bluuebunny/crossref_metadata_2025 huggingface dataset:
A Systematic Review of the Use of Standardized Patients as a Simulation Modality in Nursing Education
Authors: Rutherford-Hemming Tonya , Alfes Celeste M. , Breymier Tonya L.
Published: February 2019

AIM

The objective of the study was to search, extract, appraise, and synthesize studies using standardized patients (SPs) in nursing academia to determine how this modality of simulation is being used.

BACKGROUND

SPs are a common simulation modality used in nursing education.

METHOD

This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Five databases were searched as well as keywords to retrieve nonindexed citations for the period January 2011 to September 2016. The inclusion criteria included nurses, a simulated experience with SPs, and original research published in English.

RESULTS

Sixty-five studies were identified and analyzed.

CONCLUSION

More randomized controlled trials and studies with power analyses and validated measurement instruments are needed. Studies that compare SPs to high-fidelity simulators are also desired to determine optimal student learning outcomes and standardize best practices in simulation.
The promotion of social justice in healthcare
Authors: Smith Mary Atkinson
Published: February 2019

As nurses, we can advocate for health equity and equality for our vulnerable patient populations.
The NP's role in promoting and supporting breastfeeding
Authors: Coffman Lindsay
Published: February 2019

This article reinforces the many health benefits associated with breastfeeding and exposes lactation barriers for mothers and healthcare practitioners. NPs can use various strategies outlined in this article to help patients overcome these barriers.
Infection prevention and control core practices
Authors: Carrico Ruth M. , Garrett Hudson , Balcom Dawn , Glowicz Janet Burton
Published: February 2019

The CDC continues to stress the urgent issue of increasing microbial resistance. The organization recently joined forces with the American Nurses Association to bring awareness to this issue through an approach that prevents inappropriate antibiotic use and stresses infection prevention.
Update
Authors: Craig-Brangan Karen Jean , Day Mary Patricia
Published: February 2019

In November 2017, the American Heart Association published updates to its adult and pediatric Basic Life Support and Cardiopulmonary Resuscitation guidelines; one year later, it published updates to its Advanced Cardiovascular Life Support and Pediatric Advanced Life Support guidelines. This article reviews these updated guidelines and highlights the key changes and how to integrate them into practice.
Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries
Authors: Guglielminotti Jean , Landau Ruth , Li Guohua
Published: February 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Compared with neuraxial anesthesia, general anesthesia for cesarean delivery is associated with increased risk of maternal adverse events. Reducing avoidable general anesthetics for cesarean delivery may improve safety of obstetric anesthesia care. This study examined adverse events, trends, and factors associated with potentially avoidable general anesthetics for cesarean delivery.

Methods

This retrospective study analyzed cesarean delivery cases without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia in New York State hospitals, 2003 to 2014. Adverse events included anesthesia complications (systemic, neuraxial-related, and drug-related), surgical site infection, venous thromboembolism, and the composite of death or cardiac arrest. Anesthesia complications were defined as severe if associated with death, organ failure, or prolonged hospital stay.

Results

During the study period, 466,014 cesarean deliveries without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia were analyzed; 26,431 were completed with general anesthesia (5.7%). The proportion of avoidable general anesthetics decreased from 5.6% in 2003 to 2004 to 4.8% in 2013 to 2014 (14% reduction; P < 0.001). Avoidable general anesthetics were associated with significantly increased risk of anesthesia complications (adjusted odds ratio, 1.6; 95% CI, 1.4 to 1.9), severe complications (adjusted odds ratio, 2.9; 95% CI, 1.6 to 5.2), surgical site infection (adjusted odds ratio, 1.7; 95% CI, 1.5 to 2.1), and venous thromboembolism (adjusted odds ratio, 1.9; 95% CI, 1.3 to 3.0), but not of death or cardiac arrest. Labor neuraxial analgesia rate was one of the most actionable hospital-level factors associated with avoidable general anesthetics. Relative to hospitals with a rate greater than or equal to 75%, the adjusted odds ratio of avoidable general anesthetics increased to 1.3 (95% CI, 1.2 to 1.4), 1.6 (95% CI, 1.5 to 1.7), and 3.2 (95% CI, 3.0 to 3.5) as the rate decreased to 50 to 74.9%, 25 to 49.9%, and less than 25%, respectively.

Conclusions

Compared with neuraxial anesthesia, avoidable general anesthetics are associated with increased risk of adverse maternal outcomes.
Cerebrospinal Fluid Glucose and Lactate Levels After Subarachnoid Hemorrhage: A Multicenter Retrospective Study
Authors: Taccone Fabio S. , Badenes Rafael , Arib Safa , Rubulotta Francesca , Mirek Sebastien , Franchi Federico , Gordon Sara , Nadji Abdelouaïd , Crippa Ilaria A. , Stazi Elisabetta , Bouhemad Belaïd , Lozano Roig Angels , Creteur Jacques , Bilotta Federico
Published: February 2019

Background:

In patients with subarachnoid hemorrhage (SAH), abnormalities in glucose and lactate metabolism have been described using cerebral microdialysis. Glucose and lactate concentrations in cerebrospinal fluid (CSF) are more easily accessible, but scarce data are available in this setting. The aim of this study is to assess the relationship of CSF glucose and lactate with blood concentrations and with unfavorable neurological outcome after SAH.

