bluuebunny/crossref_metadata_2025 huggingface dataset:
The Presence of Pneumonia Is Strongly Associated With Higher Prevalence of Non-ST-Elevation Myocardial Infarction Using a Large NIS Database
Authors: Gill Manrit , Movahed Mohammad Reza , Hashemzadeh Mehrtash , Hashemzadeh Mehrnoosh
Published: May 2023

Objective:

Inflammation is a risk factor for myocardial infarction. Pneumonia leads to severe inflammatory response. Some studies suggest higher risk of myocardial infarction in patients with pneumonia. We used a large inpatient database (National Inpatient Sample) to evaluate this association.

Methods:

This study includes patients from a Nationwide Inpatient Sample hospital in 2005 to 2014 with International Classification of Diseases, Ninth Revision, and Clinical Modification codes consistent with pneumonia and non-ST elevation myocardial infarction (NSTEMI). Subjects were stratified into all hospitalized patients aged 30 and above. Univariate and multivariate analysis was performed adjusting for age, race, gender, tobacco use, diabetes mellitus, hypertension, and hyperlipidemia.

Results:

NSTEMI was present in 3.2% of pneumonia patients versus 1.8% in the non-pneumonia population over 10-year period. For example, the 2005 database: [odds ratio (OR), 1.77; 95% confidence interval (CI), 1.73-1.80; P < 0.001]. For 2014, NSTEMI was present in 4.1% of pneumonia patients (PNA) versus 2.4% in the non-pneumonia population (OR, 1.72; 95% CI, 1.70-1.75; P < 0.001). NSTEMI remained independently associated with pneumonia following a multivariate analysis in 2005 (OR, 1.477; 95% CI, 1.447-1.508; P < 0.001) with a similar value in 2014 (OR, 1.445; 95% CI, 1.421-1.469; P < 0.001).

Conclusions:

Using a large inpatient database, we found that NSTEMI was strongly associated with PNA versus non-pneumonia population over a 10-year period. Suggesting acute inflammatory cytokines or hypoxia which occurs during lung infection may play a role in NSTEMI development, reinforcing the importance of acute cardiac monitoring in patients with PNA.
Impact of a targeted temperature management quality improvement project on survival and neurologic outcomes in cardiac arrest patients
Authors: Hsu Thung-Hsien , Huang Wei-Chun , Lin Kun-Chang , Huang Chieh-Ling , Tai Hsiao-Yun , Tsai Yi-Ching , Wu Meng-Chen , Chang Yun-Te
Published: May 2023

Background:

Targeted temperature management (TTM) is recommended for postresuscitation care of patients with sudden cardiac arrest (SCA) and its implementation remains challenging. This study aimed to evaluate the newly designed Quality Improvement Project (QIP) to improve the quality of TTM and outcomes of patients with SCA.

Methods:

Patients who experienced out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) with return of spontaneous circulation (ROSC) and were treated in our hospital between January 2017 and December 2019 were enrolled retrospectively. All included patients received QIP intervention initiated as follows: (1) Protocols and standard operating procedures were created for TTM; (2) shared decision-making was documented; (3) job training instruction was created; and 4) lean medical management was implemented.

Results:

Among 248 included patients, the postintervention group (n = 104) had shorter duration of ROSC to TTM than the preintervention group (n = 144) (356 vs 540 minutes, p = 0.042); better survival rate (39.4% vs 27.1%, p = 0.04), and neurologic performance (25.0% vs 17.4%, p < 0.001). After propensity score matching (PSM), patients who received TTM (n = 48) had better neurologic performance than those without TTM (n = 48) (25.1% vs 18.8%, p < 0.001). OHCA (odds ratio [OR] = 2.705, 95% CI: 1.657-4.416), age >60 (OR = 2.154, 95% CI: 1.428-3.244), female (OR = 1.404, 95% CI: 1.005-1.962), and diabetes mellitus (OR = 1.429, 95% CI: 1.019-2.005) were negative predictors of survival; while TTM (OR = 0.431, 95% CI: 0.266-0.699) and bystander cardiopulmonary resuscitation (CPR) (OR=0.589, 95% CI: 0.35-0.99) were positive predictors. Age >60 (OR= 2.292, 95% CI: 1.58-3.323) and OHCA (OR= 2.928, 95% CI: 1.858-4.616) were negative predictors of favorable neurologic outcomes; while bystander CPR (OR=0.572, 95% CI: 0.355-0.922) and TTM (OR=0.457, 95% CI: 0.296-0.705) were positive predictors.

Conclusion:

A new QIP with defined protocols, documented shared decision-making, and medical management guidelines improves TTM execution, duration from ROSC to TTM, survival, and neurologic outcomes of cardiac arrest patients.
Federal Data for Conducting Patient-centered Outcomes Research on Economic Outcomes
Authors: Brown Derek S. , Srinivasan Mithuna , Arbulu Lucas , Dullabh Prashila , Curtis Kamisha , Zott Courney , Smith Scott R.
Published: May 2023

Background:

Patients are increasingly interested in data on the economic burdens and impacts of health care choices; caregivers, employers, and payers are also interested in these costs. Although there have been various federal investments into patient-centered outcomes research (PCOR), an assessment of the coverage and gaps in federally funded data for PCOR economic evaluations has not been produced to date.

Objectives:

To classify relevant categories of PCOR economic costs, to assess current federally funded data for coverage of these categories, and to identify gaps for future research and collection.

Research Design:

A targeted internet search was conducted to identify a list of relevant outcomes and data sources. The study team assessed data sources for coverage of economic outcomes. A technical panel and key informant interviews were used for evaluation and feedback.

