bluuebunny/crossref_metadata_2025 huggingface dataset:
Kinetic and Kinematics Parameters of Hip in Gait for a Congenital Longitudinal Tibial Deficiency with Orthoprosthesis and Transfemoral Prosthesis: A Case Study
Authors: Alsancak Serap , Güner Senem , Tuncay İsmail Cengiz
Published: August 2021

Introduction

Congenital longitudinal tibial deficiency is a rare condition. It is characterized by partial or complete absence of tibia with a relatively intact fibula. Its standard treatment is surgery and employing orthoprosthesis or prosthesis. However, the effects of gaits according to the types of prosthesis is barely known.

Methods

Orthoprosthesis is offered to a 30-year-old man experiencing left-side congenital type 1 tibial hemimelia (classified as Jones type 1B) deficiency with thoracolumbar scoliosis and exhibiting a depressed shoulder as well as a stiff knee. He decided to have an amputation to wear a transfemoral (TF) prosthesis comprising a microprocessor-controlled knee.

Results

Three-dimensional gait analyses and a 6-minute walk test were performed preoperatively and postoperatively with the orthoprosthesis and TF prosthesis. Furthermore, the kinematics of hip flexion/extension and pelvic anterior/posterior tilt range of the motion degree were increased using TF prosthesis. The result of the kinetics of the hip flexion/extension moment and hip power parameters were affected using the TF prosthesis.

Conclusions

This case study suggests that the new prosthesis provides removable and adaptable component; further, it delivers a comfortable sitting experience because of its new socket design and knee joint flexion.

Clinical Relevance

Patient satisfaction is better with TF prosthesis than with orthoprosthesis. TF prosthesis is more cosmetic than orthoprosthesis, provides a symmetrical gait pattern, decreases donning and doffing durations, and there is no uncomfortable protrusion when sitting (due to amputation of the foot and leg part).
The Long-Term Wearing of Foot Orthoses Can Change the Frequency Domain of Ground Reaction Forces in Children with Flexible Flat Feet
Authors: Jafarnezhadgero AmirAli , Musavi Seyed Hamed , Alavi Mehr Seyed Majid , Madadi-Shad Morteza
Published: August 2021

Introduction

Analyzing the frequency content of ground reaction forces (GRFs) might be helpful when assessing gait abnormalities in children with flexible flatfeet. The aims of this study were therefore to evaluate 1) differences in GRF frequency content between children with and without flatfeet; and 2) whether the long-term wearing of foot orthoses changes the GRF frequency contents in children with flatfeet.

Materials and Methods

This is a pre-post study design. GRFs were collected at baseline for boys both with and without flatfeet. Boys with flatfeet wore custom-made foot orthoses with unique shoes for 4 months; GRFs were collected for the flatfeet group after 4 months too. Data were collected while participants wore shoes without foot orthoses in the pretest and shoes with foot orthoses in the posttest. GRFs were collected during walking by two Kistler force platforms (each force plate was used for each leg). Multivariate analysis of variance (MANOVA) test and a separate 2 (side: dominant vs. nondominant) × 2 (time: pretest vs. posttest) ANOVA with repeated measures were used for statistical analysis.

Results

The flatfeet group indicated lower vertical GRF frequency (P = 0.003; d = 1.21; 95% confidence interval [CI], 7.12–7.59) and greater vertical amplitude of harmonic 16 for the nondominant limb (P = 0.030; d = 0.71; 95% CI, 0.0001–0.0022) than the normal feet group. No significant differences in GRF frequency content were found for the dominant limb between pretest and posttest (P > 0.05; d = 0.01–039). However, for nondominant limb, vertical GRF frequency content (P < 0.001; d = 0.85; 95% CI, 6.21–7.36) was diminished at posttest compared with pretest. In the nondominant limb, the anteroposterior GRF frequency with a power of 99.5% showed a significant increase at posttest compared with pretest (P = 0.025; d = 0.50; 95% CI, 13.30–16.20). For both limbs, amplitudes of three-dimensional GRF components were lower at posttest than at pretest (P < 0.05; d = 0.0.14–1.20; 95% CI, −0.0005 to −0.0083).

Conclusions

The results indicated lower GRF frequency content and amplitudes after long-term wearing of foot orthoses. Therefore, long-term wearing of foot orthoses may be applied to obtain functional improvements in children with flatfeet.