Methods:

A retrospective cohort study was conducted in 5 European University intensive care units. Patients aged 18 years and above who were admitted after a nontraumatic SAH over a 4-year period (2011 to 2014) were included if they had an external ventricular drain placed, daily analysis of CSF including glucose (±lactate) concentrations for 1 to 4 consecutive days, and concomitant analysis of glucose and lactate concentrations in the arterial blood.

Results:

A total of 144 patients were included in the final analysis (median age: 58 [49 to 66] y; male sex: 77/144). Median time from admission to external ventricular drain placement was 1 (0 to 3) day; median Glasgow Coma Scale on admission was 10 (7 to 13), and CT-scan Fisher scale was 4. A total of 81 (56%) patients had unfavorable neurological outcome at 3 months (Glasgow Outcome Scale ≤3). There was a weak correlation between blood and CSF glucose (r
2=0.07, P=0.007), and between blood and CSF lactate levels (r
2=0.58, P<0.001) on day 1, which were not influenced by insulin therapy. The presence of shock and low CSF glucose/lactate ratio were the only independent predictors of unfavorable outcome.

Conclusions:

CSF glucose and lactate levels poorly correlated with blood concentrations. Low CSF glucose/lactate ratio was associated with poor neurological outcome.
Complications during the treatment of missed Monteggia fractures with unilateral external fixation: a report on 20 patients in a 10-year period in a tertiary referral center
Authors: Gallone Giovanni , Trisolino Giovanni , Stilli Stefano , Di Gennaro Giovanni L.
Published: February 2019

The treatment of a missed Monteggia (MM) fracture dislocation is still controversial. We describe our initial experience with ulnar osteotomy and progressive correction with unilateral external fixator in MM. We retrospectively evaluated 20 children undergoing ulnar osteotomy and progressive distraction angulation by unilateral external fixator to treat MM. Nine patients had closed reduction, whereas 11 patients had simultaneous open reduction, repair, or reconstruction of the annular ligament and K-wire stabilization of the radiocapitellar joint. Patients were followed for an average of 3 (1–11) years. Three children developed aseptic nonunion and one child had delayed union. A distal level of the osteotomy significantly increased the rate of nonunion or delayed union. At the final follow-up, eight children had complete reduction of the radial head, six children had partial reduction, whereas in six cases, the radial head remained dislocated. The angulation and the level of the osteotomy significantly influenced the relocation, whereas the open reduction had no significant effect on the final position of the radial head. At the final follow-up, the Kim’s score averaged 93.25. The flexion-extension arc significantly improved postoperatively, and it was positively correlated with the angulation. The ulnar osteotomy and progressive traction-angulation by unilateral external fixator can achieve satisfactory results in MM, if a meticulous surgical technique is applied; care must be taken regarding the level of osteotomy and the progressive traction-angulation.
Outcome of hand surgery in children with spasticity – a 9-year follow-up study
Authors: Pontén Eva , von Walden Ferdinand , Lenke-Ekholm Catarina , Zethraeus Britt-Marie , Eliasson Ann-Christin
Published: February 2019

The aim of this study was to evaluate whether short-term positive effects on bimanual function after surgery of the paretic arm in cerebral palsy are maintained long term. Assisting Hand Assessment (AHA) and active range of motion was tested before surgery and at 7 month and 9-year follow-up (n=18). AHA improved significantly from 50 to 52 U at 7 months, but was not different from before surgery at the 9-year follow-up, 49 U. Surgery of wrist and elbow flexors significantly improved active extension. Improvement in wrist and elbow extension was maintained at the 9-year follow-up, but usefulness of the hand measured with AHA had returned to the same level as before surgery.
Evaluation of Current Trends in Treatment of Single-level Cervical Radiculopathy
Authors: Mok Jung K. , Sheha Evan D. , Samuel Andre M. , McAnany Steven J. , Vaishnav Avani S. , Albert Todd J. , Gang Catherine Himo , Qureshi Sheeraz
Published: February 2019

Study design:

This was a retrospective cohort study.

Objectives:

The main objectives of this study were to identify epidemiological trends, differences, and complications in patients undergoing surgical treatment for single-level cervical radiculopathy (SLCR).

Summary of Background Data:

SLCR that fails nonoperative management is effectively treated with either anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR), or posterior cervical foraminotomy (PCF). Although studies have shown that all 3 options are clinically effective, trends in usage, differences in patient population, and differences in complications remain unknown.

Materials and Methods:

Patients who underwent either ACDF, CDR, or PCF in the treatment of SLCR from 2010 to 2016 were retrospectively reviewed using the National Surgical Quality Improvement Program (NSQIP) database. Demographic data consisted of sex, age, ASA class, body mass index, and inpatient/outpatient status. Complications included surgical site infection, pneumonia, reintubation, pulmonary embolism, deep vein thrombosis, readmissions, reoperations, operating time, and hospital length of stay. Utilization trends by year among the 3 procedures were also analyzed.

Results:

A total of 1102 patients with SLCR treated with single-level ACDF, CDR, or PCF were identified in NSQIP from 2010 to 2016. There was a relative increase in the number of CDR procedures (7.7%–16.1%) and a corresponding decrease in PCF procedures (20.3%–10.6%) without a significant effect on ACDF procedures (72.0%–73.3%). Patients who underwent CDR were younger and in a lower ASA class than those undergoing ACDF or PCF. Patients undergoing PCF were more likely to be treated as an outpatient. PCF procedures also had the shortest operating time and hospital length of stay. There were no significant differences in complications among the 3 procedures. Moreover, there were no significant trends in demographics or outcome measures.

