bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of Life and Its Influencing Factors Among Chinese Patients With Permanent Colostomy in the Early Postoperative Stage
Authors: Yan Ming-hui , Lv Lin , Zheng Mei-chun , Jin Ying , Zhang Jun-e
Published: September 2020

Background

Colorectal cancer is one of the most common cancers worldwide. Although colostomies are necessary for disease treatment, they unavoidably affect patient quality of life (QOL), especially in the early postoperative stage.

Objective

The aim of this study was to investigate the dynamic changes and factors influencing QOL among Chinese patients with permanent colostomy.

Methods

We investigated 74 patients before discharge and at 1 and 3 months after discharge. Instruments included the Quality of Life Questionnaire for People With Ostomy–Chinese version, Stoma Self-efficacy Scale, Stoma Self-care Scale–Early Stage Version, and a demographic and stoma-related information questionnaire.

Results

The average QOL increased significantly after discharge (P < .01). Multivariate linear regression showed that the influencing factor of QOL was self-efficacy (before discharge, explained 22.9% of the variance); self-efficacy, truth-telling, average time of stoma care, communicating with friends with colostomy, and family relationship (1 month after discharge, explained 48.8% of the variance); and self-efficacy, body image loss, and participating in activities of patients with colostomy (3 months after discharge, explained 85.2% of the variance).

Conclusions

Clinicians need to give attention to improving the QOL of colostomy patients especially 1 month after discharge. Interventions aimed at improving self-efficacy, preoperative education regarding the surgery, colostomy care ability, family relationship, stoma self-acceptance, and involvement in activities of friends with colostomy should be considered to improve QOL among Chinese patients in this setting.

Implications for Practice

Transitional care should be provided for colostomy patients especially 1 month after discharge. Interventions should focus on enhancing self-efficacy, stoma self-management, and social-environmental support.
The Lived Experiences of Mothers Who Are Parenting Children With Leukemia
Authors: Al Omari Omar , Roach Erna Judith , Shakman Lina , Al Hashmi Aysha , Sunderraj Sheeba John , Francis Frincy , Joseph Mickael Antoine
Published: September 2020

Background

Mothers parenting children with leukemia face innumerable challenges in meeting their own personal needs, as well as the needs of their ill child.

Objective

To explore the lived experiences of Omani mothers who are parenting children with leukemia, using interpretative phenomenological analysis design.

Methods

Data were collected from 10 mothers who were parenting children with leukemia who shared their experiences through a face-to-face recorded interview. Data were analyzed using the interpretative phenomenological analysis approach methods.

Results

Three main themes emerged from the mothers’ experiences: (1) unexpected shocking diagnosis; (2) life is not the same anymore; and (3) viable support systems. Mothers found their child’s diagnosis to be shocking and terrifying. The diagnosis and treatment cast a shadow on the mothers’ lives. Mothers abandoned their work and left their healthy children to their spouses. Mothers relied on other mothers also parenting children with cancer and on the support of the extended family and health team members to cope and prayed to God to help them overcome the calamity.

Conclusion

The mothers perceived their life as changing immediately upon hearing their child’s cancer diagnosis as they experienced a plethora of emotions. They sought support at various points during their child’s illness to cope and overcome the challenges during the cancer treatment journey.

Implications for Practice

Pediatric oncology nurses can support mothers during their transition to caring for a child with leukemia and can provide the needed support to reduce maternal distress and increase effective coping with the challenges.
Predicting Clinical Practice Change: An Evaluation of Trainings on Sexually Transmitted Disease Knowledge, Diagnosis, and Treatment
Authors: Voegeli Christopher , Fraze Jami , Wendel Karen , Burnside Helen , Rietmeijer Cornelis A. , Finkenbinder Allison , Taylor Kimberly , Devine Sharon ,   on behalf of the National Network of STD Clinical Prevention Training Centers
Published: October 2020

Background

Sexually transmitted disease clinical training for working professionals requires substantial time and resources. Understanding the predictors of change in worksite practices and barriers to change will allow educators, learners, and clinical leadership to aid in ensuring learned practices are implemented and barriers are addressed.

Methods

Data for this analysis come from the first standardized national evaluation of a Centers for Disease Control and Prevention–funded clinical prevention training network, including precourse registration and responses to immediate postcourse (1–3 days) and 90-day postcourse evaluations from 187 courses. Univariate statistics describe the trainees and their workplace. Bivariate statistics describe their intention to change and actual change stratified by functional role and employment setting. Logistic regression identified predictors of self-reported changes in practice.

Results

The strongest predictors for practice change included an intention to change and attendance at a training lasting 4 hours or more. Functional role was a weaker predictor of change in practice; employment setting did not predict change. More than half of the trainees (65.9%; n = 912) stated their intention to make a change in their practice immediately after training. At 90 days after a course, 62.4% (n = 863) reported making a practice change. Trainees that took courses lasting 4 hours or more reported making a change more often (70%) compared with trainees from shorter courses (53%). We also report on trainees’ barriers to practice change.

