bluuebunny/crossref_metadata_2025 huggingface dataset:
Searching optimum equations of state of neutron star matter in strong magnetic fields with rotation
Authors: Watanabe C , Yanase K , Yoshinaga N
Published: August 2020

Masses and radii of neutron stars are obtained in the presence of strong magnetic fields together with rotation. Mass-radius relations are calculated using 11 equations of state (EoSs: GM1, TM1-a, TM1-b, TM2$\omega\rho$-a, TM2$\omega\rho$-b, NL3-a, NL3-b, NL3$\omega\rho$-a, NL3$\omega\rho$-b, DDME2-a and DDME2-b) in relativistic mean field (RMF) theory. Obtained masses are over and around twice the solar mass ($M_\odot$) for all EoSs in the presence of strong magnetic fields of $3 \times 10^{18}$ G at the center. For NL3$\omega\rho$-a and NL3$\omega\rho$-b EoSs, masses are more than $M=2.17\,M_\odot$(observed maximum mass: $2.14\,M_\odot$) even without magnetic fields. Rotational effects are found to be insignificant in any case, at least up to the Kepler frequency. Suitable EoSs are also selected concerning the constraint on the radius of a neutron star.
COVID-19: spiritual interventions for the living and the dead
Authors: Corpuz Jeff Clyde G
Published: August 2020

In a recently published correspondence to the editor of this journal, the authors have called for a need to address the risk and dangers of preparing of funeral directors in handling the dead. This paper provides an urgent appeal to the medical community to include the issue of religious or spiritual interventions for the living and the dead. However, a question is raised: what kind and form of spiritual or religious interventions can the religious leaders come up with? The most immediate need is to provide care for those infected by the COVID-19, providing assistance in their healing process and giving spiritual support to the bereaved family members.
Consensus-based recommendations for the management of juvenile systemic sclerosis
Authors: Foeldvari Ivan , Culpo Roberta , Sperotto Francesca , Anton Jordi , Avcin Tadej , Baildam Eileen , Boros Christina , Chaitow Jeffrey , Constantin Tamas , Kasapcopur Ozgur , Knupp Feitosa de Oliveira Sheila , Pilkington Clarissa , Toplak Natasa , van Royen Annet , Saad Magalhaes Claudia , Vastert Sebastiaan J , Wulffraat Nico , Zulian Francesco
Published: August 2020

Juvenile systemic sclerosis (JSSc) is a rare disease of childhood and currently no international consensus exists with regard to its assessment and treatment. This SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) initiative, based on expert opinion informed by the best available evidence, provides recommendations for the assessment and treatment of patients with JSSc with a view to improving their outcome. Experts focused attention not only on the skin assessment but also on the early signs of internal organ involvement whose proper treatment can significantly affect the long-term outcome. A score for disease severity is proposed in order to perform a structured assessment of outcome over time but a validation in a wider patient population is recommended. Finally, a stepwise treatment approach is proposed in order to unify the standard of care throughout Europe with the aim to reduce morbidity and mortality in this disease.
Economic Studies Reinforce Efforts to Safeguard Specialty Crops in the United States
Authors: Fuchs M. , Almeyda C. V. , Al Rwahnih M. , Atallah S. S. , Cieniewicz E. J. , Farrar K. , Foote W. R. , Golino D. A. , Gómez M. I. , Harper S. J. , Kelly M. K. , Martin R. R. , Martinson T. , Osman F. M. , Park K. , Scharlau V. , Smith R. , Tzanetakis I. E. , Vidalakis G. , Welliver R.
Published: August 2020

Pathogen-tested foundation plant stocks are the cornerstone of sustainable specialty crop production. They provide the propagative units that are used to produce clean planting materials, which are essential as the first-line management option of diseases caused by graft-transmissible pathogens such as viruses, viroids, bacteria, and phytoplasmas. In the United States, efforts to produce, maintain, and distribute pathogen-tested propagative material of specialty crops are spearheaded by centers of the National Clean Plant Network (NCPN). Agricultural economists collaborated with plant pathologists, extension educators, specialty crop growers, and regulators to investigate the impacts of select diseases caused by graft-transmissible pathogens and to estimate the return on investments in NCPN centers. Economic studies have proven valuable to the NCPN in (i) incentivizing the use of clean planting material derived from pathogen-tested foundation plant stocks; (ii) documenting benefits of clean plant centers, which can outweigh operating costs by 10:1 to 150:1; (iii) aiding the development of disease management solutions that are not only ecologically driven but also profit maximizing; and (iv) disseminating integrated disease management recommendations that resonate with growers. Together, economic studies have reinforced efforts to safeguard specialty crops in the United States through the production and use of clean planting material.
Longitudinal Patterns of Pain Reporting Among Community-dwelling Older Adults
Authors: Rundell Sean D. , Phelan Elizabeth A. , Patel Kushang V. , Jones Bobby L. , Marcum Zachary A.
Published: August 2020

Objective:

The objective of this study was to identify and describe long-term trajectories of bothersome pain and activity-limiting pain in a population-based sample of older adults.

Materials and Methods:

We conducted a retrospective cohort study of 6783 community-dwelling participants using 6 years of longitudinal data from the National Health and Aging Trends Study (NHATS). NHATS is a cohort of older adults that is representative of Medicare Beneficiaries aged 65 years and older. NHATS data collection began in 2011, and demographic and health data are collected annually through in-person interviews. Participants were asked if they had bothersome pain and activity-limiting pain in the past month. We used group-based trajectory modeling to identify longitudinal patterns of bothersome pain and activity-limiting pain over 6 years. We used weighted, multinomial logistic regression to examine associations with each trajectory.