Results:

Four types of formal health care sector costs, 3 types of informal health care sector costs, and 10 types of non–health care sector costs were identified as relevant for PCOR economic evaluations. Twenty-nine federally funded data sources were identified. Most contained elements on formal costs. Data on informal costs (eg, transportation) were less common, and non–health care sector costs (eg, productivity) were the least common. Most data sources were annual, cross-sectional, nationally representative individual-level surveys.

Conclusions:

The existing federal data infrastructure captures many areas of the economic burden of health and health care, but gaps remain. Research from multiple data sources and potential future integrations may offset gaps in individual data sources. Linkages are promising strategies for future research on patient-centered economic outcomes.
Risk Adjustment of ICD-10-CM Coded Potential Inpatient Complications Using Administrative Data
Authors: Korvink Michael , Gunn Laura H. , Molina German , Hayes Tracy , Selves Esther , Duan Michael , Martin John
Published: May 2023

Objective:

To risk-adjust the Potential Inpatient Complication (PIC) measure set and propose a method to identify large deviations between observed and expected PIC counts.

Data Sources:

Acute inpatient stays from the Premier Healthcare Database from January 1, 2019 to December 31, 2021.

Study Design:

In 2014, the PIC list was developed to identify a broader set of potential complications that can occur as a result of care decisions. Risk adjustment for 111 PIC measures is performed across 3 age-based strata. Using patient-level risk factors and PIC occurrences, PIC-specific probabilities of occurrence are estimated through multivariate logistic regression models. Poisson Binomial cumulative mass function estimates identify deviations between observed and expected PIC counts across levels of patient-visit aggregation. Area under the curve (AUC) estimates are used to demonstrate PIC predictive performance in an 80:20 derivation-validation split framework.

Data collection/Extraction methods:

We used N=3,363,149 administrative hospitalizations between 2019 and 2021 from the Premier Healthcare Database.

Principal Findings:

PIC-specific model predictive performance was strong across PICs and age strata. Average area under the curve estimates across PICs were 0.95 (95% CI: 0.93–0.96), 0.91 (95% CI: 0.90–0.93), and 0.90 (95% CI: 0.89–0.91) for the neonate and infant, pediatric, and adult strata, respectively.

Conclusions:

The proposed method provides a consistent quality metric that adjusts for the population’s case mix. Age-specific risk stratification further addresses currently ignored heterogeneity in PIC prevalence across age groups. Finally, the proposed aggregation method identifies large PIC-specific deviations between observed and expected counts, flagging areas with a potential need for quality improvements.
Postoperative surgical complications after pediatric kidney transplantation in low weight recipients (<15 kg): a systematic review
Authors: Prudhomme Thomas , Mesnard Benoit , Abbo Olivier , Banuelos Beatriz , Territo Angelo
Published: May 2023

Purpose of review

Kidney transplantation in low-weight recipients (<15 kg) is a challenging surgery with special characteristics. We proposed to perform a systematic review to determine the postoperative complication rate and the type of complications after kidney transplantation in low-weight recipients (<15 kg). The secondary objectives were to determine graft survival, functional outcomes, and patient survival after kidney transplantation in low-weight recipients.

Methods

A systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses. Medline and Embase databases were searched to identify all studies reporting outcomes on kidney transplantation in low-weight recipients (<15 kg).

Results

A total of 1254 patients in 23 studies were included. The median postoperative complications rate was 20.0%, while 87.5% of those were major complications (Clavien ≥3). Further, urological and vascular complications rates were 6.3% (2.0–11.9) and 5.0% (3.0–10.0), whereas the rate of venous thrombosis ranged from 0 to 5.6%. Median 10-year graft and patient survival were 76 and 91.0%.

Kidney transplantation in low-weight recipients is a challenging procedure complicated by a high rate of morbidity. Finally, pediatric kidney transplantation should be performed in centers with expertise and multidisciplinary pediatric teams.
Overview of pregnancy in solid-organ transplantation
Authors: Yenebere Priya , Doraiswamy Mohankumar , Gundroo Aijaz
Published: May 2023

Purpose of review

Pregnancy in solid organ transplantation (SOT) is a very complex part of transplant medicine wherein there is scarce information available in the literature. Solid organ transplant recipients often have comorbidities, such as hypertension and diabetes, which add additional risk to a pregnancy.

Recent findings

We present this review article on the various aspects of different types of immunosuppressant medications used in pregnancy with added inputs on contraception and fertility after transplant. We described the antepartum and postpartum considerations and discussed the adverse effects of the immunosuppressive medications. Maternal and fetal complications of each SOT have been also discussed in this article.

This article will serve as the primary review articles for the use of immunosuppressive medications during pregnancy with consideration during pregnancy after SOT.
Effectiveness of Switching to Subcutaneous Infliximab in Pediatric Inflammatory Bowel Disease Patients on Intravenous Maintenance Therapy
Authors: Gianolio Laura , Armstrong Katherine , Swann Ewan , Shepherd Rhona , Henderson Paul , Wilson David C. , Russell Richard K.
Published: May 2023

No real-world data are available on subcutaneous infliximab (SC-IFX) in pediatric inflammatory bowel disease (PIBD). We report a single-center cohort experience of an elective switching program from biosimilar intravenous infliximab to SC-IFX, 120 mg fortnightly, as maintenance. Clinical and laboratory data were collected for 7 patients with infliximab trough levels collected prior and at 6 and 40 weeks after the switch. High treatment persistence was registered with a single patient discontinuing the treatment due to high IFX antibodies, already present before switching. All patients remained in clinical remission with no significant changes in laboratory markers and median infliximab trough levels (12.3 µg/mL at baseline; 13.9 and 14.0 µg/mL at 6 and 40 weeks respectively). No newly-developed IFX antibodies were detected and no adverse reactions or rescue therapies were recorded. Our real-world data support the feasibility of an elective switch to SC-IFX in PIBD as maintenance with potential advantages concerning medical resources and patient satisfaction.
Establishment of Nurse Case Manager Role in a Pediatric Orthopedic Team
Authors: Bourque Maryanne , McCarraher Elizabeth A.
Published: May 2023