Conclusions

Results suggest that longer trainings may result in more practice change than shorter trainings, recruitment of trainees should focus on those more likely to make a change in their practice, and future trainings should focus on organizational capacity building and assessing change at the organizational level.
Survey of Health Care Providers’ Practices and Opinions Regarding Bacterial Sexually Transmitted Infection Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men
Authors: Rana Jayoti , Guiang Charlie B. , Lisk Ryan , Shahin Rita , Brunetta Jason , Mitterni Leo , Grewal Ramandip , Tan Darrell H.S. , Gilbert Mark , Yeung Anna , Kwag Michael , Logie Carmen H. , Bacon Jean , Gesink Dionne , Burchell Ann N.
Published: October 2020

Background

Rates of bacterial sexually transmitted infections (STIs) continue to rise among gay, bisexual, and other men who have sex with men (GBMSM) globally. Testing and treatment can prevent morbidity and transmission. However, testing rates remain suboptimal.

Methods

In 2018, we conducted an online cross-sectional survey to explore STI testing ordering practices, 14 potential barriers for testing and 11 possible ways to improve testing from the perspective of health care providers in Toronto, Ontario. An estimated 172 providers were invited from primary care and sexual health clinic settings. Providers were eligible to complete the survey if they provided care for ≥1 GBMSM per week and were involved in the decision-making process in providing STI tests. We used descriptive statistics to summarize survey responses.

Results

Ninety-five providers (55% response rate) participated, of whom 68% worked in primary care and 32% in sexual health settings. Most (66%) saw ≤10 GBMSM clients per week. In primary care (65%) and sexual health (40%) clinic settings, insufficient consultation time was the most common barrier to STI testing. In primary care, other common barriers included difficulty introducing testing during unrelated consultations (53%), forgetting (47%), and patients being sexually inactive (31%) or declining testing (27%). The following were most likely to improve testing: express/fast-track testing services (89%), provider alerts when patients are due for testing (87%), patient-collected specimens (84%), nurse-led STI testing (79%), and standing orders (79%).

Conclusions

Promising interventions to improve bacterial STI testing included initiatives that simplify and expedite testing and expand testing delivery to other health care professionals.
Characteristics of the Largest Network Component of Individuals With or Exposed to Early Syphilis in Central Indiana: 2016 to 2017
Authors: Hanley Shane , Parmar Samir , Dawson Bodashus , Haecker Kari , Rios Mackie , Arno Janet N.
Published: October 2020

Background

The surge of syphilis infections in the United States continues. This study examined the sexual networks of early syphilis cases to determine whether repeat infection, demographics, or behaviors differed among network components (groups of connected persons).

Methods

We examined a retrospective cohort of all early syphilis cases in Central Indiana reported from January, 1, 2016, to January 24, 2018, in the state's reporting database. Cases were linked to their sexual partners and analyzed using UCINET and NetDraw. Attributes of network members were derived from disease intervention specialist interviews. Repeat cases were defined as those who also had ≥1 early syphilis infection at any time between 2011 and 2017. The resulting network included 1140 unique individuals, 436 cases and 704 contacts. We compared members of the main component, that is, the largest one, with the rest of the network using multiple logistic regression and network analyses.

Results

The network formed 197 separate components. The main component contained 473 individuals (41% of the cohort). Main component members were more likely to have repeat early syphilis, gonorrhea, Black race, male sex, and a history of methamphetamine use, and be HIV positive by multiple logistic regression. Results from multiple centrality measures indicated persons who might be most effective at disseminating information or fragmenting the main component.

Conclusions

Network analysis identified a group of linked individuals most likely to be reinfected with syphilis in Central Indiana. Further investigation is needed to determine whether engaging such a high-risk group could better focus resources and decrease infections.
Estimating Recommended Gonorrhea and Chlamydia Treatment Rate Using Linked Medical Claims, Prescription, and Laboratory Data in US Private Settings
Authors: Tao Guoyu , Workowski Kimberly , Bowden Katherine E. , Pearson William S. , Sullivan Jane M. , Henk Henry J. , Gift Thomas L.
Published: October 2020

Background

The Centers for Disease Control and Prevention (CDC) recommends specific regimens for chlamydia and dual therapy for gonorrhea to mitigate antimicrobial-resistant gonorrhea in the CDC 2015 sexually transmitted disease treatment guidelines. Only limited studies examining adherence to these recommendations have been conducted at private practices in the United States.

Methods

We used the OptumLabs Data Warehouse, a comprehensive, longitudinal data asset with deidentified persons with linked commercial insurance claims and clinical information, to identify persons aged 15 to 60 years who had valid nucleic acid amplification testing results demonstrating urogenital or extragenital gonorrhea or chlamydia in 2016 to 2018. We defined valid laboratory results as positive or negative. We then assessed the time of their first positive test result and the type of treatment within 30 days to determine if there was evidence in the claims record that the CDC-recommended treatment was provided. We defined presumed treatment if the date of treatment was before the date of the positive test result within 30 days.

Results

Among 6476 patients with positive gonorrhea test results and 26,847 patients with positive chlamydia test results only, 34.8% and 64.2% had evidence of receiving the CDC-recommended therapy, respectively. Approximately 11.6% of patients with positive gonorrhea test results with recommended dual treatment and 7.1% of patients with positive chlamydia test results only with recommended chlamydia treatment were presumptively treated.