Clinical Relevance

Clinicians are advised to apply foot orthoses to improve functions in children with flatfeet.
Treatment of chlamydia and gonorrhea infections during the COVID-19 pandemic using provisional Centers for Disease Control guidance
Authors: Fawcett Susan E. , Williams Amy A. , Johnson Emily E. , Ramsey Keith M.
Published: August 2021

Background:

The COVID-19 pandemic created new challenges in controlling the transmission of sexually transmitted diseases (STDs), forcing the Centers for Disease Control and Prevention (CDC) to temporarily modify recommendations. As rapid COVID-19 testing emerged, supplies for similar testing platforms, specifically Chlamydia trachomatis and Neisseria gonorrhoeae, became compromised.

Local Problem:

The local community was identified as having the highest rate of chlamydia infections in North Carolina. Concerns regarding disease transmission within the community were amplified as the project site began experiencing a critical shortage of chlamydia and gonorrhea testing kits.

Methods:

This quality improvement (QI) project, conducted in an emergency department, located in an underserved area with high STD infection rates, offered a prioritized approach to STD testing and treatment during a critical time with limited testing capabilities.

Interventions:

Program analysis evaluated the management of 227 patients preintervention and 218 patients postintervention with confirmed or suspected infection, using a testing and treatment algorithm to identify and treat those most likely to be infected while preserving testing supplies for those at higher risk for complications from infections.

Results:

Test utilization decreased by 25% (p-value = .003 via t-test), whereas a significant improvement in empiric treatment, increasing from 59% (133/227) to 73% (158/218), was also observed (p-value = .002 via chi-square analysis).

Conclusions:

Results suggest that a testing and treatment algorithm for providers can successfully guide testing and treatment decisions, reducing onward transmission and preserving supplies for those more likely to experience complications from chlamydia and gonorrhea infections.
Primary Vestibular Schwannoma Cells Activate p21 and RAD51-Associated DNA Repair Following Radiation-Induced DNA Damage
Authors: Thielhelm Torin P. , Goncalves Stefania , Welford Scott , Mellon Eric A. , Bracho Olena , Estivill Michael , Brown Clifford , Morcos Jacques , Ivan Michael E. , Telischi Fred , Fernandez-Valle Cristina , Dinh Christine T.
Published: August 2021

Hypothesis:

Vestibular Schwannoma (VS) can avoid cell death following radiation injury by entering cell cycle arrest and activating RAD51-related DNA repair.

Background:

Although the radiobiology of various cancers is well-studied, the radiobiological effects in VS are poorly understood. In this study, we describe how VS cells enter cell cycle arrest (through p21 expression), activate DNA repair (through RAD51 upregulation), and avoid cell death after radiation-induced double-stranded breaks (DSB) in DNA (as measured by γ-H2AX).

Methods:

Primary human VS cells were cultured on 96-well plates and 16-well culture slides at 10,000 cells/well and exposed to either 0 or 18 Gray of radiation. Viability assays were performed at 96 h in vitro. Immunofluorescence for γ-H2AX, RAD51, and p21 was performed at 6 h.

Results:

Radiation (18 Gy) induced the expression of γ-H2AX, p21, and RAD51 in six cultured VS, suggesting that irradiated VS acquire DSBs, enter cell cycle arrest, and initiate RAD51 DNA repair to evade cell death. However, viability studies demonstrate variable responses in individual VS cells with 3 of 6 VS showing radiation resistance to 18 Gy. On further analyses, radiation-resistant VS cells expressed significantly more p21 than radiation-responsive tumors.

Conclusions:

In response to radiation-induced DNA damage, primary VS cells can enter cell cycle arrest and express RAD51 DNA repair mechanisms to avoid cell death. Radioresistant VS cells may mount a more robust p21 response to ensure sufficient time for DNA repair. Further investigation into DNA repair proteins and cell cycle checkpoints may provide important insight on the radiobiology of VS and mechanisms for resistance.
Innovation in measuring obese patients’ blood pressure: measurement with conical wrapping technique
Authors: Şahan Seda , Şahin Sevil , Aygün Hakan , Yildiz Ayşegül
Published: August 2021

Introduction

Accurate measurement of blood pressure (BP) is difficult in obese patients due to their upper arm shape and width. Errors made during BP measurement cause misdiagnosis or lead to wrong treatment.

Method

The data of this methodological study were collected from 40 patients who were 18 years old or above, with a BMI above 25 kg/m2, and who were followed up with radial catheter arterial pressure in adult intensive care and postoperative care units between March and December 2020.