Purpose/Objectives:

Incorporating a nurse case manager (NCM) directly into a pediatric orthopedic department was implemented to address gaps in processes that had previously led to common delays in discharge planning. The orthopedic NCM works within an interdisciplinary team and provides guidance and support for both elective and emergent pediatric admissions. Applying continuous improvement techniques, the NCM role included the review of existing processes and determination of root causes of delays. This article describes some of the unique challenges and new processes included in the NCM role in the pediatric orthopedic setting, several solutions created and implemented to address identified delays, and statistical results of anticipatory discharge planning.

Primary Practice Setting:

An NCM role was initiated in the orthopedic department at a quaternary-level freestanding pediatric hospital.

Findings/Conclusions:

After interdisciplinary planning and implementation, the NCM role was established within the orthopedic department to facilitate timely, efficient, safe, and sustained discharges of patients. Success was realized through decreased denials and decreased number of avoidable inpatient days. Once rapport was established and streamlined work was developed, a retrospective review of length of stay was conducted to compare time periods prior to and after embedding this position. Changes in discharge planning processes positively affected the average length of stay for patients managed by the NCM. Cost savings are found in decreased avoidable inpatient days, decreased number of denials of inpatient medical necessity, and improved progression of care, which resulted in timely transitions and discharges. The effects of a consignment process and web-based ordering of durable medical equipment were also evaluated. Although this process in and of itself did not seem to impact length of stay, it did foster an improvement in team satisfaction around discharge readiness.

Implications for Case Management:

Pediatric orthopedic service teams benefit from the role of the NCM when there is interdisciplinary involvement and a focus on streamlining processes from preadmission through transition of care. Further study in a concurrent design will shed light on other factors that impact length of stay, such as specific diagnoses and medical complexity. Average length of stay is an effective metric for services with a high percentage of elective admissions but may not be as dependable for teams that do not have prescribed lengths of stay. Study with a specific focus around those factors that impact both team and family satisfaction is also indicated.
Why Shared Decision Making Matters
Authors: Lal M. Maureen
Published: May 2023

Shared decision making is a hallmark of Magnet® organizations. Although the terminology can vary, the essence is the same: nurses at all levels, and in all settings, need to be a part of the decision making structure and process. Their voices, along with those of their interprofessional colleagues, ensure a culture of accountability. During times of financial challenges, trimming shared decision making councils may seem an easy place to save money. However, eliminating the councils may lead to increased unintentional costs. This month's Magnet Perspectives takes a closer look at the benefits of shared decision making and its enduring value.
The Impact of a Nurse Leader Learning Laboratory on Nurse Manager Perception of Leadership Competency and Skills
Authors: Swinton Carolyn , Haverkamp Jaqueline
Published: May 2023

This quality improvement project sought to improve nurse managers' perceptions of leadership competencies through experiential nurse leader laboratories. Nurse managers attended a 3-month pilot of nurse leader learning laboratories that included didactic and experiential components derived from the American Organization for Nursing Leadership's competencies. Clinical significance can be inferred from increases in postintervention Emotional Intelligence Assessment scores and postintervention increases in all categories of the American Organization for Nursing Leadership's Nurse Manager Skills Inventory; therefore, healthcare organizations stand to reap the benefits of cultivating leadership competencies among experienced and novice tenured nurse managers.
Mesotheliomas in Children
Authors: Zambrano Eduardo , Matoso Andrés , Reyes-Múgica Miguel
Published: May 2023

Mesotheliomas are rare and aggressive tumors that originate from mesothelial cells. Although exceedingly rare, these tumors may occur in children. Different from adult mesotheliomas, however, environmental exposures particularly to asbestos do not appear to play a major role in mesotheliomas in children, in whom specific genetic rearrangements driving these tumors have been identified in recent years. These molecular alterations may increasingly offer opportunities for targeted therapies in the future, which may provide better outcomes for these highly aggressive malignant neoplasms.
Pre-Extubation Cuffed Tube Leak Test and Subsequent Post-Extubation Laryngeal Edema: Prospective, Single-Center Evaluation of PICU Patients*
Authors: Kanno Koji , Fujiwara Naoki , Moromizato Takuhiro , Fujii Shuichi , Ami Yuki , Tokushige Akihiro , Ueda Shinichiro
Published: May 2023

OBJECTIVES:

We performed our standard air leak, leak percentage, and cuff leak percentage tests in pediatric patients intubated with microcuff pediatric tracheal tubes (MPTTs) just before extubation. We examined the association between test findings and the subsequent occurrence of post-extubation laryngeal edema (PLE).

DESIGN:

Prospective, single-center, observational study.

SETTING:

PICU (June 1, 2020 to May 31, 2021).

PATIENTS:

Pediatric patients intubated and scheduled for extubation during the day shift in the PICU.

INTERVENTIONS:

Multiple pre-extubation leak tests were performed on each patient immediately before extubation. In our center, the standard leak test is positive if a leak is audible at 30 cm H2O applied pressure with the MPTT cuff deflated. Two other tests were calculated in the pressure control-assist control ventilator mode using the following formulas: leak percentage with deflated cuff = (inspiratory tidal volume [Vt]–expiratory Vt) × 100/inspiratory Vt; cuff leak percentage = (expiratory Vt with inflated cuff–expiratory Vt with deflated cuff) × 100/expiratory Vt with inflated cuff.

