bluuebunny/crossref_metadata_2025 huggingface dataset:
Dental Silicone-based Surgical Guides to Harvest the Chimeric Scapular Flap: Preventing Iatrogenic Vascular Injury
Authors: Matsui Chihiro , Escandón Joseph M. , Mohammad Arbab , Tanaka Takakuni , Sasaki Masashi , Myo May Me , Mon Le Yu , Cho Thein Yi Yi , Mizuno Hiroshi
Published: June 2022

The angular branch of the thoracodorsal artery and the periosteal branches of the circumflex scapular artery can be easily injured while harvesting a chimeric scapular flap. Thus, we reported the use of 3D printed scapular models using CT angiography to prepare inexpensive surgical guides from autoclavable dental silicone impressions for scapular flap harvest. Mandibular and scapular models were prepared using a 3D printer for 11 patients undergoing chimeric scapular flap transfer following mandibular resection. During preoperative simulation surgery, we molded dental silicone accordingly with scapular models to produce surgical cutting guides. Six men (54.5%) and five women (45.5%) were included. The average age of patients was 65.4 years. Fourteen bone units were reconstructed as three patients needed two bone segments (27.3%) whereas eight patients required reconstruction of one bone segment (72.7%). The mean flap harvest time and total surgical time were 52.1 min and 633.8 min, respectively. The mean duration for osteotomies and bone plate fixation was 26.2 min. The difference between the length of the preoperative surgical model (64.92 mm) and the postoperative 3D-CT measurements (64.48 mm) was not statistically significant (0.95 mm, P = 0.397). No injuries were caused to the angular and periosteal vessels. Four patients exhibited donor-site seroma (36.4%). The cost of the dental silicone for surgical guide was only $5 per patient. Dental silicone-based surgical guides help minimize the risk of vascular injury while harvesting chimeric scapular flaps. The osteotomies were performed with precision and in a time-efficient manner.
A case of novel mutation of Cullin 3 gene in pseudohypoaldosteronism type II
Authors: Wang Liang , Nie Muwen , Guo Fan , Tian Zhuang , Guo Xiaoxiao , Zhang Shuyang
Published: June 2022

Pseudohypoaldosteronism type II (PHA II) is a rare inherited disease characterized by hypertension, hyperkalemia and metabolic acidosis. With the development of gene sequencing technology, more genetic mutations underlying PHA II were reported and the understanding of its pathogenesis has gone deep into the molecular level. Here, we present a juvenile case of PHA II. A novel missense mutation (c.1376 A>T) located in exon 9 of Cullin 3 (CUL3) was found by whole-exome sequencing. The clinical manifestations were significantly improved after oral hydrochlorothiazide. This case enriches the genetic and clinical phenotype spectrum of PHA II and provides experience for diagnosing and treating the disease.
Epidemiology and outcomes of hypertensive crisis in patients with chronic kidney disease: a nationwide analysis
Authors: Pothuru Suveenkrishna , Chan Wan-Chi , Ranka Sagar , Acharya Prakash , Mehta Harsh , Cannon Chad , Yarlagadda Sri G. , Shah Zubair , Gupta Kamal
Published: June 2022

Background:

The epidemiology and outcomes of hypertensive crisis (HTN-C) in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have not been well studied. The objective of our study is to describe the incidence, clinical characteristics, and outcomes of emergency department (ED) visits for HTN-C in patients with CKD and ESRD.

Methods:

We performed a secondary analysis of Nationwide Emergency Department Sample databases for years 2016–2018 by identifying adult patients presenting to ED with hypertension related conditions as primary diagnosis using appropriate diagnosis codes.

Results:

There were 348 million adult ED visits during the study period. Of these, 680 333 (0.2%) ED visits were for HTN-C. Out of these, majority were in patients without renal dysfunction (82%), with 11.4 and 6.6% were in patients with CKD and ESRD, respectively. The CKD and ESRD groups had significantly higher percentages of hypertensive emergency (HTN-E) presentation than in the No-CKD group (38.9, 34.2 and 22.4%, respectively; P < 0.001). ED visits for HTN-C frequently resulted in hospital admission and these were significantly higher in patients with CKD and ESRD than in No-CKD (78.3 vs. 72.6 vs. 44.7%; P < 0.0001). In-hospital mortality was overall low but was higher in CKD and ESRD than in No-CKD group (0.3 vs. 0.2 vs. 0.1%; P < 0.0001), as was cost of care (USD 28 534, USD 29 465 and USD 26 394, respectively; P < 0.001).

Conclusion:

HTN-C constitutes a significant burden on patients with CKD and ESRD compared with those without CKD with a higher proportion of ED visits, incidence of HTN-E, hospitalization rate, in-hospital mortality and cost of care.