Results:

The cohort was 57% female, 68% white, and 58% were 75 years and older. Four trajectories were identified for the probability of bothersome pain: persistently high (n=1901, 35%), increasing (n=898, 17%), decreasing (n=917, 17%), and low (n=1735, 32%). Similar trajectories were identified for activity-limiting pain: persistently high (n=721, 13%), increasing (n=812, 15%), decreasing (n=677, 12%), and low (n=3241, 60%). The persistently high bothersome and activity-limiting pain groups had worse health characteristics, were more likely to have fallen in the past year, and had slower gait speed and worse physical capacity compared with the low groups.

Discussion:

Approximately one half of older adults had a high or increasing probability of long-term bothersome pain, and over one quarter had a high or increasing probability of long-term activity-limiting pain.
Scarf and Akin Osteotomy for Hallux Valgus
Authors: Hariharan Kartik , Ramesh Pal
Published: August 2020

Surgical treatment of hallux valgus by scarf and akin osteotomy has dramatically changed the outcomes since its introduction few decades ago. These procedures provide a stable construct and pain relief, significantly improving the patient journey. Despite the advent of newer options, the scarf osteotomy is continuing to be a popular procedure, especially among European foot and ankle surgeons. The authors describe this versatile procedure in details with a review of 39 patients with a minimum of 6 months follow-up.

Level of Evidence:Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Influenza A virus exposure may cause increased symptom severity and deaths in coronavirus disease 2019
Authors: Hu Zhan-Wei , Wang Xi , Zhao Jian-Ping , Ma Jing , Li Hai-Chao , Wang Guang-Fa , Cheng Yuan , Zhang Hong
Published: August 2020

Background

The coronavirus disease 2019 (COVID-19) outbreak occurred during the flu season around the world. This study aimed to analyze the impact of influenza A virus (IAV) exposure on COVID-19.

Methods

Seventy COVID-19 patients admitted to the hospital during January and February 2020 in Wuhan, China were included in this retrospective study. Serum tests including respiratory pathogen immunoglobulin M (IgM) and inflammation biomarkers were performed upon admission. Patients were divided into common, severe, and critical types according to disease severity. Symptoms, inflammation indices, disease severity, and fatality rate were compared between anti-IAV IgM-positive and anti-IAV IgM-negative groups. The effects of the empirical use of oseltamivir were also analyzed in both groups. For comparison between groups, t tests and the Mann-Whitney U test were used according to data distribution. The Chi-squared test was used to compare disease severity and fatality between groups.

Results

Thirty-two (45.71%) of the 70 patients had positive anti-IAV IgM. Compared with the IAV-negative group, the positive group showed significantly higher proportions of female patients (59.38% vs. 34.21%, χ
2 = 4.43, P = 0.035) and patients with fatigue (59.38% vs. 34.21%, χ
2 = 4.43, P = 0.035). The levels of soluble interleukin 2 receptor (median 791.00 vs. 1075.50 IU/mL, Z = −2.70, P = 0.007) and tumor necrosis factor α (median 10.75 vs. 11.50 pg/mL, Z = −2.18, P = 0.029) were significantly lower in the IAV-positive group. Furthermore, this group tended to have a higher proportion of critical patients (31.25% vs. 15.79%, P = 0.066) and a higher fatality rate (21.88% vs. 7.89%, P = 0.169). Notably, in the IAV-positive group, patients who received oseltamivir had a significantly lower fatality rate (0 vs. 36.84%, P = 0.025) compared with those not receiving oseltamivir.

Conclusions

The study suggests that during the flu season, close attention should be paid to the probability of IAV exposure in COVID-19 patients. Prospective studies with larger sample sizes are needed to clarify whether IAV increases the fatality rate of COVID-19 and to elucidate any benefits of empirical usage of oseltamivir.
Role of immunodeficiency in Acinetobacter baumannii associated pneumonia in mice
Authors: Liu Ai-Ran , Du Wen-Jing , Xie Jian-Feng , Xu Jing-Yuan , Huang Ying-Zi , Qiu Hai-Bo , Yang Yi
Published: August 2020

Background

Acinetobacter baumannii (A. baumannii) has become one of the most important opportunistic pathogens inducing nosocomial pneumonia and increasing mortality in critically ill patients recently. The interaction between A. baumannii infection and immune response can influence the prognosis of A. baumannii related pneumonia. The target of the present study was to investigate the role of immunodeficiency in A. baumannii induced pneumonia.

Methods

Male BALB/c mice were randomly divided into the normal immunity control (NIC) group, normal immunity infection (NIA) group, immune compromised control (CIC) group, and immune compromised infection (CIA) group (n = 15 for each group). Intraperitoneal injection of cyclophosphamide and intranasal instillation of A. baumannii solution were used to induce compromised immunity and murine pneumonia, respectively. The mice were sacrificed at 6 and 24 h later and the specimens were collected for further tests. Seven-day mortality of mice was also assessed.

