bluuebunny/crossref_metadata_2025 huggingface dataset:
State of the Union: Timeliness to Antibiotics in Open Fractures
Authors: Barnard Eric R. , Stwalley Dustin , Miller Anna N.
Published: February 2023

Objective:

In open fractures, early administration of systemic antibiotics has recently been recognized as a universal recommendation, with the current American College of Surgeons Trauma Center Verification recommendation for administration within 1 hour of facility arrival. We sought to quantify the baseline rate of timely antibiotic administration and the various factors associated with delay.

Methods:

Data from the National Trauma Data Bank were obtained for all patients treated for open fractures in 2019. 65,552 patients were included. Univariate and multivariate analyses were performed, first for patient, prehospital, and hospital factors compared with rate of antibiotic administration within 1 hour of hospital arrival, then with a multivariate analysis of factors affecting these times.

Results:

The overall rate of antibiotic administration within 1 hour of arrival was 47.6%. Patient factors associated with lower rates of timely antibiotics include increased age, Medicare status, and a higher number of comorbidities. Associated prehospital factors included non–work-related injuries, fixed-wing air or police transport, and walk-in arrival method. Patients with lower extremity open fractures were more likely to receive antibiotics within 1 hour of arrival than those with upper extremity open fractures. Traumatic amputations had a higher rate of timely administration (67.3%). ACS trauma Level II (52.5%) centers performed better than Level III (48.3%), Level I (45.5%), and Level IV (34.5%) centers. Multivariate analysis confirmed the findings of the univariate analysis.

Conclusions:

Despite current clinical standards, rates of adherence to rapid antibiotic administration are low. Certain patient, facility, and environmental factors are associated with delays in antibiotic administration and can be a focus for quality improvement processes. We plan to use these data to evaluate how focus on antibiotic administration as this quality standard changes practice over time.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Impact of Increased Time to Surgery in Geriatric Patients With Acetabular Fractures
Authors: Seilern und Aspang Jesse , Zamanzadeh Ryan S. , Bonsu Janice M. , Fraser Helyn G. , Maceroli Michael A. , Ibnamasud Shadman , McKegg Phillip , Boissonneault Adam R.
Published: February 2023

Objectives:

To explore the association between time to surgery (TTS) and postoperative complications in geriatric patients with acetabular fractures.

Design:

Retrospective cohort study.

Setting:

Level I trauma center.

Patients/Participants:

51 consecutive geriatric patients (60 years of age or older) who presented to a Level 1 trauma center for surgical fixation of an acetabular fracture between 2013 and 2020.

Main Outcome Measurement:

The primary and secondary outcomes were 30-day postoperative complications and length of hospital stay (LOS), respectively. TTS was determined by time between arrival to ED and time of surgery, with a threshold of 48 hours (early vs. delayed TTS group).

Results:

Nineteen patients (37.3%) had ≥1 postoperative complications. Patients in the delayed TTS group had 5× higher odds of developing ≥1 complications (odds ratio: 4.86, confidence interval: 1.48–15.96). There were no 30-day mortalities in either group. Patients in the delayed TTS group had an average LOS of 19 days compared with early TTS patients who had an average LOS of 12 days (P = 0.040).

Conclusion:

Geriatric patients with acetabular fractures with delayed TTS had increased postoperative complications and LOS. These data suggest that expedited care may have a similar protective effect in geriatric patients with acetabular fractures, as it does in the acute hip fracture population.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Coxa Magna following treatment of developmental dysplasia of the hip: investigation for associated potential factors
Authors: Topak Duran , Aslan Ahmet , Yorgancigil Hüseyin
Published: February 2023

Coxa Magna (CM) is defined as a condition in which the horizontal (transverse) diameter of the femoral head is larger on the affected side than on the intact side. CM can occur as a manifestation of avascular necrosis (AVN) following treatment for the developmental dysplasia of the hip (DDH). Alternatively, it can also be secondary to other hip disorders, such as Perthes’ disease. This study aimed to determine the prevalence and indicators of CM and AVN of the femoral head that can be detected during follow-up in patients with unilateral DDH treated with closed reduction (CR) or open reduction (OR) surgery. The files of 143 patients treated for unilateral DDH between January 1997 and December 2017 were reviewed retrospectively. A total of 104 patients, including Group 1 (n = 49) patients who underwent CR under general anesthesia and Group 2 (n = 55) patients who underwent OR were included in the study. CM; It was considered as the case where the femoral head was 15% or more larger than the intact side. A total of 104 patients were followed up for 77.27 ± 13.96 months, with a mean age of 15.43 ± 7.76 months. When Group 1 and Group 2 were compared, there was no statistical difference in terms of sex, side, adductor tenotomy, and AVN (P > 0.05). CM developed in 22.4% (n = 11) of the patients in Group 1 and in 49.1% (n = 27) in Group 2, and the difference was statistically significant (P = 0.008). When the effect of independent variables on the development of CM is evaluated with the multivariate logistic regression model, the risk of developing CM is 3474 times higher in those who underwent iliopsoas tenotomy compared with those who did not. The primary outcome of this study is that CM is more frequent in patients treated with OR for DDH. CM may be a nonpathological condition that occurs in connection with iliopsoas tenotomy or surgical treatment. Prospective studies with a larger number of cases, designed to minimize confounding factors, are required.
Patterns of Vertebral Bone Marrow Edema in the Normal Healing Process of Lumbar Interbody Fusion: Baseline Data for Diagnosis of Pathological Events
Authors: Hasegawa Yuichi , Kanayama Masahiro , Oha Fumihiro , Shimamura Yukitoshi , Tsujimoto Takeru , Hashimoto Tomoyuki , Iwasaki Norimasa
Published: February 2023

Study Design.