Conclusions:

ACDF remains the most common surgical treatment for patients with SLCR, and its utilization has remained consistent. Meanwhile, the increased utilization of CDR for the treatment of SLCR has resulted in a corresponding decrease in the utilization of PCF.
Asymmetric Z-Tendon Shortening to Maximize Excision of Abnormal Tendon Tissue: A Technique Tip to Treat Elongated Tendons With Pathology
Authors: Stathakis Alexander , Wadden Cai , Glazebrook Mark
Published: February 2019

Operative treatment for a diseased or elongated Achilles tendon often involves resection of diseased tissue and Achilles tendon shortening. If the amount of diseased tissue is minimal, a traditional Z-shortening technique can be used to achieve appropriate tendon repair and function, which involves making an incision along the longitudinal axis mid-substance of the Achilles tendon. This technique is limited in its ability to resect abnormal tissue due to the placement of the incision traditionally along the midline of the tendon. In this chapter we describe an original modification of the Z-shortening technique to allow for the flexibility to resect pathologic tendon tissue and preserve more normal tissue.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
“Fibula plus Ilizarov”: a Simpler Strategy Than Bone Transport for Major Bone Defects in Children
Authors: Subramanyam Koushik N. , Mundargi Abhishek V. , Umerjikar Sagar
Published: February 2019

Bone infection in children can cause extensive diaphyseal defects that are challenging to reconstruct. We report a modified technique of ours in 2 of our patients. One was a 10-year-old boy with 8 cm tibial defect and the other was 13-year-old boy with 7 cm femoral defect. The first stage of treatment involved radical debridement, sequestrectomy, antibiotic spacer application, stabilization with conventional external fixation, and 6 weeks of antibiotic therapy. The second stage of treatment consisted of intramedullary autologous fibular strut grafting stabilized with intramedullary K-wire supplemented with corticocancellous graft and stabilized with simple Ilizarov fixator. Patients began full weight bearing walking with fixator at three months of application. Fibular graft incorporated at 4 and 8 months for the femoral and tibial defects respectively. At follow-up of 3 years both patients are independent ambulators with preserved joint range of motion. We present this simple, cost-effective, and replicable technique.
Does Obesity Protect Against Death in Sepsis? A Retrospective Cohort Study of 55,038 Adult Patients*
Authors: Pepper Dominique J. , Demirkale Cumhur Y. , Sun Junfeng , Rhee Chanu , Fram David , Eichacker Peter , Klompas Michael , Suffredini Anthony F. , Kadri Sameer S.
Published: February 2019

Objectives:

Observational studies suggest obesity is associated with sepsis survival, but these studies are small, fail to adjust for key confounders, measure body mass index at inconsistent time points, and/or use administrative data to define sepsis. To estimate the relationship between body mass index and sepsis mortality using detailed clinical data for case detection and risk adjustment.

Design:

Retrospective cohort analysis of a large clinical data repository.

Setting:

One-hundred thirty-nine hospitals in the United States.

Patients:

Adult inpatients with sepsis meeting Sepsis-3 criteria.

Exposure:

Body mass index in six categories: underweight (body mass index < 18.5 kg/m2), normal weight (body mass index = 18.5–24.9 kg/m2), overweight (body mass index = 25.0–29.9 kg/m2), obese class I (body mass index = 30.0–34.9 kg/m2), obese class II (body mass index = 35.0–39.9 kg/m2), and obese class III (body mass index ≥ 40 kg/m2).

Measurements:

Multivariate logistic regression with generalized estimating equations to estimate the effect of body mass index category on short-term mortality (in-hospital death or discharge to hospice) adjusting for patient, infection, and hospital-level factors. Sensitivity analyses were conducted in subgroups of age, gender, Elixhauser comorbidity index, Sequential Organ Failure Assessment quartiles, bacteremic sepsis, and ICU admission.

Main Results:

From 2009 to 2015, we identified 55,038 adults with sepsis and assessable body mass index measurements: 6% underweight, 33% normal weight, 28% overweight, and 33% obese. Crude mortality was inversely proportional to body mass index category: underweight (31%), normal weight (24%), overweight (19%), obese class I (16%), obese class II (16%), and obese class III (14%). Compared with normal weight, the adjusted odds ratio (95% CI) of mortality was 1.62 (1.50–1.74) for underweight, 0.73 (0.70–0.77) for overweight, 0.61 (0.57–0.66) for obese class I, 0.61 (0.55–0.67) for obese class II, and 0.65 (0.59–0.71) for obese class III. Results were consistent in sensitivity analyses.

Conclusions:

In adults with clinically defined sepsis, we demonstrate lower short-term mortality in patients with higher body mass indices compared with those with normal body mass indices (both unadjusted and adjusted analyses) and higher short-term mortality in those with low body mass indices. Understanding how obesity improves survival in sepsis would inform prognostic and therapeutic strategies.
Short-Term Adverse Outcomes Associated With Hypoglycemia in Critically Ill Children
Authors: Faustino Edward Vincent S. , Hirshberg Eliotte L. , Asaro Lisa A. , Biagas Katherine V. , Pinto Neethi , Srinivasan Vijay , Bagdure Dayanand N. , Steil Garry M. , Coughlin-Wells Kerry , Wypij David , Nadkarni Vinay M. , Agus Michael S. D.
Published: February 2019

Objectives:

Previous studies report worse short-term outcomes with hypoglycemia in critically ill children. These studies relied on intermittent blood glucose measurements, which may have introduced detection bias. We analyzed data from the Heart And Lung Failure-Pediatric INsulin Titration trial to determine the association of hypoglycemia with adverse short-term outcomes in critically ill children.

