bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of vonoprazan for initial and maintenance therapy in reflux esophagitis, nonerosive esophagitis, and proton pump inhibitor-resistant gastroesophageal reflux disease
Authors: Gotoh Yasuhiko , Ishibashi Emiko , Honda Shunichiro , Nakaya Tomohisa , Noguchi Chishio , Kagawa Koichi , Murakami Kazunari
Published: March 2020

Proton pump inhibitors (PPIs) have been the first line treatment for gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the efficacy of vonoprazan (VPZ), a potassium-competitive acid blocker for reflux esophagitis (RE), nonerosive reflux disease (NERD), and PPI-resistant GERD patients.

An open-label, single-center, observational study in our hospital was performed from August 2016 to August 2017. All patients diagnosed with GERD were asked to self-report a questionnaire of frequency scale for the symptoms of GERD (FSSG) and rate their degree of satisfaction with the treatment of GERD during outpatient visit. A total of 200 (RE 47, NERD 49, PPI-resistant GERD 104) patients were included in the present study. The primary endpoint was the change of FSSG and the proportion of degree of satisfaction with the treatment at the end of the initial therapy. A percentage of improvement (improvement rate) and resolution (resolution rate) at the end of the initial therapy were evaluated. Secondary endpoint included the proportion of patients with symptomatic relapse in the 24-week maintenance phase.

FSSG and the degree of satisfaction were significantly improved after the initial therapy in every group. Improvement and resolution rate after the initial therapy were 83.0% and 67.0% in RE, 66.7% and 60.4% in NERD, and 76.0% and 60.4% in PPI-resistant group. There was no significance between after the initial therapy and 24 weeks in improvement and resolution rate. Thirty-two of the total 48 patients did not take VPZ at 24 weeks. Total FSSG score in each group was 1.67 ± 1.97, 2.71 ± 4.91, and 4.0 ± 4.93. The nonrelapse rate at 24 weeks in each group was 66.7%, 60.0%, and 50.0%. The resolution rate at 24 weeks in each group was 38.9%, 45.0%, and 30.0%.

The VPZ therapy is effective for initial and maintenance therapy and improves heartburn and patient's satisfaction significantly in all 3 groups. Among patients who stopped taking VPZ during the maintenance period, 42.0% of RE and NERD group and 30% of PPI-resistant group experience complete remission from GERD at 24 weeks by introduction of VPZ.
Effect of continuous nursing care based on the IKAP theory on the quality of life of patients with chronic obstructive pulmonary disease
Authors: Li Xin-Xia , Du Xue-Wei , Song Wen , Lu Chang , Hao Wen-Nv
Published: March 2020

Objective:

To explore the effect of continuous nursing care based on the Information, Knowledge, Attitude, and Practice (IKAP) theory on the quality of life of patients with chronic obstructive pulmonary disease (COPD).

Methods:

This study is a randomized control trial. COPD patients attending the Affiliated Hospital of Inner Mongolia Medical University, China between July 1 and October 31, 2017 were eligible. Following random assignment of participants to either the intervention group or control group, 70 patients (35 in each group) were included in the final sample. The intervention group received nursing care based on the Information, Knowledge, Attitude, and Practice theory, while the control group received standard nursing care. Data were collected before the intervention, 1 month after the intervention, and three months after the intervention. The St. George's Respiratory Questionnaire (SGRQ) was used to measure quality of life.

Results:

Three months after the intervention, there were significant differences in the total SGRQ score (20.29 ± 10.03 vs 30.14 ± 12.52) and in the three SGRQ dimensions between the intervention group and the control group (P < .05). A repeated-measures analysis of variance showed that the total SGRQ score and the scores for impact and symptoms had a significant time effect (P < .001), that the total SGRQ score and the score for symptoms had a significant interaction effect (P < .05), and that the impact dimension had a significant group effect (P = .042). Pairwise comparisons of the data for the intervention group showed that there were significant differences between the pre-intervention and 1 month after intervention scores as well as between pre-intervention and three months after intervention, for the total SGRQ scores and the scores for impact and symptoms(P < .001). In terms of the impact dimension, there was a significant difference in the intervention group between 1 month after intervention and 3 months after intervention (P = .016).

Conclusion:

Continuous nursing care based on Information, Knowledge, Attitude, and Practice theory improved quality of scores at 3 months after intervention among COPD patients. Given limitations of the study, future large-scale studies are needed to validate our results.
Association of vitamin D status with coronary artery disease in postmenopausal women
Authors: Xu Rui , Li Yan-Yan , Ma Ling-Ling , Yang Hong-Ni
Published: March 2020

The relationship between coronary artery disease (CAD) and low serum 25-hydroxyvitamin D (25(OH)D) levels has emerged. Postmenopausal (PM) women are at increased risk of CAD and vitamin D (VitD) deficiency.

To investigate the relationship between CAD and VitD levels in PM women.

This case–control study included 93 consecutive female patients aged 50 to 79 years old undergoing coronary angiography for evaluation of CAD and 119 age-matched controls. Serum 25(OH)D concentrations were classed as adequate (serum 25(OH)D: ≥20 ng/mL); insufficient (serum 25(OH)D: 10 to <20 ng/mL); and deficient (serum 25(OH)D: <10 ng/mL). Major cardiovascular risk factors were also explored.

CAD occurred in 67/127 (52.8%) patients with VitD deficiency; 21/66 (31.8%) patients that were VitD insufficient; and in 5/19 (26.3%) patients with adequate VitD levels. Multivariate regression analysis suggested that a deficiency of VitD increased CAD (odds ratio = 2.891; 95% confidence interval = 1.459–7.139, P < .001).