MEASUREMENTS AND MAIN RESULTS:

The diagnostic criteria for PLE was made by at least two healthcare professionals and included upper airway stricture with stridor-requiring nebulized epinephrine. Eighty-five pediatric patients (< 15 yr) who had been intubated for at least 12 hours using the MPTT were included. Positive rates for the standard leak, leak percentage (cutoff 10%), and cuff leak percentage (cutoff 10%) tests were 0.27, 0.20, and 0.64, respectively. The standard leak, leak percentage, and cuff leak tests showed sensitivities of 0.36, 0.27, and 0.55, respectively; and specificities of 0.74, 0.81, and 0.35, respectively. PLE occurred in 11 of 85 patients (13%), and there were no instances of needing reintubation.

CONCLUSIONS:

The pre-extubation leak tests in current practice for intubated pediatric patients in the PICU all lack diagnostic accuracy for PLE.
Clinical and Analytic Accuracy of Simultaneously Acquired Hemoglobin Measurements: A Multi-Institution Cohort Study to Minimize Redundant Laboratory Usage
Authors: Dziorny Adam C. , Jones Chloe , Salant Jennifer A. , Kubis Sherri , Zand Martin S. , Wolfe Heather A. , Srinivasan Vijay
Published: May 2023

OBJECTIVES:

Frequent diagnostic blood sampling contributes to anemia among critically ill children. Reducing duplicative hemoglobin testing while maintaining clinical accuracy can improve patient care efficacy. The objective of this study was to determine the analytical and clinical accuracy of simultaneously acquired hemoglobin measurements with different methods.

DESIGN:

Retrospective cohort study.

SETTING:

Two U.S. children’s hospitals.

PATIENTS:

Children (< 18 yr old) admitted to the PICU.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We identified hemoglobin results from complete blood count (CBC) panels paired with blood gas (BG) panels and point-of-care (POC) devices. We estimated analytic accuracy by comparing hemoglobin distributions, correlation coefficients, and Bland-Altman bias. We measured clinical accuracy with error grid analysis and defined mismatch zones as low, medium, or high risk-based on deviance from unity and risk of therapeutic error. We calculated pairwise agreement to a binary decision to transfuse based on a hemoglobin value. Our cohort includes 49,004 ICU admissions from 29,926 patients, resulting in 85,757 CBC-BG hemoglobin pairs. BG hemoglobin was significantly higher (mean bias, 0.43–0.58 g/dL) than CBC hemoglobin with similar Pearson correlation (R2) (0.90–0.91). POC hemoglobin was also significantly higher, but of lower magnitude (mean bias, 0.14 g/dL). Error grid analysis revealed only 78 (< 0.1%) CBC-BG hemoglobin pairs in the high-risk zone. For CBC-BG hemoglobin pairs, at a BG hemoglobin cutoff of greater than 8.0 g/dL, the “number needed to miss” a CBC hemoglobin less than 7 g/dL was 275 and 474 at each institution, respectively.

CONCLUSIONS:

In this pragmatic two-institution cohort of greater than 29,000 patients, we show similar clinical and analytic accuracy of CBC and BG hemoglobin. Although BG hemoglobin values are higher than CBC hemoglobin values, the small magnitude is unlikely to be clinically significant. Application of these findings may reduce duplicative testing and decrease anemia among critically ill children.
Autologous Breast Reconstruction Success Rates in Hypercoagulable Patients
Authors: Egan Katie G , Elver Ashlie A , Birney Jalee M , Nazir Niaman , Butterworth James A , Lai Eric C
Published: May 2023

Introduction:

Hypercoagulable disorders may adversely affect microsurgical outcomes, including increased flap failure and complication rates. Outcomes specific to autologous breast reconstruction patients are not well described.

Methods:

A retrospective review was performed of autologous breast reconstructions between 2009 to 2020. Patients with either a thrombophilic disorder diagnosis or a previous thrombotic event were identified. The analysis compared perioperative complications and flap success rates.

Results:

In this series, 23 thrombophilic disorder patients underwent 39 flaps, and 78 thrombotic event patients underwent 126 flaps, compared to 815 control patients who underwent 1300 flaps. In logistic regression models, a thrombophilic disorder diagnosis was an independent predictor of early total flap loss (OR 8.42 [1.59-44.47], p=.01), late partial flap loss (OR 3.9 [1.0-15.22], p=.05), and delayed healing (OR 2.26 [1.02-5.04], p=.04). Thrombotic event history trended towards an association only with late partial flap loss (p=.057). Flap salvage rates (25%) and flap success rates (92.3%) were statistically lower in thrombophilic disorder patients but normal in thrombotic event patients.

Conclusion:

A microsurgical breast reconstruction is a reasonable option for hypercoagulable patients. No increased risk of flap complications is associated with a previous thrombotic event; however, thrombophilic disorders carry an increased risk.
Double-Blinded Randomized Control Trial Comparing Liposomal Bupivacaine and Plain Bupivacaine in Transversus Abdominis Plane For Deep Inferior Epigastric Artery Perforator (DIEP) Flap Breast Reconstruction
Authors: Nguyen Lyly , Glassman Gabriella E. , Afshari Ashkan , Feng Xiaoke , Shastri Uma Devi , Kaoutzanis Christodoulos , McEvoy Matthew David , Bansal Vik , Canlas Christopher , Yao Julia , Higdon Kye , Perdikis Galen
Published: May 2023

Background:

Pain control after autologous breast reconstruction is important for patient satisfaction and early recovery. Transversus Abdominis Plane (TAP) blocks are commonly used as part of an Enhanced Recovery After Surgery (ERAS) pathway for breast reconstruction. It is uncertain if liposomal bupivacaine used in TAP blocks offer additional advantages. This study aimed to compare the efficacy of liposomal bupivacaine versus plain bupivacaine for patients undergoing deep inferior epigastric perforator (DIEP) flap reconstruction.

