bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic value of automated assessment of interstitial lung disease on CT in systemic sclerosis
Authors: Le Gall Aëlle , Hoang-Thi Trieu-Nghi , Porcher Raphaël , Dunogué Bertrand , Berezné Alice , Guillevin Loïc , Le Guern Véronique , Cohen Pascal , Chaigne Benjamin , London Jonathan , Groh Matthieu , Paule Romain , Chassagnon Guillaume , Vakalopoulou Maria , Dinh-Xuan Anh-Tuan , Revel Marie Pierre , Mouthon Luc , Régent Alexis
Published: April 2023

Objective

Stratifying the risk of death in SSc-related interstitial lung disease (SSc-ILD) is a challenging issue. The extent of lung fibrosis on high-resolution CT (HRCT) is often assessed by a visual semiquantitative method that lacks reliability. We aimed to assess the potential prognostic value of a deep-learning–based algorithm enabling automated quantification of ILD on HRCT in patients with SSc.

Methods

We correlated the extent of ILD with the occurrence of death during follow-up, and evaluated the additional value of ILD extent in predicting death based on a prognostic model including well-known risk factors in SSc.

Results

We included 318 patients with SSc, among whom 196 had ILD; the median follow-up was 94 months (interquartile range 73–111). The mortality rate was 1.6% at 2 years and 26.3% at 10 years. For each 1% increase in the baseline ILD extent (up to 30% of the lung), the risk of death at 10 years was increased by 4% (hazard ratio 1.04, 95% CI 1.01, 1.07, P = 0.004). We constructed a risk prediction model that showed good discrimination for 10-year mortality (c index 0.789). Adding the automated quantification of ILD significantly improved the model for 10-year survival prediction (P = 0.007). Its discrimination was only marginally improved, but it improved prediction of 2-year mortality (difference in time-dependent area under the curve 0.043, 95% CI 0.002, 0.084, P = 0.040).

Conclusion

The deep-learning–based, computer-aided quantification of ILD extent on HRCT provides an effective tool for risk stratification in SSc. It might help identify patients at short-term risk of death.
Life stress and suicidality mediated by insomnia and depressive symptoms in adolescents: a three-wave longitudinal study
Authors: Liu Xianchen , Yang Yanyun , Liu Zhen-Zhen , Jia Cun-Xian
Published: April 2023

Study Objectives

Little empirical work has investigated the associations between life stress (LS), insomnia, depression, and suicidality in multi-wave longitudinal studies. With three waves of data collection 1-year apart, this longitudinal study with a large sample of adolescents examined the predicting effects of LS on suicidality 1-year later and 2 years later and the mediating roles of insomnia and depression in the LS-suicidality link.

Methods

A total of 6995 adolescents (mean age = 14.86 years, 51.4% male) participated in a three-wave longitudinal study of behavior and health in Shandong, China. A self-administered structured questionnaire and standardized scales were used to assess suicidality (including suicidal thought [ST], suicide plan [SP], and suicide attempt [SA]), LS, insomnia, and depression in 2015 (T1), 1-year later (T2), and 2 years later (T3). Mediation effects were examined with path models.

Results

The overall prevalence rates of past-year suicidality were 13.4% at T1, 10.0% at T2, and 9.5% at T3, respectively. The prevalence rates of suicidality across T1–T3 significantly increased with elevated levels of baseline LS, insomnia, and depression (p < .001). Path models indicated that the relationship between baseline LS and suicidal ideation (i.e., ST/SP) 2 years later was significantly mediated by both insomnia and depression. Depression was also a significant mediator between LS and SA.

Conclusions

LS is a significant predictor of suicidality 1–2 years later in adolescents. Depression mediates the association between LS and suicidal ideation and suicide attempt while insomnia appears to be a mediator for suicidal ideation rather than suicide attempt.
Identifying Climatic Drivers of Hybridization with a New Ancestral Niche Reconstruction Method
Authors: Folk Ryan A , Gaynor Michelle L , Engle-Wrye Nicholas J , O’Meara Brian C , Soltis Pamela S , Soltis Douglas E , Guralnick Robert P , Smith Stephen A , Grady Charles J , Okuyama Yudai
Published: April 2023

Applications of molecular phylogenetic approaches have uncovered evidence of hybridization across numerous clades of life, yet the environmental factors responsible for driving opportunities for hybridization remain obscure. Verbal models implicating geographic range shifts that brought species together during the Pleistocene have often been invoked, but quantitative tests using paleoclimatic data are needed to validate these models. Here, we produce a phylogeny for Heuchereae, a clade of 15 genera and 83 species in Saxifragaceae, with complete sampling of recognized species, using 277 nuclear loci and nearly complete chloroplast genomes. We then employ an improved framework with a coalescent simulation approach to test and confirm previous hybridization hypotheses and identify one new intergeneric hybridization event. Focusing on the North American distribution of Heuchereae, we introduce and implement a newly developed approach to reconstruct potential past distributions for ancestral lineages across all species in the clade and across a paleoclimatic record extending from the late Pliocene. Time calibration based on both nuclear and chloroplast trees recovers a mid- to late-Pleistocene date for most inferred hybridization events, a timeframe concomitant with repeated geographic range restriction into overlapping refugia. Our results indicate an important role for past episodes of climate change, and the contrasting responses of species with differing ecological strategies, in generating novel patterns of range contact among plant communities and therefore new opportunities for hybridization. The new ancestral niche method flexibly models the shape of niche while incorporating diverse sources of uncertainty and will be an important addition to the current comparative methods toolkit. [Ancestral niche reconstruction; hybridization; paleoclimate; pleistocene.]
Gender as a social and structural variable: research perspectives from the National Institutes of Health (NIH)
Authors: Barr Elizabeth , Popkin Ronna , Roodzant Erik , Jaworski Beth , Temkin Sarah M
Published: April 2023