Retrospective investigation using a prospectively collected database.

Objective.

To examine the appearance and characteristics of vertebral bone marrow edema (BME) in the normal healing of lumbar interbody fusion.

Summary of Background Data.

Although BME in pathological spinal conditions has been well-documented, the patterns and characteristics of BME in the normal healing process of spinal fusion remains unexplored.

Materials and Methods.

We reviewed imaging from 225 patients with normal healing following posterior lumbar interbody fusion or transforaminal lumbar interbody fusion. BME was identified on magnetic resonance imaging at the third postoperative week and categorized with respect to its appearance, including assessment of area and extension within the relevant vertebrae.

Results.

Three hundred eighty-nine of the 450 instrumented vertebrae (86.4%) displayed evidence BME. All instances of BME were associated with the area of contact with the endplate. The average extent of BME was 32.7±1.0%. BME within normal healing following interbody fusion could be categorized into four types: no edema (13.6%), anterior corner (36.6%), around-the-cage focal (48.0%), and diffuse (1.8%). Anterior corner BME was significantly associated with instances of single cage placement than in dual cages (42.6% vs. 24.7%, P=0.0002). Single cages had a significantly higher rate of BME than dual cages (92.0% vs. 75.3%, P<0.0001). The extent of BME was significantly greater in the single cage cohort (36.9% vs. 24.2% in dual cages, P<0.0001).

Conclusions.

This serves as the first study demonstrating the patterns of BME associated with normal healing following lumbar interbody fusion procedures. Anterior corner BME and around-the-cage focal BME were the most common patterns encountered, with diffuse BME a relatively rare pattern. These findings might contribute to the better differentiation of postoperative pathological events from normal healing following lumbar interbody fusion.

Level of Evidence.

4.
Female Sex and Supine Proximal Lumbar Lordosis Are Associated With the Size of the LLIF “Safe Zone” at L4-L5
Authors: Fourman Mitchell S. , Alluri Ram K. , Sarmiento J. Manuel , Lyons Keith W. , Lovecchio Francis C. , Araghi Kasra , Dalal Sidhant S. , Shinn Daniel J. , Song Junho , Shahi Pratyush , Melissaridou Dimitra , Carrino John A. , Sheha Evan D. , Iyer Sravisht , Dowdell James E. , Qureshi Sheeraz S.
Published: February 2023

Study Design.

Retrospective chart review

Objective.

Identify demographic and sagittal alignment parameters that are independently associated with femoral nerve position at the L4-L5 disk space.

Summary of Background Data.

Iatrogenic femoral nerve or lumbar plexus injury during lateral lumbar interbody fusion (LLIF) can result in neurological complications. The LLIF “safe zone” is the anterior half to two third of the disk space. However, femoral nerve position varies and is inconsistently identifiable on magnetic resonance imaging. The safe zone is also narrowest at L4-L5.

Methods.

An analysis of patients with symptomatic lumbar spine pathology and magnetic resonance imaging with a visibly identifiable femoral nerve evaluated at a single large academic spine center from January 1, 2017, to January 8, 2020, was performed. Exclusion criteria were transitional anatomy, severe hip osteoarthritis, coronal deformity with cobb >10 degrees, > grade 1 spondylolisthesis at L4-L5 and anterior migration of the psoas.

Standing and supine lumbar lordosis (LL) and its proximal (L1-L4) and distal (L4-S1) components were measured. Femoral nerve position on sagittal imaging was then measured as a percentage of the L4 inferior endplate. A stepwise multivariate linear regression of sagittal alignment and LL parameters was then performed. Data are written as estimate, 95% CI.

Results.

Mean patient age was 58.2±14.7 years, 25 (34.2%) were female and 26 (35.6%) had a grade 1 spondylolisthesis. Mean femoral nerve position was 26.6±10.3% from the posterior border of L4. Female sex (−6.6, −11.1 to −2.1) and supine proximal lumbar lordosis (0.4, 0.1–0.7) were independently associated with femoral nerve position.

Conclusions.

Patient sex and proximal LL can serve as early indicators of the size of the femoral nerve safe zone during a transpsoas LLIF approach at L4-L5.
Cross-Cultural Adaptation and Psychometric Validation of the Hindi Version of the Neck Disability Index in Patients With Chronic Neck Pain
Authors: Geete Dipti Baban , Mhatre Bhavana Suhas , Vernon Howard
Published: February 2023

Study Design.

Translation and psychometric testing.

Objectives.

To cross-culturally adapt the Neck Disability Index (NDI) into the Hindi language, the local language of India, and to investigate the psychometric properties of the Neck Disability Index-Hindi (NDI-H) version in patients with neck pain.

Summary of Background Data.

The NDI is the most used self-reported outcome measure for neck pain. The previous NDI-H version did not obtain advance permission from Mapi trust to translate this scale. As a result, this scale’s availability is limited.

Materials and Methods.

Following established guidelines, the NDI was translated and culturally adapted into Hindi. A total of 120 chronic neck pain patients (20 for cognitive interviews and 100 for psychometric testing) participated in this study. The content validity, construct validity, internal consistency, test-retest reliability, and responsiveness of the NDI-H were all evaluated. The intraclass correlation coefficient was computed to determine test-retest reliability. Internal consistency was assessed using Cronbach α. The NDI’s factor structure was investigated using principal component factor analysis. The Neck Pain and Disability Scale, Numeric Pain Rating Scale, and Anxiety and Depression scales were used to test criterion validity. The receiver operating characteristic curve analysis was used to determine the cut-off point and the area under the curve.