Conclusion

Analysis of treatment claims and medical records from private settings indicated low rates of recommended gonorrhea and chlamydia treatment. Validation of treatment claims is needed to support further quality of care interventions based on these data.
Gonorrhea and Chlamydia Rates Among 12- to 24-Year-Old Patients in an Urban Health System
Authors: Douglas Claudia M. , O’Leary Sonja C. , Tomcho Margaret M. , Wu Florence J. , Penny Lara , Federico Steven G. , Wilson Michael L. , Rinehart Deborah J. , Frost Holly M.
Published: October 2020

Background

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infection rates continue to rise. Screening guidelines have largely focused on sexually active female individuals and men who have sex with men populations. Health care system testing and infection rates, particularly among heterosexual male individuals, are poorly understood. Our aim was to evaluate CT and GC testing and prevalence among 12- to 24-year-old patients in an urban federally qualified health center system.

Methods

This retrospective study analyzed electronic health record data from 2017 to 2019 in a large system of federally qualified health centers in Denver, CO. Abstracted data included demographics, sexual activity, sexual orientation, and laboratory results. χ2 Tests were used to evaluate differences between groups.

Results

Of the 44,021 patients included, 37.6% were tested, 15.0% were positive for CT, and 3.4% were positive for GC. Heterosexual male patients had a testing rate of 22.8% and positivity rates of CT and GC at 13.1% and 3.0%, respectively. Among tested patients documented as not sexually active, 7.5% were positive for CT. Multiple or reinfections were detected in 29% of patients.

Conclusions

This study shows low testing rates and high rates of CT and GC infections among all patients, including heterosexual male patients and those documented as not sexually active. Improved screening of these populations in the primary care setting may be key to combating the sexually transmitted disease epidemic.
Opt-Out, Routine Emergency Department Syphilis Screening as a Novel Intervention in At-Risk Populations
Authors: Stanford Kimberly A. , Hazra Aniruddha , Friedman Eleanor , Devlin Samantha , Winkler Nolan , Ridgway Jessica P. , Schneider John
Published: October 2020

Background

With syphilis rates rising rapidly in the United States, novel means of reaching high-risk populations for screening and treatment are needed. Building on successful models for emergency department (ED) HIV screening, a routine opt-out syphilis screening program was implemented in a large, urban, tertiary care hospital ED in May 2019. This study aims to assess the prevalence of syphilis in this population and to evaluate the routine, opt-out syphilis screening model.

Methods

A retrospective chart review was performed of all patients screened for syphilis in the ED from June to December 2019. Demographic information, HIV status, chief complaint, and follow-up visits were examined.

Results

During the study period, 9198 people aged 18 to 64 years were screened for syphilis. Of these, 97 (1.1%) had presumed active syphilis infection (PAI), 354 (3.8%) were presumed not to have active syphilis, and 8747 (95.1%) were negative for infection. Patients with PAI were more likely to be male (67%; adjusted odds ratio, 3.5; 95% confidence interval, 2.3–5.3; P < 0.001), although the percentage of women was considerably higher than the nationally reported rate, and most were non-Hispanic Black (93.8%). Among patients with PAI, 23 (23.7%) were HIV positive. Only 18.6% of patients with PAI presented with complaints related to sexually transmitted infections.

Conclusions

Syphilis rates in this community are very high, and many infections were found in populations traditionally considered at lower risk by demographic or presenting complaint, indicating that universal screening is needed. Routine ED syphilis screening in high-prevalence communities will be critical to addressing the syphilis epidemic.
Clear Cell Change in Reactive Angiogenesis
Authors: Brčić Iva , Spasić Smiljana , England Jonathan S. , Zuo Yiqin , Velez-Torres Jaylou , Diaz-Perez Julio A. , Gorkiewicz Gregor , Rosenberg Andrew E.
Published: September 2020

Reactive angiogenesis is commonplace, occurs in many circumstances, and is important in the repair of injured tissue. Histologically, it is characterized by newly formed capillaries arranged in a lobular architecture and lined by plump endothelial cells. We have encountered a form of reactive angiogenesis not well described; composed of large endothelial cells with abundant clear cytoplasm that causes diagnostic challenges. The cohort includes 10 patients, aged 4 to 61, mean 40 years; 7 males, 3 females. One case involved bone (ilium), and 9 involved soft tissue: fingers (n=2), toes (n=2), hip joint (n=1), shoulder (n=1), thigh (n=2), and anal mucosa (n=1). Clinically, the patients had chronic ulcers, osteomyelitis, or localized infection. All cases exhibited a lobular proliferation of capillaries lined by large polyhedral endothelial cells that obscured the vessel lumens and were admixed with acute and chronic inflammation. The endothelial nuclei were vesicular with small nucleoli and the cytoplasm was abundant and clear or palely eosinophilic. The endothelial cells were stained with CD31 and ERG (7/7 cases), CD34 (6/6), FLI1 (4/4), and were negative for keratin and CD68 (6/6). Periodic acid-Schiff stain and periodic acid-Schiff stain–diastase on 3 cases did not demonstrate glycogen. Using a polymerase chain reaction, no Bartonella henselae was found in all 6 cases tested. Reactive angiogenesis with clear cell change unassociated with Bartonella spp. has not been described. It causes diagnostic challenges and the differential diagnosis includes benign and malignant tumors, as well as unusual infections. It is important to distinguish between these possibilities because of the significant impact on treatment and prognosis.
The Effect of Age on Fat Distribution in the Neck Using Volumetric Computed Tomography
Authors: Orra Susan , Tadisina Kashyap , Charafeddine Ali , Derakhshan Adeeb , Halliburton Sandra , Hashem Ahmed , Doumit Gaby , Zins James E.
Published: October 2020

Background:

Neck fat distribution plays an important role in aging, yet how fat distribution changes with age is largely unknown. This study used volumetric computed tomography in live patients to characterize neck fat volume and distribution in young and elderly women.