Method:

This prospective, double-blinded, randomized controlled trial studied patients undergoing abdominally based autologous breast reconstruction between June 2019 to August 2020. Subjects were randomly assigned liposomal or plain bupivacaine, performed using ultrasound-guided TAP block technique. All patients were managed according to an ERAS protocol. Primary outcomes were postoperative narcotic analgesia required measured in oral morphine equivalents (OME) from postoperative day (POD) 1 to 7. Secondary outcomes included POD 1-7 pain Numeric Pain Scale (NPS), non-narcotic pain medication usage, time to first narcotic use, return of bowel function, and length of stay (LOS).

Results:

Sixty patients were enrolled, 30 received liposomal bupivacaine, while 30 received plain bupivacaine. There were no significant differences in demographics, daily OME narcotic use, non-narcotic pain medication use, time to narcotic use, NPS, time to bowel function, or LOS.

Conclusion:

Liposomal bupivacaine does not confer advantages over plain bupivacaine when used in TAP blocks for abdominally based microvascular breast reconstruction in patients under ERAS protocols and multimodal approaches for pain control.
Cathelicidin LL-37 expression in human breast implant capsules
Authors: Segreto Francesco , Carotti Simone , Marangi Giovanni Francesco , Francesconi Maria , Calia Eleonora , Cagli Barbara , Cimmino Andrea , Rossi Caterina , Morini Sergio , Persichetti Paolo
Published: May 2023

Background:

Capsular contracture is the most common complication following breast implant placement. Cathelicidin LL-37 is a cationic peptide involved in innate immunity. Initially investigated for its antimicrobial role, it was found to have pleiotropic activities, such as immunomodulation, angiogenesis stimulation and tissue healing. The aim of the study was to investigate the expression and localization of LL-37 in human breast implant capsules and its relationship with capsular formation, remodeling and clinical outcomes.

Methods:

The study enrolled 28 women (29 implants) who underwent expander substitution with definitive implant. Contracture severity was evaluated. Specimens were stained with hematoxylin/eosin, Masson trichrome, immunohistochemistry and immunofluorescence for LL-37, CD68, α-SMA, Collagen type I and III, CD31 and TLR-4.

Results:

LL-37 was expressed in macrophages and myofibroblasts of capsular tissue in 10 (34%) and 9 (31%) of the specimens, respectively. In 8 cases (27.5%) it was expressed by both macrophages and myofibroblasts of the same specimen. In infected capsules, expression by both cell types was found in all (100%) specimens. LL-37 expression by myofibroblasts positively correlated with its expression by macrophages (p<0.001). Moreover, LL-37 expression by macrophages of peri-expander capsules negatively correlated with the severity of capsular contracture on definitive implants (p=0.04).

Conclusions:

This study demonstrates the expression of LL-37 in macrophages and myofibroblasts of capsular tissue and its negative correlation with the severity of capsular contracture following permanent implant placement. Expression or up-regulation of LL-37 may be involved in myofibroblast and macrophages modulation, thus playing a role in the pathogenic fibrotic process underlying capsular contracture.
The Effect of Daytime Surgical Hospitalists on Reducing Night Shift Physicians’ Workload
Authors: Jung Yoon Bin , Lee Kang Young
Published: May 2023

Background

The shortage of doctors at night makes it difficult to execute complex tasks and deliver accurate decisions. Therefore, reducing the night shift physician’s workload is essential for patient safety. This study aimed to observe the effect of daytime surgical hospitalists on the reduction in night shift physicians’ workload by analyzing the volume of electronic orders generated at night for postoperative patients.

Methods

A total of 9328 hospitalized patients who underwent colorectal or gastrointestinal surgery for more than 120 minutes were reviewed retrospectively. This study reviewed the nighttime volume difference of electronic orders between patients cared for by a daytime surgical hospitalist and patients cared for by a resident. Multiple logistic regression analysis was performed to analyze the risk factors of nighttime orders during hospitalization (dichotomous end point). Negative binomial regression analysis was also performed to analyze the volume of electronic orders as countable data, and the incident rate ratio was estimated (count end point).

Results

The risk of the occurrence of nighttime electronic order for patients treated by a surgical hospitalist was lower than that of patients cared for by a resident (adjusted odds ratio, 0.616; 95% confidence interval, 0.558–0.682; P < 0.001). In the negative binomial regression analysis, the total volume of electronic orders at night was lower in patients cared for by a surgical hospitalist than in patients cared for by a resident (adjusted incident rate ratio, 0.653; 95% confidence interval, 0.623–0.685; P < 0.001).

Conclusions

The introduction of daytime surgical hospitalists is associated with the lower workload of night shift physicians.
Viral Hepatitis and Human Papillomavirus Vaccination During HIV Pre-Exposure Prophylaxis: Factors Associated With Missed Vaccination
Authors: Raccagni Angelo Roberto , Ceccarelli Daniele , Trentacapilli Benedetta , Galli Laura , Lolatto Riccardo , Canetti Diana , Bruzzesi Elena , Candela Caterina , Castagna Antonella , Nozza Silvia
Published: May 2023

Background:

We evaluated factors associated with lack of triple vaccination (hepatitis A virus [HAV], hepatitis B virus [HBV], and human papillomavirus [HPV]) among men who have sex with men using pre-exposure prophylaxis (PrEP).