Design:

Nested case-control study.

Setting:

Thirty-five PICUs. A computerized algorithm that guided the timing of blood glucose measurements and titration of insulin infusion, continuous glucose monitors, and standardized glucose infusion rates were used to minimize hypoglycemia.

Patients:

Nondiabetic children with cardiovascular and/or respiratory failure and hyperglycemia. Cases were children with any hypoglycemia (blood glucose < 60 mg/dL), whereas controls were children without hypoglycemia. Each case was matched with up to four unique controls according to age group, study day, and severity of illness.

Interventions:

None.

Measurements and Main Results:

A total of 112 (16.0%) of 698 children who received the Heart And Lung Failure-Pediatric INsulin Titration protocol developed hypoglycemia, including 25 (3.6%) who developed severe hypoglycemia (blood glucose < 40 mg/dL). Of these, 110 cases were matched to 427 controls. Hypoglycemia was associated with fewer ICU-free days (median, 15.3 vs 20.2 d; p = 0.04) and fewer hospital-free days (0 vs 7 d; p = 0.01) through day 28. Ventilator-free days through day 28 and mortality at 28 and 90 days did not differ between groups. More children with insulin-induced versus noninsulin-induced hypoglycemia had zero ICU-free days (35.8% vs 20.9%; p = 0.008). Outcomes did not differ between children with severe versus nonsevere hypoglycemia or those with recurrent versus isolated hypoglycemia.

Conclusions:

When a computerized algorithm, continuous glucose monitors and standardized glucose infusion rates were used to manage hyperglycemia in critically ill children with cardiovascular and/or respiratory failure, severe hypoglycemia (blood glucose < 40 mg/dL) was uncommon, but any hypoglycemia (blood glucose < 60 mg/dL) remained common and was associated with worse short-term outcomes.
Cannabinoids: a new approach for pain control?
Authors: Lossignol Dominique
Published: February 2019

Purpose of review

To analyze available data related to the use of cannabinoids in medicine, with a special focus on pain management in cancer. The use of cannabis for medical purposes is growing but there are still numerous questions to be solved: effectiveness, safety, and specific indications.

Recent findings

There is considerable variation between countries in the approaches taken, reflecting a variety of historical and cultural factors and despite few randomized controlled studies using natural cannabinoids, there is a trend to state that the use of cannabis should be taken seriously as a potential treatment of cancer-related pain. Cannabidiol, a nontoxic phytocannabinoid with few side-effects is promising in various indications in medicine.

The endocannabinoid system is a potential therapeutic target. Cannabinoids may be considered as potential adjuvant in cancer-related pain management. Cannabidiol appears to be the drug of choice. Analgesic trial designs should evolve to get closer to real-life practice and to avoid biases.
Importance of Team Functioning as a Target of Quality Improvement Initiatives in Nursing Homes: A Qualitative Process Evaluation
Authors: Desveaux Laura , Halko Roxanne , Marani Husayn , Feldman Sid , Ivers Noah M.
Published: February 2019

Introduction:

Quality improvement interventions demonstrate variable degrees of effectiveness. The aim of this work was to (1) qualitatively explore whether, how, and why an academic detailing intervention could improve evidence uptake and (2) identify perceived changes that occurred to inform outcomes appropriate for quantitative evaluation.

Methods:

A qualitative process evaluation was conducted involving semistructured interviews with nursing home staff. Interviews were analyzed inductively using the framework method.

Results:

A total of 29 interviews were conducted across 13 nursing homes. Standard processes to reduce falls are well-known but not fully implemented due to a range of mostly postintentional factors that influence staff behavior. Conflicting expectations around professional roles impeded evidence uptake; physicians report a disconnection between the information they would like to receive and the information communicated; and a high proportion of casual and part-time staff creates challenges for those looking to effect change. These factors are amenable to change in the context of an active, tailored intervention such as academic detailing. This seems especially true when the entire care team is actively engaged and when the intervention can be tailored to the varied determinants of behaviors across different team members.

Discussion:

Interventions aiming to increase evidence-based practice in the nursing home sector need to move beyond education to explicitly address team functioning and communication. Variability in team functioning requires a flexible intervention with the ability to tailor to individual- and home-level needs. Evaluations in this setting may benefit from measuring changes in team functioning as an early indicator of success.
A population-based study of the treatment effect of first-line ipilimumab for metastatic or unresectable melanoma
Authors: Drysdale Erik , Peng Yingwei , Nguyen Paul , Baetz Tara , Hanna Timothy P.
Published: February 2019