Methods:

A retrospective analysis was conducted of head and neck computed tomographic angiographs of 20 young (aged 20 to 35 years) and 20 old (aged 65 to 89 years) women. Fat volume in the supraplatysmal and subplatysmal planes was quantified. Distribution of fat volume was assessed by dividing each supraplatysmal and subplatysmal compartment into upper, middle, and lower thirds.

Results:

Total supraplatysmal fat volume was greater than subplatysmal in all patients. Young patients had more total supraplatysmal fat than old patients (p < 0.0001). No difference was found between age groups in subplatysmal fat (p > 0.05). No difference was found between upper/middle/lower third supraplatysmal fat volumes in young patients. When comparing supraplatysmal thirds within the elderly population, the middle third fat volume (28.58 ± 20.01 cm3) was greater than both upper (18.93 ± 10.35 cm3) and lower thirds (15.46 ± 11.57 cm3) (p < 0.01).

Conclusions:

This study suggests that total supraplatysmal fat volume decreases with age. Older patients had more fat volume in the upper and middle thirds compared with the lower third of the supraplatysmal fat compartment, whereas young patients had more evenly distributed fat. These results suggest that fat deposition and redistribution in the neck occur with age and may be a contributing factor to the obtuse cervicomandibular angle of the elderly.
Association of Breast Implants with Nonspecific Symptoms, Connective Tissue Diseases, and Allergic Reactions: A Retrospective Cohort Analysis
Authors: Barbosa Monica R. , Makris Una E. , Mansi Ishak A.
Published: October 2020

Background:

Given the rising media attention regarding various adverse conditions attributed to breast implants, the authors examined the association between breast implantation and the risk of being diagnosed with connective tissue diseases, allergic reactions, and nonspecific constitutional complaints in a cohort study with longitudinal follow-up.

Methods:

Women enrolled in a regional military health care system between 2003 and 2012 were evaluated in this retrospective cohort study. A propensity score was generated to match women who underwent breast implantation with women who did not undergo breast implantation. The propensity score included age, social history, health care use, comorbidities, and medication use. Outcomes assessed included International Classification of Diseases, Ninth Revision, diagnoses codes for (1) nonspecific constitutional symptoms, (2) nonspecific cardiac conditions, (3) rheumatoid arthritis and systemic lupus erythematosus, (4) other connective tissue diseases, and (5) allergic reactions.

Results:

Of 22,063 women included in the study (513 breast implants and 21,550 controls), we propensity score–matched 452 breast implant recipients with 452 nonrecipients. Odds ratios and 95 percent confidence intervals in breast implant recipients compared to nonrecipients were similar, including nonspecific constitutional symptoms (OR, 0.77; 95 percent CI, 0.53 to 1.13), nonspecific cardiac conditions (OR, 0.97; 95 percent CI, 0.69 to 1.37), rheumatoid arthritis and systemic lupus erythematosus (OR, 0.66; 95 percent CI, 0.33 to 1.31), other connective tissue diseases (OR, 1.02; 95 percent CI, 0.78 to 1.32), and allergic reactions (OR, 1.18; 95 percent CI, 0.84 to 1.66).

Conclusions:

Women with breast implants did not have an increased likelihood of being diagnosed with nonspecific constitutional symptoms, connective tissue disorders, and/or allergic reaction conditions.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Long-Term Outcomes after Surgical Treatment of Radial Sensory Nerve Neuromas: Patient-Reported Outcomes and Rate of Secondary Surgery
Authors: Gottlieb Rachel W. , Westenberg Ritsaart F. , Chen Neal C. , Coert J. Henk , Eberlin Kyle R.
Published: October 2020

Background:

This study aimed to (1) describe long-term patient-reported outcomes of surgically treated symptomatic radial sensory nerve neuromas on function, pain interference, pain intensity, and satisfaction; (2) assess which factors were associated with worse function, higher pain intensity, and more pain interference; and (3) describe the secondary surgery rate and factors associated with secondary surgery.

Methods:

The authors conducted a retrospective review of patients surgically treated for radial sensory nerve neuroma from 2002 to 2016 (n = 54). Twenty-five of these 54 patients completed a follow-up survey including the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity, pain interference, and depression scales; numerical rating scale pain and satisfaction instruments; and the global rating scale of change, at a mean period of 10.7 ± 4.3 years after neuroma surgery.

Results:

The mean PROMIS scores were 45.0 ± 12.1 for upper extremity, 55.5 ± 10.3 for pain interference, and 49.9 ± 10.2 for depression, and were within 1 SD of the general population. Eight patients (32 percent) reported symptoms as unchanged or worse following neuroma surgery. The median numerical rating scale pain was 3 (interquartile range, 1 to 6) and the global rating scale of change satisfaction was 10 (interquartile range, 7 to 10). Older patients (p = 0.002) and patients with higher PROMIS pain interference (p < 0.001), higher numerical rating scale for pain (p = 0.012), and lower global rating scale of change scores (p = 0.01) had worse PROMIS upper extremity scores. The secondary surgery rate was 20 percent and was associated with the presence of multiple neuromas (p = 0.001).