Results.

The NDI-H demonstrated good test-retest reliability (intraclass correlation coefficient = 0.92) and excellent internal consistency (Cronbach α = 0.90). The one-factor structure was revealed by the factor analysis. The NDI has a strong relationship with the Neck Pain and Disability Scale and Numeric Pain Rating Scale, as well as the Anxiety and Depression scales. The cut-point for detecting a change was 9.3.

Conclusions.

The NDI was successfully translated into Hindi in this study. The NDI-H is a reliable and valid and responsive instrument that can be used to treat patients with chronic neck pain in clinical and research settings.
Refractory acute promyelocytic leukemia with PLZF/RARa rearrangement: a case report and literature review
Authors: Duan Xiaoqiong , Liu Baoru , Yang Min
Published: February 2023

Acute promyelocytic leukemia patients with PLZF–RARa rearrangement have no obvious differentiation-inducing effect on retinoic acid, have a poor response to traditional chemotherapy, and have poor overall prognosis. A case of acute promyelocytic leukemia with PLZF/RARa rearrangement reported in this article was treated with induction chemotherapy with arsenic trioxide combined with a new anthracycline (idarubicin) cytotoxic chemotherapy. The patient achieved complete response in the bone marrow. After the first induction, and achieved molecular remission after the second consolidation chemotherapy. At present, the patient was followed up for 40 months after hematological and cytogenetic remission, and the PLZF/RARa real-time PCR test was continuously negative.
Efficacy of Duloxetine on electrodiagnostic findings of Paclitaxel-induced peripheral neuropathy, does it have a prophylactic effect? A randomized clinical trial
Authors: Aghabozorgi Reza , Hesam Marzieh , Zahed Ghazal , Babaee Marzieh , Hashemi Mahdis , Rayegani Seyed Mansoor
Published: February 2023

This study aimed to evaluate the efficacy of Duloxetine on electrodiagnostic findings of Paclitaxel-induced peripheral neuropathy in patients with breast cancer. This randomized, double-blind clinical trial was conducted on 40 patients with breast cancer who received Paclitaxel as their first chemotherapy session. All the patients were randomly allocated into two groups, intervention (20 subjects) and placebo (20 subjects). The intervention group received 30 mg duloxetine/day in the first week, followed by 60 mg (twice daily) until 8 weeks. The patient neurotoxicity questionnaire (PNQ) was used to evaluate the severity of neuropathy. Nerve conduction study was also performed. The evaluations were performed at the baseline and 8 weeks after the treatment. Out of 20 subjects in the placebo group, 10 (50%) patients had neurotoxicity (two milds, three moderate, four severe, and one incapacitated), according to PNQ. However, in the duloxetine group, two patients had mild neurotoxicity (P = 0.03). Significant differences between groups related to the mean of Median Sensory Latency (P <0.001), Median Motor Latency (P < 0.001), and Median Motor velocity (P = 0.001) were reported. However, the relative risk of polyneuropathy between the two groups (relative risk: 1) was not significant. Regarding the results, duloxetine could be an effective treatment for preventing paclitaxel-induced peripheral neuropathy in patients with breast cancer, and an electrodiagnostic study confirmed this effect.
Neoadjuvant target therapy with ensartinib in lung adenocarcinoma with EML4-ALK fusion variant: a case report and literature review
Authors: Wu Yimin , Huang Lijian , Li Wenshan , Chai Ying
Published: February 2023

Although neoadjuvant target therapy has been used to treat patients with non-small-cell lung cancer (NSCLC), most of these patients have mutations in the epidermal growth factor receptor (EGFR) gene. Few patients to date have received neoadjuvant target therapy for NSCLC containing variants in genes encoding anaplastic lymphoma kinase-tyrosine kinase inhibitors (ALK-TKIs). Herein, we present a 51-year-old man with a lung mass in the left lower lobe with enlarged mediastinal lymph nodes. He was diagnosed with NSCLC after needle lung biopsy, with next-generation sequencing showing an echinoderm microtubule-associated protein-like 4 gene-anaplastic lymphoma kinase (EML4-ALK) fusion variant. The patient received neoadjuvant ensartinib, a second-generation ALK-TKI, for 5 months, followed by successful lobectomy through uniportal video-assisted thoracic surgery and adjuvant ensartinib. To our knowledge, few patients with ALK-positive NSCLC had received neoadjuvant treatment with ensartinib. Findings in this patient may widen indications for neoadjuvant target therapy in the treatment of resectable stage II-IIIA ALK-positive NSCLC.
Safety, tolerability, pharmacokinetics and immunogenicity of an antibody–drug conjugate (SHR-A1201) in patients with HER2-positive advanced breast cancer: an open, phase I dose-escalation study
Authors: Li Yinjuan , Qi Lu , Wang Yu , Zhao Xia , Lv Shuzhen , Feng Yu , Liu Chen , Li Pu , Xiong Bingjun , Guo Yihui , Lv Dapeng , Liu Yongbo , Mao Ting , Yuan Keyu , Cheng Xiaoqiang , Li Yanping , Wang Xinghe
Published: February 2023