Results

After A. baumannii stimulation, the recruitment of neutrophils in mice with normal immunity increased sharply (P 
= 0.030 at 6 h), while there was no significant raise of neutrophil counts in mice with compromised immune condition (P 
= 0.092 at 6 h, P 
= 0.772 at 24 h). The Th cell polarization presented with pulmonary interleukin (IL)-4 and interferon (IFN)-γ level in response to the A. baumannii in CIA group were significantly depressed in comparison with in NIA group (IFN-γ: P 
= 0.003 at 6 h; P 
= 0.001 at 24 h; IL-4: P 
< 0.001 at 6 h; P 
< 0.001 at 24 h). The pulmonary conventional dendritic cell accumulation was even found to be inhibited after A. baumannii infection in immunocompromised mice (P 
= 0.033). Correspondingly, A. baumannii associated pneumonia in mice with compromised immunity caused more early stage death, more severe histopathological impairment in lung.

Conclusion

A. baumannii could frustrate the immune response in immunocompromised conditions, and this reduced immune response is related to more severe lung injury and worse outcome in A. baumannii induced pneumonia.
Comparison of Antihypertensive Drug Classes for Dementia Prevention
Authors: Walker Venexia M. , Davies Neil M. , Martin Richard M. , Kehoe Patrick G.
Published: August 2020

Background:

Hypertension in midlife is associated with increased risk of Alzheimer disease and vascular dementia late in life. In addition, some antihypertensive drugs have been proposed to have cognitive benefits, independent of their effect on hypertension. Consequently, there is potential to repurpose antihypertensive drugs for the prevention of dementia. This study systematically compared seven antihypertensive drug classes for this purpose, using the Clinical Practice Research Datalink.

Methods:

We assessed treatments for hypertension in an instrumental variable analysis to address potential confounding and reverse causation. We used physicians’ prescribing preference as an ordinal instrument, defined by the physicians’ last seven prescriptions. Participants considered were new antihypertensive users between 1996 and 2016, aged 40 and over.

Results:

We analyzed 849,378 patients, with total follow up of 5,497,266 patient-years. We estimated that β-adrenoceptor blockers and vasodilator antihypertensives conferred small protective effects—for example, β-adrenoceptor blockers were associated with 13 (95% confidence interval = 6, 20) fewer cases of any dementia per 1000 treated compared with other antihypertensives.

Conclusions:

We estimated small differences in the effects of antihypertensive drug classes on dementia outcomes. We also show that the magnitude of the differences between drug classes is smaller than that previously reported. Future research should look to implement other causal analysis methods to address biases in conventional observational research, with the ultimate aim of triangulating the evidence concerning this hypothesis.
Consequences of Depletion of Susceptibles for Hazard Ratio Estimators Based on Propensity Scores
Authors: Fireman Bruce , Gruber Susan , Zhang Zilu , Wellman Robert , Nelson Jennifer Clark , Franklin Jessica , Maro Judith , Murray Catherine Rogers , Toh Sengwee , Gagne Joshua , Schneeweiss Sebastian , Amsden Laura , Wyss Richard
Published: August 2020

We use simulated data to examine the consequences of depletion of susceptibles for hazard ratio (HR) estimators based on a propensity score (PS). First, we show that the depletion of susceptibles attenuates marginal HRs toward the null by amounts that increase with the incidence of the outcome, the variance of susceptibility, and the impact of susceptibility on the outcome. If susceptibility is binary then the Bross bias multiplier, originally intended to quantify bias in a risk ratio from a binary confounder, also quantifies the ratio of the instantaneous marginal HR to the conditional HR as susceptibles are depleted differentially. Second, we show how HR estimates that are conditioned on a PS tend to be between the true conditional and marginal HRs, closer to the conditional HR if treatment status is strongly associated with susceptibility and closer to the marginal HR if treatment status is weakly associated with susceptibility. We show that associations of susceptibility with the PS matter to the marginal HR in the treated (ATT) though not to the marginal HR in the entire cohort (ATE). Third, we show how the PS can be updated periodically to reduce depletion-of-susceptibles bias in conditional estimators. Although marginal estimators can hit their ATE or ATT targets consistently without updating the PS, we show how their targets themselves can be misleading as they are attenuated toward the null. Finally, we discuss implications for the interpretation of HRs and their relevance to underlying scientific and clinical questions. See video Abstract: http://links.lww.com/EDE/B727.
Forgoing Care in Southernmost Texas
Authors: Tabler Jennifer , Mykyta Laryssa
Published: August 2020

This study examines how material hardship and perceived discrimination are associated with health care access and self-rated health among lower Rio Grande Valley residents. Of respondents to surveys administered at 2 clinic systems (N = 546), approximately 67% reported forgoing medical care in the past 12 months. Regression results suggested that perceived discrimination (odds ratio [OR] = 1.05, P < .05) and material hardship (OR = 1.63, P < .001) increased the odds of forgoing care. Also, discrimination (OR = 1.04, P < .01) and material hardship (OR = 1.24, P < .001) were independently associated with worse self-rated health. Service providers should consider screening for hardship experiences to target resources to address these stressors on patient health.
Conducting a Community “Street Survey” to Inform an Obesity Intervention
Authors: Mosavel Maghboeba , Ferrell Dwala , LaRose Jessica Gokee , Lu Juan , Winship Jodi
Published: August 2020

Using a community-based participatory research approach, a citywide survey was conducted to explore perceptions of obesity and interventions to reduce obesity within an African American urban community. More than 1300 surveys were collected within 3 months; 92.9% of respondents agreed or strongly agreed that obesity was an important health issue in the community and the majority indicated that family-based interventions were the preferred pathway for improving physical activity (86.0%) and nutrition (85.2%). Engaging community members in survey development and implementation was an effective approach to build local research capacity and establish a shared agenda of reaching a diverse sample of community residents.
Artificial iris exchange
Authors: Bahadur Gavin G. , Miller Kevin M.
Published: August 2020

Purpose:

To describe the indications, motivations, and outcomes of artificial iris exchange.