Graphical abstract:

http://links.lww.com/HJH/C22
Aerial and Collimated Sensor Radiological Mapping Following Dispersal of Activated Potassium Bromide
Authors: Simerl Nathanael , Beavers Jace , Bahadori Amir Alexander , McNeil Walter
Published: June 2022

The exposure rate distribution was quantified over a site of three activated potassium bromide radiological dispersal device detonations at the Idaho National Laboratory Radiological Response Training Range with unmanned aerial vehicle (UAV) and ground-based methods. Discussions on the methods’ survey characteristics, such as survey time, data spatial resolution, and area coverage, serve to inform those concerned with radiological response and cleanup efforts. Raster scans over the site at 4 m s−1 with 6 m between passes at an altitude of 4 m above ground level were executed with a 2.54 cm × 2.54 cm × 7.62 cm cesium iodide, sodium-doped [CsI(Na)] sensor mounted to a UAV. Exposure rates were calculated from the spectra obtained by the CsI(Na) using a flux unfolding method. Data obtained from the UAV raster were interpolated to produce a continuous exposure rate map across the site. The activity on the ground, inferred from collimated, ground-based sensor (Nomad) measurements in previous work, was used to calculate exposure rate distributions at the same altitude as the UAV-mounted CsI(Na) sensor. Agreement between Nomad and UAV exposure rate distributions is observed at rates up to 1.0 mR h−1 after corrections for ground effects were implemented on the Nomad data. Discrepancies in exposure rate contours are present at higher rates, directly above the detonation locations. In areas of high exposure rate gradients, it is anticipated that a faster UAV-mounted sensor and more refined scans by the UAV will improve characterization of the distribution.
Energy Dose-Response in Selective Laser Trabeculoplasty: A Review
Authors: Radcliffe Nathan , Gazzard Gus , Samuelson Thomas , Khaw Peng , Sun Xinghuai , Aung Tin , Lam Dennis , Singh Kuldev , Katz L. Jay , Aronov Michael , Sacks Zachary , Solberg Yoram , Lindstrom Richard , Belkin Michael
Published: June 2022

Précis:

A literature review of selective laser trabeculoplasty (SLT) energy dose-response found no definitive relationship between intraocular pressure (IOP) reduction with respect to total or pulse energy, race, pigmentation, or application pattern.

Purpose:

SLT is a safe and effective treatment for lowering IOP. Although evidence is mounting for the advantage of its use as a first-line treatment for IOP reduction, the SLT procedures in use vary widely. The purpose of this literature review was to investigate whether there were any relationships between SLT energy and efficacy for lowering IOP in the published literature.

Methods:

A literature review was undertaken that included studies in which energy levels required for successful SLT treatment were investigated: in general, with respect to angle pigmentation, race or ethnicity, and treatment arc extent.

Results:

There was no indication that higher (or lower) energy used in the treatment leads to greater (or less) IOP reduction. Similar results were obtained regarding the level of trabecular meshwork pigmentation. Race was not found to be associated with altered dose response in SLT. There were indications that treating the full 360 degrees, as opposed to smaller arcs, could be beneficial for more IOP reduction. IOP reduction from SLT was found to be similar to that provided by topical medications.

Conclusions:

The optimal energy level of SLT needed for IOP reduction has not yet been definitively established, with all reported pulse energies resulting in similar IOP reduction. Furthermore, similar lack of conclusive findings exists regarding optimal SLT energy dosage for use in different races and degrees of trabecular meshwork pigmentation. This parameter and each of the abovementioned factors requires further research.
Mortality Risk Factors Among Critically Ill Children With Acute COVID-19 in PICUs: A Multicenter Study From Turkish Pediatric Critical COVID-19 and MIS-C Study Group
Authors: Akcay Nihal , Kihtir Hasan Serdar , Durak Cansu , Kendirli Tanil , Havan Merve , Kockuzu Esra , Bozan Gurkan ,   TuPCOM Study Group, Sevketoglu Esra
Published: June 2022

Background:

During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU.

Methods:

A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month–18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded.

Results:

Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2–14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55–2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03–6.80), were associated with mortality.

Conclusions:

This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality.
Characterization of Methicillin-resistant Staphylococcus aureus From Children at Hospital Admission: Experiences From a Hospital in a German Metropolitan Area
Authors: Selb Regina , Albert-Braun Sabine , Weltzien Alexandra , Schürmann Jacqueline , Werner Guido , Layer Franziska
Published: June 2022

Background:

Since the 1990s, community-associated Methicillin-resistant Staphylococcus aureus (CA-MRSA) are described as emerging independent of health care. CA-MRSA is associated with the colonization and infection of healthy, immunocompetent younger individuals. While skin and soft tissue infections (SSTI) are predominant, life-threatening syndromes can also occur.

Methods:

In this retrospective study, we investigated MRSA stains isolated from community-onset infections and from MRSA screening of children at admission to a tertiary-care hospital in 2012–2018. In total, 102 isolates were subjected to antibiotic susceptibility testing by broth microdilution, spa-typing, multilocus sequence typing, SCCmectyping and virulence/resistance gene detection by polymerase chain reaction.

Results:

The majority of isolates originated from community-onset infections (80/102), of these primarily from SSTI (70/80). Additional strains were isolated by MRSA screening (22/102). In total 61.8% of the MRSA carried the gene for the Panton-Valentine leukocidin (lukPV). Molecular characterization of isolates revealed various epidemic MRSA clones, circulating in both community and hospital settings. Most prevalent epidemic lineages were isolates of the “European CA-MRSA clone” (CC80-MRSA-IV), the “Bengal Bay clone” (ST772-MRSA-V), or the “USA300 NAE clone” (ST8-MRSA-IVa).