SHR-A1201 is an antibody–drug conjugate (ADC) that combines trastuzumab with DM1 (a chemotherapeutic agent) using a chemical connector. This phase I study investigated the safety, tolerability and pharmacokinetics of SHR-A1201 in patients with human epidermal growth factor receptor 2-positive advanced breast cancer. This phase I study enrolled patients in a traditional 3 + 3 dose-escalation design to receive a single dose of SHR-A1201 (1.2 mg/kg, 2.4 mg/kg, 3.6 mg/kg or 4.8 mg/kg). The observation period of dose-limiting toxicity (DLT) was 21 days. A total of 12 patients were enrolled and received SHR-A1201. Most treatment-emergent adverse events (TEAEs) were grade 1 or 2 in severity, with elevated aspartate aminotransferase (75%), thrombocytopenia (75%), and nausea (66.7%) being reported most frequently. The common grade 3 TEAEs were thrombocytopenia and decreased lymphocyte count, and there were no grade 4 or above TEAEs. There were no serious adverse events or drug-related deaths. One DLT occurred in one patient treated with SHR-A1201 4.8 mg/kg (asymptomatic grade 3 increased γ-glutamyltransferase). The maximum tolerated dose of SHR-A1201 was not lower than that of T-DM1 (3.6 mg/kg). A total of 8.3% (1/12) of patients had ADA-positive reactions 504 h after administration, but no differences were observed in the type, incidence, or severity of TEAEs between patients with and without ADA. SHR-A1201 exhibited the pharmacokinetics characteristics of typical ADCs. An encouraging antitumor effect was observed in the 4.8 mg/kg dose group. SHR-A1201 was well tolerated and safe in patients with advanced HER2-positive breast cancer. The pharmacokinetics parameters showed a linear trend, and the immunogenicity results met the clinical expectations.
A novel ribociclib derivative WXJ-103 exerts anti-breast cancer effect through CDK4/6
Authors: Ji Jing , Zhang Zhen , He Xingbei , Pan Gang , Li Guanchu , Lv Jinyu , Xu Yuxin , Xie Mengru , Feng Jing , Wang Weiling , Liu Bin , Ma Jinming , Wang Xiujun
Published: February 2023

The triple-negative breast cancer (TNBC) subtype is the most aggressive type of breast cancer with a low survival prognosis and high recurrence rate. There is currently no effective treatment to improve it. In this work, we explored the effect of a synthetic compound named WXJ-103 on several aspects of TNBC biology. The human breast cancer cell lines MDA-MB-231 and MCF-7 were used in the experiments, and the cell viability was detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide method, and the cell migration and invasion abilities were detected by wound healing assay and Transwell invasion assay. Cell cycle and apoptosis experiments were analyzed by flow cytometry, and protein levels related to cyclin-dependent kinase (CDK) 4/6–cyclin D–Rb–E2F pathway were analyzed by western blotting. Then, in-vivo experiments were performed to determine the clinical significance and functional role of WXJ-103. The results show that WXJ-103 can inhibit the adhesion, proliferation, migration, and invasion of TNBC cells, and can arrest the cell cycle in G1 phase. The levels of CDK4/6–cyclin D–Rb–E2F pathway-related proteins such as CDK6 and pRb decreased in a dose-dependent manner. Therefore, the antitumor activity of WXJ-103 may depend on the inhibition of CDK4/6–cyclin D1–Rb–E2F pathway. This research shows that WXJ-103 may be a new promising antitumor drug, which can play an antitumor effect on TNBC and provide new ideas for the treatment of TNBC.
Transcription factor ZEB1 regulates PLK1-mediated SKA3 phosphorylation to promote lung cancer cell proliferation, migration and cell cycle
Authors: Ning Guangyao , Lu Chen , Chen Yu , Jiang Menglong , Si Panpan , Zhang Renquan
Published: February 2023

Lung cancer (LC) is one of the most common malignancies worldwide with low 5-year survival rate. The mechanism of spindle and kinetochore-associated complex subunit 3 (SKA3) in LC tumorgenesis remains largely unclear. The expression of SKA3 in LC cells was detected by quantitative PCR. Cell proliferation, migration and cell cycle were evaluated by functional assays including 5-ethynyl-2′-deoxyuridine, wound healing, transwell assays and flow cytometry analysis. Bioinformatics analysis, chromatin immunoprecipitation, luciferase reporter, co-immunoprecipitation and in vitro phosphorylation assays were applied to explore the interactions between zinc finger E-box binding homeobox 1 (ZEB1) and SKA3/polo-like kinase 1 (PLK1). SKA3 is highly expressed in LC cell lines and drives LC cell proliferation, migration and cell cycle. PLK1 also enhances the malignancy of LC cells. PLK1 can mediate SKA3 phosphorylation and enhance the stability of SKA3 protein, thus promoting LC progression. Besides, we found that transcription factor ZEB1 transcriptionally activates SKA3/PLK1 expression, contributing to LC cell malignancy. This study demonstrated that transcription factor ZEB1 modulates PLK1-mediated SKA3 phosphorylation to accelerate LC cell growth, migration and cycle, which might offer novel insight into LC treatment.
Diaphragm Neurostimulation Mitigates Ventilation-Associated Brain Injury in a Preclinical Acute Respiratory Distress Syndrome Model
Authors: Bassi Thiago G. , Rohrs Elizabeth C. , Fernandez Mr. Karl C. , Ornowska Ms. Marlena , Nicholas Ms. Michelle , Wittmann Ms. Jessica , Gani Mr. Matt , Evans Mr. Doug , Reynolds Steven C.
Published: February 2023

CONTEXT:

In a porcine healthy lung model, temporary transvenous diaphragm neurostimulation (TTDN) for 50 hours mitigated hippocampal apoptosis and inflammation associated with mechanical ventilation (MV).

HYPOTHESIS:

Explore whether TTDN in combination with MV for 12 hours mitigates hippocampal apoptosis and inflammation in an acute respiratory distress syndrome (ARDS) preclinical model.