Ipilimumab is an anti-CTLA4 monoclonal antibody with demonstrated efficacy for metastatic melanoma in randomized controlled trials, including in the first-line setting. Population-based outcomes directly compared with historic chemotherapy treatment in metastatic or unresectable melanoma are lacking. Using population-based data from the province of Ontario, the benefit of first-line ipilimumab was estimated by comparing outcomes of patients treated with first-line dacarbazine over the period 2007–2009 with patients treated over the period 2010–2015 with first-line ipilimumab. Cutaneous and noncutaneous cases were included. The administrative data set utilized was high-dimensional; meaning, there was a large number of variables relative to the sample size. To adjust for important confounders among the many available variables, we utilized a double-selection method, a modified machine learning algorithm to extract the important variables that were related to both survival times and treatment usage. Time-dependent treatment modeling was utilized. Among the 2793 melanoma patients receiving palliative treatment (systemic therapy, surgery, or radiation) in Ontario (2007–2015), there were 289 patients treated with first-line ipilimumab (2010–2015) and 175 patients treated with first-line dacarbazine (2007–2009). For first-line ipilimumab, the adjusted hazard ratio compared with dacarbazine for overall survival (OS) was 0.63 (95% confidence interval: 0.47–0.84) with a 1-year survival of 46.5 versus 18.9% with dacarbazine. In subgroup analysis, ipilimumab was associated with improved OS across groups (age, sex, comorbidity, income quintile, previous interferon). First-line ipilimumab was found to have a significant OS benefit compared with historical controls in a population including those patients not routinely included in clinical trials. The treatment effect was similar to randomized controlled trials, suggesting a meaningful benefit when utilized in a population-based setting.
Real-World Experience With 100 Consecutive Patients Undergoing Neck Contouring With ATX-101 (Deoxycholic Acid): An Updated Report With A 2-Year Analysis
Authors: Shridharani Sachin M.
Published: February 2019

BACKGROUND

Deoxycholic acid (DCA; ATX-101) injection was approved for the treatment of mild-to-moderate convexity associated with submental fat in 2015.

OBJECTIVE

To evaluate the experience with DCA injections in a clinical practice setting.

MATERIALS AND METHODS

This ongoing, prospective, single-center, single-arm, observational study evaluated 100 consecutive patients treated with subcutaneous DCA (2 mg/cm2) injections (maximum 6 sessions at ≥1-month intervals). Treatment response was assessed using the clinician-reported submental fat rating scale (CR-SMFRS) and confirmed by independent physician review of photographs at 1 and 5 to 7 weeks after treatment.

RESULTS

Since the previous published report, 17 patients have undergone additional treatment sessions, with a total of 100 patients having undergone 195 treatment sessions: 41, 36, 14, 6, 2, and 1 patient underwent 1, 2, 3, 4, 5, and 6 sessions, respectively. Overall, 91.7% of patients in the single treatment session group and 100% in the multiple treatment session group had an improvement of ≥1 point on the CR-SMFRS. The mean (SD) duration of local edema, numbness, and tenderness after treatment was 7.1 (5.1), 27.9 (11.3), and 3.5 (3.5) days, respectively.

CONCLUSION

Deoxycholic acid injections were generally well tolerated, and ≥2 treatment sessions were required to achieve the desired aesthetic goal in a private practice setting.
Delayed-Onset Nodules to Differentially Crosslinked Hyaluronic Acids: Comparative Incidence and Risk Assessment
Authors: Sadeghpour Mona , Quatrano Nicola A. , Bonati Lauren Meshkov , Arndt Kenneth A. , Dover Jeffrey S. , Kaminer Michael S.
Published: February 2019

BACKGROUND

Robust and long-term data on true incidence of delayed-onset nodules and immune tolerance of hyaluronic acid (HA) fillers are lacking.

OBJECTIVE

To characterize the incidence of delayed nodules in Vycross (VYC) HA fillers compared with previously reported FDA and non-FDA data of all HA fillers.

METHODS AND MATERIALS

The incidence of delayed nodules in all patients who had received VYC fillers in a 12-month period was assessed through a retrospective chart review. Nodule incidence for currently approved nonanimal-stabilized hyaluronic acid (NASHA) fillers was assessed using the FDA Summary of Safety and Effectiveness Data.

RESULTS

Overall, 1,029 patients received 1,250 VYC filler treatments. Five patients developed delayed nodules to VOB, with an incidence of 1.0% per patient and 0.8% per syringe. No nodules were observed in patients who received VLR or VOL. All nodules were treated successfully using a combination of intralesional triamcinolone and hyaluronidase. Compared with other currently approved NASHA fillers, VOB is associated with a higher incidence of nodule formation.

CONCLUSION

The introduction of VYC HAs has introduced a new variable that may be changing the immune tolerance of these substances, resulting in a higher incidence of delayed nodules than previously expected.
Sun Smoke in Sweden
Authors: Casey Joan A. , Gemmill Alison , Elser Holly , Karasek Deborah , Catalano Ralph
Published: February 2019

Background:

The Icelandic volcano Laki erupted from June 1783 through January 1784. It produced 122 megatons of sulfur dioxide, particulate matter, and acid rain and contributed to one of the coldest winters on record in Western Europe. Although uncontrollable volcanic eruptions continue, few studies have investigated their perinatal health implications.

Methods:

Using the Human Mortality Database, we assessed the association between the Laki event and the secondary sex ratio, infant mortality rates, and the number of births from 1751 to 1800 with time-series models that controlled for temporal trends.

Results:

The secondary sex ratio decreased 3% below expected levels in 1784 (95% CI = −4%, −1%). Both female and male infant mortality rates exceeded expectation in 1785, by 54% (95% CI = 25%, 83%) and 37% (−1%, 74%), respectively. We observed little change in female live births but a reduction in male live births in 1784.