Conclusions:

Radial sensory nerve neuromas remain difficult to treat. They have a high secondary surgery rate (20 percent), with only 68 percent of patients reporting improvement after surgical intervention. Patient-reported outcomes after surgery are similar to conditions of the general population; however, the range of outcomes is wide.
Efficacy of Nonoperative Treatments for Lateral Epicondylitis: A Systematic Review and Meta-Analysis
Authors: Kim You J. , Wood Shannon M. , Yoon Alfred P. , Howard Julia C. , Yang Lan Y. , Chung Kevin C.
Published: October 2020

Background:

Lateral epicondylitis is a common overuse injury affecting approximately 1 to 3 percent of the population. Although symptoms may disappear spontaneously within 1 year, the clinical guidelines for conservative treatment are not clear. The authors’ objective was to examine the outcomes of nonsurgical treatments for lateral epicondylitis through a meta-analysis and provide a treatment recommendation using the available evidence.

Methods:

The authors searched the PubMed, EMBASE, Scopus, and Web of Science databases to identify primary research articles studying conservative treatments (electrophysiotherapy, physical therapy, and injections) for lateral epicondylitis. The authors included randomized controlled trials published in peer-reviewed journals. Data related to outcomes (pain, grip strength, Patient-Rated Tennis Elbow Evaluation score, and Disabilities of the Arm, Shoulder and Hand score) and complications were extracted.

Results:

Fifty-eight randomized controlled trials were included in the meta-analysis. Electrophysiotherapy was effective in improving pain [mean difference, −10.0 (95 percent CI, −13.8 to −6.1)], Patient-Rated Tennis Elbow Evaluation score [mean difference, −10.7 (95 percent CI, −16.3 to −5.0)], and Disabilities of the Arm, Shoulder and Hand score [mean difference, −11.9 (95 percent CI, −15.8 to −7.9)]; and physical therapy improved pain [mean difference, −6.0 (95 percent CI, −9.7 to −2.3)] and Patient-Rated Tennis Elbow Evaluation scores [mean difference, −7.5 (95 percent CI, −11.8 to −3.2)] compared to placebo. Injections did not improve any outcome measures. Patients who received electrophysiotherapy and injections reported higher adverse effects than physical therapy patients.

Conclusions:

Patients who received electrophysiotherapy and physical therapy reported statistically and clinically improved scores in pain and function compared to placebo. Injections may put patients at higher risk for adverse effects compared to other conservative treatments. When managing lateral epicondylitis conservatively, electrophysiotherapy and physical therapy should be prioritized before other interventions.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, I.
Postirradiation Capsular Contracture in Implant-Based Breast Reconstruction: Management and Outcome
Authors: Haran Oriana , Bracha Gal , Tiosano Alon , Menes Tehillah , Madah Ehab , Gur Eyal , Barnea Yoav , Arad Ehud
Published: October 2020

Background:

Implant-based breast reconstruction is commonly avoided in the setting of radiation therapy, mainly because of risks of capsular contracture. Nevertheless, as breast reconstruction is becoming more available, more patients undergo both implant-based breast reconstruction and radiotherapy. The dilemma is how to manage capsular contracture if it does occur. The goal of this study was to examine the outcome of patients with implant-based breast reconstruction who developed postirradiation capsular contracture and were treated with capsulotomy or capsulectomy, with or without fat grafting.

Methods:

The authors reviewed charts of patients who developed capsular contracture following alloplastic breast reconstruction followed by radiation therapy, between 2008 and 2018. The surgical treatment methods for capsular contracture were evaluated along with their outcomes. A follow-up of at least 1 year was required.

Results:

Forty-eight breasts with postirradiation capsular contracture underwent surgical implant exchange with capsular release, of which 15 had combined fat grafting and 33 did not. Overall, 35 breasts (72.9 percent) showed long-term resolution of capsular contracture; 24 underwent a single procedure and 11 required an additional fat grafting procedure. Some patients [six breasts (12.5 percent)] were offered a consecutive round of fat grafting, and some [seven breasts (14.5 percent)] were offered autologous reconstruction because of lack of improvement. Fat grafting increased the success rate by more than 30 percent when it was initially and consecutively used.

Conclusions:

Postirradiation capsular contracture may be treated successfully by secondary procedures, sustaining implant-based breast reconstruction in over 70 percent of breasts. Fat grafting may elevate resolution rates even further, to 86 percent. Larger prospective studies are required to validate these findings.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Incidental Discovery of a COVID-19 Infection on a Reevaluation FDG PET/CT in a Patient Treated for Hodgkin Lymphoma
Authors: Simand Celestine , Bund Caroline , Guffroy Blandine , Chaban Vitaliy , Herbrecht Raoul
Published: September 2020

We report the results of 18F-FDG PET/CT in an asymptomatic case of COVID-19 infection. A 27-year-old woman underwent FDG PET/CT for revaluation of a stage IIIE B Hodgkin lymphoma after the fourth cycle of chemotherapy. It showed intense avid FDG subpleural mixed ground-glass and consolidative lesions, especially in the left lung. Because of this morpho-metabolic aspect and the epidemic context, a viral pneumopathy was suspected. The patient who was initially asymptomatic was admitted for fever 28 hours after the PET/CT. The nasopharyngeal swab was positive for COVID-19, and the outcome was favorable.
Segmentation in Non–Small Cell Lung Tumors Using 18F-FDG PET/CT
Authors: Jiménez Londoño Germán Andrés , Pérez-Beteta Julián , Bosque Jesús J. , Honguero-Martinez Antonio Fancisco , García Vicente Ana Maria
Published: September 2020