Setting:

PrEP users at the San Raffaele Scientific Institute, Italy, with ≥1 follow-up visit (May 2017–2022).

Methods:

Participants were considered protected if (1) before PrEP access: positive serology (IgG-HAV+, hepatitis B surface antigen >10 mUI/mL) or vaccination history was recorded and (2) after starting PrEP: ≥1 dose of each vaccination was administered. Individuals were considered fully protected if they received the following before/during PrEP access: HAV vaccination/infection, HBV vaccination/infection, and HPV vaccination. χ2and Kruskal–Wallis tests were used to compare characteristics of those fully, partially, and not protected. Factors associated with the lack of triple vaccination were assessed by using multivariable logistic regression and classification tree analysis.

Results:

Overall, 473 men who have sex with men were considered: 146 (31%) were fully protected, 231 (48%) partially, and 96 (20%) were not. Daily-based PrEP users (fully: 93, 63.7%; partially: 107, 46.3%; and not protected: 40, 41.7%;P= 0.001) and those with a sexually transmitted infection at the first visit (43, 29.5%; 55, 23.8%; 15, 15.6%;P= 0.048) were more frequently fully protected. At multivariable analysis, the odds of lack of triple vaccination was lower among daily-based users (adjusted odds ratio = 0.47, 95% confidence interval = 0.31–0.70,P< 0.001). Classification tree analysis showed that among daily-based users, with sexually transmitted infection prior and at the first PrEP visit, there was a lower chance of lack of triple vaccination (P= 44%).

Conclusions:

Strategies targeting PrEP users at risk of missing HAV, HBV, and HPV vaccinations need to be implemented, focusing mostly on event-based users.
Renal Involvement of Immunoglobulin G4–Related Disease Presenting as a Solitary Hypermetabolic Mass Mimicking Renal Tumor on 18F-FDG PET/CT
Authors: Hu Guilan , Huo Li , Li Fang , Luo Yaping
Published: May 2023

A 62-year-old woman with a 5-year history of diabetes insipidus was found with a solitary renal mass in contrast-enhanced CT. 18F-FDG PET/CT showed a hypermetabolic mass in the right kidney. Besides, there was increased uptake in the pituitary stalk. The histopathological examination of renal biopsy confirmed the diagnosis of immunoglobulin G4–related disease. After treatment with prednisone and cyclophosphamide, there was obvious radiographic improvement of the renal lesion.
Predicting Falls in Rehabilitation: A Comparison of Three Instruments Including Hester Davis
Authors: Harmon Erin Y. , Cournan Michele C. , Teale Amy E.
Published: May 2023

Purpose

The aim of this study was to evaluate the ability of the Hester Davis Scale (HDS), Section GG, and facility fall risk assessment scores to predict patients who fall during inpatient rehabilitation.

Design

This study was an observational quality improvement project.

Methods

Nurses administered the HDS in parallel to the facility’s current fall risk assessment and Section GG of the Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility Patient Assessment Instrument. Receiver operating characteristic curves were compared in 1,645 patients. Relationships of individual scale items to falls were also assessed.

Results

The HDS (area under the curve [AUC] = .680, 95% CI [.626, .734]), facility fall risk assessment (AUC = .688, 95% CI [.637, .740]), and Section GG scores (AUC = .687, 95% CI [.638, .735]) adequately identified patients who fell. AUCs did not significantly differ between assessments. HDS scores of ≥13, facility scores of ≥14, and Section GG scores of ≤51 resulted in the highest sensitivity/specificity balance.

Conclusions

HDS, facility fall risk assessment, and Section GG scores adequately and similarly identified patients of mixed diagnoses at risk of falling in inpatient rehabilitation.

Clinical Relevance to the Practice of Rehabilitation Nursing

Rehabilitation nurses have several options including the HDS and Section GG to identify patients at greatest risk of falling.
Gasless Endoscopic Submandibular Gland Excision Through Hairline Approach
Authors: Yang Fan , Alkebsi Khaled , Chen Su , Lubamba Grace Paka , Xiao Lan , Wang Xiao-Yi , Li Long-Jiang , Li Chun-Jie , Zhu Gui-Quan
Published: May 2023

Background:

The aim of this study was to evaluate the therapeutic effect of gasless endoscopic submandibular gland excision through hairline approach and the safety, feasibility and practicability of this technique.

Methods:

Twenty-five patients with submandibular gland lesions who underwent gasless endoscopic submandibular gland excision through hairline approach at the Department of Head and Neck Oncology of the West China Hospital of Stomatology from May 1st 2021 to May 31st 2022 were included in this prospective study. The variables were analyzed statistically with SPSS software version 23.0 (IBM Corp, Armonk, New York, USA).

Results:

There was a female predominance (72%), female to male ratio was 2.6. The mean age was 30.6±10.2 years (range: 11 to 52 year). All 25 cases of endoscopic submandibular gland excision through hairline approach were done without conversion to conventional approach. This approach was indicated in 14 cases (56%) for pleomorphic adenoma, 8 cases (32%) for chronic sialadenitis, 2 cases (8%) for adenoid cystic carcinoma, and 1 case (4%) for lymphadenitis. The incision length mean was 4.8±0.4 mm (range: 4 to 5 mm); the operation duration mean was 100.6±39.7 min (range: 51 to 197 min); the intraoperative bleeding mean was 13.2±5.7 ml (range: 5 to 20 ml); the hospital length of stay mean was 4.5±0.8 days (range: 3 to 6 days). The follow-up mean was 10±3.4 months (range: 5 to 16 months). The patients were very satisfied with postoperative cosmetic result (score mean: 9.2±1). No recurrence of disease and complications such as postoperative bleeding, hematoma, nerve damage, skin necrosis, infection, and hair loss occurred.