Setting:

Stein Eye Institute.

Design:

Consecutive case series.

Methods:

Review of medical records of patients implanted with an artificial iris device who underwent a subsequent artificial iris exchange.

Results:

Five patients were identified: 4 women and 1 man. Their ages ranged from 19 to 58 years at the time of the exchange. One patient had congenital aniridia; the other 4 had acquired iris defects. Three exchanges were simultaneous; 2 were consecutive. Corneal decompensation was the most common indication for the surgery precipitating the exchange. Explanted iris devices included models from Ophtec, Morcher, BrightOcular, and HumanOptics. Replacement models were from Morcher and HumanOptics. Three of the original irides were passively fixated in the capsular bag or ciliary sulcus. All of the replacement irides were suture-fixated to the sclera, either directly or secondarily by way of an intraocular lens. The motivation for the exchange was improved cosmesis in 4 patients and sustained cosmesis in 1 patient. Final visual acuities were 20/25 for 2 patients, 20/100 for 1 patient, and hand motion for 2 patients.

Conclusions:

No 2 iris exchanges were similar. Clinical indications and outcomes varied considerably from patient to patient. A common thread was each patient's motivation to maintain or improve on the functional and cosmetic benefits of having been previously implanted with an artificial iris device. Final visual acuity results were often poor because of the effects of comorbidities, especially glaucoma and corneal decompensation.
Preliminary assessment of video-based blood pressure measurement according to ANSI/AAMI/ISO81060-2:2013 guideline accuracy criteria: Anura smartphone app with transdermal optimal imaging technology
Authors: Yang Deye , Xiao Guomin , Wei Jing , Luo Hong
Published: August 2020

Objective

A new smartphone app called Anura can measure blood pressure (BP) any time and any place without cuffs or special equipment from video of the face. This study assessed its accuracy in close conformity with the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2013 standard for BP measurement devices.

Methods

We validated Anura in reference to auscultation using a mercury sphygmomanometer and then assessed accuracy against the two accuracy criteria described in the guideline (n = 85 subjects; three measurement pairs per subject).

Results

The mean difference between the Anura measurement and its paired auscultatory reference measurement across all 255 measurement pairs was –0.4 ± 6.7 mmHg for systolic blood pressure (SBP) and 1.2 ± 7.0 mmHg for diastolic blood pressure (DBP). Both are within the acceptable limit of 5 ± 8 mmHg and thus satisfy accuracy criterion 1. When mean differences are averaged for each subject, the mean across all 85 subjects is –0.4 ± 5.8 mmHg for SBP and 1.2 ± 6.7 mmHg for DBP. Both are within acceptable limits (based on the mean difference) and thus satisfy accuracy criterion 2.

Conclusions

Anura meets ANSI/AAMI/ISO 81060-2:2013 standard with respect to BP measurement accuracy. As the ANSI/AAMI/ISO 81060-2:2013 standard has not been developed for cuffless devices, further research assessing additional accuracy issues specific to such devices is needed.
Early Discontinuation of Breast Free Flap Monitoring: A Strategy Driven by National Data
Authors: Baltodano Pablo A. , Schalet Grant , Rezak Kristen , Aliu Oluseyi , Weinberg Maxene , Ata Ashar , Agag Richard L. , Patel Ashit , Ricci Joseph A.
Published: August 2020

Background:

Multiple single-institution studies have revealed that breast free flap compromise usually occurs within the first 48 postoperative hours. However, national studies analyzing the rates and timing of breast free flap compromise are lacking. This study aimed to fill this gap in knowledge to better guide postoperative monitoring.

Methods:

All women undergoing breast free flap reconstruction from the American College of Surgeons National Surgical Quality Improvement Program 2012 to 2016 database were analyzed to determine the rates and timing of free flap take-back. Take-backs were stratified by postoperative day through the first month. Multivariable modified Poisson regression analysis was used to determine the independent predictors of free flap take-back.

Results:

A total of 6792 breast free flap patients were analyzed. Multivariable analysis revealed that body mass index of 40 kg/m2 or higher, hypertension, American Society of Anesthesiologists class of 3 or higher, steroid use, and smoking were independent predictors of take-back (p < 0.05). Take-back occurred at the highest rate during postoperative day 1, dropped significantly by postoperative day 2 (p < 0.001), and remained consistently low after postoperative day 2 (<0.6 percent daily). The identified risk factors significantly increased the likelihood of take-back on postoperative day 1 (p < 0.05), with a trend noted on postoperative day 2 (p = 0.06). Fewer than 0.4 percent of patients (n = 27) underwent take-back on postoperative day 2 without having risk factors.

Conclusions:

This is the first national study specifically analyzing rates, timing, and independent predictors of breast free flap take-back. The data support discontinuing breast free flap monitoring by the end of postoperative day 1 for patients without risk factors, given the very low rate of take-back for such patients during postoperative day 2 (≤0.4 percent).