The assessment of tumor parameters derived from 18F-FDG PET/CT in oncology provides valuable information in non–small cell lung cancer. A proper segmentation should delineate tumor with high accuracy, being the most important step to measure metabolic parameters. However, there is still no consensus about the optimal methodology. Additionally, some clinical conditions inherently tied to tumor and imaging can limit the proper tumor delineation. We present some practical cases that represent different aspects to consider during segmentation of primary non–small cell lung cancer by using 18F-FDG-PET/CT and some possible solutions to tackle with the most common limitations in clinical practice.
The Use of FDG PET Parametric Imaging in the Diagnosis of Olivopontocerebellar Atrophy
Authors: Harfouch Nassier , Finkelstein Mark , Sathe Swati , Raden Mark , Brenner Arnold I.
Published: September 2020

Olivopontocerebellar atrophy is a rare neurodegenerative syndrome associated with 2 distinct disorders: multiple system atrophy and spinocerebellar ataxia. We present a case involving a 66-year-old man with adult-onset progressing cerebellar signs reflective of a cerebellar syndrome with no significant family history and unremarkable genetic testing for spinocerebellar ataxia. This case was found to be most consistent with sporadic olivopontocerebellar atrophy, which falls under the multiple system atrophy category. This diagnosis can be made using 18F-FDG PET/CT scanning and with MRI in some cases. However, in this case, relatively new PET/CT quantification and parametric imaging software was used for analysis, CortexID Suite.
Primary Pancreatic Lymphoma on FDG PET/CT
Authors: Wang Peipei , Cheng Xin , Huo Li , Li Fang
Published: September 2020

A 69-year-old man underwent FDG PET/CT to evaluate a right upper abdominal mass. The images showed peripherally increased activity with central photopenic region in the head of the pancreas, which was consistent with pancreatic malignancy. Histopathologic findings showed characteristic findings of diffuse large B-cell lymphoma. The activity was diminished on follow-up PET/CT after 8 courses of chemotherapy.
Dynamic Whole-Body 18F-FDG PET for Minimizing Patient Motion Artifact
Authors: Kaji Tomohito , Osanai Kouji , Nakata Tomoaki , Tamaki Nagara
Published: September 2020

Recent PET/CT systems permit short acquisition with acceptable image quality. In addition, continuous-bed-motion mode is available for whole-body PET imaging with some PET cameras providing better uniformity and reproducibility throughout the field of view. We demonstrate a case with patient motion during the dynamic scan. Although the total summation of serial whole-body scan showed image artifact, the first 15 minutes’ summation of the serial scans provided high-quality images by eliminating the frames with motion. This acquisition mode seems to be particularly useful to perform for those who may likely to move during PET scan.
18F-FBPA PET in Sarcoidosis
Authors: Watabe Tadashi , Shimamoto Hiroaki , Naka Sadahiro , Kamiya Takashi , Murakami Shumei
Published: September 2020

A 68-year-old man with sarcoidosis showed high 18F-FDG uptake in the mediastinal and hilar lymph nodes on 18F-FDG PET, suggesting active inflammation. 18F-fluoro-boronophenylalanine (FBPA) PET showed no significant uptake in the mediastinal and hilar lymph nodes, suggesting its cancer specificity as a substrate of l-type amino acid transporter 1. 18F-fluoro-boronophenylalanine PET can be used for precise evaluation in oncology when the differentiation between inflammation and metastasis is inconclusive on 18F-FDG PET.
Performance of Chest Computed Tomography in Differentiating Coronavirus Disease 2019 From Other Viral Infections Using a Standardized Classification
Authors: Borges da Silva Teles Gustavo , Kaiser Ururahy Nunes Fonseca Eduardo , Yokoo Patricia , Marques Almeida Silva Murilo , Yanata Elaine , Shoji Hamilton , Bastos Duarte Passos Rodrigo , Caruso Chate Rodrigo , Szarf Gilberto
Published: October 2020

Background:

An expert consensus recently proposed a standardized coronavirus disease 2019 (COVID-19) reporting language for computed tomography (CT) findings of COVID-19 pneumonia.

Purpose:

The purpose of the study was to evaluate the performance of CT in differentiating COVID-19 from other viral infections using a standardized reporting classification.

Methods:

A total of 175 consecutive patients were retrospectively identified from a single tertiary-care medical center from March 15 to March 24, 2020, including 87 with positive reverse transcription-polymerase chain reaction (RT-PCR) test for COVID-19 and 88 with negative COVID-19 RT-PCR test, but positive respiratory pathogen panel. Two thoracic radiologists, who were blinded to RT-PCR and respiratory pathogen panel results, reviewed chest CT images independently and classified the imaging findings under 4 categories: “typical” appearance, “indeterminate,” “atypical,” and “negative” for pneumonia. The final classification was based on consensus between the readers.

Results:

Patients with COVID-19 were older than patients with other viral infections (P=0.038). The inter-rater agreement of CT categories between the readers ranged from good to excellent, κ=0.80 (0.73 to 0.87). Final CT categories were statistically different among COVID-19 and non-COVID-19 groups (P<0.001). CT “typical” appearance was more prevalent in the COVID-19 group (64/87, 73.6%) than in the non-COVID-19 group (2/88, 2.3%). When considering CT “typical” appearance as a positive test, a sensitivity of 73.6% (95% confidence interval [CI]: 63%-82.4%), specificity of 97.7% (95% CI: 92%-99.7%), positive predictive value of 97% (95% CI: 89.5%-99.6%), and negative predictive value of 78.9% (95% CI: 70%-86.1%) were observed.