Gender is a social and structural variable that encompasses multiple domains, each of which influences health: gender identity and expression, gender roles and norms, gendered power relations, and gender equality and equity. As such, gender has far-reaching impacts on health. Additional research is needed to continue delineating and untangling the effects of gender from the effects of sex and other biological variables. The National Institutes of Health (NIH) vision for women’s health is a world in which the influence of sex and/or gender are integrated into the health research enterprise. However, much of the NIH-supported research on gender and health has, to date, been limited to a small number of conditions (e.g., HIV, mental health, pregnancy) and locations (e.g., sub-Saharan Africa; India). Opportunities exist to support transdisciplinary knowledge transfer and interdisciplinary knowledge building by advancing health-related social science research that incorporates best practices from disciplines that have well-established methods, theories, and frameworks for examining the health impacts of gender and other social, cultural, and structural variables.
Exposure to quasi-ultrafine particulate matter accelerates memory impairment and Alzheimer’s disease-like neuropathology in the AppNL-G-F knock-in mouse model
Authors: Kilian Jason G , Mejias-Ortega Marina , Hsu Heng-Wei , Herman David A , Vidal Janielle , Arechavala Rebecca J , Renusch Samantha , Dalal Hansal , Hasen Irene , Ting Amanda , Rodriguez-Ortiz Carlos J , Lim Siok-Lam , Lin Xiaomeng , Vu Joan , Saito Takashi , Saido Takaomi C , Kleinman Michael T , Kitazawa Masashi
Published: April 2023

Exposure to traffic-related air pollution consisting of particulate matter (PM) is associated with cognitive decline leading to Alzheimer’s disease (AD). In this study, we sought to examine the neurotoxic effects of exposure to ultrafine PM and how it exacerbates neuronal loss and AD-like neuropathology in wildtype (WT) mice and a knock-in mouse model of AD (AppNL-G-F/+-KI) when the exposure occurs at a prepathologic stage or at a later age with the presence of neuropathology. AppNL-G-F/+-KI and WT mice were exposed to concentrated ultrafine PM from local ambient air in Irvine, California, for 12 weeks, starting at 3 or 9 months of age. Particulate matter-exposed animals received concentrated ultrafine PM up to 8 times above the ambient levels, whereas control animals were exposed to purified air. Particulate matter exposure resulted in a marked impairment of memory tasks in prepathologic AppNL-G-F/+-KI mice without measurable changes in amyloid-β pathology, synaptic degeneration, and neuroinflammation. At aged, both WT and AppNL-G-F/+-KI mice exposed to PM showed a significant memory impairment along with neuronal loss. In AppNL-G-F/+-KI mice, we also detected an increased amyloid-β buildup and potentially harmful glial activation including ferritin-positive microglia and C3-positive astrocytes. Such glial activation could promote the cascade of degenerative consequences in the brain. Our results suggest that exposure to PM impairs cognitive function at both ages while exacerbation of AD-related pathology and neuronal loss may depend on the stage of pathology, aging, and/or state of glial activation. Further studies will be required to unveil the neurotoxic role of glial activation activated by PM exposure.
A Global Review of the Perioperative Care of Patients With Aneurysmal Subarachnoid Hemorrhage Undergoing Microsurgical Repair of Ruptured Intracerebral Aneurysm
Authors: Lele Abhijit V. , Shiferaw Ananya Abate , Theard Marie Angele , Vavilala Monica S. , Tavares Cristiane , Han Ruquan , Assefa Denekew , Dagne Alemu Mihret , Mahajan Charu , Tandon Monica S. , Karmarkar Neeta V. , Singhal Vasudha , Lamsal Ritesh , Athiraman Umeshkumar ,   Global-SAH project collaborators
Published: April 2023

Introduction:

To describe the perioperative care of patients with aneurysmal subarachnoid hemorrhage (aSAH) who undergo microsurgical repair of a ruptured intracerebral aneurysm.

Methods:

An English language survey examined 138 areas of the perioperative care of patients with aSAH. Reported practices were categorized as those reported by <20%, 21% to 40%, 41% to 60%, 61% to 80%, and 81% to 100% of participating hospitals. Data were stratified by Worldbank country income level (high-income or low/middle-income). Variation between country-income groups and between countries was presented as an intracluster correlation coefficient (ICC) and 95% confidence interval (CI).

Results:

Forty-eight hospitals representing 14 countries participated in the survey (response rate 64%); 33 (69%) hospitals admitted ≥60 aSAH patients per year. Clinical practices reported by 81 to 100% of the hospitals included placement of an arterial catheter, preinduction blood type/cross match, use of neuromuscular blockade during induction of general anesthesia, delivering 6 to 8 mL/kg tidal volume, and checking hemoglobin and electrolyte panels. Reported use of intraoperative neurophysiological monitoring was 25% (41% in high-income and 10% in low/middle-income countries), with variation between Worldbank country-income group (ICC 0.15, 95% CI 0.02–2.76) and between countries (ICC 0.44, 95% CI 0.00–0.68). The use of induced hypothermia for neuroprotection was low (2%). Before aneurysm securement, variable in blood pressure targets was reported; systolic blood pressure 90 to 120 mm Hg (30%), 90 to 140 mm Hg (21%), and 90 to 160 mmHg (5%). Induced hypertension during temporary clipping was reported by 37% of hospitals (37% each in high and low/middle-income countries).