Conclusions:

Gasless endoscopic submandibular gland excision through hairline approach is safe, feasible and practicable, resulting in a very satisfied cosmetic result without significant complications; the intraoperative bleeding is less, the operative field is clear, the operation duration decreases with accumulation of experience.
Craniofacial Features of Dwarfism in the Paintings of Velázquez
Authors: Hwang Se Won , Hwang Kun , Tukeshov Sultan K.
Published: May 2023

This study describes the craniofacial features of achondroplastic dwarfism in the paintings of Velázquez. In a PubMed search, using [Velázquez] and [dwarf], 13 titles were found. In a Google Image search, [Velázquez] and [dwarf] retrieved 5 paintings. The craniofacial manifestations of the dwarfs depicted in the paintings were analyzed. Frontal bossing, antimongoloid slant, depressed nasal bridge (saddle nose), bulbous tip, malar hypoplasia, malocclusion, and chin asymmetry were observed. The presence of each manifestation was checked. In 5 paintings, portraits of 6 dwarfs having craniofacial deformities were found: Mariabárbola Asquin (left) in Las Meninas, Nicolasito Pertusato (right) in Las Meninas, Portrait of Sebastián de Morra, Portrait of Francisco Lezcano, The Jester Don Diego de Acedo, and Prince Balthasar Charles with a Dwarf. The most frequent craniofacial manifestation was malar hypoplasia (100%), followed by a bulbous tip (83.3%), saddle nose (66.7%), and frontal bossing (50%). Antimongoloid slant, malocclusion, and chin asymmetry were relatively rare (16.7% each). Through an analysis of 6 dwarfs in Velázquez’s paintings, we can show that he realized and frequently expressed the craniofacial manifestations of achondroplasia: malar hypoplasia, bulbous tip, saddle nose, and frontal bossing. Despite the rarity of these presentations, he was also aware of antimongoloid slant, malocclusion, and chin asymmetry. Velázquez was a famous painter in the 17th century (i.e., during the Baroque period). Based on his excellent expression of the craniofacial manifestations of dwarfism, we can assume that he had a sound knowledge of anatomy, as well as malformations.
Occurrence of Rhabdomyosarcoma After Surgery Combined with oral Sirolimus for Mixed Vascular Malformation of the Tongue
Authors: Lin Jiawei , Han Tao , Cui Jie , Shen Weimin
Published: May 2023

Vascular malformation is the general term of a kind of lesions originated from lymphatic vessels and vascular tissues, which contains a variety of components called mixed vascular malformation. Rhabdomyosarcoma (RMS) is a kind of soft tissue sarcoma, originating from striated muscle cells or mesenchymal cells. RMS and vascular malformation mostly occur in children, and common in the head and neck, but their simultaneous occurrence is rare. A 9-year-old boy who was hospitalized for a second attack of combined vascular malformation: hemolymphangioma. The child experienced severe upper airway obstruction and tongue bleeding. Postoperative pathology demonstrated hemolymphangioma combined with RMS. Subsequently, he was transferred to the oncology department for chemotherapy and lately died of RMS with lung metastasis. The secondary RMS may be related to the usage of sirolimus. Because of its uncertain border, vascular malformation in the oral and maxillofacial region is difficult to completely remove by surgical resection, and local recurrence could be often observed. Due to its rapid progress and continuous bleeding, the possibility of malignant tumor should be considered and multidisciplinary comprehensive treatment should be actively taken. Besides, family history of related malignant tumors and immune function should be investigated in detail before choosing the application of oral sirolimus.
The Efficacy of Sequential Intranasal Packing Removal in Overcorrected Nasal Bone Fracture: Evaluation With Computed Tomography
Authors: Park Tae Hwan
Published: May 2023

Background:

Despite the evolution of new techniques to treat nasal bone fractures, closed reduction with appropriate palpation and inspection is one of the critical basic tools to treat nasal bone fractures properly. Despite its rarity, overcorrection after closed reduction of the nasal bone fracture could happen even with experienced surgeons. This study hypothesized that sequential packing removal is mandatory for optimal outcomes based on the preoperative and postoperative Computed Tomography scans in overcorrected cases. This is the first study to evaluate the efficacy of sequential nasal packing removal assessed by facial CT scans.

Methods:

In this retrospective study, we evaluated the medical records and preoperative and postoperative facial Computed Tomography scans of 163 patients with nasal bone fractures treated with a closed reduction from May 2021 to December 2022. Preoperative and Postoperative CT scan was routinely used to assess the outcome. Merocels were used for intranasal packing. In overcorrected cases based on immediate postoperative CT scan, we routinely removed the intranasal packing on the overcorrected side first immediately. On postoperative day 3, we removed the remaining intranasal packing on the other side. We assessed additional postoperative CT scans on postoperative two to three weeks.

Results:

With sequential packing removal starting on the day of surgery, all overcorrected cases were successfully corrected clinically and radiologically without noticeable complications. Two representative cases were presented.