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Comparison of Telfa Rolling and a Closed Washing System for Autologous Fat Processing Techniques in Postmastectomy Breast Reconstruction
Authors: Valmadrid Al C. , Kaoutzanis Christodoulos , Wormer Blair A. , Farinas Angel F. , Wang Li , Al Kassis Salam , Perdikis Galen , Braun Stephane A. , Higdon Kent K.
Published: August 2020

Background:

The purpose of this study was to compare the commonly used fat grafting techniques—Telfa rolling and a closed washing system—in breast reconstruction patients.

Methods:

Consecutive patients undergoing fat grafting were retrospectively reviewed and grouped by technique. Patients with less than 180 days of follow-up were excluded. Demographics, operative details, and complications were compared using univariate analysis with significance set at p < 0.05.

Results:

Between January of 2013 and September of 2017, 186 women underwent a total of 319 fat grafting procedures. There was no difference in demographics, number of procedures performed, volume of fat grafted, and number of days after reconstruction that fat grafting was performed between groups (p > 0.05). Telfa rolling patients had longer operative times for second fat grafting procedures (implant exchange often completed prior) [100.0 minutes (range, 60.0 to 150.0 minutes) versus 79.0 minutes (range, 64.0 to 94.0 minutes); p = 0.03]. Telfa rolling breasts had more palpable masses requiring imaging (26.0 percent versus 14.4 percent; p = 0.01) and an increased incidence of fat necrosis (20.6 percent versus 8.0 percent; p < 0.01). The closed washing system was found to be an independent predictor of decreased rates of imaging-confirmed fat necrosis (OR, 0.29; p = 0.048). There was no difference in fat necrosis excision or cancer recurrence between the groups.

Conclusion:

The closed washing system was independently associated with decreased rates of imaging-confirmed fat necrosis compared to Telfa rolling without an increase in other complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Closed Metacarpal Neck Fractures: A Review of Resource Use in Operative and Nonoperative Management
Authors: Hooper Rachel C. , Chen Jung-Sheng , Kuo Chang-Fu , Chung Kevin C.
Published: August 2020

Background:

Closed metacarpal neck fractures are extremely common. The authors investigated resource use among those managed operatively versus nonoperatively. They hypothesized that considerable use of services and costs are incurred with nonoperative management.

Methods:

The authors used the 2009 to 2017 Truven Marketscan Research Database to identify patients with closed metacarpal neck fractures and divided them into operative and nonoperative groups. They examined resource use, including imaging, clinic visits, surgery, and occupational therapy sessions, and performed a chi-square analysis of patient demographic data and resources used.

Results:

Of 125,610 patients identified, 46,845 met inclusion criteria: nonoperative, n = 45,067 (96.2 percent); and operative, n = 1778 (3.8 percent). The operative group comprised percutaneous fixation (62 percent) and open reduction and internal fixation (38 percent) patients. Nonoperative patients had the greatest mean number of clinic visits, with 1.7 per patient, compared to 1.2 for both percutaneous fixation and open reduction and internal fixation patients (p < 0.001). For nonoperative patients, one to two radiographs (beyond the index radiograph) were obtained, and they had 2.9 occupational therapy sessions; in the operative group, two to three radiographs were obtained, and they had three to four occupational therapy sessions (p < 0.001). Mean total costs were $2406 per patient for percutaneous fixation, $3092 per patient for open reduction and internal fixation, $546 per patient for closed reduction, and $261 per patient for no intervention.

Conclusions:

Nonoperative management of closed metacarpal neck fracture has lower costs without the associated operating room, surgeon, and service fees; however, patient care remains resource intensive with the use of imaging, clinic visits, and occupational therapy. Shifts in the authors’ treatment paradigm, including judicious use of services, will result in significant health care savings.
Reverse End-to-Side Anterior Interosseous Nerve–to–Ulnar Motor Transfer for Severe Ulnar Neuropathy
Authors: Doherty Christopher D. , Miller Thomas A. , Larocerie-Salgado Juliana , Byers Brett A. , Ross Douglas C.
Published: August 2020

Background:

Reverse end-to-side anterior interosseous nerve transfer has been reported to enhance treatment of severe, proximal ulnar neuropathy. The authors report on patients with severe neuropathy treated with ulnar nerve transposition and distal reverse end-to-side anterior interosseous nerve transfer.

Methods:

Thirty patients with severe ulnar neuropathy at the elbow were reviewed. Clinical parameters included preoperative and postoperative Medical Research Council muscle strength, clawing, and degree of wasting. Electrodiagnostic data included compound motor action potential and sensory nerve action potential amplitudes. Summary statistics were used for demographic and clinical data. The t test and Wilcoxon signed rank test were used where appropriate.