Conclusions:

Our data highlight the importance of CA-MRSA causing SSTI in children. More frequent microbiological and molecular analysis of these strains is important for targeted treatment and can provide valuable data for molecular surveillance of the pathogen.
Attentional interference, but no attentional bias, by tonic itch and pain stimulation
Authors: Becker Jennifer M. , Vreijling Sarah R. , Van Damme Stefaan , Kovacs Elisa A. , Veldhuijzen Dieuwke S. , Lavrijsen Adriana P.M. , van Ryckeghem Dimitri M.L. , Crombez Geert , Evers Andrea W.M. , van Laarhoven Antoinette I.M.
Published: June 2022

Introduction:

Attentional processes are involved in the experience of itch and pain. They interrupt task performance (ie, attentional interference) or bias allocation of attention toward the somatosensory stimulation, that is, attentional bias (AB). Research on AB toward pain is mostly focused on stimuli with short durations; hampering generalization to tonic pain sensations. Evidence for AB toward itch is lacking so far. This study investigated attentional interference by—and AB toward—experimentally induced tonic itch and pain.

Methods:

Fifty healthy volunteers performed a somatosensory attention task (SAT), that measured attentional interference and AB during tonic (35 s duration) pain, itch and vibrotactile stimuli. In addition, a dot-probe task measured AB toward visual representations of itch and pain, a Flanker task was used to assess attentional inhibition, and self-reported characteristics were measured.

Results:

Attentional interference during itch and pain stimuli compared with vibrotactile stimuli was found during the SAT. Exploration of shorter time segments within one tonic stimulus showed slowed responses for all three stimulus types during the first 5 seconds of stimulation. However, no prolonged interference in the following time segments was found. There was no AB toward somatosensory and visual stimuli. Furthermore, there was no association between any of the attentional measures and self-reported characteristics.

Discussion:

These findings suggest that the beginning of any somatosensory stimulus is interfering with cognitive performance, but the results for prolonged interference by itch and pain are equivocal. There was no indication for biased attention allocation. Whether this pattern is different in patients remains to be investigated in the future.
Case Series
Authors: Williams Kelly
Published: June 2022

Health technology managers play a vital role in medical device safety for pediatric patients in the neonatal intensive care unit and the pediatric intensive care unit. Medical device malfunctions and failures can contribute to potential for harm and adverse events. These patients are especially vulnerable to harm when these incidents occur. When health technology managers provide their expertise on medical device malfunction reports, their valuable input can provide a more complete view of the safety concerns to the US Food and Drug Administration and the device manufacturer. The examples in this article are from medical device reports submitted to the US Food and Drug Administration's MedSun program and illustrate how health technology managers' input has advanced US Food and Drug Administration's understanding of medical device safety concerns and contributed to subsequent recalls and other safety actions for devices used in the neonatal intensive care unit and pediatric intensive care unit.
Characteristics Associated With Health Care Worker Knowledge and Confidence in Elastomeric Half-Mask Respirator Use
Authors: Thurman Paul , Zhuang Eileen , Chen Hegang H. , McClain Caitlin , Sietsema Margaret , Fernando Rohan , McDiarmid Melissa A. , Hines Stella E.
Published: June 2022

Objective

This study evaluated health care workers' (HCWs') knowledge and confidence in using elastomeric half-mask respirator (EHMR) attributes known to influence usage.

Methods

Health care workers were surveyed regarding their EHMR donning and doffing experience. Respondents were categorized into competency categories based on their scores. Category differences were analyzed using χ2 and multiple logistic regression.

Results

Seventy-two percent showed high levels of EHMR donning and doffing knowledge and confidence (mastery); however, 21% had greater confidence than knowledge (misinformed). Respiratory therapists had greater odds of mastery than other HCWs (P < 0.05), whereas those working in medical/surgical and pediatric units had greater odds of doubt than other HCWs (P < 0.01).

Conclusions

Although most HCWs show high knowledge and confidence with EHMR use, strategies to confirm respirator use competency may ensure greater HCWs protection.
Tolerability and Feasibility of the Upper Esophageal Sphincter Assist Device in Preventing Acute and Chronic Allograft Rejection Among Lung Transplant Recipients
Authors: Iyer Neena R. , Afshar Kamyar , Golts Eugene , Onaitis Mark W. , Kafi Aarya , Yung Gordon L. , Kunkel David C.
Published: June 2022

Goals:

We aimed to evaluate a novel upper esophageal sphincter (UES) assist device loaner program for the prevention of acute cellular rejection and chronic lung allograft dysfunction among lung transplant (LTx) recipients.

Background:

Laryngopharyngeal reflux can lead to chronic microaspiration and LTx rejection. The UES assist device applies external pressure at the level of UES to decrease reflux.

Study:

We prospectively enrolled and issued UES assist devices to consecutive transplant patients referred for gastrointestinal motility testing from 2016 to 2020. Device tolerability was defined by successful utilization as a bridge to ambulatory pH monitoring and/or antireflux procedure, or as permanent therapy. Incidence of rejection was analyzed before, during, and after device implementation.