VitD deficiency should be evaluated in PM women as a possible cause of CAD.
Feasibility and learning curve of unsupervised colorectal endoscopic submucosal hydrodissection at a Western Center
Authors: Ramos-Zabala Felipe , Parra-Blanco Adolfo , Beg Sabina , García-Mayor Marian , Domínguez-Pino Ana , Cárdenas-Rebollo José Miguel , Rodríguez-Pascual Jesús , Moreno-Almazán Luis
Published: March 2020

Objectives

Colorectal endoscopic submucosal dissection (CR-ESD) is an evolving technique in Western countries. We aimed to determine the results of the untutored implementation of endoscopic submucosal hydrodissection for the treatment of complex colorectal polyps and establish the learning curve for this technique.

Methods

This study included data from 80 consecutive CR-ESDs performed by a single unsupervised western therapeutic endoscopist. To assess the learning curve, procedures were divided into four groups of 20 each.

Results

En bloc resection was achieved in 55, 75, 75 and 95% cases in the consecutive time periods (period 1 vs. 4, P = 0.003). Curative resection was achieved in 55, 75, 70 and 95%, respectively (P = 0.037). Overall, series results demonstrated R0 resection in 75% of cases, with 23.7% requiring conversion to endoscopic piecemeal mucosal resection, and 1.25% incomplete resections. Complications included perforations (7.5%) and bleeding (3.7%). Multivariate analysis revealed factors more likely to result in association with non en bloc vs. En bloc resection, where polyp size ≥35 mm [70 vs. 23.4%; odds ratio (OR) 13.2 (1.7–100.9); P = 0. 013], severe fibrosis [40 vs. 11.7%; OR 10.2 (1.2–86.3); P = 0.033] and where carbon dioxide for insufflation was not used [65 vs. 30%; OR 0.09 (0.01–0.53); P = 0.008].

Conclusion

CR-ESD by hydrodissection has good safety and efficacy profile and offers well tolerated and effective treatment for complex polyps. As such, this technique may be useful in the West, in centers, where previous gastric ESD is not frequent or Japanese mentoring is not possible.
Flipping to Motivate
Authors: Pence Patricia L. , Franzen Susan R. , Kim Myoung Jin
Published: March 2020

Background

Research suggests flipped learning may improve student motivation to learn.

Purpose

This study examined motivation and learning strategies among prelicensure BSN students in a course taught using the flipped learning model. The hypothesis was that flipped learning may improve motivation and learning strategies of students.

Methods

A descriptive, comparative design examined motivation and learning strategies used by students in a flipped learning course. The Motivated Strategies for Learning Questionnaire and a demographic survey were administered to 25 BSN students at a Midwestern university.

Results

Substantial decreases were found from pretest to posttest mean scores for the task value, control of learning beliefs, and help seeking subscales.

Conclusion

The results did not support the hypothesis that flipped learning would improve motivation and learning strategies. Further research in larger diverse samples of students in a flipped learning course is recommended.
Differential Change in Size of Human Papillomavirus–Positive Cystic Versus Solid Squamous Cell Carcinoma Lymph Node Metastases in Response to Induction Chemotherapy
Authors: Barakat Elie , Ginat Daniel Thomas
Published: March 2020

Purpose

According to certain cancer treatment protocols, the response to induction chemotherapy of lymph node metastases based on radiographic measurements guides further management. The aim of this study is to verify the observation that cystic metastatic lymph nodes tend not to shrink as rapidly as solid metastatic lymph nodes in response to induction chemotherapy in patients with human papillomavirus–related oropharyngeal squamous cell carcinoma.

Methods

The lymphadenopathy in a cohort of patients from a clinical trial with human papillomavirus–related oropharyngeal squamous cell carcinoma with both baseline and postinduction chemotherapy (carboplatin/paclitaxel/cetuximab) contrast-enhanced neck computed tomography was retrospectively reviewed. The appearance of the metastatic lymph nodes on computed tomography was characterized as cystic or solid. A cystic lymph node was defined as having a hypoattenuating component greater than 20% of the total volume. The rates of short-axis and volume changes of cystic and solid lymph nodes were compared using 1-tailedttest.

Results

A total of 46 patients were included in this study, comprising 39 solid and 45 cystic lymph nodes. The rate of short-axis decrease was significantly greater for solid (1.33% per day) than cystic (1.08% per day) lymph nodes (P= 0.036). Likewise, the rate of volume decrease was significantly greater for solid (2.13% per day) than cystic (1.87% per day) lymph nodes (P= 0.014).

Conclusions

This study suggests that in patients with human papillomavirus–related oropharyngeal squamous cell carcinoma solid lymph node metastases generally decrease in size at a greater rate than cystic lymph nodes after induction chemotherapy.
Histopathological Comparison of 2-Octyl Cyanoacrylate and Primary Suturing for Tongue Lacerations
Authors: Üstün Onur , Kumral Tolgar Lütfi , Atar Yavuz , Erdem Zeynep Betül , Hanci Deniz , Sari Hüseyin , Akgün Muhammed Fatih , Uyar Yavuz
Published: March 2020

Objective:

To enable tongue incisions to be repaired more easily, rapidly, and practically, particularly in pediatric patients by using 2-octyl cyanoacrylate (OCA) tissue adhesive.

Methods:

A single linear incision was made on the midline dorsal part of the tongue. Twenty-four rats were randomly divided into the four groups: Group 1 (n = 6), OCA healing at day 5; group 2 (n = 6), OCA healing at day 21; group 3 (n = 6), Vicryl healing at day 5; group 4 (n = 6), Vicryl healing at day 21. In groups 1 and 2, OCA was applied to the incision site. The incisions of the rats in groups 3 and 4 were closed using Vicryl sutures. Histopathological examination was compared between and within the groups at day 5 and 21.