METHODS AND MODELS:

Compare hippocampal apoptosis, inflammatory markers, and serum markers of neurologic injury between never ventilated subjects and three groups of mechanically ventilated subjects with injured lungs: MV only (LI-MV), MV plus TTDN every other breath, and MV plus TTDN every breath. MV settings in volume control were tidal volume 8 mL/kg and positive end-expiratory pressure 5 cm H2O. Lung injury, equivalent to moderate ARDS, was achieved by infusing oleic acid into the pulmonary artery.

RESULTS:

Hippocampal apoptosis, microglia, and reactive-astrocyte percentages were similar between the TTDN-every-breath and never ventilated groups. The LI-MV group had a higher percentage of these measures than all other groups (p < 0.05). Transpulmonary driving pressure at study end was lower in the TTDN-every-breath group than in the LI-MV group; systemic inflammation and lung injury scores were not significantly different. The TTDN-every-breath group had considerably lower serum concentration of homovanillic acid (cerebral dopamine production surrogate) at study end than the LI-MV group (p < 0.05). Heart rate variability declined in the LI-MV group and increased in both TTDN groups (p < 0.05).

INTERPRETATIONS AND CONCLUSIONS:

In a moderate-ARDS porcine model, MV is associated with hippocampal apoptosis and inflammation, and TTDN mitigates that hippocampal apoptosis and inflammation.
Treatment of More Than Moderate Ischemic Mitral Regurgitation in Patients Undergoing Left Ventricular Reconstruction
Authors: Tiemuerniyazi Xieraili , Song Yangwu , Ma Hanping , Xu Fei , Zhao Wei
Published: February 2023

Objective:

While evidence-based clinical guidelines recommend chordal-sparing mitral valve replacement, rather than mitral valve repair, in patients with severe ischemic mitral regurgitation (IMR) undergoing coronary artery bypass grafting, there are no similar recommendations for patients undergoing left ventricular reconstruction (LVR). This study aimed to compare the clinical outcomes of mitral valve repair and replacement in patients undergoing LVR complicated by more than moderate IMR.

Methods:

In this single-center cohort study, a total of 74 consecutive patients who underwent LVR and mitral valve surgery (repair group: 59; replacement group: 15), during the period from March 2000 to March 2021 at Fuwai Hospital (Beijing, China) were retrospectively enrolled. Survival rates were calculated with the Kaplan-Meier method and compared using the log-rank test. Univariate Cox analysis was performed to evaluate possible confounders, followed by adjustment in multivariate analysis. The primary outcome was survival free of major adverse cardiovascular and cerebrovascular events (MACCE).

Results:

Median follow-up time was 59.4 months. Compared with mitral valve replacement, mitral valve repair was associated with increased risk of perioperative use of ventricular assist device (22.0% vs. 0, P = 0.045). There was no difference in overall survival (hazard ratio (HR), 1.10; 95% confidence interval (CI), 0.31–3.93; P
logrank = 0.888) and MACCE-free survival (HR, 1.54; 95% CI, 0.65–3.65; P
logrank = 0.319), even after multivariate Cox regression (HR, 1.35; 95% CI, 0.37–4.88; P
Cox = 0.646; and HR, 1.41; 95% CI, 0.57–3.44; P
Cox = 0.455, respectively). Furthermore, while no differences were observed in ejection fraction and left ventricular end-diastolic diameter on follow-up echocardiography, mitral valve repair was associated with an increased risk of recurrent mitral regurgitation (P = 0.041).

Conclusions:

In patients undergoing LVR complicated by more than moderate IMR, both concomitant mitral valve repair and replacement can be successfully achieved with comparable overall and MACCE-free survival outcomes; however, mitral valve replacement may be superior to mitral valve repair for persistent correction of mitral dysfunction.
Fostering “Reflection-On-Practice” Through a Multisource Feedback and Peer Coaching Pilot Program
Authors: Curran Vernon , Fleet Lisa , Whitton Cynthia
Published: February 2023

Introduction:

Reflective practice involves thinking about one's practice and often involves using data to effect such reflection. Multisource feedback (MSF) involves evaluation by peers, patients, and coworkers. Coaching has been identified as a key aspect of MSF with peer coaching involving two or more colleagues working together to reflect on current practices and share ideas. We introduced a pilot MSF and peer coaching program with a goal to evaluate its effect on fostering reflective practice.

Methods:

Physician participants completed a 360-degree assessment of their practices, followed by peer coaching sessions. Peer coaches were oriented to an evidence-based theory-driven feedback model (R2C2) to support coaching skills development. A mixed-methods evaluation study was undertaken, including pre to post surveys of readiness for self-directed learning, a postevaluation survey of participant satisfaction, and semistructured participant interviews.

Results:

Thirty four (N = 34) participants completed the 360-degree assessment, and 22 participants took part in two coaching meetings. Respondents reported significant improvement to aspects of their readiness for self-directed learning (P <.05), including knowing about learning strategies to achieve key learning goals, knowing about resources to support one's own learning, and being able to evaluate one's learning outcomes. Overall, respondents felt empowered to “reflect” on their practices, affirm what they were doing well, and, for some, identify opportunities for further and ongoing professional development.

Discussion:

MSF and peer coaching emerged as key elements in enabling reflective practice by facilitating reflection on one's practice and conversations with one's peers to affirm strengths and opportunities for strengthening practice through self-directed professional development.
Long-term effect of a large dose of iodinated contrast in patients with mild thyroid dysfunction: a prospective cohort study
Authors: Si Hailong , Chen Kangyin , Qin Qin , Liu Yuanyuan , Zhao Bingrang
Published: February 2023

Background:

More than 75 million procedures with intravascular iodine-based contrast media (ICM) are performed worldwide every year, and some patients undergoing these procedures do not have normal thyroid function. The long-term effects of ICM in patients with mild thyroid dysfunction (TD) are unclear.