Results:

Average follow-up was 18.6 months. Preoperatively, 20 patients had Medical Research Council less than or equal to grade 1 in hand intrinsics, small finger sensory nerve action potentials were absent in all patients except for three, and average compound motor action potentials were severely reduced (absent in nearly 40 percent) confirming severity. All groups had a statistically significant increase in strength. More than three-quarters of patients noted partial or complete resolution of clawing and intrinsic muscle wasting. Seventy-three percent of patients regained Medical Research Council greater than or equal to grade 3 and 47 percent achieved Medical Research Council greater than or equal to grade 4. Mean time to observation of nascent units was 8.5 months, and 77 percent of patients demonstrated an augmentation of motor unit numbers with forearm pronation on needle electromyography

Conclusion:

Proximal subcutaneous ulnar nerve transposition when combined with reverse end-to-side anterior interosseous nerve–to–ulnar nerve transfer demonstrates significant clinical and electrodiagnostic improvement of intrinsic muscle function.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Psychometric Findings for the SCAR-Q Patient-Reported Outcome Measure Based on 731 Children and Adults with Surgical, Traumatic, and Burn Scars from Four Countries
Authors: Ziolkowski Natalia I. , Pusic Andrea L. , Fish Joel S. , Mundy Lily R. , Wong She Richard , Forrest Christopher R. , Hollenbeck Scott , Arriagada Cristian , Calcagno Manual , Greenhalgh David , Klassen Anne F.
Published: August 2020

Background:

Each year, millions of individuals develop scars secondary to surgery, trauma, and/or burns. Scar-specific patient-reported outcome measures to evaluate outcomes are needed. To address the gap in available measures, the SCAR-Q was developed following international guidelines for patient-reported outcome measure development. This study field tested the SCAR-Q and examined its psychometric properties.

Methods:

Patients aged 8 years and older with a surgical, traumatic, and/or burn scar anywhere on their face or body were recruited between March of 2017 and April of 2018 at seven hospitals in four countries. Participants answered demographic and scar questions, the Fitzpatrick Skin Typing Questionnaire, the Patient and Observer Scar Assessment Scale (POSAS), and the SCAR-Q. Rasch measurement theory was used for the psychometric analysis. Cronbach’s alpha, test-retest reliability, and concurrent validity were also examined.

Results:

Consent was obtained from 773 patients, and 731 completed the study. Participants were aged 8 to 88 years, and 354 had surgical, 184 had burn, and 199 had traumatic scars. Analysis led to refinement of the SCAR-Q Appearance, Symptoms, and Psychosocial Impact scales. Reliability was high, with person separation index values of 0.91, 0.81, and 0.79; Cronbach alpha values of 0.96, 0.91, and 0.95; and intraclass correlation coefficient values of 0.92, 0.94, and 0.88, respectively. As predicted, correlations between POSAS scores and the Appearance and Symptom scales were higher than those between POSAS and Psychosocial Impact scale scores.

Conclusions:

With increasing scar revisions, a scar-specific patient-reported outcome measure is needed to measure outcomes that matter to patients from their perspective. The SCAR-Q represents a rigorously developed, internationally applicable patient-reported outcome measure that can be used to evaluate scars in research, clinical care, and quality improvement initiatives.
Stability of Long-Term Outcomes in Implant-Based Breast Reconstruction: An Evaluation of 12-Year Surgeon- and Patient-Reported Outcomes in 3489 Nonirradiated and Irradiated Implants
Authors: Seth Akhil K. , Cordeiro Peter G.
Published: August 2020

Background:

Outcomes following prosthetic breast reconstruction have been well studied. However, the majority of studies are limited by short-term follow-up and a lack of aesthetic and patient-reported outcomes. This study objectively examines long-term surgeon- and patient-reported outcomes following two-stage prosthetic breast reconstruction.

Methods:

Consecutive patients undergoing two-stage prosthetic breast reconstruction from 1994 to 2016 performed by the senior author (P.G.C.), with at least 1-year follow-up after implant exchange, were reviewed retrospectively. Long-term surgeon-reported outcomes, including aesthetic and capsular contracture scores, and patient-reported outcomes using the BREAST-Q, were recorded at each outpatient visit and analyzed over the 12-year follow-up period.

Results:

Retrospective review revealed 2284 patients, or 3489 breasts, that fit the inclusion criteria. Aesthetic scores and capsular contracture rates remained stable over the entire follow-up period. Subset analysis demonstrated that bilateral and nonirradiated reconstructions consistently had the highest aesthetic scores, whereas unilateral irradiated breasts had the lowest. Irradiated breasts consistently had high rates of capsular contracture, although the extent of contracture improved over time in all patients. Patient-reported BREAST-Q scores showed either stability or improvement over time in all patients. Irradiated and nonirradiated patients demonstrated comparable long-term satisfaction with outcomes despite significant differences in satisfaction with their breasts.

Conclusions:

The authors’ study, the largest of its kind, demonstrates that prosthetic breast reconstruction outcomes do not deteriorate over time. This stability is apparent in both long-term surgeon- and patient-reported outcomes data measured in the same patients. These results contradict the surgical dogma surrounding prosthetic breast reconstruction and therefore should be given significant consideration when counseling patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Breast Reduction: Surgical Techniques with an Emphasis on Evidence-Based Practice and Outcomes
Authors: Colohan Shannon M. , Massenburg Benjamin B. , Gougoutas Alexander J.
Published: August 2020

Learning Objectives:

After studying this article, the participant should be able to: 1. Understand the relevant anatomy involved in breast reduction. 2. Understand the different breast reduction techniques and their indications. 3. Appreciate the outcomes of these techniques as they pertain to clinical outcomes.