Results:

The operation duration was significantly shorter with OCA than with Vicryl sutures(P < 0.001). Regarding the histopathological results, there were no differences between group 1 and group 3 in epithelial regeneration, inflammation, fibroblastic activity, edema, presence of giant cells, fibrin deposition, ulceration, abscess formation, and granulation tissue. However, moderate infiltration of acute inflammatory cells was significantly more frequent in group 1 than in group 3. At day 5, the incidence of moderate foreign body residue was significantly higher in group 1 than in group 3. No difference was observed between group 2 and group 4 at day 21 (P > 0.05).

Conclusion:

OCA is a practical, rapid, and effective method for repairing tongue lacerations. Although infiltration by inflammatory cells and foreign bodies increased in the early period, the long-term results of OCA were indistinguishable from those of suturing.
Evaluating the Effect of Infraorbital Region Taping Procedure on Patient Anxiety, Satisfaction, Edema, and Ecchymosis Level on Primary Septorhinoplasty
Authors: Tulaci Kamil Gokce , Arslan Erhan , Tulaci Tugba , Tastan Eren , Yazici Hasmet
Published: March 2020

Aim:

This study aims to evaluate the effect of infraorbital region taping on patients’ postoperative edema and ecchymosis, satisfaction levels, and anxiety during follow-up.

Methods:

A total of 64 patients who underwent septorhinoplasty were included in this randomized controlled prospective study. According to the randomization list, the taping group's (TG) infraorbital region was taped with adhesive strips. Others were included in the control group and were classified as the nontaping group. Two blinded physicians evaluated the degree of edema and ecchymosis according to the photographs of patients taken on the first, second, fifth, and seventh postoperative days. Patient's appearance satisfaction was evaluated for ecchymosis levels. State anxiety inventory (STAI-S) and trait anxiety inventory (STAI-T) were used to measure preoperative and postoperative anxiety levels of patients.

Results:

The degree of ecchymosis and edema were not significantly different except on the first day in the TG (P = 0.01, P = 0.01, respectively). Significant increment was found in the TG on first, second, and fifth days based on the satisfaction levels of patients for their appearance (P = 0.05, P = 0.03, P = 0.04, respectively). Preoperative STAI-S and STAI-T were similar for the groups (P = 0.78, P = 0.17, respectively). However, postoperative STAI-S of the TG were significantly lower compared with those of the nontaping group except seventh day (P < 0.05).

Conclusion:

Infraorbital taping did not decrease the edema and ecchymosis except on the first postoperative day. However, it had a significant ameliorating effect on patients’ anxiety and satisfaction levels.
Sirolimus for Kaposiform Hemangioendothelioma With Kasabach-Merritt Phenomenon in Two Infants
Authors: Wang Yuan , Kong Liangliang , Sun Buhao , Cui Jie , Shen Weimin
Published: March 2020

Kaposiform hemangioendothelioma is an aggressive vascular tumor with infiltrative growth that commonly occurs in infancy and is associated with a life-threatening consumptive coagulopathy, as well as Kasabach–Merritt phenomenon. Recently, promising results have shown that sirolimus had been successfully used to treat Kasabach–Merritt phenomenon without significant toxicity. However, the situation the authors encountered in treating infants was not so satisfactory. Here, the authors present 2 patients younger than 3 months with refractory Kaposiform hemangioendothelioma treated with sirolimus and experienced severe pneumonia. The outcomes suggest that it is necessary to keep an eye on any symptoms indicate the infection of respiratory tract and use the antibiotics in time. The 2 cases also remind us of the potential sign that indicate the recurrence of KMP, which refers to firmer lesion with deepen color, especially when it comes with complications.
Contribution of Digital Subtraction Angiogram in Diagnosis and Anatomic Recognition of Traumatic Pulsatile Mass
Authors: Zu Wenxuan , Xu Yidi , Qian Jingyu , Jiang Banghong , Zhang Li
Published: March 2020

Traumatic pulsating masses are difficult to make a definitive diagnosis due to anatomic variation of malformed vessels and rarely clinical incidence. It is essentially to recognizing the anatomy of such vessels, otherwise it may lead to an improperly treatment or serious complication. Digital subtraction angiogram (DSA) has a distinct advantage in both diagnosis and treatment of this subject. Here the authors report a case of venous malformation in the supraclavicular fossa with an underlying arteriovenous fistula following nonoperative management of a clavicle fracture in an adult, and discuss how to rule out potential differential diagnoses and get minimally invasive treatment with DSA.
Anterior Tongue Microglossia: Impact on Face Development
Authors: Wallace Robert D. , Puente-Espel Jordi , Thompson Jerome W. , Konofaos Petros
Published: March 2020

Microglossia is an extremely rare developmental condition that might impact the patient's respiratory, feeding and speech functions, in addition to other intraoral structures. Embryologically, the tongue has 2 origins, which when affected, will determine whether the patient has microglossia or aglossia. A multidisciplinary team should adopt an organized approach based on confirmation by direct laryngoscopy, determination whether associated airway anomalies, mandibular deformities are present; followed by assessment of the ventilatory and feeding status. The involvement of multiple factors, the presence of several anatomical anomalies and the growth exerted by patients, confer microglossia a rather dynamic clinical entity. Two cases of microglossia depicting these features are presented along with review of the literature and a management algorithm.
Supraclavicular Flap Reconstruction in Head and Neck Oncologic Surgery
Authors: Karabulut Burak
Published: March 2020