Methods:

This prospective cohort study was conducted in China. Patients with stable angina pectoris with total triiodothyronine (TT3) reduction, normal thyroid-stimulating hormone, and reverse triiodothyronine (rT3) were enrolled and divided into high-dose (≥100 mL ICM) and low-dose groups (<100 mL ICM). We dynamically investigated the trends in thyroid function, rT3, and thyroid antibodies 1 year after ICM exposure.

Results:

A total of 154 patients completed 6 months of follow-up and 149 completed 1 year of follow-up. Thyroglobulin antibody (TGAB) levels were elevated in 41 (26.6%) patients before ICM exposure, 11 (7.1%) of whom also had elevated thyroid peroxidase antibody levels. Transient subclinical TD occurred 6 months after ICM exposure; 75.5% of post-operative TD occurred in the high-dose group. One patient developed severe hypothyroidism with myxedema, requiring drug intervention 1 year after ICM exposure. The level of rT3 showed no statistically significant changes during post-operative follow-up (P = 0.848). The TGAB level decreased at 6th month (P < 0.001), but increased at 1 year after ICM exposure (P = 0.002).

Conclusions:

Patients with T3 reduction are at risk of transient subclinical TD and hypothyroidism after a single large dose of ICM. Follow-up of this population at 9–12 months after ICM exposure is warranted.
Epidemiological characteristics of pulmonary tuberculosis in patients with pneumoconiosis based on its social determinants and risk factors in China: a cross-sectional study from 27 provinces
Authors: Wang Huanqiang , Dai Huaping , He Jiayu , Lyu Xiangpei , Zhang Xinran , Li Tao
Published: February 2023

Background:

Patients with pneumoconiosis have an elevated risk of contracting pulmonary tuberculosis (PTB) and need particular attention. However, extensive population-based studies on the prevalence of PTB in patients with pneumoconiosis have not been reported in China since 1992. This study aimed to investigate the epidemiological characteristics of PTB in patients with pneumoconiosis based on its social determinants and risk factors in China.

Methods:

Based on the Commission on Social Determinants of Health (CSDH) framework, data were obtained from a questionnaire survey of patients with pneumoconiosis from China's 27 provinces (autonomous regions, municipalities) from December 2017 to June 2021. By chi-square and multivariate logistic regression analyses, the epidemiological characteristics of PTB in the patients were identified based on its prevalence and odds ratio (OR) and associated social determinants and risk factors. The population attributable fractions (PAFs) of significant risk factors were also calculated.

Results:

The prevalence of PTB in patients with pneumoconiosis (n = 10,137) was 7.5% (95% confidence interval [CI]: 7.0–8.0%). Multivariate logistic regression analysis showed that risk factors included in-hospital exposure to patients with PTB (OR = 3.30, 95% CI: 2.77–3.93), clinically diagnosed cases (OR = 3.25, 95% CI: 2.42–4.34), and northeastern regions (OR = 2.41, 95% CI: 1.76–3.31). In addition, lack of work-related injury insurance (WRII), being born in a rural area, being unemployed, living in western regions, household exposure to patients with PTB, smoking, being underweight, complications of pulmonary bullae or emphysema, hospitalization history, and former drinkers among the rural patients were also statistically significant risk factors. Being born in a rural area, lack of WRII and in-hospital exposure to patients with PTB had higher PAFs, which were 13.2% (95% CI: 7.9–18.5%), 12.5% (95% CI: 8.3–16.7%), and 11.6% (95% CI: 8.8–14.3%), respectively.

Conclusion:

The prevalence of PTB in pneumoconiosis remains high in China; it is basically in line with the CSDH models and has its characteristics.
Strategies for Virtual Bereavement Care
Authors: Carr Briana Marie
Published: February 2023

The contagiousness of some illnesses (e.g., COVID-19) limits the ways in which families can interact with their dying loved ones who have been admitted to the hospital, especially in the intensive care unit. As a result, nurses have developed culturally relevant strategies for virtual bereavement care for patients and families predeath, perideath, and postdeath. Specific ways nurses can support, communicate, and facilitate meaningful rituals when patients die in isolation are provided in this article.
In Vitro Exercise-Induced Endothelial Shear Stress Protects the Vascular Endothelium
Authors: Amador Manuel , Huerta Jonathan A. , Garcia Mario A. , Conde Daniel A. , Gurovich Alvaro N.
Published: February 2023

Purpose:

To determine whether exercise-induced levels of endothelial shear stress (ESS) observed in vivo upregulates endothelial protective proteins in vitro.

Methods:

In vivo carotid ESS was obtained from previously published data. Human umbilical vein endothelial cells were seeded in a collagen-coated Y-luer slides with a bifurcation that mimics the common carotid artery and its bifurcation. Four duplicate groups were exposed to 5 hours of resting ESS (18 dynes/cm2) followed by 1 hour of ESS at 18 dynes/cm2 × heart rate (HR) 60 pulses per minute (ppm) (control), 35 dynes/cm2 × HR 100 ppm (low), 50 dynes/cm2 × HR 120 ppm (moderate), or 60 dynes/cm2 × HR 150 ppm (high). After ESS exposure, cells were stained to identify cell nucleus, phosphorylated endothelial NO synthase (eNOSp), and intracellular actin concentrations using immunohistochemistry. Confocal microscopy images captured areas exposed to varying degrees of shear stress within the “common” artery, the bifurcation, and the distal branches of the bifurcation.