This continuing medical education article is designed to refresh one’s knowledge on breast reduction while placing emphasis on clinical outcomes. It reviews the relevant anatomy, techniques, and published literature on outcomes, including those that are patient-reported. Photographic representations of most techniques are shown, in addition to supplemental digital video content, to demonstrate each technique. This is designed to be an overview, and the reader should appreciate that no one technique is “right,” and the technique used should be selected with patient factors and desired outcomes in mind.
Long-Acting Injectable Cabotegravir + Rilpivirine for HIV Maintenance Therapy: Week 48 Pooled Analysis of Phase 3 ATLAS and FLAIR Trials
Authors: Rizzardini Giuliano , Overton Edgar T. , Orkin Chloe , Swindells Susan , Arasteh Keikawus , Górgolas Hernández-Mora Miguel , Pokrovsky Vadim , Girard Pierre-Marie , Oka Shinichi , Andrade-Villanueva Jaime F. , Richmond Gary J. , Baumgarten Axel , Masiá Mar , Latiff Gulam , Griffith Sandy , Harrington Conn M. , Hudson Krischan J. , St. Clair Marty , Talarico Christine L. , Patel Parul , Cutrell Amy , Van Eygen Veerle , D'Amico Ronald , Mrus Joseph M. , Wu Sterling , Ford Susan L. , Chow Ken , Roberts Jeremy , Wills Angela , Walters Nicola , Vanveggel Simon , Van Solingen-Ristea Rodica , Crauwels Herta , Smith Kimberly Y. , Spreen William R. , Margolis David A.
Published: August 2020

Background:

Long-acting (LA) injectable regimens are a potential therapeutic option in people living with HIV-1.

Setting:

ATLAS (NCT02951052) and FLAIR (NCT02938520) were 2 randomized, open-label, multicenter, multinational phase 3 studies.

Methods:

Adult participants with virologic suppression (plasma HIV-1 RNA <50 copies/mL) were randomized (1:1) to continue with their current antiretroviral regimen (CAR) or switch to the long-acting (LA) regimen of cabotegravir (CAB) and rilpivirine (RPV). In the LA arm, participants initially received oral CAB + RPV once-daily for 4 weeks to assess individual safety and tolerability, before starting monthly injectable therapy. The primary endpoint of this combined analysis was antiviral efficacy at week 48 (FDA Snapshot algorithm: noninferiority margin of 4% for HIV-1 RNA ≥50 copies/mL). Safety, tolerability, and confirmed virologic failure (2 consecutive plasma HIV-1 RNA ≥200 copies/mL) were secondary endpoints.

Results:

The pooled intention-to-treat exposed population included 591 participants in each arm [28% women (sex at birth), 19% aged ≥50 years]. Noninferiority criteria at week 48 were met for the primary (HIV-1 RNA ≥50 copies/mL) and key secondary (HIV-1 RNA <50 copies/mL) efficacy endpoints. Seven individuals in each arm (1.2%) developed confirmed virologic failure; 6/7 (LA) and 3/7 (CAR) had resistance-associated mutations. Most LA recipients (83%) experienced injection site reactions, which decreased in incidence over time. Injection site reactions led to the withdrawal of 6 (1%) participants. The serious adverse event rate was 4% in each arm.

Conclusion:

This combined analysis demonstrates monthly injections of CAB + RPV LA were noninferior to daily oral CAR for maintaining HIV-1 suppression.
Endometrial Cancer, the Current International Federation of Gynecology and Obstetrics Staging System, and the Role of Imaging
Authors: Saleh Mohammed , Virarkar Mayur , Bhosale Priya , El Sherif Sherif , Javadi Sanaz , Faria Silvana C.
Published: August 2020

Imaging plays a crucial role in the diagnosis, staging, and follow-up of endometrial cancer. Endometrial cancer is staged surgically using the International Federation of Gynecology and Obstetrics (FIGO) staging system. Preoperative imaging can complement surgical staging but is not yet considered a required component in the current FIGO staging system. Preoperative imaging can help identify some tumor characteristics and tumor spread, both locally and distally. More accurate assessment of endometrial cancers optimizes management and treatment plan, including degree of surgical intervention. In this article, we review the epidemiology, FIGO staging system, and the importance of imaging in the staging of endometrial cancer.
Association Between Incomplete Partition Type III and Abnormal Hypothalamic Morphology: Further Imaging Evidence
Authors: Oztunali Cigdem , Saylisoy Suzan , Toprak Ugur , Incesulu Armagan
Published: August 2020

Purpose

Incomplete partition III (IP-III), characterized by congenital mixed or sensorineural hearing loss, is a rare genetic disease transmitted through X-linked mode of inheritance. Inner ear findings of IP-III have been well described and allow an immediate diagnosis to be made. Recently, an association between IP-III and distinct hypothalamic malformations has been reported in some of the patients with IP-III. The purpose of this study was to investigate the morphologic abnormalities of the hypothalamus in IP-III.

Materials and Methods

Magnetic resonance imaging studies of 8 subjects, including 1 set of brothers, who were diagnosed with IP-III based on their clinical and inner ear imaging findings, were analyzed.

Results

Of the 8 subjects, 7 demonstrated some degree of morphologic abnormality of the hypothalamus. Of these, 2 showed asymmetrical thickening, 1 showed symmetrical thickening, and 4 showed mass-like enlargement of the hypothalamus. Six of 7 subjects with hypothalamic abnormalities showed asymmetry in caudal extension of the abnormalities, which was more discernible on coronal oblique T2-weighted images. Clinically, none of the subjects had endocrinologic or neurologic symptoms.