Results

In total 55% of the participants were male with a mean age of 63.9 years, mean height of 165.7 cm, mean weight of 85.2 kg and mean BMI of 31.0 ± 2.1 kg/m2. Intra-arterial BP (IABP) measurement values were found to be correlated with conical wrapping technique and cylindrical wrapping technique (P < 0.001). As a result, a statistically significance was found between conical SBP and intra-arterial SBP (r = 0.921; P < 0.05) and conical DBP and intra-arterial DBP (r = 0.902; P < 0.05)

Conclusion

It was determined that the SBP and DBP results of the conical wrapping technique were closer to the results obtained by IABP measurements. For this reason, it is more appropriate to measure BP with conical wrapping technique in clinically obese patients.
Malnutrition in patients with COVID-19: assessment and consequences
Authors: van der Meij Barbara S. , Ligthart-Melis Gerdien C. , de van der Schueren Marian A.E.
Published: August 2021

Purpose of review

COVID-19 disease often presents with malnutrition and nutrition impact symptoms, such as reduced appetite, nausea and loss of taste. This review summarizes the most up-to-date research on nutritional assessment in relation to mortality and morbidity risk in patients with COVID-19.

Recent findings

Numerous studies have been published on malnutrition, muscle wasting, obesity, and nutrition impact symptoms associated with COVID-19, mostly observational and in hospitalized patients. These studies have shown a high prevalence of symptoms (loss of appetite, nausea, vomiting, diarrhea, dysphagia, fatigue, and loss of smell and taste), malnutrition, micronutrient deficiencies and obesity in patients with COVID-19, all of which were associated with increased mortality and morbidity risks.

Early screening and assessment of malnutrition, muscle wasting, obesity, nutrition impact symptoms and micronutrient status in patients with COVID-19, followed by pro-active nutrition support is warranted, and expected to contribute to improved recovery. There is limited research on nutritional status or nutrition impact symptoms in patients living at home or in residential care. RCTs studying the effects of nutrition intervention on clinical outcomes are lacking. Future research should focus on these evidence gaps.
Triple combination cystic fibrosis transmembrane conductance regulator modulator therapy in the real world – opportunities and challenges
Authors: Barry Peter J. , Taylor-Cousar Jennifer L.
Published: August 2021

Purpose of review

The purpose of this review is to describe on-going and upcoming real-world studies that will aid the cystic fibrosis (CF) community in understanding the long-term efficacy, safety and challenges in utilizing this therapy and managing care.

Recent findings

The triple combination of elexacaftor, tezacaftor and ivacaftor (ETI) has been demonstrated to improve lung function, weight and quality of life in children and adults with CF with at least one copy of Phe508del. Treatment with ETI will potentially be available for approximately 90% of the CF population and change the face of CF.

In spite of early demonstrations of short-term efficacy and safety, for medications that may be given for much of someone's life, continued assessment of these outcomes is necessary. Furthermore, the CF community must evaluate and address the issues that arise with increased longevity including parenthood, preventive care management and the potential comorbidities of aging.
Safety and Tolerance of a Novel Anti‐Regurgitation Formula
Authors: Bellaiche Marc , Ludwig Thomas , Arciszewska Małgorzata , Bongers Anke , Gomes Cédrico , Świat Agnieszka , Dakhlia Faouzi , Piollet Anne , Oozeer Raish , Vandenplas Yvan
Published: August 2021

Objectives:

A novel anti‐regurgitation (AR) formula has been designed to support gut health and improve gastrointestinal (GI) symptoms beyond regurgitation. This study assessed the tolerance and safety of this new AR formula.

Methods:

This was a 4‐week double‐blind, randomized, controlled trial with a 4‐week extension in formula‐fed infants with regurgitation. The new AR (Test) formula contained 0.4 g/100 mL locust bean gum (LBG) as thickener, partly fermented formula with postbiotics, and short‐chain galacto‐oligosaccharides (scGOS) and long‐chain fructo‐oligosaccharides (lcFOS) (0.4 g/100 mL, ratio 9:1). The Control AR formula contained LBG (0.4 g/100 mL) with postbiotics and has a history of safe use. The primary outcome was the Infant Gastrointestinal Symptom Questionnaire (IGSQ) sum score including stooling, spitting‐up/vomiting, crying, fussiness and flatulence.

Results:

All 182 infants screened were enrolled in the study. The primary analysis showed the equivalence of the IGSQ sum scores at Week 4 between groups. IGSQ sum scores improved significantly within 1 week (Mixed Model Repeated Measurement [MMRM], P < 0.001). Post‐hoc analyses showed a bigger improvement of the IGSQ score in the Test (n = 38) versus Control (n = 44) group (MMRM, P = 0.008) in infants with more severe gastrointestinal (GI) symptoms (IGSQ score ≥35). Stool characteristics were comparable between groups. Growth related z scores were in line with the WHO child growth standards and both groups showed improvement of regurgitation. Adverse events did not show any safety concerns.