Results:

Twenty-six participants were issued devices (15 pathologic, 5 physiological, 6 unknown reflux status), none of whom developed acute rejection episodes or chronic lung allograft dysfunction while using the device. Thirteen adopted the device promptly after transplantation (mean 1.7 mo) and remained free of rejection episodes over a mean 24.7 months of follow-up. Among those with pathologic reflux, lag time to device adoption strongly correlated with the development of rejection (r=0.8, P=0.0006). There was no such correlation among those with physiological reflux. Five developed acute rejection after device return.

Conclusions:

The device was tolerated by a majority of LTx patients and appears feasible as a barrier measure in the prevention of rejection. Delayed treatment of laryngopharyngeal reflux may lead to early allograft failure; therefore, the UES assist device should be given important consideration in transplant protection.
Genetic and epigenetic nutritional interactions influencing obesity risk and adiposity outcomes
Authors: Ramos-Lopez Omar , Riezu-Boj Jose Ignacio , Milagro Fermin I.
Published: June 2022

Purpose of review

This article aims to critically overview the current interplay of genetic/epigenetic factors and several nutritional aspects influencing obesity susceptibility and adiposity outcomes for obesity management and weight status monitoring.

Recent findings

Single nucleotide polymorphisms located in or near genes participating in energy homeostasis, fatty acid metabolism, appetite control, brain regulation, and thermogenesis have been associated with body composition measures (body weight, body mass index, waist circumference, body fat percentage, and visceral adipose tissue) depending on nutrient intakes, dietary patterns, and eating behaviors. Moreover, studies analyzing interactions between the epigenome and dietary intakes in relation to adiposity outcomes are reported. The main epigenetic mechanisms include methylation levels of promoter sequences, telomere length, and micro-ribonucleic acid expression profiles, whereas covalent histone modifications remain less studied.

Exploring potential interactions between the genetic/epigenetic background and nutritional features is improving the current understanding of the obesity physiopathogenesis and the usefulness of translating this precision information in the clinical setting for weight gain prediction, the design of personalized nutrition therapies as well as individual responsiveness estimation to dietary advice. The analysis of further relationships between the genotype, the epigenotype and other precision markers including the gut microbiota and the metabolome is warranted.
Monocyte Distribution Width in Children With Systemic Inflammatory Response: Retrospective Cohort Examining Association With Early Sepsis*
Authors: Hou Sen-Kuang , Lin Hui-An , Tsai Hung-Wei , Lin Chiou-Feng , Lin Sheng-Feng
Published: June 2022

OBJECTIVES:

To investigate the association between increased monocyte distribution width (MDW) and pediatric sepsis in the emergency department (ED).

DESIGN:

Retrospective cohort study.

SETTING:

A single academic hospital study.

PATIENTS:

Patients from birth to the age of 18 years who presented at the ED of an academic hospital with systemic inflammatory response syndrome (SIRS) were consecutively enrolled. Sepsis was diagnosed using the International Pediatric Surviving Sepsis Campaign criteria.

INTERVENTIONS:

Antibiotic treatment was administrated once infection was suspected.

MEASUREMENTS and MAIN RESULTS:

Routine complete blood cell count, neutrophil-to-lymphocyte ratio (NLR), and MDW, a new inflammatory biomarker, were evaluated in the ED. Logistic regression models were used to explore associations with early pediatric sepsis. We included 201 patients with sepsis and 1,050 without sepsis. In the multivariable model, MDW greater than 23 U (odds ratio [OR], 4.97; 95% CI, 3.42–7.22; p < 0.0001), NLR greater than 6 (OR, 2.06; 95% CI, 1.43–2.94; p = 0.0001), WBC greater than 11,000 cells/µL (OR, 6.52; 95% CI, 4.45–9.53; p < 0.0001), and the SIRS score (OR, 3.42; 95% CI, 2.57–4.55; p < 0.0001) were associated with pediatric sepsis. In subgroup analysis, MDW greater than 23 U remained significantly associated with sepsis for children 6–12 years old (OR, 6.76; 95% CI, 2.60–17.57; p = 0.0001) and 13–18 years (OR, 17.49; 95% CI, 7.69–39.76; p = 0.0001) with an area under the receiver operating curve of 0.8–0.9.

CONCLUSIONS:

MDW greater than 23 U at presentation is associated with the early diagnosis of sepsis in children greater than or equal to 6 years old. This parameter should be considered as a stratification variable in studies of pediatric sepsis.
What Do Patients and Their Carers Do to Support the Safety of Cancer Treatment and Care? A Scoping Review
Authors: Tillbrook Darci , Absolom Kate , Sheard Laura , Baxter Ruth , O’Hara Jane K.
Published: June 2022

Background

Cancer patients and their carers face a multitude of challenges in the treatment journey; the full scope of how they are involved in promoting safety and supporting resilient healthcare is not known.

Objective

The study aimed to undertake a scoping review to explore, document, and understand existing research, which explores what cancer patients and their carers do to support the safety of their treatment and care.

Design

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Five online databases were searched from 2000 to 2021 to identify primary literature exploring perspectives on patient and caregiver involvement in maintaining their safety during cancer care. Narrative synthesis was then conducted on the included literature.