Conclusions:

This global survey identifies differences in reported practices during the perioperative management of patients with aSAH.
High Complication Rate After Percutaneous Screw Fixation for Valgus-Impacted Femoral Neck Fractures Without Sagittal Malalignment
Authors: Gaski Greg E. , Altman Kyle , Lear Taylor , Prodoehl Julia , Tanner Stephanie , Wang Angela , Hymes Robert A. , Hunter Brett , Adams John D.
Published: April 2023

Objectives:

To evaluate the rate of reoperation in patients without sagittal plane malalignment who underwent percutaneous screw fixation of a valgus-impacted femoral neck fracture.

Design:

Retrospective case series.

Setting:

Two Level 1 academic trauma centers.

Patients and Intervention:

Two hundred seven patients >50 years of age with valgus-impacted femoral neck fractures treated with at least 3 large-diameter (>6.5 mm) cancellous screws from 2013 to 2019. Patients were excluded if there was a sagittal plane fracture deformity.

Main Outcome Measurements:

The primary outcome was reoperation. Secondary outcomes considered “major complications” included: avascular necrosis, varus collapse or implant cutout, nonunion, deep infection, and hematoma requiring reoperation. Surgical fixation strategies (screw configuration, aim) and implant type (partial vs. fully threaded cancellous screws) were secondarily compared.

Results:

Average patient age was 77 years, and median clinical follow-up was 658 days. Thirty-one patients (15%) required reoperation, and the major complication rate was 17.3% (36 complications in 33 patients). Logistic regression analysis demonstrated a higher risk of reoperation with constructs consisting of all partially threaded screws (17.0%) compared with the use of at least 1 fully threaded screw (7.5%) when an inverted triangle configuration was used (odds ratio, 2.50; 95% CI, 0.81–7.77).

Conclusions:

This study demonstrated a relatively high rate of reoperation and major complications in patients with valgus-impacted femoral neck fractures without sagittal malalignment treated with in situ percutaneous screw fixation.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Comparison of Fixation Techniques for Lower Extremity Rotationplasty
Authors: Sullivan Mikaela H. , Arguello Alexandra M. , Stans Anthony A. , Milbrandt Todd A. , Rose Peter S. , Shaughnessy William J. , Houdek Matthew T.
Published: April 2023

Background:

Rotationplasty is a reconstructive, limb-sparing surgery indicated for patients with lower extremity musculoskeletal tumors. The procedure involves rotation of the distal lower extremity to allow the ankle to function as the new knee joint and provide an optimum weight-bearing surface for prosthetic use. Historically there is limited data comparing fixation techniques. The purpose of this study is to compare clinical outcomes between intramedullary nailing (IMN) and compression plating (CP) in young patients undergoing rotationplasty.

Methods:

A retrospective review of 28 patients with a mean age of 10±4 years undergoing a rotationplasty for either a femoral (n=19), tibial (n=7), or popliteal fossa (n=2) tumor was performed. The most common diagnosis was osteosarcoma (n=24). Fixation was obtained with either an IMN (n=6) or CP (n=22). Clinical outcomes of patients undergoing rotationplasty were compared between the IMN and CP groups.

Results:

Surgical margins were negative in all patients. The mean time to union was 24 months (range 6 to 93). There was no difference in the meantime to the union between patients treated with an IMN versus those with a CP (14±16 vs. 27±26 mo, P=0.26). Patients undergoing fixation with an IMN were less likely to have a nonunion (odds ratio: 0.35, 95% confidence interval: 0.03-3.54, P=0.62). Postoperative fracture of the residual limb only occurred in patients undergoing CP fixation (n=7, 33% vs. n=0, 0%, P=0.28). Postoperative fixation complications occurred in 13 (48%) patients, most commonly a nonunion (n=9, 33%). Patients undergoing fixation with a CP were more likely to have a postoperative fixation complication (odds ratio: 20, 95% CI: 2.14-186.88, P<0.01).

Conclusions:

Rotationplasty is an option for limb salvage for young patients with lower extremity tumors. The results of this study reveal fewer fixation complications when an IMN can be used. As such, IMN fixation should be considered for patients undergoing a rotationplasty, though equipoise should be shown by surgeons when determining technique.
Bariatric Surgery Before Spine Surgery is Associated with Fewer Post-Surgical Complications
Authors: Gupta Sahil , Tao Xu , Matur Abhijith V. , Wu Andrew , Chilakapati Sai S. , Palmisciano Paolo , Conteh Fatu S. , Duah Henry O. , Shukla Geet , Vorster Phillip , Garcia-Vargas Julia , Kwan David , Adogwa Owoicho
Published: April 2023

Study Design.

Systematic review and meta-analysis.

Objective.

To perform a systematic review and meta-analysis investigating the rate of adverse events after spine surgery in patients who underwent bariatric surgery.

Summary of Background Data.