Conclusion:

The standardized chest CT classification demonstrated high specificity and positive predictive value in differentiating COVID-19 from other viral infections when presenting a “typical” appearance in a high pretest probability environment. Good to excellent inter-rater agreement was found regarding the CT standardized categories between the readers.
Mandibular Chondrosarcoma Reconstructed Using Custom Implant and Radial Forearm Free Flap
Authors: Bitner Benjamin F. , Wang Beverly , Tjoa Tjoson
Published: September 2020

We describe the case of a 40-year-old male presenting with an enlarging left facial and temporal chondrosarcoma centered on the left mandibular coronoid process resulting in pathologic fractures of the zygomatic arch and focal erosion of the temporal bone. The patient underwent surgical resection via a combined hemicoronal and parotidectomy approach. The zygomatic arch was reconstructed with a patient-specific polyetheretherketone implant, and temporal contour was restored with a buried de-epithelialized radial forearm free flap. Final pathology demonstrated conventional central chondrosarcoma. This case demonstrates an unusual presentation of a rare head and neck chondrosarcoma that originated from the mandibular coronoid process with the unique use of a custom polyetheretherketone implant and vascularized fat and fascial reconstruction.
Simulation-Based Up-Training in Response to the COVID-19 Pandemic
Authors: Nair Sunil S. , Kaufman Brian
Published: September 2020

Summary Statement

The dramatic outbreak of COVID-19 placed unprecedented strain on the critical care workforce of New York City. The enhanced precautions required to safely care for COVID-19 patients impacted the performance of even routine critical care procedures. Meanwhile, staff were stretched to care for exponentially rising case volume as COVID intensive care units (ICUs) expanded. Simulation was used to bridge these gaps—first to familiarize personnel within the Division of Pulmonary and Critical Care with revised COVID-19 care procedures, then to orient noncritical care clinicians volunteering from other specialties for COVID ICU deployment to general critical care and COVID-19 care principles. Using mannequin-based simulation scenarios followed by comprehensive debriefing sessions, simulation participants received high-intensity, high-fidelity training in respiratory failure, circulatory failure, bedside ultrasound, bedside ICU procedures, and elements of COVID-19–specific care. More than 200 physicians and advanced practice practitioners completed simulation training in preparation for deployment, supplementing and enhancing the ICU workforce at a decisive time during the outbreak.
Readmission for venous thromboembolism after emergency general surgery is underreported and influenced by insurance status
Authors: Rattan Rishi , Cioci Alessia C. , Urréchaga Eva M. , Chatoor Matthew S. , Krocker Joseph D. , Johnson Deanna L. , Curcio Gary J. , Namias Nicholas , Yeh Daniel D. , Ginzburg Enrique , Parreco Joshua P.
Published: October 2020

BACKGROUND

Prior studies of venous thromboembolism (VTE) after emergency general surgery (EGS) are not nationally representative nor do they fully capture readmissions to different hospitals. We hypothesized that different-hospital readmission accounted for a significant number of readmissions with VTE after EGS and that predictive factors would be different for same- and different-hospital readmissions.

METHODS

The 2014 Nationwide Readmissions Database was queried for nonelective EGS hospitalizations. The outcomes were readmission to the index or different hospitals within 180 days with VTE. Multivariate logistic regressions identified risk factors for readmission to index and different hospitals with VTE, reported as odds ratios with their 95% confidence intervals. Patients were excluded if during the index admission they expired, developed a VTE, had a vena cava filter placed, or did not have at least 180 days of follow-up.

RESULTS

Of 1,584,605 patients meeting inclusion criteria, 1.3% (n = 20,963) of patients were readmitted within 180 days with a VTE. Of these, 28% (n = 5,866) were readmitted to a different hospital. Predictors overall for readmission with VTE were malignancy, prolonged hospitalization, age, and being publicly insured. However, predictors for readmission to a different hospital are based on hospital characteristics, including for-profit status, or procedure type.

CONCLUSIONS

Nearly one in three readmissions with VTE after EGS occurs at a different hospital and may be missed by current quality metrics that only capture same-hospital readmission. Such metrics may underestimate for-profit hospital postoperative VTE rates relative to public and nonprofit hospitals, potentially affecting benchmarking and reimbursement. Postdischarge VTE rate is associated with insurance status. These findings have implications for policy and prevention programming design.

LEVEL OF EVIDENCE

Epidemiological study, level III.
Detecting and distinguishing tipping points using spectral early warning signals
Authors: Bury T. M. , Bauch C. T. , Anand M.
Published: September 2020