Conclusions:

The novel AR formula combining LBG, scGOS/lcFOS and postbiotics is well‐tolerated, safe and supports adequate growth during the intervention. Post‐hoc analyses suggest that the formula results in more improvement of GI symptom burden in infants with more severe symptoms.
Young individuals with stroke in rehabilitation: a cohort study
Authors: Campo Marc , Toglia Joan , Jaywant Abhishek , O’Dell Michael W.
Published: August 2021

Stroke in younger populations is a public health crisis and the prevalence is rising. Little is known about the progress of younger individuals with stroke in rehabilitation. Characterization of the course and speed of recovery is needed so that rehabilitation professionals can set goals and make decisions. This was a cohort study with data extracted from electronic medical records. Participants were 408 individuals diagnosed with stroke who participated in inpatient rehabilitation in an urban, academic medical center in the USA. The main predictor was age which was categorized as (18–44, 45–64, 65–74 and 75+). Outcomes included baseline-adjusted discharge functional independence measure (FIM) scores and FIM efficiency. In linear regression models for FIM scores, the reference category was the youngest age group. The oldest group was discharged with significantly lower FIM total (B = −8.84), mobility (B = −4.13), self-care (B = −4.07) and cognitive (B = −1.57) scores than the youngest group after controlling for covariates. The 45–64 group also finished with significantly lower FIM total (B = −6.17), mobility (B = −2.61) and self-care (B = −3.01) scores than youngest group. FIM efficiencies were similar for all ages in each of the FIM scales. Younger individuals with stroke make slightly greater functional gains compared to older individuals with stroke, but other factors, such as admission scores, are more important and the rates of recovery may be similar.
A Retrospective Evaluation on Demographic, Phenomenological, and Comorbidity Features of Pediatric Obsessive-Compulsive Disorder
Authors: Efe Ayşegül , Açıkel Sadettin Burak , Uygun Sabide Duygu , Canlı Merve , Temeltürk Rahime Duygu , Gürel Yusuf , Çetinkaya Miray , Çakmak Fatma Hülya
Published: August 2021

The impacts of sex, age of onset, phenotype, and comorbidity on clinical features were explored in a large clinical sample with pediatric obsessive-compulsive disorder (p-OCD) (n = 457), along with concomitant specific features in the framework of different symptom dimensions/phenotypes, by a retrospective cross-sectional evaluation design. The most prevalent phenotype was obsession/checking (almost half), and the clinical features belonging to different phenotypes varied among sexes, age of onset, severity, and comorbidities. The contamination and aggressive obsessions, along with the compulsions such as cleaning and repeating routine activities, were the most prevalent symptoms, which were prevalently accompanied by generalized anxiety disorder, attention deficit hyperactivity disorder, and depression. Females with OCD were likely prone to exhibit comorbid internalizing disorders, whereas males were prone to externalizing. This recent study on a large Turkish clinical sample of p-OCD followed up within 5 years, highlighting separate evidence on subtyping of p-OCD in phenotype and comorbidity frame.
Pneumatic Impedance of Spit Socks and N95 Masks
Authors: Kroll Mark W. , Brave Michael A. , Hail Stacey L. , Kroll Ryan M. , Williams Howard E.
Published: August 2021

Introduction

Restrained subjects often spit on law enforcement and corrections officers and medical responders. Based on the droplet-transmitted risk of COVID-19, such spitting could be considered a potentially life-threatening assault. Officers commonly use “spit socks” over the head and neck of spitting subjects to reduce this risk. The pneumatic impedance of such socks has not been published, so this remains an open issue for arrest-related death investigation.

Methods

We purchased samples of 3 popular spit sock models, 3 insect-protecting “bug” socks and hats, 3 N95 masks, a standard 3-ply surgical mask, and a common dust mask. We used a BTmeter model BTN8468 digital anemometer, an HTI model HT-1890 digital manometer, and an AC Infinity Cloudline model S6 inline controllable fan to measure air flow versus pressure drop. We compared the curves graphically and also calculated a pneumatic pseudo-impedance by dividing the pressure drop by the air velocity.

Results

The spit and bug socks allowed nearly maximum airflow with minimal pressure (≤1 mm Hg), whereas none of the masks allowed greater than 2 m/s of airflow at maximum pressure of 3 mm Hg. All of the spit and bug masks were grouped together with the lowest pneumatic impedances, whereas all of the N95 masks were grouped together with the highest values. The dust mask and surgical mask were in between with the dust mask closer to the spit and bug masks, whereas the surgical mask was closer to the N95 masks in impedance.