Free flaps have been considered as the gold standard for reconstruction of head and neck region after ablative oncologic surgery. However, the reconstructive surgeon's armamentarium should also involve pedicled flaps for certain situations such as patients having comorbid diseases necessiating shorter duration of surgical procedure. The supraclavicular flap is a pedicled thin fasciacutaneous flap used to reconstruct the defects in head and neck area. The flap has advantages of wide rotation of arc, easy matching with skin color of recipient area and relatively shorter flap harvesting time. Its bloods supply depends on supraclavicular artery which is a branch of transverse cervical artery. Between August 2016 and September 2019, the pedicled supraclavicular flap was used to reconstruct 17 head and neck cancers patients after ablative oncologic surgery. In 15 patients this flap was primary choice and in 2 patients it was used as a salvage reconstructive tool. Two of 17 flaps had very distal partial necrosis. There was no total loss of any flap. Flap harvesting time was always less than 1 hour. Mean duration for drainage tube removal at the donor side was 5 days. Functional outcomes were perfect. In our suggestion pedicled supraclavicular flap is a very good alternative option to free flap reconstruction especially for skin and oral cavity defects.
Orbital Apex Syndrome Causing Blindness Secondary to a Vertical Root Fracture of a Tooth
Authors: Li Jun , Huang Jing , Qiu Yu , Lin Lisong
Published: March 2020

The authors report a case of a 35-year-old man who presented with left maxillary toothache associated with left sided facial pain and a rapidly progressive loss of vision in the left eye. Clinical and radiological assessments revealed it to be an odontogenic orbital apex syndrome secondary to a vertical root fracture of a tooth. The infection was treated and controlled, postoperative follow-up showed no recurrent inflammation and the patient recovered well. However, the vision was lost permanently. Odontogenic orbital apex syndrome is a rare, aggressive disease. Once the infection spreads, it progresses rapidly, becoming a dangerous condition. To achieve better prognosis and improve survival rates, dental practitioners and oral surgeons should be aware of this distinct presentation and should have a high index of suspicion for the complication of tooth-related problems however minor they may seem.
Temporomandibular Joint Ankylosis in Pediatric Patients With Craniofacial Differences: Causes, Recurrence and Clinical Outcomes
Authors: Ramly Elie P. , Yu Jason W. , Eisemann Bradley S. , Yue Olivia , Alfonso Allyson R. , Kantar Rami S. , Staffenberg David A. , Shetye Pradip R. , Flores Roberto L.
Published: March 2020

Background:

The authors present an institutional experience treating congenital and acquired temporomandibular joint (TMJ) ankylosis, detailing outcomes and potential risk factors of recurrence.

Methods:

Retrospective chart review identified patients with TMJ ankylosis (1976–2019). Clinical records, operative reports, and imaging studies were reviewed for demographics, surgical operations, and ankylosis including maximal interincisal opening (MIO) and re-ankylosis.

Results:

Forty-four TMJs with bony ankylosis were identified in 28 patients (mean age at any initial mandibular surgery: 3.7; range:0–14 years). Follow-up was 13.7 ± 5.9 years. Sixteen (57.1%) patients had bilateral ankylosis; 27(96.4%) had syndromes. Nine patients had congenital ankylosis, 16 had iatrogenic ankylosis (4.5 ± 3.7 years from initial distraction osteogenesis or autologous mandibular reconstruction) referred from outside institutions in 6 instances, and 3 had post-infectious ankylosis. Patients having their first mandibular operation at a younger age had more frequent reoperations for recurrent TMJ ankylosis, although this did not reach statistical significance. Mean improvement in MIO was 21.4 ± 7.3 mm. Ankylosis recurred in 21 (75%) patients. Five patients with congenital TMJ ankylosis required gastrostomy and remained at least partially dependent. Five patients had tracheostomy at the time of TMJ ankylosis surgery: 2 were eventually decannulated and 3 required repeat tracheostomy after ankylosis recurrence and remained tracheostomy-dependent.

Conclusion:

The clinical course of TMJ ankylosis in children affected by craniofacial differences is complex and typically involves a high rate of recurrence and multiple reoperations despite initial improvement in postoperative MIO. Younger age at initial mandibular surgery and number of operations require further investigation as potential predictors of recurrent TMJ ankylosis as well as tracheostomy and gastrostomy dependence.
Assessing Facial Asymmetry in Postoperative Patients With Unilateral Coronal Craniosynostosis
Authors: Gabrick Kyle S. , Wu Robin T. , Singh Anusha , Bartlett Scott P. , Taylor Jesse A. , Persing John A. , Alperovich Michael
Published: March 2020

Background:

Despite surgical correction of unilateral craniosynostosis (ULC), complex cranial base angulation can result in partial reversion to preoperative deformity with growth and time. Using 3-dimensional imaging, dysmorphic facial features of ULC in school-age patients were quantified and related to how they contribute to overall facial asymmetry and patient-reported outcomes.

Methods:

Children who underwent surgical correction of ULC were recruited from Yale University and Children's Hospital of Philadelphia. The 3D photographs were analyzed utilizing a Procrustes analysis of shape. Pearson's correlation was used to determine dysmorphic features’ impact on overall asymmetry. Patients were stratified into “moderate” and “severe” asymmetry. Finally, asymmetry was correlated to patient-reported outcome scores. Statistical analysis was performed with SPSS-25 with P < 0.05 as statistically significant.