Theory and observation tell us that many complex systems exhibit tipping points—thresholds involving an abrupt and irreversible transition to a contrasting dynamical regime. Such events are commonly referred to as critical transitions. Current research seeks to develop early warning signals (EWS) of critical transitions that could help prevent undesirable events such as ecosystem collapse. However, conventional EWS do not indicate the type of transition, since they are based on the generic phenomena of critical slowing down. For instance, they may fail to distinguish the onset of oscillations (e.g. Hopf bifurcation) from a transition to a distant attractor (e.g. Fold bifurcation). Moreover, conventional EWS are less reliable in systems with density-dependent noise. Other EWS based on the power spectrum (spectral EWS) have been proposed, but they rely upon spectral reddening, which does not occur prior to critical transitions with an oscillatory component. Here, we use Ornstein–Uhlenbeck theory to derive analytic approximations for EWS prior to each type of local bifurcation, thereby creating new spectral EWS that provide greater sensitivity to transition proximity; higher robustness to density-dependent noise and bifurcation type; and clues to the type of approaching transition. We demonstrate the advantage of applying these spectral EWS in concert with conventional EWS using a population model, and show that they provide a characteristic signal prior to two different Hopf bifurcations in data from a predator–prey chemostat experiment. The ability to better infer and differentiate the nature of upcoming transitions in complex systems will help humanity manage critical transitions in the Anthropocene Era.
Eyes are essential for magnetoreception in a mammal
Authors: Caspar Kai R. , Moldenhauer Katrin , Moritz Regina E. , Němec Pavel , Malkemper E. Pascal , Begall Sabine
Published: September 2020

Several groups of mammals use the Earth's magnetic field for orientation, but their magnetosensory organ remains unknown. The Ansell's mole-rat (Fukomys anselli, Bathyergidae, Rodentia) is a microphthalmic subterranean rodent with innate magnetic orientation behaviour. Previous studies on this species proposed that its magnetoreceptors are located in the eye. To test this hypothesis, we assessed magnetic orientation in mole-rats after the surgical removal of their eyes compared to untreated controls. Initially, we demonstrate that this enucleation does not lead to changes in routine behaviours, including locomotion, feeding and socializing. We then studied magnetic compass orientation by employing a well-established nest-building assay under four magnetic field alignments. In line with previous studies, control animals exhibited a significant preference to build nests in magnetic southeast. By contrast, enucleated mole-rats built nests in random magnetic orientations, suggesting an impairment of their magnetic sense. The results provide robust support for the hypothesis that mole-rats perceive magnetic fields with their minute eyes, probably relying on magnetite-based receptors in the cornea.
Displacement ventilation: a viable ventilation strategy for makeshift hospitals and public buildings to contain COVID-19 and other airborne diseases
Authors: Bhagat Rajesh K. , Linden P. F.
Published: September 2020

The SARS-CoV-2 virus has so far infected more than 31 million people around the world, and its impact is being felt by all. Patients with diseases such as COVID-19 should ideally be treated in negative pressure isolation rooms. However, due to the overwhelming demand for hospital beds, patients have been treated in general wards, hospital corridors and makeshift hospitals. Adequate building ventilation in hospitals and public spaces is a crucial factor to contain the disease (Escombe
et al.
2007
PLoS Med.
4
; Escombe
et al.
2019
BMC Infect. Dis.
19
, 88 (
doi:10.1186/s12879-019-3717-9
); Morawska & Milton 2020
Clin. Infect. Dis
. ciaa939. (
doi:10.1093/cid/ciaa939
)), to exit lockdown safely, and reduce the chance of subsequent waves of outbreaks. A recently reported air-conditioner-induced COVID-19 outbreak caused by an asymptomatic patient, in a restaurant in Guangzhou, China (Lu
et al.
2020
Emerg. Infect. Dis.
26
) exposes our vulnerability to future outbreaks linked to ventilation in public spaces. We argue that
displacement ventilation
(either mechanical or natural ventilation), where air intakes are at low level and extracts are at high level, is a viable alternative to negative pressure isolation rooms, which are often not available on site in hospital wards and makeshift hospitals. Displacement ventilation produces negative pressure at the occupant level, which draws fresh air from outdoors, and positive pressure near the ceiling, which expels the hot and contaminated air out. We acknowledge that, in both developed and developing countries, many modern large structures lack the openings required for natural ventilation. This lack of openings can be supplemented by installing extract fans. We have also discussed and addressed the issue of the ‘lock-up effect’. We provide guidelines for such mechanically assisted, naturally ventilated makeshift hospitals.
Amphibalanus amphitrite
begins exoskeleton mineralization within 48 hours of metamorphosis
Authors: Metzler Rebecca A. , O'Malley Jessica , Herrick Jack , Christensen Brett , Orihuela Beatriz , Rittschof Daniel , Dickinson Gary H.
Published: September 2020

Barnacles are ancient arthropods that, as adults, are surrounded by a hard, mineralized, outer shell that the organism produces for protection. While extensive research has been conducted on the glue-like cement that barnacles use to adhere to surfaces, less is known about the barnacle exoskeleton, especially the process by which the barnacle exoskeleton is formed. Here, we present data exploring the changes that occur as the barnacle cyprid undergoes metamorphosis to become a sessile juvenile with a mineralized exoskeleton. Scanning electron microscope data show dramatic morphological changes in the barnacle exoskeleton following metamorphosis. Energy-dispersive X-ray spectroscopy indicates a small amount of calcium (8%) 1 h post-metamorphosis that steadily increases to 28% by 2 days following metamorphosis. Raman spectroscopy indicates calcite in the exoskeleton of a barnacle 2 days following metamorphosis and no detectable calcium carbonate in exoskeletons up to 3 h post-metamorphosis. Confocal microscopy indicates during this 2 day period, barnacle base plate area and height increases rapidly (0.001 mm
2
h
−1
and 0.30 µm h
−1
, respectively). These results provide critical information into the early life stages of the barnacle, which will be important for developing an understanding of how ocean acidification might impact the calcification process of the barnacle exoskeleton.