Results

Of the 1582 results generated from the initial search, 16 studies were included in the review. Most consisted of qualitative semistructured interviews with patients, as well as carers and healthcare professionals (HCP). Four narrative themes were identified: patient perception of safety and their involvement; patients take charge of their own care and well-being; safety as a dynamic collective responsibility; and carers are an undersupported asset. Patients and their carers involve themselves in a variety of behaviors in physical care, well-being, communication, and care coordination to ensure safety and support system resilience. This review adds a novel perspective on cancer patient and caregiver involvement in supporting resilient healthcare.

Conclusions

Patients and their carers play an important role in promoting safe cancer care and healthcare system resilience. Further research is recommended to realize the full extent of the system gaps encountered and mediated by patients and their carers.
Kynurenine/tryptophan ratio for detection of active tuberculosis in adults with HIV prior to antiretroviral therapy
Authors: Olsson Oskar , Skogmar Sten , Tesfaye Fregenet , Mulleta Daba , Jansson Marianne , Björkman Per
Published: June 2022

Objective

The aim of this study was to assess the performance of kynurenine/tryptophan ratio for tuberculosis (TB) case-finding among antiretroviral therapy (ART)-naive people with HIV (PWH), and to investigate other factors associated with kynurenine/tryptophan ratio in this population.

Design

A nested case--control study based on a cohort of 812 ambulatory PWH in the Oromia region, Ethiopia.

Methods

At enrolment, all participants submitted sputum samples for bacteriological TB investigations. Concentrations of kynurenine and tryptophan in plasma were quantified using liquid chromatography-mass spectrometry. Receiver operator characteristic curves were constructed to assess diagnostic performance (area under the curve; AUC) for kynurenine, tryptophan, and kynurenine/tryptophan ratio. Sensitivity, specificity, and predictive values were calculated. Kynurenine/tryptophan ratios were correlated to plasma levels of nine inflammation mediators, plasma HIV RNA levels, CD4+ cell count, BMI, and mid-upper arm circumference (MUAC).

Results

We included 124 individuals with HIV-TB coinfection (HIV+/TB+) and 125 with HIV mono-infection (HIV+/TB-). Tryptophan levels were lower in HIV+/TB+ than in HIV+/TB- (median 19.5 vs. 29.8 μmol/l, P < 0.01), while kynurenine levels were similar between these groups (median 2.95 vs. 2.94 μmol/l, P = 0.62). Median kynurenine/tryptophan ratio was 0.15 in HIV+/TB+, significantly higher compared with HIV+/TB- (0.11; P < 0.01), with AUC 0.70 for TB detection. Kynurenine/tryptophan ratio was positively correlated to plasma HIV RNA levels, IP-10, IL-18, and IL-27, and negatively correlated to CD4+ cell count, BMI, and MUAC (all P < 0.01).

Conclusion

Among ART-naive PWH, kynurenine/tryptophan ratio has modest potential for TB discrimination, limiting its utility for TB case-finding in this population.
Using Implementation Science to Promote Integration and Sustainability of Community Health Workers in the HIV Workforce
Authors: Rajabiun Serena , Killion Kate , Lennon-Dearing Robin , Williams Brandon Bernard , Hirschi Melissa
Published: June 2022

Background:

Community health worker (CHW) interventions are an evidence-based practice adopted by health care settings to increase retention in care and viral suppression for people living with HIV (PLWH) from racial/ethnic minority communities. However, disparate funding, unclear roles vis a vis other care team members, limited training and promotion opportunities, and a lack of standards for wages and tasks limit the ability to effectively use CHWs as part of the health care team. Guided by the Exploration, Preparation, Implementation, and Sustainment and Reach, Effectiveness, Adoption, Implementation, and Maintenance frameworks, this study describes the key determinants for CHW integration and sustainability at 3 agencies in Shelby County, TN, to improve viral suppression and reduce disparities among rural and urban people living with HIV.

Setting:

Memphis Transitional Grant Area (TGA) which includes 8 rural and urban counties in west Tennessee, Arkansas, and Mississippi.

Methods:

Seventeen key informants were identified using purposeful and snowball sampling techniques, including community and agency leadership staff, frontline staff, and faith leaders.

Results:

Key determinants of CHW integration include establishing clear and standardized CHW roles within and across organizations, facilitating interorganizational networks, and leveraging funds for livable CHW wages and sustainable positions. Training strategies that strengthen the CHW workforce include content related to trauma-informed care, managing stress, and cultural humility.

Conclusion:

Several inner and outer settings and innovation and bridging factors affect CHW positions. Data collected will inform the implementation and sustainment of future policies and interventions intended to improve HIV care continuum outcomes and reduce disparities for PLWH.
Multilevel Determinants of Rapid Antiretroviral Treatment Implementation and Demand in Miami-Dade County
Authors: Harkness Audrey , Wawrzyniak Andrew J. , Kolber Michael A. , Villamizar Kira , Botero Valeria , Rodriguez Jacqueline E. , Orr Jessica L. , Zukerberg Julia , Rodríguez Allan E.
Published: June 2022

Background:

Rapidly linking newly diagnosed HIV patients to antiretroviral treatment (ART) is the best practice for achieving optimal treatment outcomes, including viral suppression. However, rapid ART implementation varies throughout the United States, highlighting the importance of identifying rapid ART implementation determinants in US HIV epicenters, such as Miami-Dade County (MDC).