Conclusions

Commonly used spit socks offer nearly zero resistance to breathing. The highest resistance spit sock was still 100 times better than the best N95 mask for airflow during inhalation. Our results do not support the occasional hypothesis that spit socks might contribute to an arrest-related death.
Scope and Practices of Physical Therapists Working With Children: Results From an International Online Survey
Authors: Camden Chantal , Mulligan Hilda , Nugraha Boya , Berbari Jade , Gauvin Cheyenne , Cinar Eda , Gutenbrunner Christoph
Published: August 2021

Purpose:

To describe the scope of practice of physical therapists (PTs) working with children worldwide.

Methods:

PTs working with children in any context and country were invited via social media and email campaigns to complete an online survey containing 42 questions about work context and service delivery. Descriptive statistics were computed.

Results:

Of the 1133 participants from 77 countries, most worked with children full-time (51.8%), and in government-funded work settings (57.5%). Modalities of access to services varied across countries, work settings, and children's conditions, yet 46.7% of PTs reported that most children had direct access to services. PTs provided services to children with a variety of conditions, with cerebral palsy being most reported (83.3%). Interventions focused primarily on improving body function (42.0%) and on providing face-to-face individual treatment (96.6%).

Conclusions:

This study provides an international portrait of pediatric PT practice and illustrates the diversity of services in pediatric PT.
Dynamic Characteristics of Foot Development: A Narrative Synthesis of Plantar Pressure Data During Infancy and Childhood
Authors: Montagnani Eleonora , Price Carina , Nester Chris , Morrison Stewart C.
Published: August 2021

Purpose:

Quantifying plantar pressure throughout childhood enables clinicians to enhance knowledge of typical changes in foot function. This narrative review aims to describe existing research reporting plantar pressure analysis in infants and children developing typically, to advance understanding of foot development.

Methods:

A narrative approach was used; 263 articles were identified and 13 met inclusion criteria.

Results:

Plantar pressures during walking rapidly change in infancy and childhood. With development, pressures increasingly resemble those in adults with the development of initial heel contact, shift in pressure distribution from medial to lateral foot side, decreasing midfoot pressure magnitude. The literature has a variety of study designs, data collection protocols, and analysis.

Conclusion:

This review describes plantar pressure changes occurring as walking develops, emphasizing the typical trajectory of foot function development in infancy and childhood. The present finding describes the complex biomechanical development of foot function in typically developing infancy and childhood.
Hammersmith Infant Neurological Examination Clinical Use to Recommend Therapist Assessment of Functional Hand Asymmetries
Authors: Pietruszewski Lindsay , Nelin Mary Ann , Batterson Nancy , Less Julia , Moore-Clingenpeel Melissa , Lewandowski Dennis , Levengood Katelyn , Maitre Nathalie L.
Published: August 2021

Purpose:

To determine whether asymmetry scores derived from the Hammersmith Infant Neurological Examination (HINE) can provide cutoff scores for recommending in-depth assessment of upper extremity functional deficits by therapists using the Hand Assessment for Infants (HAI).

Methods:

Observational study in a clinical laboratory with the HINE and the HAI administered concurrently to 101 infants 3 to 12 months corrected age developing typically or atypically. Predictive value of HINE asymmetry scores for atypical HAI was determined.

Results:

Total HINE asymmetry scores of 4 or greater had 100% sensitivity and 88% or greater specificity for identifying infants with an asymmetric HAI score of 3 or greater point difference between hands.

Conclusions:

For infants receiving a total HINE asymmetry score of 4 or greater, referral to therapists for HAI assessment may be beneficial to precisely evaluate function and determine the need for targeted upper extremity interventions.
Multidimensional Effects of Solid and Hinged Ankle-Foot Orthosis in Children With Cerebral Palsy
Authors: Limpaninlachat Sivaporn , Prasertsukdee Saipin , Palisano Robert J. , Burns Joshua , Kaewkungwal Jaranit , Inthachom Rumrada
Published: August 2021

Purpose:

To compare the effect of solid (SAFO) and hinged (HAFO) ankle-foot orthoses in children with cerebral palsy spastic diplegia and true equinus and jump gait.

Methods:

Participants were 26 children (13 wore SAFO and 13 wore HAFO) aged 4 to 14 years classified as Gross Motor Function Classification System levels I to III. Children were tested on standardized measures of body structure and function, activity, and participation.

Results:

Children wearing HAFO reached further in standing than those wearing SAFO. Among children who walked without an assistive device, children wearing HAFO had greater stride length and faster velocity. Mean Gross Motor Function Measure and Pediatric Evaluation of Disability Inventory mobility scores did not differ between groups. The cost-to-benefit ratios showed parents preferred HAFO.