Conclusion:

Sequential nasal packing removal provides significant benefits in overcorrected cases. An immediate postoperative CT scan is also vital to do this procedure. This strategy is advantageous if the fracture is significant and there is a substantial possibility of overcorrection.
Treatment and Management of a Sinonasal Hemangiopericytoma
Authors: Cascio Filippo , Stagno d’Alcontres Ferdinando , Gazia Francesco
Published: May 2023

Sinonasal Hemangiopericytoma (HPC) is a rare vascular tumor originated from Zimmermann’s pericyte with not well valuable course. The diagnosis needs a careful ENT endoscopic examination, radiological study and histopathological analysis with immunohistochemistry for confirmation of diagnosis. We describe a case of a male patient, 67 years old, with history of repeated monolateral right epistaxis. Endoscopic and radiological examination showed an ethmoid-sphenoidal lesion which occupied the entire nasal fossa extending towards the choana, with blood supply coming from the posterior ethmoidal artery. The patient performed an extemporaneous biopsy with subsequent en-bloc removal in operating room, without prior embolization, with the Centripetal Endoscopic Sinus Surgery technique (CESS). The histopathologic analysis led to the diagnosis of sinus HPC. The patient performed close endoscopic follow-ups every 2 months, without performing radio or chemotherapy, and with no evidence of recurrence after 3 years of follow-up. Analyzing the recent literature, a more indolent course with low recurrence rates after total endoscopic surgery remotion was described. Preoperative embolization can be useful in determinate cases, but cause to different complications, it should not be ordinarily performed.
Prognostic Effect of Liver Resection in Extended Cholecystectomy for T2 Gallbladder Cancer Revisited
Authors: Park Yeshong , Lee Jun Suh , Lee Boram , Jo Yeongsoo , Lee Eunhye , Kang MeeYoung , Kwon Wooil , Lim Chang-Sup , Jang Jin-Young , Han Ho-Seong , Yoon Yoo-Seok
Published: May 2023

Objective:

In this study, we evaluated the effect of liver resection on the prognosis of T2 gallbladder cancer (GBC).

Summary Background Data:

Although extended cholecystectomy (lymph node dissection [LND] + liver resection) is recommended for T2 GBC, recent studies have shown that liver resection does not improve survival outcomes relative to LND alone.

Methods:

Patients with pT2 GBC who underwent extended cholecystectomy as an initial procedure and not reoperation after cholecystectomy at three tertiary referral hospitals between January 2010 and December 2020 were analyzed. Extended cholecystectomy was defined as either LND with liver resection (LND+L group) or LND only (LND group). We conducted 2:1 propensity score matching to compare the survival outcomes of the groups.

Results:

Of the 197 patients enrolled, 100 patients from the LND+L group and 50 from the LND group were successfully matched. The LND+L group experienced greater estimated blood loss (P < 0.001) and a longer postoperative hospital stay (P=0.047). There was no significant difference in the 5-year disease-free survival (DFS) of the two groups (82.7% vs. 77.9%, respectively, P=0.376). A subgroup analysis showed that the 5-year DFS was similar in the two groups in both T substages (T2a: 77.8% vs. 81.8%, respectively, P=0.988; T2b: 88.1% vs. 71.5%, respectively, P=0.196). In a multivariable analysis, lymph node metastasis (hazard ratio [HR] 4.80, P=0.006) and perineural invasion (HR 2.61, P=0.047) were independent risk factors for DFS; liver resection was not a prognostic factor (HR 0.68, P=0.381).

Conclusions:

Extended cholecystectomy including LND without liver resection may be a reasonable treatment option for selected T2 GBC patients.
Proceedings of the 27th Annual Congress of the International Liver Transplantation Society
Authors: Campos-Varela Isabel , Rammohan Ashwin , Chadha Ryan , Alconchel Felipe , Hakeem Abdul R. , Mathew Johns S. , Goldaracena Nicolas , Syn Nicholas , Shankar Sadhana , Patel Dhupal , Keskin Onur , Liu Jiang , Nasralla David , Mazzola Alessandra , Shingina Alexandra , Spiro Michael , Patel Madhukar S. , Tanaka Tomohiro , Victor David , Yoon Uzung , Yoon Young-in , Shaker Tamer , Vinaixa Carmen , Kirchner Varvara A. , De Martin Eleonora
Published: May 2023

After a virtual congress in 2021 and a previous absence in 2020 because of the coronavirus disease 2019 pandemic, the 27th Annual Congress of the International Liver Transplantation Society was held from May 4 to 7, 2022, in a hybrid format in Istanbul, with 1123 (58% on-site) liver transplant professionals from 61 countries attending the meeting. The hybrid format successfully achieved a balance of much yearned-for “in-person interaction” and global online participation. Almost 500 scientific abstracts were presented. In this report, the Vanguard Committee aims to present a summary of key invited lectures and selected abstracts for the liver transplant community.
The Significance of Major Histocompatibility Complex Class I Chain-related Molecule A in Solid Organ and Hematopoietic Stem Cell Transplantation: A Comprehensive Overview
Authors: Schinstock Carrie A. , Agrawal Amogh , Valenzuela Nicole M.
Published: May 2023

Improving long-term allograft survival and minimizing recipient morbidity is of key importance in all of transplantation. Improved matching of classical HLA molecules and avoiding HLA donor-specific antibody has been a major focus; however, emerging data suggest the relevance of nonclassical HLA molecules, major histocompatibility complex class I chain-related gene A (MICA) and B, in transplant outcomes. The purpose of this review is to discuss the structure, function, polymorphisms, and genetics of the MICA molecule and relates this to clinical outcomes in solid organ and hematopoietic stem cell transplantation. The tools available for genotyping and antibody detection will be reviewed combined with a discussion of their shortcomings. Although data supporting the relevance of MICA molecules have accumulated, key knowledge gaps exist and should be addressed before widespread implementation of MICA testing for recipients pre- or posttransplantation.