Conclusions:

Our findings are consistent with the hypothesis that the large-scale Laki volcanic eruptions of 1783–1784 resulted in adverse perinatal health outcomes in Sweden.
A Pooled Analysis of Breastfeeding and Breast Cancer Risk by Hormone Receptor Status in Parous Hispanic Women
Authors: Sangaramoorthy Meera , Hines Lisa M. , Torres-Mejía Gabriela , Phipps Amanda I. , Baumgartner Kathy B. , Wu Anna H. , Koo Jocelyn , Ingles Sue A. , Slattery Martha L. , John Esther M.
Published: February 2019

Background:

Data on breastfeeding and breast cancer risk are sparse and inconsistent for Hispanic women.

Methods:

Pooling data for nearly 6,000 parous Hispanic women from four population-based studies conducted between 1995 and 2007 in the United States and Mexico, we examined the association of breastfeeding with risk of breast cancer overall and subtypes defined by estrogen receptor (ER) and progesterone receptor (PR) status, and the joint effects of breastfeeding, parity, and age at first birth. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression.

Results:

Among parous Hispanic women, older age at first birth was associated with increased breast cancer risk, whereas parity was associated with reduced risk. These associations were found for hormone receptor positive (HR+) breast cancer only and limited to premenopausal women. Age at first birth and parity were not associated with risk of ER− and PR− breast cancer. Increasing duration of breastfeeding was associated with decreasing breast cancer risk (≥25 vs. 0 months: OR = 0.73; 95% CI = 0.60, 0.89; P
trend = 0.03), with no heterogeneity by menopausal status or subtype. At each parity level, breastfeeding further reduced HR+ breast cancer risk. Additionally, breastfeeding attenuated the increase in risk of HR+ breast cancer associated with older age at first birth.

Conclusions:

Our findings suggest that breastfeeding is associated with reduced risk of both HR+ and ER− and PR− breast cancer among Hispanic women, as reported for other populations, and may attenuate the increased risk in women with a first pregnancy at older ages.
Prenatal Exposure to Endocrine-disrupting Chemicals in Relation to Autism Spectrum Disorder and Intellectual Disability
Authors: Hamra Ghassan B. , Lyall Kristen , Windham Gayle C. , Calafat Antonia M. , Sjödin Andreas , Volk Heather , Croen Lisa A.
Published: February 2019

Background:

Exposure to endocrine disruptors is unavoidable. Many such compounds are suspected to impact neurologic development of children, but most studies conducted have considered effects of individual chemicals in isolation. Because exposures co-occur, it is important to consider their health impacts in a single regression framework.

Methods:

We applied Bayesian statistical tools (including shared mean and mixture priors for 25 unique chemicals) to study independent associations of endocrine disruptor biomarkers with autism spectrum disorder (ASD) (n = 491) and intellectual disability (n = 155), compared with 373 general population controls, in the Early Markers for Autism study. We measured biomarkers in maternal serum collected and stored from midpregnancy and considered them individually or as a class (i.e., summed polychlorinated biphenyls). We adjusted all models for original matching factors (child sex and month and year of birth), maternal age, maternal race/ethnicity, parity, and maternal education at the time samples were collected. We estimated the change in the odds of ASD or intellectual disability per 1 SD increase in the z-score of measured biomarker concentration for each chemical.

Results:

Odds of ASD and intellectual disability did not change with increasing concentration for any specific endocrine disruptor. The effect estimates for each chemical were centered on or near an odds ratio of 1.00 in both models where we applied a shared mean or a mixture prior.

Conclusion:

Our mixtures analyses do not suggest an independent relationship with ASD or intellectual disability with any of the 25 chemicals examined together in this mixtures analysis.
Smoking and Influenza-associated Morbidity and Mortality
Authors: Han Lefei , Ran Jinjun , Mak Yim-Wah , Suen Lorna Kwai-Ping , Lee Paul H. , Peiris Joseph Sriyal Malik , Yang Lin
Published: February 2019

Background:

Although smoking has been recognized as a risk factor for many respiratory diseases, its effects of influenza-associated morbidity and mortality remain controversial. We conducted a systematic review and meta-analysis to assess the impact of smoking on influenza-associated hospital admissions, intensive care unit (ICU) admissions, and deaths.

Methods:

We searched the databases of PubMed, CINAHL, EMBASE, and the China National Knowledge Infrastructure for all observational studies published between 1 January 2000 and 30 November 2017 on ever-active/secondhand smoking and influenza-associated hospital admissions, ICU admissions, and deaths. We pooled data using random effect models.

Results:

The initial search retrieved 7495 articles, of which 20 studies were included for systematic review, and 12 studies (eight case–control studies, two cohort studies, and two cross-sectional studies) with 18612 subjects were included in meta-analysis. The overall quality of selected studies was moderate. Ever-active smokers had higher odds of hospital admissions (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.3, 1.7) and ICU admissions (OR 2.2; 95% CI = 1.4, 3.4) after influenza infections, as compared with never smokers. No association was observed between ever-active smoking and influenza-associated deaths. We found a positive association between secondhand smoking and influenza-associated hospital admissions, but only in children below 15 years of age.