Obesity is an established risk factor for post-operative complications after spine surgery. Bariatric surgery has been associated with improvements in health in patients with severe obesity. However, it is not known whether undergoing bariatric surgery prior to spine surgery is associated with reduced adverse outcomes.

Methods.

PubMed, EMBASE, Scopus, and Web-of-Science were systematically searched according to PRISMA guidelines. The search included indexed terms and text words from database inception to the date of the search (May 27th, 2022). Data and estimates were pooled using the Mantel-Haenszel method for random-effects meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute risk of bias tool. The primary outcome was all-cause complication rate after surgery. Relative risks for surgical and medical complications were assessed.

Results.

A total of 4 studies comprising 177,273 patients were included. The pooled analysis demonstrated that all-cause medical complication rate after spine surgery was lower in patients undergoing bariatric surgery (RR: 0.54, 95% CI: [0.39, 0.74], P<0.01). There was no difference in rates of surgical complications and 30-day hospital readmission rate between the cohort undergoing bariatric surgery prior to spine surgery and the cohort that did not.

Conclusion.

These analyses suggest that obese patients undergoing bariatric surgery prior to spine surgery have significantly lower adverse events rates. Future prospective studies are needed to corroborate these findings.

Level of Evidence.

IV
Response to pre-operative Steroid Injections Predicts Surgical Outcomes in Patients Undergoing Fusion for Isthmic Spondylolisthesis
Authors: Turtle Joel , Randell Zane , Karamian Brian , Spiker Ryan , Lawrence Brandon , Brodke Darrel , Spina Nicholas
Published: April 2023

Study Design.

Retrospective Cohort Study

Objective.

The decision to pursue operative intervention for patients with isthmic spondylolisthesis is complex. While steroid injections are a well-accepted therapeutic modality that may delay or obviate surgery, little is known regarding their ability to predict surgical outcomes.

Summary of Background Data.

Here we examine whether improvement following pre-operative steroid injections can accurately predict clinical outcomes after surgery.

Materials and Methods.

A retrospective cohort analysis was performed on adult patients undergoing primary posterolateral lumbar fusion for isthmic spondylolisthesis between 2013 and 2021. Data were stratified into a control (no pre-operative injection) group and an injection group (received a pre-operative diagnostic and therapeutic injection). We collected demographic data, peri-injection VAS pain scores, PROMIS pain interference (PI) and physical function (PF) scores, ODI, and VAS pain (back and leg). Student t test was utilized to compare baseline group characteristics. Linear regression was performed comparing changes in peri-injection VAS pain scores and post-operative measures.

Results.

73 patients did not receive a pre-operative injection and were included in the control group. 59 patients were included in the injection group. Of patients who received an injection, 73% had greater than 50% relief of their pre-injection VAS pain score. Linear regression revealed a positive interaction between the injection efficacy and post-operative pain relief as measured by VAS leg scores (P<0.05). There was also an association between injection efficacy and back pain relief, though this did not achieve statistical significance (P=0.068). No association was found between injection efficacy and improvement in ODI nor PROMIS measures.

Conclusions.

Steroid injections are often utilized in the non-operative therapeutic management of patients with lumbar spine disease. Here, we demonstrate the diagnostic value of steroid injections in predicting post-operative leg pain relief in patients undergoing posterolateral fusion for isthmic spondylolisthesis.
Long COVID in Cancer
Authors: Fankuchen Olivia , Lau Jennifer , Rajan Mangala , Swed Brandon , Martin Peter , Hidalgo Manuel , Yamshon Samuel , Pinheiro Laura , Shah Manish A.
Published: April 2023

Objectives:

The long-term effects of severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) infection in patients with cancer are unknown. We examined 1-year mortality and prevalence of long COVID in patients with and without cancer after initial hospitalization for acute COVID-19 infection.

Methods:

We previously studied 585 patients hospitalized from March to May 2020 with acute COVID-19 infection at Weill Cornell Medicine (117 patients with cancer and 468 age, sex, and comorbidity-matched non-cancer controls). Of the 456 patients who were discharged, we followed 359 patients (75 cancer and 284 non-cancer controls) for COVID-related symptoms and death, at 3, 6, and 12 months after initial symptom onset. Pearson χ2 and Fisher exact tests were used to determine associations between cancer, postdischarge mortality, and long COVID symptoms. Multivariable Cox proportional hazards models adjusting for potential confounders were used to quantify the risk of death between patients with and without cancer.

Results:

The cancer cohort had higher mortality after hospitalization (23% vs 5%, P < 0.001), a hazard ratio of 4.7 (95% CI: 2.34-9.46) for all-cause mortality, after adjusting for smoking and oxygen requirement. Long COVID symptoms were observed in 33% of patients regardless of cancer status. Constitutional, respiratory, and cardiac complaints were the most prevalent symptoms in the first 6 months, whereas respiratory and neurological complaints (eg, “brain fog” and memory deficits) were most prevalent at 12 months.