Results:

Twenty-one patients were included with average age at analysis of 12.3 years. Fifty-seven percent of patients had right-sided fusion. The overall Procrustes analysis indicated a root mean square difference of 2.21 mm. Pearson's correlation indicated that the facial middle 3rd (P ≤ 0.001), orbital dystopia (P < 0.001), chin point deviation (P = 0.011), and nasal root angulation (P = 0.019) contributed most to overall asymmetry. Patients in the severe asymmetry cohort had greater facial middle-third asymmetry (P < 0.001) and orbital dystopia (P < 0.001). Asymmetry did not correlate with patient-reported outcomes.

Conclusion:

Patients with ULC have persistent facial asymmetry at school-age with the greatest levels of asymmetry in the facial middle-third, orbit, and nasal root. Beyond the cranial dysmorphology, initial skull base angulation in unilateral coronal craniosynostosis manifests in long-term mid and lower-third facial asymmetry.
Radiographic Predictors of FACE-Q Outcomes Following Non-Operative Orbital Floor Fracture Management
Authors: Gabrick Kyle , Smetona John , Iyengar Rajiv , Dinis Jacob , Chouiari Fouad , Peck Connor J. , Persing John , Alperovich Michael
Published: March 2020

Background:

Orbital floor fractures are common injuries treated by multiple surgical subspecialties. Controversy exists regarding the operative indications. This study sought to correlate radiographic characteristics of orbital floor fractures with validated patient reported outcome measures following non-operative management.

Materials and Methods:

Patients who underwent non-operative management of an orbital floor fracture at Yale New Haven Hospital from 2013 to 2018 were queried retrospectively. Patients with GCS < 15 and/or distracting facial soft tissue or bony injuries were excluded from analysis. CT images, demographic information, and FACE-Q patient reported outcomes (Satisfaction with Eyes, Psychological Function, Social Function, and Appearance Related Psychosocial Distress) were reviewed. Statistical analysis was performed with SPSS with statistical significance set at P < .05.

Results:

Eighteen patients were included in the study. The mean time between injury and completion of the survey was 3.6 years. Fifty-six percent of patients had a right-sided fracture. The mean fracture area was 73.6 mm2 (Range:15–172 mm2), and 913 mm3 (Range: 0–3106) was the mean volume displaced into the maxillary sinus. The unaffected inferior rectus muscle shape (height/width) was 0.5 (Range: 0.2–0.98) compared to 0.8 (Range 0.4–1.6) for the affected inferior rectus. After controlling for the time interval between survey and injury, gender, income, and education, rounding of the inferior rectus muscle was a significant predictor of appearance related psychosocial distress (P = 0.006). Inferior rectus rounding was stratified into “severe” (75%) and “moderate” (25%) categories. Severe rounding was associated with a larger orbital floor fracture area (110 versus 64 mm2; P = 0.074), volume displaced into the maxillary sinus (1,716 versus 610 mm3; P = 0.024), and worse appearance-related psychosocial distress (70 versus 25; P = 0.013). Sixty-one percent of patients followed up in clinic with a mean duration of 194 days.

Conclusion:

Prior studies have correlated presenting radiographic findings to follow-up clinical findings. However, this study is the first to assess long-term outcomes using validated patient-reported questionnaires. Inferior rectus muscle belly rounding significantly correlated with appearance related psychosocial distress. This radiographic finding may be valuable to consider in orbital floor fracture management.
Frequency and Management of Craniofacial Syndromes
Authors: Vandeput An-Sofie , Carels Carine , Da Costa Senior Oliver , Peeters Hilde , Politis Constantinus
Published: March 2020

Background:

Craniofacial syndromes occur in approximately 1 in 5600 to 100,000 infants, often resulting in significant morbidity. Due to the heterogeneity of this patient population, no clear consensus consists on optimal treatment modalities and timing. The aim of this study was to analyze the craniofacial syndrome population that were treated at the University Hospital Leuven.

Methods:

A retrospective analysis of patients with a clinical diagnosis of a craniofacial syndrome was performed. Inclusion criteria were patients with a clinical diagnosis of a craniofacial syndrome and that received treatment between “2000–2005” and “2010–2015.” Patients with nonsyndromic conditions were excluded. Data regarding patient characteristics, treatment modalities, and treatment outcomes were analyzed.

Results:

After matching the inclusion criteria, 98 eligible patients, affected by 40 different syndromes were included. In the period of “2000 to 2005,” 48 patients were treated, as compared to 50 patients in the period of “2010 to 2015.” A statistically significant decrease over time is seen for cleft surgery and orthodontic treatment (P = 0.0017 and P = 0.0015, respectively). No statistically significant differences were found concerning the age at which treatment was received (P = 0.42). Significant associations between treatment modalities were found for orthognathic surgery and distraction osteogenesis (P < 0.0001), orthognathic surgery and orthodontic treatment (P < 0.0001), and between orthodontic treatment and distraction osteogenesis (P = 0.03311).

Conclusion:

A decline in cleft reconstruction surgery and orthodontic treatment for patients with craniofacial syndromes was seen over time. A significant association was found between distraction osteogenesis and orthognathic surgery, possibly due to higher reintervention rates for patients treated at a young age.
Prospective validation of the Emergency Surgery Score in emergency general surgery: An Eastern Association for the Surgery of Trauma multicenter study
Authors: Kaafarani Haytham M.A. , Kongkaewpaisan Napaporn , Aicher Brittany O. , Diaz Jose J. , O'Meara Lindsay B. , Decker Cassandra , Rodriquez Jennifer , Schroeppel Thomas , Rattan Rishi , Vasileiou Georgia , Yeh D. Dante , Simonoski Ursula J. , Turay David , Cullinane Daniel C. , Emmert Cory B. , McCrum Marta L. , Wall Natalie , Badach Jeremy , Goldenberg-Sandau Anna , Carmichael Heather , Velopulos Catherine , Choron Rachel , Sakran Joseph V. , Bekdache Khaldoun , Black George , Shoultz Thomas , Chadnick Zachary , Sim Vasiliy , Madbak Firas , Steadman Daniel , Camazine Maraya , Zielinski Martin D. , Hardman Claire , Walusimbi Mbaga , Kim Mirhee , Rodier Simon , Papadopoulos Vasileios N. , Tsoulfas Georgios , Perez Javier Martin , Velmahos George C.
Published: March 2020

BACKGROUND

The Emergency Surgery Score (ESS) was recently developed and retrospectively validated as an accurate mortality risk calculator for emergency general surgery. We sought to prospectively validate ESS, specifically in the high-risk nontrauma emergency laparotomy (EL) patient.