Results:

Images showed a higher expression of eNOSp and actin that is generally intensity and location dependent. High shear stress (HSS) showed the greatest eNOSp expression compared with all conditions at the after-bifurcation site (P < .05). Interestingly, HSS continued to result in greater expression of actin at the bifurcation site across all 4 intensities, where blood flow is known to be more turbulent.

Conclusions:

These findings may support the hypothesis that high shear stress plays an important protective endothelial role in relation to individualized exercise prescription as a contribution to precision medicine.

Impact Statement:

Endurance exercise intensity has a direct impact in endothelial cell homeostasis at the physiological and molecular levels. When a physical therapist prescribes endurance exercise for cardiovascular diseases, the goal should be to deliver precision medicine to enhance patient's health outcomes.
Cardiovascular Manifestations in Rheumatoid Arthritis
Authors: Sanghavi Nirali , Ingrassia Jenne P. , Korem Sindhuja , Ash Julia , Pan Stephen , Wasserman Amy
Published: February 2023

Rheumatoid arthritis (RA) is a systemic inflammatory disorder that characteristically affects the joints. RA has extra-articular manifestations that can impact multiple organ systems including the heart, lungs, eyes, skin, and brain. Cardiovascular involvement is a leading cause of mortality in RA. Cardiovascular manifestations of RA include accelerated atherosclerosis, heart failure, pericarditis, myocarditis, endocarditis, rheumatoid nodules, and amyloidosis. Inflammation is an important mediator of endothelial dysfunction and is a key driver of cardiovascular risk and complications in patients with RA. Prompt identification of cardiac pathologies in patients with RA is essential for appropriate management and treatment. Choosing the most appropriate treatment regimen is based on individual patient factors. In this article, we provide a comprehensive review of the epidemiology, pathophysiology, clinical manifestations, diagnosis, and medical management of cardiovascular manifestations of RA. We also discuss the relationship between anti-rheumatic medications, specifically non-steroidal anti-inflammatory drugs, corticosteroids, methotrexate, statins, tumor necrosis factor inhibitors, interleukin-6 inhibitors, Janus kinase inhibitors, and cardiovascular disease.
Sodium-Glucose Co-transporter 2 Inhibitors in Patients with Heart Failure with Preserved Ejection Fraction: Proposed Mechanisms, Recent Evidence, and Clinical Implications
Authors: Plosker Aaron , Frishman WIlliam H.
Published: February 2023

Heart failure (HF) affects approximately 6 million Americans and is projected to increase in prevalence as the population ages. While progress has been made in the treatment of heart failure with reduced ejection fraction (HFrEF), treatments for heart failure with preserved ejection fraction (HFpEF) are few and far between. Since HFpEF makes up half of all heart failure cases, its management may be the biggest unmet need in cardiology. Results from the recent EMPEROR-Preserved trial are encouraging. After 26 months, patients with HFpEF who used the sodium-glucose co-transporter 2 inhibitor empagliflozin had a lower risk of hospitalization for HF than patients taking a placebo. However, the trial did not show empagliflozin to reduce the risk of cardiovascular death, unlike the EMPEROR-Reduced trial, in which empagliflozin was associated with a reduced risk of both cardiac death and hospitalization for patients with HFrEF. The outcomes of these trials highlight the dissimilarities between the two diseases. While HFrEF is mainly a disease of cardiomyocyte injury and systolic dysfunction, HFpEF is a multifactorial syndrome of inflammation and endothelial dysfunction stemming from chronic diseases like hypertension, diabetes and obesity. While trials of empagliflozin for HFpEF did not show a mortality benefit, sodium-glucose co-transporter 2 inhibitors are promising additions to the management of HFpEF for their effects on the disease’s risk factors through weight loss, natriuresis, blood pressure lowering, and glycemic control.
Impact of COVID-19 on Families with Children: Examining Sociodemographic Differences
Authors: Gissandaner Tre D. , Lim Crystal S. , Sarver Dustin E. , Brown Dustin , McCulloh Russell , Malloch Lacy , Annett Robert D.
Published: February 2023

Objective:

The COVID-19 pandemic has exacerbated differences related to employment and family psychological health. However, empirical evidence examining COVID-19–linked differences concerning children and families remains scant. This study addresses this gap by examining sociodemographic differences associated with COVID-19 on family access to resources and family psychological health.

Method:

A telephone survey of 600 caregivers living in Mississippi was conducted from August 2020 to April 2021. Caregivers answered questions about levels of worry regarding themselves or their child contracting COVID-19 and impact of the pandemic on household income, access to resources, and family psychological health.

Results:

Multivariate models demonstrated that Black caregivers (n = 273; 45.5%) had increased odds of agreeing that they worry about contracting COVID-19 (odds ratio [OR] = 2.57). Furthermore, as caregiver reported household annual income decreased, caregivers had increased odds of agreeing that they worry about contracting COVID-19 (OR = 1.16), lost job-related income (OR = 1.14), and had a hard time obtaining resources (OR = 1.16) because of the pandemic. No significant differences related to rural or urban residence were observed.