Conclusions:

Among children with true equinus and jump gait, the effects of HAFO were greater in children who walked without an assistive mobility device.
1.5 vs 3 Tesla Magnetic Resonance Imaging
Authors: Radbruch Alexander , Paech Daniel , Gassenmaier Sebastian , Luetkens Julian , Isaak Alexander , Herrmann Judith , Othman Ahmed , Schäfer Jürgen , Nikolaou Konstantin
Published: August 2021

The second part of this review deals with experiences in neuroradiological and pediatric examinations using modern magnetic resonance imaging systems with 1.5 T and 3 T, with special attention paid to experiences in pediatric cardiac imaging. In addition, whole-body examinations, which are widely used for diagnostic purposes in systemic diseases, are compared with respect to the image quality obtained in different body parts at both field strengths. A systematic overview of the technical differences at 1.5 T and 3 T has been presented in part 1 of this review, as well as several organ-based magnetic resonance imaging applications including musculoskeletal imaging, abdominal imaging, and prostate diagnostics.
Contrast Challenge Algorithms for Adhesive Small Bowel Obstructions Are Safe in Children
Authors: Rubalcava Nathan S. , Bence Christina M. , Jensen Amanda R. , Minneci Peter C. , Van Arendonk Kyle J. , Mak Grace , Rymeski Beth A. , Kohler Jonathan E. , Beyene Tariku , Lim Irene Isabel P. , Hirschl Ronald B. , Speck K. Elizabeth
Published: August 2021

Objective:

The purpose of this study was to evaluate the safety of a water-soluble contrast challenge as part of a nonoperative management algorithm in children with an adhesive small bowel obstruction (ASBO).

Background:

Predicting which children will successfully resolve their ASBO with non-operative management at the time of admission remains difficult. Additionally, the safety of a water-soluble contrast challenge for children with ASBO has not been established in the literature.

Methods:

A retrospective review was performed of patients who underwent non-operative management for an ASBO and received a contrast challenge across 5 children’s hospitals between 2012 and 2020. Safety was assessed by comparing the complication rate associated with a contrast challenge against a pre-specified maximum acceptable level of 5%. Sensitivity, specificity, negative (NPV) and positive (PPV) predictive values of a contrast challenge to identify successful nonoperative management were calculated.

Results:

Of 82 children who received a contrast challenge, 65% were successfully managed nonoperatively. The most common surgical indications were failure of the contrast challenge or failure to progress after initially passing the contrast challenge. There were no complications related to contrast administration (0%; 95% confidence interval: 0–3.6%, P = 0.03). The contrast challenge was highly reliable in determining which patients would require surgery and which could be successfully managed non-operatively (sensitivity 100%, specificity 86%, NPV 100%, PPV 93%).

Conclusion:

A contrast challenge is safe in children with ASBO and has a high predictive value to assist in clinical decision-making.
Perioperative and Oncological Outcomes of Robotic Versus Open Pancreaticoduodenectomy in Low-Risk Surgical Candidates
Authors: Liu Qu , Zhao Zhiming , Zhang Xiuping , Wang Wei , Han Bing , Chen Xiong , Tan Xiaodong , Xu Shuai , Zhao Guodong , Gao Yuanxing , Gan Qin , Yuan Jianlei , Ma Yuntao , Dong Ye , Liu Zhonghua , Wang Hailong , Fan Fangyong , Liu Jianing , Lau Wan Yee , Liu Rong
Published: August 2021

Objectives:

This study aimed to perform a multicenter comparison between robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD).

Background:

Previous comparisons of RPD versus OPD have only been carried out in small, single-center studies of variable quality.

Methods:

Consecutive patients who underwent RPD (n = 1032) or OPD (n = 1154) at 7 centers in China between July 2012 and July 2020 were included. A 1:1 propensity score matching (PSM) was performed.

Results:

After PSM, 982 patients in each group were enrolled. The RPD group had significantly lower estimated blood loss (EBL) (190.0 vs 260.0 mL; P < 0.001), and a shorter postoperative 1length of hospital stay (LOS) (12.0 (9.0–16.0) days vs 14.5 (11.0–19.0) days; P < 0.001) than the OPD group. There were no significant differences in operative time, major morbidity including clinically relevant postoperative pancreatic fistula (CR-POPF), bile leakage, delayed gastric emptying, postoperative pancreatectomy hemorrhage (PPH), reoperation, readmission or 90-day mortality rates. Multivariable analysis showed R0 resection, CR-POPF, PPH and reoperation to be independent risk factors for 90-day mortality. Subgroup analysis on patients with pancreatic ductal adenocarcinoma (PDAC) (n = 326 in each subgroup) showed RPD had advantages over OPD in EBL and postoperative LOS. There were no significant differences in median disease-free survival (15.2 vs 14.3 months, P = 0.94) or median overall survival (24.2 vs 24.1 months, P = 0.88) between the 2 subgroups.