Conclusions:

Patients with cancer have higher mortality after hospitalization for acute severe acute respiratory syndrome coronavirus 2 infections. The risk of death was highest in the first 3 months after discharge. About one-third of all patients experienced long COVID.
Melanocytic Matricoma With Atypical Histopathological Features: A Case Report of an Extremely Rare Entity and Review of the Literature
Authors: Nogales-Moro Adrián , Pinilla-Pagnon Ignacio , Silvestre-Torner Nicolás , Romero-Jiménez Belén , García de Casasola-Rodríguez Gonzalo , Chao-Crecente Montserrat
Published: April 2023

Melanocytic matricoma with atypical features is a rare, biphasic adnexal neoplasm displaying hair matrix differentiation, with only 3 reported cases worldwide. Generally, the lesion comprised a solid matrical and supramatrical cell proliferation, admixed with intermediate cell aggregates with sparse anucleated “shadow cells” and a prominent pigmented melanocytic hyperplasia. We report the case of a 78-year-old man with a slow-growing crusted lesion on the frontal left scalp, which in a matter of 1–2 months became a 0.6 cm well-defined, black purplish exophytic nodule. Histopathologically, the lesion presented a well-circumscribed border with a nodular dermal growth pattern, presenting different architectural features varying from benign pilomatricoma-like changes to atypical features such as moderate-to-high nuclear pleomorphism in both basaloid (matrical/supramatrical) and epidermal (keratinous) components. Strong nuclear and cytoplasmic positivity for β-catenin was observed in matrical cells, whereas prominent cytoplasmic membrane positivity for Melan-A in dendritic melanocytes. Owing to the evidence of atypical cytological features, we propose the “atypical/borderline” category of melanocytic matricoma as part of a possible spectrum among matrical neoplasms. Pathologists should be aware of any atypical histopathological features while reporting cases due to their potential malignant transformation.
Central Centrifugal Cicatricial Alopecia Associated With PDL1 Loss and Increased Expression of Caspase 3: A Case Series
Authors: Smith Shane D. B. , Woddor Navitha , Cassarino David S. , Chen Wen , Clemetson Nashay , Nava Victor E.
Published: April 2023

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia that disproportionately affects patients with skin of color. Genetic studies have revealed that approximately 30% of CCCAs are associated with peptidyl arginine deiminase 3 misfolding mutations. Patients with CCCA usually have a poor prognosis with progressive and permanent hair loss. To further characterize CCCA, we evaluated the inflammatory milieu, PDL1, and caspase 3 expression. The data support the idea of CCCA being a CD4-predominant T-cell process. The loss of PDL1 and increase in caspase 3 expression raises the possibility of involvement of the PD1/PDL1 pathway in CCCA.
Surgery of Severe Cauliflower Ear Deformity
Authors: Putri Indri Lakhsmi , Bogari Melia , Khoirunnisa Auliai , Dhafin Faizal Rezky , Kuswanto Djoko
Published: April 2023

A cauliflower ear is an auricular deformity characterized by thickened soft tissue and cartilage. A subperichondrial hematoma or fluid collection causes this malformation. As a result of being cut off from the perichondrium blood supply, the ear cartilage becomes ischemic, developing scar tissue, fibrous tissue, new cartilage overgrowth, or necrosis beneath the skin, resulting in a permanent alteration in the shape of the external ear resembling that of a cauliflower. To properly fix defects, the surgeon must grasp ear anatomy and be familiar with a variety of reconstructive alternatives. It requires meticulous attention, due to the intricate design of the ear. Simple and complex techniques for treating cauliflower ears have been developed. However, in severe cases, simple techniques are often insufficient. As a result, complex techniques such as replacement with an auricular prosthesis or implant or autogenous costal cartilage framework were developed. We present a case of a 25-year-old man who experienced a severe cauliflower ear as a result of an infection during adolescence. The patient was concerned about the shape of his ear and was depressed. Ear reconstruction was accomplished using the costal cartilage framework engraved according to a three-dimensional cutting guide for surgical planning. Costal cartilage is chosen to provide a framework for reconstruction as it is strong and rigid, and its curved shape is similar to that of the external ear. There were no complications after surgery. The ear projection and shape have performed admirably. The patient was pleased with the outcome and felt more confident after surgery.
Resilience Room Use and Its Effect on Distress Among Nurses and Allied Staff
Authors: Prendergast Virginia , Elmasry Sandra , Juhl Natasha A. , Chapple Kristina M.
Published: April 2023

BACKGROUND: Nationwide nursing shortages have spurred nursing research on burnout and resiliency to better understand the emotional health of nurses and allied staff to retain talent. Our institution implemented resilience rooms in the neuroscience units of our hospital. The goal of this study was to evaluate the effects of resilience room use on emotional distress among staff. METHODS: Resilience rooms opened to staff in the neuroscience tower in January 2021. Entrances were electronically captured via badge readers. Upon exit, staff completed a survey containing items on demographics, burnout, and emotional distress. RESULTS: Resilience rooms were used 1988 times, and 396 surveys were completed. Rooms were most used by intensive care unit nurses (40.1% of entrances), followed by nurse leaders (28.8%). Staff with >10 years of experience accounted for 50.8% of uses. One-third reported moderate burnout, and 15.9% reported heavy or extreme burnout. Overall, emotional distress decreased by 49.4% from entrance to exit. The greatest decreases in distress were recorded by those with the lowest levels of burnout (72.5% decrease). CONCLUSION: Resilience room use was associated with significant decreases in emotional distress. The greatest decreases occurred with the lowest levels of burnout, suggesting that early engagement with resilience rooms is most beneficial.
Why We Left: A Qualitative Investigation of Former Physician Assistant Faculty
Authors: Graham-Burnet Karen
Published: April 2023

Introduction

In an era of rapid professional growth, retaining a workforce of career physician assistant (PA) educators is crucial; yet, PA education has historically struggled with faculty retention. The purpose of this study was to examine the lived experiences of PAs who have left academia in order to better understand PA faculty attrition.