Conclusion:

The findings highlight the need for pragmatic responses that are attuned to differences by providing more equitable access to resources for families. The findings suggest that strategies addressing family worry, obtaining job-related income support, and helping families obtain tangible resources may positively affect family psychological health. As population changes in vaccination rates and COVID variants emerge, reassessment of family and community impact seems indicated. Limitations and future research directions are discussed.
An Introduction to Artificial Intelligence in Developmental and Behavioral Pediatrics
Authors: Aylward Brandon S. , Abbas Halim , Taraman Sharief , Salomon Carmela , Gal-Szabo Diana , Kraft Colleen , Ehwerhemuepha Louis , Chang Anthony , Wall Dennis P.
Published: February 2023

Technological breakthroughs, together with the rapid growth of medical information and improved data connectivity, are creating dramatic shifts in the health care landscape, including the field of developmental and behavioral pediatrics. While medical information took an estimated 50 years to double in 1950, by 2020, it was projected to double every 73 days. Artificial intelligence (AI)–powered health technologies, once considered theoretical or research-exclusive concepts, are increasingly being granted regulatory approval and integrated into clinical care. In the United States, the Food and Drug Administration has cleared or approved over 160 health-related AI-based devices to date. These trends are only likely to accelerate as economic investment in AI health care outstrips investment in other sectors. The exponential increase in peer-reviewed AI-focused health care publications year over year highlights the speed of growth in this sector. As health care moves toward an era of intelligent technology powered by rich medical information, pediatricians will increasingly be asked to engage with tools and systems underpinned by AI. However, medical students and practicing clinicians receive insufficient training and lack preparedness for transitioning into a more AI-informed future. This article provides a brief primer on AI in health care. Underlying AI principles and key performance metrics are described, and the clinical potential of AI-driven technology together with potential pitfalls is explored within the developmental and behavioral pediatric health context.
Microneedling in Combination With 15% Trichloroacetic Acid Peel Versus 25% Pyruvic Acid Peel in the Treatment of Acne Scars
Authors: Solanki Bhawna , Relhan Vineet , Sahoo Bijaylaxmi , Sarkar Rashmi , Choudhary Priya
Published: February 2023

BACKGROUND

Acne scars are a permanent disfiguring sequel of acne.

OBJECTIVE

To compare the efficacy of microneedling with 15% trichloroacetic acid (TCA) peel versus microneedling with 25% pyruvic acid peel in the management of postacne scars.

MATERIAL AND METHODS

Thirty patients with atrophic acne scars were randomized into 2 groups receiving microneedling on both sides of the face at 0,6, and 12 weeks and 15% TCA on one side and 25% pyruvic acid on other side at 3,9, and 15 weeks. Acne scar scoring performed using the Echelle D'Evaluation Clinique des Cicatrices D'Acne (ECCA) and visual analogue scales by patient and physician were used to grade improvement at all visits and at 21 weeks.

RESULTS

The mean ECCA score on the TCA side declined from 151.17 ± 26.90 to 138.83 ± 30.56 and on the pyruvic side declined from 151.83 ± 27.53 to 141.33 ± 28.92 after 21 weeks (statistically significant: p-value <.05). Comparing the ECCA on the TCA and pyruvic sides at 21 weeks was not significant. VAS showed moderate-to-marked improvement after 3 months in both groups.

CONCLUSION

In our study, the combination modality showed early reduction in rolling and boxcar compared with icepick scars. These peels led to improvement in overall texture of the skin, hence more patient satisfaction. On comparing ECCA, a significant difference was not observed.
Combination Approaches to Hand Rejuvenation: A Review of the Literature and Discussion
Authors: Chandan Neha , Puyana Carolina , Haber Roger
Published: February 2023

BACKGROUND

Various noninvasive/minimally invasive modalities for hand rejuvenation exist, and the efficacy and safety of these procedures as both monotherapy and same-day procedures is increasingly being studied.

OBJECTIVE

To review data on the efficacy and safety of hand rejuvenation modalities and suggest a practical combination approach for these procedures.

METHODS

The PubMed database was queried for peer-reviewed articles regarding hand rejuvenation techniques, including chemical peels, laser and light sources, sclerotherapy, autologous fat transfer, and injectable volumetric fillers.

RESULTS

Chemical peels have been studied the least, with most studies evaluating the use of fillers and laser/light-based devices. Most studies reported overall good results with high patient satisfaction. Satisfaction rates were lower in laser/light-based treatments compared with other modalities. Transient erythema, edema, or pain after procedures was common; most studies did not report serious postprocedure complications. Importantly, there was no significant increase in adverse effects after same-day procedures.

CONCLUSION

Using same-day procedures allows practitioners to address hand rejuvenation from different aspects, seems to improve outcomes, and reduces time spent in the office for patients. The authors suggest a practical framework for combining cosmetic approaches to achieve the most optimal outcome for hand rejuvenation.
Eyebrow Shape Preference Across Age, Gender, and Self-reported Ethnic Group
Authors: Richer Vincent , Berkowitz Jonathan , Trindade de Almeida Ada
Published: February 2023

BACKGROUND

Preference in eyebrow shape has been studied in young women, but less so in older adults, men, and a wide variety of ethnic groups.

OBJECTIVE

To identify preference in eyebrow shape across age groups, genders, and ethnic groups for both the survey responder and the observed subject.

METHODS

Digital images of subjects from 3 age groups (18–39, 40–59, and 60+ years), 2 genders (female and male), and 4 self-identified ethnic backgrounds (“Asian,” “Black,” “Latinx,” and “White”) were edited to correspond to 5 brow shapes (Anastasia, head-up, horizontal, rounded, and tail-up). Panels of images representing the same subject with different brow shapes were displayed and responders ranked them in order of attractiveness via an online survey.

RESULTS

Six hundred fifty-two responders answered the survey. Survey responders generally preferred the Anastasia shape, but not in all subgroups. Strength of preference in eyebrow shape was more marked when observing images of women and less marked when observing men.

CONCLUSION

An arched brow, such as the Anastasia shape, was the preferred eyebrow shape. This study is limited by its survey nature, underrepresentation of self-identified Black study responders, and categorization of data. Despite these findings, the authors advocate determining eyebrow shape preference individually with patients during cosmetic consultations.