Conclusions

This retrospective analysis presents further magnetic resonance imaging evidence on the association between the rare IP-III malformations and the presence of hypothalamic morphologic abnormalities.
Computed Tomography Angiography–Based Pulmonary Artery Volumetry as a Diagnostic Tool for Pulmonary Hypertension
Authors: Cassady Steven James , Mills-Robertson Kweku , Deepak Janaki , Hossain Rydhwana
Published: August 2020

Objectives

We evaluated use of three-dimensional pulmonary artery volumes derived from computed tomography pulmonary angiography (CTPA) in a group with pulmonary hypertension (PH) compared with healthy controls as a tool for the diagnosis of PH.

Methods

Retrospective analysis was performed of 40 CTPA scans obtained within 90 days of right heart catheterization demonstrating PH. The CTPA scans of 40 age- and sex-matched patients without cardiopulmonary disease were used as comparison. Diameters and volumes of the pulmonary arteries were compared.

Results

Adjusted total volume of the main, right, and left proximal pulmonary arteries (PAvol) demonstrated area under the curve of 0.918 (95% confidence interval, 0.860–0.975) for detection of PH, comparable to main pulmonary artery diameter measurement. Area under the curve values for PAvol were higher in subgroups divided by sex and PH severity.

Conclusions

Volumetric analysis of the proximal pulmonary arteries using CTPA is a promising diagnostic tool for PH in a real-world cohort.
Prevention and Treatment of Posttraumatic Lymphedema by Soft Tissue Reconstruction With Lymphatic Vessels Free Flap
Authors: Pereira Nicolás , Cambara Álvaro , Kufeke Matías , Roa Ricardo
Published: August 2020

Background

Extremities soft tissue damage may increase the risk of presenting posttraumatic lymphedema. This type of lymphedema is often ignored in trauma and reconstructive literature. We propose a microsurgical soft tissue reconstruction approach to prevent and/or treat posttraumatic lymphedema.

Patients and Methods

This is a multicentric retrospective observational study. Primary and secondary end points were to prevent and/or treat posttraumatic lymphedema and to achieve a stable soft tissue coverage, respectively. Patients with posttraumatic lymphedema and functional lymphatic channels in the indocyanine green lymphography, and patients with acute soft tissue trauma with lymphatic damage without lymphedema, either to treat and prevent lymphedema, respectively, were included as candidates for soft tissue reconstruction using a superficial circumflex iliac artery perforator lymphatic vessels free flap (SCIP-LV). Patients with no pitting edema, fibrosis, or nonfunctional lymphatics channels were excluded. The inguinal lymphatic anatomy was studied with indocyanine green lymphography for designing and in-setting the flap.

Results

Eleven patients underwent to microsurgical reconstruction with SCIP-LV free flap; minimum follow-up was 12 months. There were no flap failures. In the posttraumatic lymphedema group, the mean reduction of excess volume was 63.01%. Quality of life improved 51.85%. No patients in the acute trauma group developed lymphedema after the preventive microsurgical approach.

Conclusions

Soft tissue reconstruction with SCIP-LV free flap is an effective approach to prevent and treat posttraumatic lymphedema.
Temporal Changes in REBOA Utilization Practices are Associated With Increased Survival: an Analysis of the AORTA Registry
Authors: Bukur Marko , Gorman Elizabeth , DiMaggio Charles , Frangos Spiros , Morrison Jonathan J. , Scalea Thomas M. , Moore Laura J. , Podbielski Jeanette , Inaba Kenji , Kauvar David , Cannon Jeremy W. , Seamon Mark J. , Spalding M. Chance , Fox Charles , DuBose Joseph J.
Published: August 2020

Background:

Aortic occlusion (AO) is utilized for patients in extremis, with resuscitative endovascular balloon occlusion of the aorta (REBOA) use increasing. Our objective was to examine changes in AO practices and outcomes over time. The primary outcome was the temporal variation in AO mortality, while secondary outcomes included changes in technique, utilization, and complications.

Study Design:

This study examined the AORTA registry over a 5-year period (2014–2018). AO outcomes and utilization were analyzed using year of procedure as an independent variable. A multivariable model adjusting for year of procedure, signs of life (SOL), SBP at AO initiation, operator level, timing of AO, and hemodynamic response to AO was created to analyze AO mortality.

Results:

One thousand four hundred fifty-eight AO were included. Mean age (39.1 ± 16.7) and median ISS (34[25,49]) were comparable between REBOA and open AO. Open AO patients were more likely: male (84% vs. 77%, P = 0.001), s/p penetrating trauma (61% vs. 19%, P < 0.001), and arrived without SOL (60% vs. 40%, P = 0.001). REBOA use increased significantly and adjusted mortality decreased 22%/year while open AO survival was unchanged. REBOA initiation SBP increased significantly over the study period (52.2 vs. 65, P = 0.04). Compared with patients undergoing AO with CPR, each decile increase in SBP improved survival 12% (AOR 1.12, adj P = 0.001). The use of 7F REBOA (2.9%–54.8%) and Zone III deployment increased significantly (14.7% vs 40.6%), with Zone III placement having decreased associated mortality (AOR 0.33, adj P = 0.001). Overall REBOA complication rate was 4.5% and did not increase over time (P = 0.575).

Conclusions:

REBOA survival has increased significantly while open AO survival remained unchanged. This may be related to lower thresholds for REBOA insertion at higher blood pressures, increased operator experience, and improved catheter technology leading to earlier deployment.