Methods

Purposeful sampling was used to identify PAs who had recently left academic positions, with recruitment continuing until thematic saturation was reached. A total of 18 semi-structured interviews were conducted via phone or email, and a thematic qualitative analysis of the transcripts was completed.

Results

Ineffective leadership, unsustainable workloads, inadequate mentorship or training, erroneous expectations of academic work, and a “pull” back to clinical practice emerged as dominant themes in participants' decisions to leave academia. Ineffective leadership was an issue at both the program and the institutional level, resulting in feelings of inadequate institutional support. The availability of clinical jobs facilitated attrition decisions by providing an easily accessible exit from academia.

Discussion

This research provides a model for understanding PA faculty attrition and has implications for retention. Effective program leadership that supports new faculty development, creates sustainable workloads, and advocates for the program within the institution has a significant role in faculty retention. Leadership development should be a priority for the profession and is vital to securing a PA education workforce. A limitation of this study is that the data were collected prepandemic, so the impact of recent cultural and institutional changes is unknown.
Validation of the AViTA BPM636 upper arm blood pressure monitor in adults and pregnant women according to the ANSI/AAMI/ISO 81060-2:2013
Authors: Lee Chien-Nan , Wu Cho-Kai , Huang I-Chih
Published: April 2023

Objective

To evaluate the accuracy of the AViTA oscillometric upper arm home blood pressure (BP) monitor in adult and pregnant populations according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/ International Organization for Standardization (ANSI/AAMI/ISO) Universal Standard (ISO 81060-2:2013).

Methods

BP measurements on the upper arm were performed on 85 adult subjects and 46 pregnant subjects. The AViTA BPM636 and a standard mercury reference sphygmomanometer were applied and followed the same arm sequential BP measurement method. The universal cuff of the test device was used for arm circumference of 22–42 cm.

Results

For validation criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 1.1 ± 5.49/2.9 ± 5.17 mmHg (systolic/diastolic) for adults; and -2.2 ± 5.93/1.5 ± 4.92 mmHg (systolic/diastolic) for pregnant women. For criterion 2, the SD of the averaged BP differences between the test device and reference BP per adult subject was 4.45/4.20 mmHg (systolic/diastolic) and per pregnant women was 4.66/3.96.

Conclusion

The AViTA BPM636 had passed the criteria of the ANSI/AAMI/ISO 81060-2:2013 protocol and can be recommended for home BP measurements in adults and pregnant populations.
Calcium phosphate microcrystallopathy as a paradigm of chronic kidney disease progression
Authors: Kuro-o Makoto
Published: April 2023

Purpose of review

Calciprotein particles (CPP) are colloidal mineral–protein complexes mainly composed of solid-phase calcium phosphate and serum protein fetuin-A. CPP appear in the blood and renal tubular fluid after phosphate intake, playing critical roles in (patho)physiology of mineral metabolism and chronic kidney disease (CKD). This review aims at providing an update of current knowledge on CPP.

Recent findings

CPP formation is regarded as a defense mechanism against unwanted growth of calcium phosphate crystals in the blood and urine. CPP are polydisperse colloids and classified based on the density and crystallinity of calcium phosphate. Low-density CPP containing amorphous (noncrystalline) calcium phosphate function as an inducer of FGF23 expression in osteoblasts and a carrier of calcium phosphate to the bone. However, once transformed to high-density CPP containing crystalline calcium phosphate, CPP become cytotoxic and inflammogenic, inducing cell death in renal tubular cells, calcification in vascular smooth muscle cells, and innate immune responses in macrophages.

CPP potentially behave like a pathogen that causes renal tubular damage, chronic inflammation, and vascular calcification. CPP have emerged as a promising therapeutic target for CKD and cardiovascular complications.
Kidney stones, hypercalciuria, and recent insights into proximal tubule calcium reabsorption
Authors: Alexander R. Todd
Published: April 2023

Purpose of review

Most kidney stones are composed of calcium, and the greatest risk factor for kidney stone formation is hypercalciuria. Patients who form kidney stones often have reduced calcium reabsorption from the proximal tubule, and increasing this reabsorption is a goal of some dietary and pharmacological treatment strategies to prevent kidney stone recurrence. However, until recently, little was known about the molecular mechanism that mediates calcium reabsorption from the proximal tubule. This review summarizes newly uncovered key insights and discusses how they may inform the treatment of kidney stone formers.

Recent findings

Studies examining claudin-2 and claudin-12 single and double knockout mice, combined with cell culture models, support complementary independent roles for these tight junction proteins in contributing paracellular calcium permeability to the proximal tubule. Moreover, a family with a coding variation in claudin-2 causing hypercalciuria and kidney stones have been reported, and reanalysis of Genome Wide Association Study (GWAS) data demonstrates an association between noncoding variations in CLDN2 and kidney stone formation.

