initial evaluation of trauma patients with complete ultrasonography of trauma (CUST) demonstrating equivalence to computed tomography (CT) for detecting clinically significant abdominal hemorrhage. Initial reports demonstrated high sensitivity of CUST for the bedside diagnosis of pneumothorax. We hypothesized that the sensitivity of CUST would be greater than initial supine chest radiograph (CXR) for detecting pneumothorax.

METHODS

A retrospective analysis of patients diagnosed with pneumothorax from 2018 through 2020 at a Level I trauma center was performed. Patients included had routine supine CXR and CUST performed prior to intervention as well as confirmatory CT imaging. All CUST were performed during the initial evaluation in the trauma bay by a registered sonographer. All imaging was evaluated by an attending radiologist. Subgroup analysis was performed after excluding occult pneumothorax. Immediate tube thoracostomy was defined as tube placement with confirmatory CXR within 8 hours of admission.

RESULTS

There were 568 patients screened with a diagnosis of pneumothorax, identifying 362 patients with a confirmed pneumothorax in addition to CXR, CUST, and confirmatory CT imaging. The population was 83% male, had a mean age of 45 years, with 85% presenting due to blunt trauma. Sensitivity of CXR for detecting pneumothorax was 43%, while the sensitivity of CUST was 35%. After removal of occult pneumothorax (n = 171), CXR was 78% sensitive, while CUST was 65% sensitive (p < 0.01). In this subgroup, CUST had a false-negative rate of 36% (n = 62). Of those patients with a false-negative CUST, 50% (n = 31) underwent tube thoracostomy, with 85% requiring immediate placement.

CONCLUSION

Complete ultrasonography of trauma performed on initial trauma evaluation had lower sensitivity than CXR for identification of pneumothorax including clinically significant pneumothorax requiring tube thoracostomy. Using CUST as the primary imaging modality in the initial evaluation of chest trauma should be considered with caution.

LEVEL OF EVIDENCE

Diagnostic Test study, Level IV.
Experimental evaluation of a linear angular momentum multiplexed radio link for moving platforms
Authors: Allen Ben , Brown Tim W. C. , Drysdale Timothy D.
Published: October 2021

Linear angular momentum multiplexing (LAMM) has recently been proposed for high spectral-efficiency communications between moving platforms, such as between trains and ground infrastructure. We present performance results obtained from a scale experimental system comprising a 2 × 2 antenna system operating at 2.35 GHz. The link transmitted two independent video streams, using RF pre-coding and software-defined radios to modulate and up/down-convert the signals. Linear motion is introduced to demonstrate the translation-invariance of the technique. We interpret the measured data with the aid of an analytical model to show that crosstalk between the two channels is at levels low enough to consistently support the video streams without interruption. Specifically, our results show spectral efficiency is consistently higher when LAMM coding is enabled compared with an uncoded channel.
Maximally mutable Laurent polynomials
Authors: Coates Tom , Kasprzyk Alexander M. , Pitton Giuseppe , Tveiten Ketil
Published: October 2021

We introduce a class of Laurent polynomials, called maximally mutable Laurent polynomials (MMLPs), which we believe correspond under mirror symmetry to Fano varieties. A subclass of these, called rigid, are expected to correspond to Fano varieties with terminal locally toric singularities. We prove that there are exactly 10 mutation classes of rigid MMLPs in two variables; under mirror symmetry these correspond one-to-one with the 10 deformation classes of smooth del Pezzo surfaces. Furthermore, we give a computer-assisted classification of rigid MMLPs in three variables with reflexive Newton polytope; under mirror symmetry these correspond one-to-one with the 98 deformation classes of three-dimensional Fano manifolds with very ample anti-canonical bundle. We compare our proposal to previous approaches to constructing mirrors to Fano varieties, and explain why mirror symmetry in higher dimensions necessarily involves varieties with terminal singularities. Every known mirror to a Fano manifold, of any dimension, is a rigid MMLP.
Observation of reversal in twist-stretch coupling of RNA suggests a unified mechanism for the opposite couplings of DNA and RNA
Authors: Qiang Xiao-Wei , Zhang Chen , Dong Hai-Long , Tian Fu-Jia , Fu Hang , Yang Ya-Jun , Dai Liang , Zhang Xing-Hua , Tan Zhi-Jie
Published: October 2021