METHODS

This is an Eastern Association for the Surgery of Trauma multicenter prospective observational study. Between April 2018 and June 2019, 19 centers enrolled all adults (aged >18 years) undergoing EL. Preoperative, intraoperative, and postoperative variables were prospectively and systematically collected. Emergency Surgery Score was calculated for each patient and validated using c-statistic methodology by correlating it with three postoperative outcomes: (1) 30-day mortality, (2) 30-day complications (e.g., respiratory/renal failure, infection), and (3) postoperative intensive care unit (ICU) admission.

RESULTS

A total of 1,649 patients were included. The mean age was 60.5 years, 50.3% were female, and 71.4% were white. The mean ESS was 6, and the most common indication for EL was hollow viscus perforation. The 30-day mortality and complication rates were 14.8% and 53.3%; 57.0% of patients required ICU admission. Emergency Surgery Score gradually and accurately predicted 30-day mortality; 3.5%, 50.0%, and 85.7% of patients with ESS of 3, 12, and 17 died after surgery, respectively, with a c-statistic of 0.84. Similarly, ESS gradually and accurately predicted complications; 21.0%, 57.1%, and 88.9% of patients with ESS of 1, 6, and 13 developed postoperative complications, with a c-statistic of 0.74. Emergency Surgery Score also accurately predicted which patients required intensive care unit admission (c-statistic, 0.80).

CONCLUSION

This is the first prospective multicenter study to validate ESS as an accurate predictor of outcome in the EL patient. Emergency Surgery Score can prove useful for (1) perioperative patient and family counseling, (2) triaging patients to the intensive care unit, and (3) benchmarking the quality of emergency general surgery care.

LEVEL OF EVIDENCE

Prognostic study, level III.
Human mesenchymal stromal cell source and culture conditions influence extracellular vesicle angiogenic and metabolic effects on human endothelial cells in vitro
Authors: Chance Tiffani C. , Herzig Maryanne C. , Christy Barbara A. , Delavan Christopher , Rathbone Christopher R. , Cap Andrew P. , Bynum James A.
Published: March 2020

BACKGROUND

Mesenchymal stem/stromal cell (MSC)-derived extracellular vesicles (EVs) are a possible cell-free alternative to MSCs because they retain the regenerative potential of MSCs, while still mitigating some of their limitations (such as the possible elicitation of host immune responses). The promotion and restoration of angiogenesis, however, is an important component in treating trauma-related injuries, and has not been fully explored with EVs. Herein, we describe the effects of monolayer adipose-derived EVs, spheroid adipose-derived EVs (SAd-EVs), monolayer bone marrow-derived EVs (MBM-EVs), and spheroid bone marrow-derived EVs (SBM-EVs) on human umbilical vein endothelial cell (HUVEC) tube formation and mitochondrial respiration.

METHODS

The successful isolation of EVs derived from adipose MSCs or bone marrow MSCs in monolayer or spheroid cultures was confirmed by NanoSight (particle size distribution) and Western blot (surface marker expression). The EV angiogenic potential was measured using a 24-hour HUVEC tube formation assay. The EV effects on HUVEC mitochondrial function were evaluated using the Seahorse respirometer machine.

RESULTS

The number of junctions, branches, and the average length of branches formed at 24 hours of tube formation were significantly affected by cell and culture type; overall adipose-derived EVs outperformed bone marrow-derived EVs, and spheroid-derived EVs outperformed monolayer-derived EVs. Additionally, adipose-derived EVs resulted in significantly increased HUVEC mitochondrial maximal respiration and adenosine triphosphate (ATP) production, while only MBM-EVs negatively impacted HUVEC proton leak.

CONCLUSION

Adipose-derived EVs promoted HUVEC tube formation significantly more than bone marrow-derived EVs, while also maximizing HUVEC mitochondria function. Results demonstrate that, as with MSC therapies, it is possible to tailor EV culture and production to optimize therapeutic potential.

LEVEL OF EVIDENCE

Basic or Foundational Research.
Rib fixation in geriatric trauma: Mortality benefits for the most vulnerable patients
Authors: Chen Zhu Roger , de Roulet Amory , Ogami Takuya , Khariton Konstantin
Published: March 2020

BACKGROUND

Rib fractures in the geriatric trauma population are associated with significant morbidity and mortality. The outcomes of surgical stabilization of rib fractures (SSRF) have not been well defined in this population.

METHODS

Data from the 2016 to 2017 Trauma Quality Improvement Program database were analyzed. Patients older than 65 years admitted with isolated chest wall injury and multiple rib fractures were abstracted from the database. Multivariate propensity score matching was utilized to stratify patients that underwent rib fixation versus nonoperative management. In the matched cohort, we assessed outcomes including mortality, intensive care unit (ICU) and hospital lengths of stay (LOS), tracheostomy rates, and ventilator-associated pneumonia (VAP) rates. We performed a secondary analysis of patients receiving early (<72 hours) versus late SSRF.