The current work begins to delineate the molecular mechanisms whereby calcium is reabsorbed from the proximal tubule and suggests a role for altered claudin-2 mediated calcium reabsorption in the pathogenesis of hypercalciuria and kidney stone formation.
Sumac
Authors: Singletary Keith W.
Published: April 2023

The spice sumac is prepared from the fruit of the small deciduous tree Rhus coriaria L. (family Anacardiaceae), cultivated mainly in the Mediterranean region, North Africa, and the Middle East. The genus Rhus contains well over a hundred individual species of flowering plants, some varieties of which are edible, including not only R. coriaria but also R. glabra L. (or smooth sumac) used by the indigenous peoples of North America, Rhus typhina L. (staghorn sumac), and R. aromatica Aiton (fragrant sumac), among others. In the Middle East and Turkey, sumac is commonly included in food preparations to impart a tangy, citruslike flavor. Primarily in the Middle East, sumac is used extensively in traditional medicine. Sumac extracts may be used to treat diarrhea, diseases of the mouth and throat, gastrointestinal distress, inflammatory conditions of the skin, and pain, to name a few. Recent human studies examining the potential health benefits of sumac are limited and mainly explore the actions of R. coriaria toward cardiometabolic risk factors. This narrative overview summarizes these clinical trials, as well as relevant, associated animal experiments, and suggests opportunities for future research.
Direct trans-vestibular feminization thyroid laryngochondroplasty
Authors: Neiderman Narin N Carmel , Arbel Shimrit , Diamant Noa , Wolfman Karin , Yanko Ravit , Lior Yotam , Kidron Anat , Ianculovici Clariel , Kleinman Shlomo , Oestreicher-Kedem Yael
Published: April 2023

Background:

Feminization laryngochondroplasty (FLC) evolved from a midcervical incision to a submental less visible incision. This scar may be unacceptable to the patient since it bears witness to gender reassignment. An endoscopic transoral approach to FLC inspired by transoral endoscopic thyroidectomy was recently suggested to avoid the neck scar, however, it requires special equipment and has a long learning curve. A vestibular incision is used to approach the chin in lower-third facial feminization surgery. We propose that this incision may be extended to the thyroid cartilage in performing direct FLCs. We describe a novel minimally invasive, direct trans-vestibular use of the chin reshaping incision, and describe our experience with it.

Methods:

The medical records of all patients who underwent direct trans-vestibular FLC (DTV-FLC) from December 2019 to September 2021 were retrieved and reviewed for this retrospective cohort study. Data on the operative, postoperative and follow-up courses, complications, and functional and cosmetic results were retrieved.

Results:

Nine transgender females were included. Seven DTV-FLCs were performed during lower-third facial feminization surgery and two were isolated DTV-FLCs. One was a revision DTV-FLC. Transient minor complications were encountered and resolved by the postoperative visit at 1-2 months. Vocal fold function and voice quality remained intact. Eight available patients were satisfied with the surgical results. A blinded assessment by eight plastic surgeons determined that seven procedures were successful.

Conclusions:

The novel DTV-FTLC approach either in isolation or as part of lower-third facial feminization surgery facilitated scar-free FLC with satisfactory cosmetic and functional results.
Neurofibromatosis type II and facial paralysis - clinical evaluation and management.
Authors: Mohanty Ahneesh J. , DeVahl Julie , Kutz Walter J. , Rozen Shai M.
Published: April 2023

Background:

Facial paralysis secondary to neurofibromatosis type 2 (NF2) presents the reconstructive surgeon with unique challenges due to its pathognomonic feature of bilateral acoustic neuromas, involvement of multiple cranial nerves, and use of antineoplastic agents in its management. Facial reanimation literature on managing this patient population is scant.

Methods:

A comprehensive literature review was performed. All patients with NF2-related facial paralysis who presented in the last 13 years were retrospectively reviewed for type and degree of paralysis, NF2 sequelae, number of cranial nerves involved, interventional modalities, and surgical notes.

Results:

12 patients with NF2-related facial paralysis were identified. All patients presented after resection of vestibular schwannoma. Mean duration of weakness prior to surgical intervention was 8 months. On presentation, 1 patient suffered bilateral facial weakness, 11 had multiple cranial nerves involvement, and 7 were treated with antineoplastic agents. 2 patients underwent gracilis free functional muscle transfer, 5 underwent masseteric-to-facial nerve transfer, of whom 2 were dually innervated with a cross facial nerve graft, and 1 patient underwent depressor anguli oris myectomy. Trigeminal schwannomas did not affect reconstructive outcomes if trigeminal nerve motor function on clinical exam was normal. Additionally, antineoplastic agents such as bevacizumab and temsirolimus did not affect outcomes if stopped in the perioperative period.

Conclusions:

Effectively managing patients with NF2-related facial paralysis necessitates understanding the progressive and systemic nature of the disease, bilateral facial nerve and multiple cranial nerve involvement, and common antineoplastic treatments. Neither antineoplastic agents nor trigeminal nerve schwannomas associated with normal exam, affected outcomes.
Perforator-Based Cross Midline Flaps of the Trunk: A Paradigm Shift in Flap Design
Authors: Angrigiani Claudio , Rancati Alberto , Nahabedian Maurice Y. , Spinelli Esteban , Breppe Pablo , Rancati Agustin
Published: April 2023

Introduction:

The traditional design for truncal perforator flaps are ipsilateral without midline decussation. The presumed rational is to minimize the risk of distal flap necrosis. In this paper we present our experience and results contralateral truncal perforator flaps designed and raised crossing the midline.