Conclusions:

RPD was comparable to OPD in feasibility and safety. For patients with PDAC, RPD resulted in similar oncologic and survival outcomes as OPD.
Extended Versus Standard Complete Mesocolon Excision in Sigmoid Colon Cancer
Authors: Planellas Pere , Marinello Franco , Elorza Garazi , Golda Thomas , Farrés Ramon , Espín-Basany Eloy , Enríquez-Navascués Jose Mari , Kreisler Esther , Cornejo Lídia , Codina-Cazador Antoni
Published: August 2021

Objective:

The aim of this study was to evaluate whether extended complete mesocolic excision (e-CME) for sigmoid colon cancer improves oncological outcomes without compromising morbidity or functional results.

Background:

In surgery for cancer of the sigmoid colon and upper rectum, s-CME removes the lymphofatty tissue surrounding the inferior mesenteric artery (IMA), but not the lymphofatty tissue surrounding the portion of the inferior mesenteric vein that does not run parallel to the IMA. Evidence about the safety and efficacy of extending CME to include this tissue is lacking.

Methods:

This single-blind study randomized sigmoid cancer patients at 4 centers to undergo e-CME or s-CME. The primary outcome was the total number of lymph nodes harvested. Secondary outcomes included disease-free and overall survival at 2 years, morbidity, and bowel and genitourinary function. Clinicaltrials.gov: NCT03107650.

Results:

We analyzed 93 patients (46 e-CME and 47 s-CME). Perioperative outcomes were similar between groups. No differences between groups were found in the total number of lymph nodes harvested [21 (interquartile range, IQR, 14–29) in e-CME vs 20 (IQR, 15–27) in s-CME, P = 0.873], morbidity (P = 0.829), disease-free survival (P = 0.926), or overall survival (P = 0.564). The extended specimen yielded a median of 1 lymph node (range, 0–6), none of which were positive.

Bowel function recovery was similar between arms at all timepoints. Males undergoing e-CME had worse recovery of urinary function (P = 0.026).

Conclusion:

Extending lymphadenectomy to include the IMV territory did not increase the number of lymph nodes or improve local recurrence or survival rates.
Burn Resuscitation Practices in North America
Authors: Greenhalgh David G. , Cartotto Robert , Taylor Sandra L. , Fine Jeffrey R. , Lewis Giavonni M. , Smith David J. , Marano Michael A. , Gibson Angela , Wibbenmeyer Lucy A. , Holmes James H. , Rizzo Julie A. , Foster Kevin N. , Khandelwal Anjay , Fischer Sarah , Hemmila Mark R. , Hill David , Aballay Ariel M. , Tredget Edward E. , Goverman Jeremy , Phelan Herbert , Jimenez Carlos J. , Baldea Anthony , Sood Rajiv
Published: August 2021

Objectives:

ABRUPT was a prospective, noninterventional, observational study of resuscitation practices at 21 burn centers. The primary goal was to examine burn resuscitation with albumin or crystalloids alone, to design a future prospective randomized trial.

Summary Background Data:

No modern prospective study has determined whether to use colloids or crystalloids for acute burn resuscitation.

Methods:

Patients ≥18 years with burns ≥ 20% total body surface area (TBSA) had hourly documentation of resuscitation parameters for 48 hours. Patients received either crystalloids alone or had albumin supplemented to crystalloid based on center protocols.

Results:

Of 379 enrollees, two-thirds (253) were resuscitated with albumin and one-third (126) were resuscitated with crystalloid alone. Albumin patients received more total fluid than Crystalloid patients (5.2 ± 2.3 vs 3.7 ± 1.7 mL/kg/% TBSA burn/24 hours), but patients in the Albumin Group were older, had larger burns, higher admission Sequential Organ Failure Assessment (SOFA) scores, and more inhalation injury. Albumin lowered the in-to-out (I/O) ratio and was started ≤12 hours in patients with the highest initial fluid requirements, given >12 hours with intermediate requirements, and avoided in patients who responded to crystalloid alone.

Conclusions:

Albumin use is associated with older age, larger and deeper burns, and more severe organ dysfunction at presentation. Albumin supplementation is started when initial crystalloid rates are above expected targets and improves the I/O ratio. The fluid received in the first 24 hours was at or above the Parkland Formula estimate.
Improving Surgical Quality for Patients With Mental Illnesses
Authors: Afford Rebecca M. , Ball Chad G. , Sidhu Jesse A. , Sekhon Myp S. , Hameed Morad S.
Published: August 2021

Objective:

The aim of this study was to identify disparities in care for surgical patients with preexisting mental health diagnoses.