Conclusions:

The literature evidence showed that smoking was consistently associated with higher risk of hospital admissions after influenza infection, but the results for ICU admissions and deaths were less conclusive because of the limited number of studies.
Maternal sepsis: new concepts, new practices
Authors: Foeller Megan E. , Gibbs Ronald S.
Published: February 2019

Purpose of review

Sepsis is a leading cause of severe maternal morbidity and maternal death. As pregnancy-related sepsis can be difficult to recognize, clinicians should maintain a low threshold for early evaluation and treatment.

Recent findings

Definitions and treatment guidelines for maternal sepsis were recently revised in 2016 and 2017 by the Surviving Sepsis Campaign and WHO. Multiple clinical decision tools have been created to aid clinicians in early recognition and risk prediction for sepsis in obstetric populations, but currently, an optimal screening tool does not exist. Early recognition and urgent treatment is paramount for patient survival. Antibiotics should be started within 1 h and fluid resuscitation should be initiated if sepsis-induced hypoperfusion is present. Care should be escalated to appropriate settings and source control provided.

Obstetricians have a heightened understanding of the physiologic changes in pregnancy and play a vital role in coordinating patient care and improving outcomes. The recent 2016 and 2017 revisions of definitions for maternal sepsis and treatment should be incorporated into clinical practice.
Perceived social support and the risk of cardiovascular disease and all-cause mortality in the Women's Health Initiative Observational Study
Authors: Freeborne Nancy , Simmens Samuel J. , Manson JoAnn E. , Howard Barbara V. , Cené Crystal W. , Allison Matthew A. , Corbie-Smith Giselle , Bell Christina L. , Denburg Natalie L. , Martin Lisa Warsinger
Published: February 2019

Objective:

Previous studies have shown social support to be inversely associated with cardiovascular disease (CVD) in men, whereas fewer studies have assessed the relationship in women. The purpose of this study was to evaluate the relationship between perceived social support and cardiovascular outcomes among postmenopausal women enrolled in the Women's Health Initiative Observational Study.

Methods:

We examined the relationships between perceived social support and (1) incident coronary heart disease (CHD), (2) total CVD, and (3) all-cause mortality. Participants were Women's Health Initiative Observational Study women, ages 50 to 79 years, enrolled between 1993 and 1998 and followed for up to 10.8 years. Social support was ascertained at baseline via nine questions measuring the following functional support components: emotional/informational, tangible, positive social interaction, and affectionate support.

Results:

Among women with prior CVD (n = 17,351) and no prior CVD (n = 73,421), unadjusted hazard ratios ranged from 0.83 to 0.93 per standard deviation increment of social support. Adjustment for potential confounders, such as smoking and physical activity levels, eliminated the statistical significance of the associations with CHD and CVD. However, for all-cause mortality and among women free of baseline CVD, the association was modest but remained statistically significant after this adjustment (hazard ratio = 0.95 [95% confidence interval, 0.91-0.98]). No statistically significant association was observed among women with a history of CVD.

Conclusions:

After controlling for potential confounding variables, higher perceived social support is not associated with incident CHD or CVD. However, among women free of CVD at baseline, perceived social support is associated with a slightly lower risk of all-cause mortality.
Lifelong Residual bone Marrow Damage in Murine Survivors of the Hematopoietic Acute Radiation Syndrome (H-ARS): A Compilation of Studies Comprising the Indiana University Experience
Authors: Chua Hui Lin , Plett P. Artur , Fisher Alexa , Sampson Carol H. , Vemula Sasidhar , Feng Hailin , Sellamuthu Rajendran , Wu Tong , MacVittie Thomas J. , Orschell Christie M.
Published: February 2019

Accurate analyses of the delayed effects of acute radiation exposure in survivors of the hematopoietic acute radiation syndrome are hampered by low numbers of mice for examination due to high lethality from the acute syndrome, increased morbidity and mortality in survivors, high cost of husbandry for long-term studies, biological variability, and inconsistencies of models from different laboratories complicating meta-analyses. To address this, a compilation of 38 similar hematopoietic acute radiation syndrome studies conducted over a 7-y period in the authors’ laboratory, comprising more than 1,500 irradiated young adult C57BL/6 mice and almost 600 day-30 survivors, was assessed for hematopoietic delayed effects of acute radiation exposure at various times up to 30 mo of age. Significant loss of long-term repopulating potential of phenotypically defined primitive hematopoietic stem cells was documented in hematopoietic acute radiation syndrome survivors, as well as significant decreases in all hematopoietic lineages in peripheral blood, prominent myeloid skew, significantly decreased bone marrow cellularity, and numbers of lineage-negative Sca-1+ cKit+ CD150+ cells (KSL CD150+; the phenotype known to be enriched for hematopoietic stem cells), and increased cycling of KSL CD150+ cells. Studies interrogating the phenotype of bone marrow cells capable of initiation of suspension cultures and engraftment in competitive transplantation assays documented the phenotype of hematopoietic stem cells in hematopoietic acute radiation syndrome survivors to be the same as that in nonirradiated age-matched controls. This compilation study adds rigor and validity to our initial findings of persistent hematopoietic dysfunction in hematopoietic acute radiation syndrome survivors that arises at the level of the hematopoietic stem cell and which affects all classes of hematopoietic cells for the life of the survivor.
Radiological Risks From Potential Exposure of the Population to Radiation From Orphan Radioactive Sources
Authors: Tsilikis Ioannis , Pantos Ioannis , Zouliati Ifigeneia , Koutras Antonios , Kalinterakis Georgios , Syllaios Athanasios
Published: February 2019