Methods:

This retrospective analysis included 43 patients (25 men and 18 women) who underwent reconstructive surgery from 1984 to 2021 using a contralateral flap design crossing the midline in the anterior trunk and upper back. Considerations included: pathology, location, as well as the dimensions of the defect and flap. An arithmetic and weighted mean with their 95% CI was estimated to compare ipsilateral and contralateral techniques.

Results:

Contralateral flaps utilized included the internal mammary perforator flap (n=28) superficial superior epigastric artery (n=8), superior epigastric perforator (n=2), and the 2 nd or 9 th dorsal intercostal artery perforator flaps (n=5). All of these flaps excluding the superficial superior epigastric artery demonstrated length and coverage surface averages that were significantly greater than those traditional ipsilateral flaps. However, with the contralateral superficial superior epigastric artery, both measures were statistically similar to those traditional ipsilateral flaps.

Conclusions:

The anatomic variation design suggests that trunk midline is not a barrier and that perforator flaps in these two regions may be raised on different longitudinal axes without compromising vitality.
Prophylactic Muscle Flaps in Patients with Oncologic Spine Disease Decrease Wound Complication Rates: A single institution cohort study
Authors: Dalton Tara , Darner Grant , McCray Edwin , Price Meghan , Baëta Cesar , Erickson Melissa , Karikari Isaac O. , Abd-El-Barr Muhammad M. , Goodwin C. Rory , Brown David A.
Published: April 2023

Background:

Patients with oncologic spine disease face a high systemic illness burden and often require surgical intervention to alleviate pain and maintain spine stability. Wound healing complications are the most common reason for reoperation in this population and are known to impact quality of life and initiation of adjuvant therapy. Prophylactic muscle flap (MF) closures are known to reduce wound healing complications in high risk patients, but the efficacy in oncologic spine patients is not well established.

Methods:

A collaboration at our institution presented an opportunity to study the outcomes of prophylactic MF closure. We performed a retrospective cohort study of patients who underwent MF closure versus a cohort who underwent non-MF closure in the preceding time. Demographic and baseline health data were collected, as well as postoperative wound complication data.

Results:

A total of 166 patients were enrolled, including 83 patients in the MF cohort and 83 control patients. Patients in the MF group were more likely to smoke (p=0.005) and had a higher incidence of prior spine irradiation (p=0.002). Postoperatively, 5 (6%) patients in the MF group developed wound complications, compared to 14 (17%) patients in the control group (p=0.028). The most common overall complication was wound dehiscence requiring conservative therapy, which occurred in 6 (7%) control patients and 1 (1%) MF patient (p=0.053).

Conclusions:

Prophylactic MF closure during oncologic spine surgery significantly reduces the wound complication rate. Future studies should examine the precise patient population that stands to benefit most from this intervention.
False-Positive Radioactive Iodine Uptake Caused by Cervical Myofascitis in a Patient With Differentiated Thyroid Carcinoma
Authors: Tan Xiang , Wang Hao , Deng Yujiao , He Limeng , Zhang Wei
Published: April 2023

A 31-year-old woman with a history of papillary thyroid cancer underwent ablative131I therapy. Posttherapeutic whole-body131I scintigraphy revealed abnormally increased activity in the neck. Additional SPECT/CT images localized the activity in the bilateral peripheral fascia of the platysma.
Malignant Melanoma of the External Auditory Canal on 68Ga-FAPI PET/CT
Authors: Liu Ya , Ding Haoyuan , Wan Zibei , Fan Dongmei , Huang Zhanwen
Published: April 2023

External ear melanomas are relatively rare and usually occur in the regions of helix and ear lobes. Rarer still are primary melanomas of the external auditory canal. We report findings of melanoma of the external auditory canal on 68Ga-FAPI PET/CT in a 56-year-old man who presented with sharp pain in the external auditory canal for 7 months.
Role of Preoperative Hepatobiliary Scintigraphy in Children Requiring Liver Resection
Authors: Chaurasiya Kailash , Kireeva Elena , Yadgarov Mikhail , Akhaladze Dmitry , Likar Yury
Published: April 2023

Purpose

The risk of posthepatectomy liver failure (PHLF) remains an important concern following major liver resection. Assessment of future remnant liver function (FRLF) by hepatobiliary scintigraphy has shown its significance to prevent PHLF after major liver resection in adults with a threshold value of FRLF greater than 2.7%/min per m2. However, such data for pediatric patients were not published.

Methods

A total of 77 pediatric patients with liver tumors who underwent 1-stage liver resection were included in this study. Assessment of FRLF, future remnant liver volume (FRLV), and the ratio of remnant liver volume to body weight (RLV-BWR) was performed before the surgery.

Results

All patients had RLV-BWR values of more than 0.5%/kg. Future remnant liver volume values ranged from 19% to 89%, and FRLF values ranged from 1.8% to 31.8%/min per m2. Only 7 of 77 patients had FRLV values less than 25%, but their FRLF values exceeded 2.7%/min per m2. Two patients developed grade A and grade B PHLF.

Conclusion

Future remnant liver volume and the RLV-BWR can be used in most pediatric patients for the assessment of liver before hepatectomy. According to our data, implementation of FRLF assessment using hepatobiliary scintigraphy can be most beneficial for children with FRLV of less than 25%. The cutoff value of FRLV greater than 25% can be slightly decreased with minimal risk of developing PHLF. However, to establish a new cutoff value for FRLV in children, further prospective studies including larger numbers of patients with FRLV of less than 25% are needed.