Methods:

Clinic focus groups (N = 4 clinics) and patient interviews (N = 31 recently diagnosed patients) systematically and qualitatively assessed rapid ART implementation determinants in MDC. Independent coders analyzed focus groups and interviews using a directed content analysis approach guided by the Consolidated Framework for Implementation Research.

Results:

For clinic stakeholders, key rapid ART implementation determinants included the following: complexity and adaptability (innovation characteristics); networks between clinics and patient needs rooted in structural inequities (outer setting); leadership and available resources (inner setting); staff/provider flexibility (characteristics of individuals); and appointing patient navigators and champions (process). For patients, key determinants included complexity and relative advantage of rapid treatment (innovation characteristics); patient needs and clinic networks (outer setting); provider knowledge and skills (inner setting); provider warmth and affirmation (characteristics of individuals); and need for improved outreach (process).

Conclusions:

Multilevel factors impact clinic implementation and patient demand for rapid ART in MDC. Informed by these factors, we identified potential implementation strategies to enhance rapid ART implementation throughout MDC. These implementation strategies can be tested in an implementation trial, enhancing the toolkit of strategies to ensure that evidence-based tools, particularly rapid ART, are readily available to the most impacted communities.
Ultra-Low-Dose Photon-Counting CT Imaging of the Paranasal Sinus With Tin Prefiltration
Authors: Grunz Jan-Peter , Petritsch Bernhard , Luetkens Karsten Sebastian , Kunz Andreas Steven , Lennartz Simon , Ergün Süleyman , Bley Thorsten Alexander , Huflage Henner
Published: June 2022

Objectives

In this study, we compared photon-counting detector computed tomography (PCD-CT) and energy-integrating detector computed tomography (EID-CT) for ultra-low-dose paranasal sinus examinations with employed tin prefiltration. The goal of our investigation was to define the most dose-effective scan protocols for diagnostic assessment of midface trauma, preoperative sinonasal anatomy, and acute rhinosinusitis.

Materials and Methods

Five cadaveric heads were examined with the standard-resolution scan mode of both CT systems using a tube potential of 100 kV and tin prefiltration for 7 dose-equivalent scan protocols (CTDIvol = 4.16–0.15 mGy) and 2 additional ultra-low-dose protocols exclusively feasible on the PCD-CT scanner (0.10 and 0.08 mGy). After applying comparable iterative reconstruction algorithms, image quality was subjectively assessed by 4 radiologists. The intraclass correlation coefficient was calculated to estimate the agreement among readers. Image noise was quantified in standardized regions of interest to establish an additional quantitative criterion of image quality.

Results

The most dose-effective scan protocols for diagnostic imaging of midface trauma (PCD-CT: 1.24 mGy; EID-CT: 2.05 mGy), preoperative sinonasal anatomy (PCD-CT: 0.20 mGy; EID-CT: 0.40 mGy), and acute rhinosinusitis (PCD-CT: 0.08 mGy; EID-CT: 0.15 mGy) required less radiation exposure on the PCD-CT system (P < 0.050). Despite higher image noise, ultra-low-dose PCD-CT studies (0.08 and 0.10 mGy) were considered suitable for inflammation-focused imaging, offering lower-dose penalties than EID-CT studies. Interobserver reliability for subjective image quality was excellent (intraclass correlation coefficient, 0.90; 95% confidence interval, 0.88–0.93; P < 0.001).

Conclusions

In paranasal sinus imaging with tin prefiltration, the PCD-CT allowed for superior image quality compared with high-end EID-CT. Assessment of paranasal sinuses with an ultra-low radiation exposure of 0.08 mGy was deemed adequate, suggesting substantial dose reduction potential for clinical routine, for example, in the diagnostic workup of patients with rhinosinusitis.
Finger Reconstruction With Distally Based Dorsal Metacarpal Flaps
Authors: Shimbo Keisuke , Kawamoto Haruka , Koshima Isao
Published: June 2022

Background

Distally based dorsal metacarpal flaps for the reconstruction of finger soft-tissue defects are classified into 3 categories: dorsal metacarpal artery perforator flap, reverse dorsal metacarpal artery (RDMA) flap, and extended reverse dorsal metacarpal artery (ERDMA) flap. The present systematic review aimed to evaluate differences in the outcomes of commonly encountered defects and postoperative complications among these three flaps.

Methods

PubMed, Scopus, and Web of Science were systematically searched from when the flats were first reported to May 2021. Random-effects meta-analysis for each outcome was performed, and 24 studies were included in the analysis.

Results

Dorsal metacarpal artery perforator flaps were mainly used for defects extending to the proximal interphalangeal joint (n = 62 [29.1%]) and proximal phalanx (n = 85 [39.9%]). Conversely, defects extending to the distal phalanx (n = 24 [43.6%]) were mostly reconstructed using the ERDMA flap. The rate of venous congestion was highest for the ERDMA flap (29.3%; 95% confidence interval [CI], −17.2% to 65.1%; I
2 = 0%) and lowest for RDMA flap (8.1%; 95% CI, −5.9% to 21.7%; I
2 = 0%). The RDMA flap showed the lowest rate of any short-term complications, including partial and total necrosis (6.6%; 95% CI, −6.8% to 19.8%; I
2 = 0%).