The functions of DNA and RNA rely on their deformations. When stretched, both DNA and RNA duplexes change their twist angles through twist-stretch coupling. The coupling is negative for DNA but positive for RNA, which is not yet completely understood. Here, our magnetic tweezers experiments show that the coupling of RNA reverses from positive to negative by multivalent cations. Combining with the previously reported tension-induced negative-to-positive coupling-reversal of DNA, we propose a unified mechanism of the couplings of both RNA and DNA based on molecular dynamics simulations. Two deformation pathways are competing when stretched: shrinking the radius causes positive couplings but widening the major groove causes negative couplings. For RNA whose major groove is clamped by multivalent cations and canonical DNA, their radii shrink when stretched, thus exhibiting positive couplings. For elongated DNA whose radius already shrinks to the minimum and canonical RNA, their major grooves are widened when stretched, thus exhibiting negative coupling.
Immune Responses in Fully Vaccinated Individuals Following Breakthrough Infection with the SARS-CoV-2 Delta Variant in Provincetown, Massachusetts
Authors: Collier Ai-ris Y. , Brown Catherine M. , Mcmahan Katherine , Yu Jingyou , Liu Jinyan , Jacob-Dolan Catherine , Chandrashekar Abishek , Tierney Dylan , Ansel Jessica L. , Rowe Marjorie , Sellers Daniel , Ahmad Kunza , Aguayo Ricardo , Anioke Tochi , Gardner Sarah , Siamatu Mazuba , Bermudez Rivera Lorraine , Hacker Michele R. , Madoff Lawrence C. , Barouch Dan H.
Published: October 2021

Background

A cluster of over a thousand infections with the SARS-CoV-2 delta variant was identified in a predominantly fully vaccinated population in Provincetown, Massachusetts in July 2021. Immune responses in breakthrough infections with the SARS-CoV-2 delta variant remain to be defined.

Methods

Humoral and cellular immune responses were assessed in 35 vaccinated individuals who were tested for SARS-CoV-2 in the Massachusetts Department of Public Health outbreak investigation.

Results

Vaccinated individuals who tested positive for SARS-CoV-2 demonstrated substantially higher antibody responses than vaccinated individuals who tested negative for SARS-CoV-2, including 28-fold higher binding antibody titers and 34-fold higher neutralizing antibody titers against the SARS-CoV-2 delta variant. Vaccinated individuals who tested positive also showed 4.4-fold higher Spike-specific CD8+ T cell responses against the SARS-CoV-2 delta variant than vaccinated individuals who tested negative.

Conclusions

Fully vaccinated individuals developed robust anamnestic antibody and T cell responses following infection with the SARS-CoV-2 delta variant. These data suggest important immunologic benefits of vaccination in the context of breakthrough infections.
Quantifying Cause-Effect Relations Between Walking Speed, Propulsive Force, and Metabolic Cost
Authors: Pimentel Richard E. , Feldman Jordan N. , Lewek Michael D. , Franz Jason R.
Published: October 2021

Walking speed is a useful surrogate for health status across the population. Walking speed appears to be governed in part by propulsive force (FP) generated during push-off and simultaneously optimized to minimize metabolic cost. However, no study to our knowledge has established empirical cause-effect relations between FP, walking speed, and metabolic cost, even in young adults. To overcome the potential linkage between these factors, we used a self-paced treadmill controller and real-time biofeedback to independently prescribe walking speed or FP across a range of condition intensities. Walking with larger and smaller FP led to instinctively faster and slower walking speeds, respectively, with about 80% of variance explained between those outcomes. We also found that comparable changes in either FP or walking speed elicited predictable and relatively uniform changes in metabolic cost, each explaining about ∼53% of the variance in net metabolic power and ∼15% of the variance in cost of transport, respectively. These findings build confidence that interventions designed to increase FP will translate to improved walking speed. Repeating this protocol in other populations may identify additional cause-effect relations that could inform the time course of gait decline due to age and disease.