RESULTS

Of the 44,450 patients included in the study analysis, 758 (1.7%) underwent SSRF. Patients undergoing SSRF were younger, had a higher prevalence of flail chest, higher rates of emergency room intubation, higher Injury Severity Score, and increased ICU admission rates. The 1:1 propensity score match resulted in 758 patients in each group. The in-hospital mortality rate was significantly lower in patients that underwent SSRF (4.2% vs. 7.3%, p = 0.01). However, the fixation group also had higher rates of tracheostomy during admission (11.2% vs. 4.6%, p < 0.001) and VAP (3.0% vs. 1.6%, p = 0.007). In a secondary matched analysis of 326 pairs of patients undergoing SSRF, we found that early fixation was associated with decreased rates of VAP (1.5% vs. 4.6%, p = 0.01), fewer ventilator days (4 days vs. 7 days, p = 0.003), shorter ICU LOS (6 days vs. 9 days, p = 0.001), and shorter hospital LOS (10 days vs. 15 days, p < 0.001).

CONCLUSION

This study demonstrates a mortality benefit in geriatric trauma patients undergoing SSRF. Early SSRF was observed to be associated with decreased rates of VAP, decreased ICU LOS, and decreased hospital LOS. Early SSRF may be associated with improved outcomes in the geriatric trauma population with multiple rib fractures.

LEVEL OF EVIDENCE

Therapeutic/Care management, level III.
Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma
Authors: Kim Dennis Y. , Biffl Walter , Bokhari Faran , Brakenridge Scott , Chao Edward , Claridge Jeffrey A. , Fraser Douglas , Jawa Randeep , Kasotakis George , Kerwin Andy , Khan Uzer , Kurek Stan , Plurad David , Robinson Bryce R.H. , Stassen Nicole , Tesoriero Ron , Yorkgitis Brian , Como John J.
Published: March 2020

BACKGROUND

Blunt cerebrovascular injuries (BCVIs) are associated with significant morbidity and mortality. This guideline evaluates several aspects of BCVI diagnosis and management including the role of screening protocols, criteria for screening cervical spine injuries, and the use of antithrombotic therapy (ATT) and endovascular stents.

METHODS

Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, a taskforce of the Practice Management Guidelines Committee of the Eastern Association for the Surgery of Trauma performed a systematic review and meta-analysis of currently available evidence. Four population, intervention, comparison, and outcome questions were developed to address diagnostic and therapeutic issues relevant to BCVI.

RESULTS

A total of 98 articles were identified. Of these, 23 articles were selected to construct the guidelines. In these studies, the detection of BCVI increased with the use of a screening protocol versus no screening protocol (odds ratio [OR], 4.74; 95% confidence interval [CI], 1.76–12.78; p = 0.002), as well as among patients with high-risk versus low-risk cervical spine injuries (OR, 12.7; 95% CI, 6.24–25.62; p = 0.003). The use of ATT versus no ATT resulted in a decreased risk of stroke (OR, 0.20; 95% CI, 0.06–0.65; p < 0.0001) and mortality (OR, 0.17; 95% CI, 0.08–0.34; p < 0.0001). There was no significant difference in the risk of stroke among patients with Grade II or III injuries who underwent stenting as an adjunct to ATT versus ATT alone (OR, 1.63; 95% CI, 0.2–12.14; p = 0.63).

CONCLUSION

We recommend using a screening protocol to detect BCVI in blunt polytrauma patients. Among patients with high-risk cervical spine injuries, we recommend screening computed tomography angiography to detect BCVI. For patients with low-risk risk cervical injuries, we conditionally recommend performing a computed tomography angiography to detect BCVI. We recommend the use of ATT in patients diagnosed with BCVI. Finally, we recommend against the routine use of endovascular stents as an adjunct to ATT in patients with Grade II or III BCVIs.

LEVEL OF EVIDENCE

Guidelines, Level III.
Heroes in crisis: Trauma centers should be screening for and intervening on posttraumatic stress in our emergency responders
Authors: Tatebe Leah C. , Rajaram Siva Nandini , Pekarek Sydney , Liesen Erik , Wheeler Andrew , Reese Carol , Schlanser Victoria , Kaminsky Matthew , Messer Thomas , Starr Frederic , Mis Justin , Bokhari Faran , Dennis Andrew
Published: March 2020

BACKGROUND

Emergency responders face a crisis of rising suicide rates, and many resist seeking help due to the stigma surrounding mental health. We sought to evaluate the feasibility of an urban trauma center to screen for posttraumatic stress (PTS) among emergency responders and to provide mental health services.

METHODS

Paramedics, firefighters, law enforcement, and corrections officers involved with patients in the trauma unit were asked to complete the Post-Traumatic Growth Inventory (PTGI) and Post-Traumatic Checklist for Diagnostic and Statistical Manual-5 (PCL-5). Additional factors known to affect PTS were correlated: occupation, age, sex, years of service, marital status, children, and pets. Willingness and barriers to seeking interventions for PTS were evaluated.

RESULTS

A total of 258 responded: 36.7% paramedics, 40.2% law enforcement officers, 18.4% corrections officers, 0.8% firefighters, and 3.5% with multiple positions. Responders had a mean of 14.5 years of service (SD, 9.9 years). Mean PTGI and PCL-5 scores were 52.1 (SD, 25.1) and 17.2 (SD, 16.5), respectively. Overall, 24.7% had diagnostic PTS disorder with no difference seen in rates between professions. Of these, 80.7% had not sought care. Barriers included that they were not concerned (46%), did not recognize symptoms (24%), and were worried about consequences (20%). Concern over career advancement or losing one's job was the greatest barrier cited for seeking care. Among law enforcement, 47.7% were concerned that they would lose their ability to carry a firearm if they sought care for PTS. The PTGI score, divorce, and 46 years to 50 years were the only factors examined that correlated with increased PCL-5 score. There were 82.5% that felt the trauma center was the right place to screen and intervene upon PTS.