Conclusions

This systematic review demonstrated that the dorsal metacarpal artery perforator flap was suitable for reconstruction proximal to the middle phalanx, and the ERDMA flap was suitable for reconstruction distal to the distal interphalangeal joint. Although the RDMA flap showed the lowest rate of short-term complications and limited analysis was secondary to limited data available, these occurred in 6.6% to 10.9% of distally based dorsal metacarpal flaps.
The 3-Dimensional “Croissant Mastopexy”
Authors: Handel Neal
Published: June 2022

Crescent mastopexy is an operation that is often maligned and infrequently used. However, it can be a useful adjunct both in primary augmentation mammaplasty and in secondary breast revision cases. The key to achieving good results with this procedure lies in conceptualizing the operation in 3 dimensions rather than 2. Most publications about the surgical technique describe deepithelialization (or at most full-thickness skin resection) of a crescent-shaped area superior to the areola and a single-layer closure of the defect. Improved outcomes are achieved if a full-thickness composite segment of tissue—skin, subcutaneous fat, and a wedge of breast parenchyma—is resected and the resulting defect closed in multiple layers. A more fitting descriptive term for this procedure, one that conveys the 3-dimensional nature of the tissue resection, is “croissant mastopexy.” Croissant mastopexy has been used by the author in primary augmentation in women with mild to moderate ptosis, in patients with asymmetrical nipple position and in patients with tuberous breast deformity. The procedure is also applicable in secondary cases, but precautions must be taken to ensure that blood supply to the nipple is not compromised. When properly executed, croissant mastopexy yields good results without undue stretching of the superior half of the areola and with acceptable scars.
Breast Implant–Related Outcomes After Cardiothoracic Surgeries and Electrophysiologic Procedures
Authors: Coombs Demetrius M. , Wu Shannon S. , Bernard Steven , Djohan Risal , Isakov Raymond , Schwarz Graham , Bassiri Gharb Bahar , Rampazzo Antonio
Published: June 2022

Background

Outcomes related to preexisting breast implants after cardiothoracic procedures are poorly characterized. This study evaluated complications after minimally invasive cardiac surgery (MICS), median sternotomy (MS), and electrophysiologic procedures (EP) in patients with preexisting breast implants.

Methods

A retrospective review of patients with prior breast implants who underwent MICS, MS, or EP from 1994 to 2019 was performed. Demographic, treatment, and outcome characteristics were recorded. χ2 Test and analysis of variance were used to perform statistical comparisons.

Results

In total, 78 patients (37 MICS, 21 MS, and 20 EP) were identified. Mean breast implant age was 13.3, 11.7, and 10.2 years, respectively (P = 0.235). Intraoperative plastic surgeon involvement was present in 26 (70.3%) MICS cases, compared with 2 (9.5%) MS and 0% EP (P < 0.001). Intraoperative rupture occurred in 5 (13.5%) MICS cases and no MS or EP cases (P < 0.001). Postoperative implant complications occurred in 6 (16.2%) MICS, 8 (38.1%) MS, and 5 (25.0%) EP (P = 0.350) cases, with median time to complication of 5.9, 5.4, and 38.9 months, respectively (P = 0.596). Revision surgery was performed in 5 (13.5%) MICS, 7 (33.3%) MS, and 5 (25.0%) EP (P = 0.246) cases. On multivariate analysis, lack of intraoperative plastic surgeon involvement (P = 0.034) and breast implant age (P = 0.001) were significant predictors of postoperative complications.

Conclusions

Long-term complication rates are highest among patients with breast implants undergoing MS. Plastic surgeon involvement was significantly associated with fewer postoperative complications. Our results support a multidisciplinary approach to managing breast implants during cardiothoracic procedures.
A Systematic Review and Meta-analysis of Techniques for Management of Postoperative Lymphatic Leaks After Groin Surgery
Authors: Song Siyou , Parmeshwar Nisha , Steiner Gabriela , Kim Esther A.
Published: June 2022

Purpose

Plastic surgeons are often consulted to manage postoperative groin lymphatic leaks that may lead to serious sequelae if not promptly treated. Because there are no standardized guidelines for best treatment practices, this systematic review and meta-analysis evaluates the outcomes of multiple management modalities to ultimately guide decision making for surgeons.

Methods

Literature surrounding lymphatic leaks in the groin was reviewed from PubMED, MEDLINE, EMBASE, and the Cochrane Library from January 1, 2000, to December 1, 2020 according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The inciting procedure, postoperative lymphatic complication, used management, and days to resolution were recorded. Pairwise comparisons using the Wilcoxon rank sum test with Bonferroni continuity correction were used to determine which treatment modalities differed significantly and accounted for multiple hypothesis testing.

Results

A total of 1468 total studies were initially found, which narrowed to 267 unique articles after duplicates were removed. Twelve articles ultimately met the inclusion criteria and were included in the data analysis. There were 264 groin complications, of which 217 were initially treated with conservative management, 81 with a minimally invasive procedure, and 125 with surgery. More than 95% of all cases had an inciting procedure of a vascular nature.