People in their everyday lives are exposed to radiation. Natural radiation is emitted from space, subsoil, and various materials which contain radioactive materials. Humans are also exposed to radiation from medical and industrial applications that use radioactive sources with artificial radioactive materials. Such radioactive sources may nevertheless get out of the control system and become orphan sources. Because these radiation sources are usually contained within metal shields such as lead and iron, the shields can end up as scrap metal being used in the metallurgical industry as raw material. Incidents have been recorded around the world, and several are reported in the literature and described here, where orphan sources have caused direct radiation exposure and/or environmental and personal contamination when the sources leaked. Timely and prompt recognition of an orphan radioactive source or device is crucial in order to minimize the radiological risk and its implications for the general population.
ACUTE MACULAR AND PERIPAPILLARY ANGIOGRAPHIC CHANGES WITH INTRAVITREAL INJECTIONS
Authors: Barash Alexander , Chui Toco Y. P. , Garcia Patricia , Rosen Richard B.
Published: February 2019

Purpose:

Intravitreal injections acutely and temporarily increase intraocular pressure (IOP), and this may have cumulative long-term effects including an increased risk for glaucoma surgery. This study was designed to measure retinal perfusion density changes on optical coherence tomography (OCT) angiography and OCT thickness alterations associated with acutely increased IOP after intravitreal injections.

Methods:

Retrospective observational clinical study of 40 eyes (39 patients) with various retinopathies from October 2016 to June 2017 at a tertiary care retina clinic in NYC. Patients were older than 18 years, with vision >20/100, able to fixate and without media opacities precluding OCT angiography, receiving intravitreal bevacizumab or aflibercept for diabetic retinopathy, retinal vein occlusion, macular degeneration, retinal neovascularization, or radiation retinopathy. The 3-mm × 3-mm macular and 4.5-mm × 4.5-mm peripapillary OCT angiography perfusion density, macular OCT thickness, and IOP were measured before and immediately after intravitreal injections. Paired t-test was used to compare preinjection and postinjection values for perfusion density and OCT thickness. Regression analysis was performed for potential effects of baseline IOP, IOP change, and age.

Results:

Statistically significant decreases in angiographic perfusion density (P < 0.05) were found in most areas of the superficial and deep layer macular OCT angiography, and the overall optic nerve head and the radial peripapillary capillary layer, preferentially temporal. Macular OCT thickness was significantly decreased in the temporal region and increased in the nasal region. Regression analysis showed relationships between age and decreased superficial macular perfusion. Preinjection IOP was only related to OCT thickness in the fovea. Intraocular pressure change was related only to decreased superficial macular perfusion density.

Conclusion:

Intravitreal injections produce acute IOP changes that are associated with reduced macular and peripapillary perfusion density. Therefore, it is possible that patients receiving regular intravitreal injections may be sustaining perfusion-related injury to ocular structures that may produce glaucomatous damage to the macula and optic nerve.
EVALUATION OF PHOTORECEPTORS, RETINAL CAPILLARY PLEXUSES, AND CHORIOCAPILLARIS IN PATIENTS WITH BIRDSHOT CHORIORETINOPATHY
Authors: Forte Raimondo , Saleh Maher , Aptel Florent , Chiquet Christophe
Published: February 2019

Purpose:

To assess the status of the cone photoreceptors using adaptive optics flood illumination ophthalmoscopy in patients with birdshot chorioretinopathy and to study their relationship with optical coherence tomography (OCT) angiography.

Methods:

Seventeen patients with birdshot chorioretinopathy were studied using standard automated perimetry, color vision testing, fluorescein angiography, indocyanine green angiography, spectral domain OCT, enhanced depth imaging OCT, and adaptive optics flood illumination ophthalmoscopy (rtx1, Imagine Eyes, Orsay, France) in a 90 × 90-μm area at 1.5° temporal of the fovea and OCT angiography (Spectralis OCT2, Heidelberg Engineering, Heidelberg, Germany). For adaptive optics flood illumination ophthalmoscopy, spectral domain OCT, and OCT angiography, a control group of 12 healthy patients (12 eyes) matched for age, sex, and refractive error was included.

Results:

After excluding low-quality adaptive optics flood illumination ophthalmoscopy images, 12 eyes (12 patients, 7 women, mean age 53.5 ± 10.8 years) were analyzed. Best-corrected visual acuity was 0.01 ± 0.03 LogMAR (20/25 Snellen equivalent), and foveal threshold at standard automated perimetry was 35.2 ± 3.0. Cone density at 1.5° of the fovea in the birdshot chorioretinopathy group (11,435.25 ± 4,342.9 cells/mm2) was significantly smaller than in the control group (24,594.04 ± 4,764.3 cells/mm2, P < 0.001). In the same area, birdshot chorioretinopathy eyes showed disruption of the ellipsoid/interdigitation zone and vascular abnormalities, such as capillary loops (58.3%), increased superficial intercapillary spaces (75%), increased deep intercapillary spaces (58.3%), capillary dilations (58.3%), telangiectatic vessels (66.6%), and absence of choriocapillary flow (58%). Cone density at 1.5° was associated with duration of the disease (Spearman's rho −0.8, P = 0.01), although it was not associated with OCT angiography abnormalities in the same area.

Conclusion:

Birdshot chorioretinopathy can result in a reduction in cone density and development of macular vascular abnormalities even in the presence of preserved visual function.