CONCLUSION

Trauma centers are an ideal and safe place to both screen for PTS and offer mental health assistance. Comprehensive trauma-informed care by hospital-based intervention programs must expand to include emergency responders.

LEVEL OF EVIDENCE

Epidemiological study type, Level II.
Enterocutaneous fistula after emergency general surgery: Mortality, readmission, and financial burden
Authors: Hatchimonji Justin S. , Passman Jesse , Kaufman Elinore J. , Sharoky Catherine E. , Ma Lucy W. , Scantling Dane , Xiong Ruiying , Holena Daniel N.
Published: March 2020

BACKGROUND

The burden of enterocutaneous fistula (ECF) after emergency general surgery (EGS) has not been rigorously characterized. We hypothesized that ECF would be associated with higher rates of postdischarge mortality and readmissions.

METHODS

Using the 2016 National Readmission Database, we conducted a retrospective study of adults presenting for gastrointestinal (GI) surgery. Cases were defined as emergent if they were nonelective admissions with an operation occurring on hospital day 0 or 1. We used International Classification of Diseases, 10th Revision, code K63.2 (fistula of intestine) to identify postoperative fistula. We measured mortality rates and 30- and 90-day readmission rates censuring discharges occurring in December or from October to December, respectively.

RESULTS

A total of 135,595 patients underwent emergency surgery; 1,470 (1.1%) developed ECF. Mortality was higher in EGS patients with ECF than in those without (10.1% vs. 5.4%; odds ratio [OR], 1.99; 95% confidence interval [CI], 1.67–2.36) among patients who survived the index admission. Readmission rates were higher for EGS patients with ECF than without at 30 days (31.0% vs. 12.6%; OR, 3.12; 95% CI, 2.76–3.54) and at 90 days (51.1% vs. 20.1%; OR, 4.15; 95% CI, 3.67–4.70). Similar increases were shown in elective GI surgery.

CONCLUSIONS

Enterocutaneous fistula after GI EGS is associated with significantly increased odds of mortality and readmission, with rates continuing to climb out to at least 90 days. Processes of care designed to mitigate risk in this high-risk cohort should be developed.

LEVEL OF EVIDENCE

Prognostic and Epidemiological Study, Level III.
Duration of viral detection in throat and rectum of a patient with COVID-19
Authors: Van Tan Le , Ngoc Nghiem My , Ton That Bui Thi , Tam Uyen Le Thi , Thu Hong Nguyen Thi , Phuong Dung Nguyen Thi , Truc Nhu Le Nguyen , Thanh Tran Tan , Huy Man Dinh Nguyen , Thanh Phong Nguyen , Hien Tran Tinh , Truong Nguyen Thanh , Thwaites Guy , Van Vinh Chau Nguyen
Published: March 2020

The rapid spread of coronavirus disease 2019 (COVID-19) raises concern about a global pandemic. Knowledge about the duration of viral shedding remains important for patient management and infection control. We report the duration of viral detection in throat and rectum of a COVID-19 patient treated at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam. Despite clinical recovery, SARS-CoV-2 RNA remained detectable by real time RT-PCR in throat and rectal swabs until day 11 and 18 of hospitalization, respectively. Because live SARS-CoV-2 has been successfully isolated from a stool sample from a COVID-19 patient in China, the results demonstrate that COVID-19 patients may remain infectious for long periods, and fecal-oral transmission may be possible. Therefore, our finding has important implications for infection control.
Clinical features and outcomes of 2019 novel coronavirus–infected patients with cardiac injury
Authors: Liu Youbin , Li Jinglong , Liu Dehui , Song Huafeng , Chen Chunlin , Lv Mingfang , Pei Xing , Qin Zhihui , Hu Zhongwei
Published: March 2020

Aims

To explore the epidemiological and clinical features of 2019 novel coronavirus(2019-nCoV)-infected patients with cardiac injury.

Methods and results

Data were collected from patients’ medical records, and we defined cardiac injury according to cardiac biomarker troponin I level > 0.03 μg/L. Among the 291 patients, 15 (5.2%) showed evidence of cardiac injury. Of 15 hospitalized patients with cardiac injury, the median age was 65 years, and 11/15 (73.3%) were men. Underlying cardiovascular diseases in some patients were hypertension (n=7, 46.7%), coronary heart disease (n=3, 20%) and diabetes (n=3, 20%). The most common symptoms at illness onset in patients with cardiac injury were fever (n=11, 73.3%), cough (n=7, 46.7%), headache or fatigue (n=5, 33.3%) and dyspnea (n=4, 26.7%). These patients had higher systolic pressures, white blood cell count, neutrophil count, troponin I, brain natriuretic peptide, D-dimer and lower lymphocyte count, and platelet count, compared with patients without cardiac injury, respectively. Bilateral infiltrates on chest X-ray and elevated C-reactive protein occurred in all patients with cardiac injury. Compared with patients without cardiac injury, patients with cardiac injury were more likely to develop acute respiratory distress syndrome, and receive mechanical ventilation, continuous renal replacement therapy, extracorporeal membrane oxygenation and vasopressor therapy and be admitted to the intensive care unit.

Conclusion

Cardiac injury is a common condition among patients infected with 2019-nCoV. Compared with patients without cardiac injury, the clinical outcomes of patients with cardiac injury are relatively worse.