For vascular surgery–induced lymphatic leak treated by minimally invasive and surgical techniques, a significantly higher number of cases resolved compared with those treated conservatively (100% and 96.7% compared with 29.5%, respectively, P < 0.05). However, there were no significant differences in the proportion that resolved between the minimally invasive and surgical cases (P = 0.11). Vascular cases that were only managed with surgery had significantly shorter days to resolution compared with cases that first attempted conservative management (P < 0.001).

Conclusions

Both minimally invasive and surgical options have increased odds of resolution and lower failure rates compared with conservative management alone. The odds of resolution were higher when treated with more invasive procedures compared with conservative-only management, but the mean days to resolution was longer. This meta-analysis depicts successful resolution with procedural management and supports an initial trial of minimally invasive techniques.
Microsurgical Anterolateral Thigh Flap for Reconstruction of Extremity Soft Tissue Defects in Pediatric Patients
Authors: Shi Yan , Xu Yongqing , Zhu Yueliang , Yang Xi , Wang Teng , Cui Yi , Zhang Xulin , He Xiaoqing
Published: June 2022

Background

The anterolateral thigh flap is one of the most widely used flaps because it has the advantages of less damage to the donor site, no sacrifice of main blood vessels, and abundant soft tissue. However, the application of anterolateral thigh flap in children is relatively rare because of small blood vessels and rapid physiological changes. The aim of this study was to explore the effectiveness and characteristics of free anterolateral thigh flaps for the reconstruction of extremity soft tissue defects in pediatric patients.

Patients and Methods

This study included 26 pediatric patients, with an average age of 6.7 years (range, 2–13 years). There were 5 cases of upper limb defects and 21 cases of lower limb defects, all of which were accompanied by exposed bones or tendons. The causes of defects included traffic injury in 9 cases, mechanical injury in 7 cases, collision injury in 4 cases, spoke injury in 3 cases, cicatricial contracture in 2 cases, and fibroma in 1 case. All defects were reconstructed with free anterolateral thigh flaps.

Results

Twenty-six anterolateral thigh flaps were harvested, including 15 fasciocutaneous flaps and 11 musculocutaneous flaps. The mean size of the flap was 73.4 cm2 (range, 4 × 3 to 24 × 8 cm). The donor sites were sutured directly in 19 cases and underwent split-thickness skin grafting in 7 cases. There were 3 cases of vascular crisis, 3 cases of flap edge necrosis, 3 cases of infection, 1 case of pressure ulcer, and 1 case of dehiscence after surgery. Eleven patients had scar hyperplasia in the donor site. A total of 34 reoperations were performed, including 14 flap debulking, 7 debridement, 4 skin graft, 3 vascular crisis re-exploration, and 6 other procedures.

Conclusions

Free anterolateral thigh flap was a safe and reliable option for reconstructing soft tissue defects of extremities in pediatric patients. Notably, the incidence of scar hyperplasia in the donor site and the possibility of reoperation in pediatric patients were higher than those in adult patients.
A Descriptive Analysis of Integrated Plastic Surgery Residency Program Directors in the United States
Authors: Hughes Alexa J. , Samson Thomas D. , Henry Cathy R. , Johnson Timothy Shane
Published: June 2022

Background

The role sex plays in surgical leadership positions is heavily discussed in the literature; however, there is an absence of research looking at plastic surgery program director (PD) demographics and the differences between male and female PDs.

Methods

A cross sectional study of publicly available online resources of all integrated plastic surgery residency programs was performed. Demographic and academic data of integrated plastic surgery PDs was analyzed focusing on the differences in PDs based on sex.

Results

Eighty-two integrated plastic surgery residencies were analyzed. Fifteen PDs (18.3%) were female. Fifty-six (68%) PDs completed general surgery residencies, whereas 24 (29%) completed an integrated plastics residency. All female PDs were fellowship trained, whereas only 46 (68%) male PDs pursued additional training after residency (P = 0.02). Research output among male PDs was greater with 49.9 publications and a higher average H-index, at 13.3, compared with women with an average of 27.5 publications (P = 0.008) and an H-index of 8.7 (P = 0.02). When comparing male to female PDs, there was no difference between age at PD appointment (P = 0.15), or in the amount of time between completion of plastic surgery training to PD appointment (P = 0.29). Male PDs were older (52.2) compared with female PDs (46.5) (P = 0.02). Male PDs served longer terms (4.98 years) than female PDs (2.87 years) (P = 0.003).

Conclusions

The majority of integrated plastic surgery PDs are men with a Doctor of Medicine degree who completed a general surgery residency and a plastic surgery fellowship. Most PDs also completed fellowship in a plastic subspecialty. Male PDs had higher research output, which may be attributed to their older age on average. Although women make up only 18.3% of plastic surgery PDs, this percentage is similar to the 17.2% of active female plastic surgeons in the United States. As more women train in plastic surgery, it is possible that the percentage of women serving academic leadership roles will increase. By gaining a better understanding of the demographics and diversity in plastic surgery residency program leadership, efforts can be made to increase the representation of minority groups in academic leadership roles.