Summary Background Data:

Mental illness affects approximately 6.7 million Canadians. For them, stigma, comorbid disorders, and sequelae of psychiatric diagnoses can be barriers to equitable health care. The goal of this review is to define inequities in surgical care for patients with preexisting mental illness.

Methods:

We searched OVID Medline, Pubmed, EMBASE, and the Cochrane review files using a combination of search terms using a PICO (population, intervention, comparison, outcome) model focusing on surgical care for patients with mental illness.

Results:

The literature on mental illness in surgical patients focused primarily on preoperative and postoperative disparities in surgical care between patients with and without a diagnosis of mental illness. Preoperatively, patients were 7.5% to 40% less likely to be deemed surgical candidates, were less likely to receive testing, and were more likely to present at later stages of their disease or have delayed surgical care. Similar themes arose in the postoperative period: patients with mental illness were more likely to require ICU admission, were up to 3 times more likely to have a prolonged length of hospital stay, had a 14% to 270% increased likelihood of having postoperative complications, and had significantly higher health care costs.

Conclusions:

Surgical patients with preexisting psychiatric diagnoses have a propensity for worse perioperative outcomes compared to patients without reported mental illness. Taking a thorough psychiatric history can potentially help surgical teams address disparities in access to care as well as anticipate and prevent adverse outcomes.
Mapping of common rib fracture patterns and the subscapular flail chest associated with operative scapula fractures
Authors: Thomas Claire N. , Lindquist Timothy J. , Paull Thomas Z. , Tatro Joscelyn M. , Schroder Lisa K. , Cole Peter A.
Published: August 2021

BACKGROUND

Rib fractures occur in approximately 10% of trauma patients and are associated with more than 50% of patients with scapula fractures. This study investigates the location and patterns of rib fractures and flail chest occurring in patients with operatively treated scapula fractures. Novel frequency mapping techniques of rib fracture patterns in patients who also injure the closely associated scapula can yield insight into surgical approaches and fixation strategies for complex, multiple injuries patients. We hypothesize that rib fractures have locations of common occurrence when presenting with concomitant scapula fracture that requires operative treatment.

METHODS

Patients with one or more rib fractures and a chest computed tomography scan between 2004 and 2018 were identified from a registry of patients having operatively treated scapula fractures. Unfurled rib images were created using Syngo-CT Bone Reading software (Siemens Inc., Munich, Germany). Rib fracture and flail segment locations were marked and measured for standardized placement on a two-dimensional chest wall template. Location and frequency were then used to create a gradient heat map.

RESULTS

A total of 1,062 fractures on 686 ribs were identified in 86 operatively treated scapula fracture patients. The mean ± SD number of ribs fractured per patient was 8.0 ± 4.1 and included a mean ± SD of 12.3 ± 7.2 total fractures. Rib fractures ipsilateral to the scapula fracture occurred in 96.5% of patients. The most common fracture and flail segment location was ipsilateral and subscapular; 51.4% of rib fractures and 95.7% of flail segments involved ribs 3 to 6.

CONCLUSION

Patients indicated for operative treatment of scapula fractures have a substantial number of rib fractures that tend to most commonly occur posteriorly on the rib cage. There is a pattern of subscapular rib fractures and flail chest adjacent to the thick bony borders of the scapula. This study enables clinicians to better evaluate and diagnose scapular fracture patients with concomitant rib fractures.

LEVEL OF EVIDENCE

Diagnostic test, level IV.
Magnetic Resonance Imaging Findings in the Pregeniculate Visual Pathway in Leber Hereditary Optic Neuropathy
Authors: Zhao Juan , Zhang Qing , Wang Jiawei
Published: August 2021

Background:

Current research has not provided a consistent and qualitative description of MRI features in Leber hereditary optic neuropathy (LHON). Our study aims to investigate the MRI findings in the pregeniculate visual pathway and discuss their clinical significance in LHON.

Methods:

Orbital MRI was retrospectively analyzed for 53 patients with LHON (101 afflicted eyes) admitted to the Department of Neurology, Beijing Tongren Hospital, Capital Medical University, from 2014 to 2019. We described the imaging abnormalities and discussed their associations with the time interval from the onset of vision loss to the performance of MRI (TIOVP), prevalence of m.11778G>A, and best-corrected visual acuity (BCVA).

Results:

T2 hyperintense signal (HS) was determined in 82 afflicted eyes, with 34 located in the intraorbital segment (IO) of the optic nerve (ON), 26 in the IO concurrent with intracanalicular segment (ICn), 14 in the IO and ICn concurrent with intracranial segment (ICr) of the ON, 4 in the IO, ICn, and ICr concurrent with optic chiasm (OCh), and 4 in the IO, ICn, ICr, and OCh concurrent with optic tract (OTr). MRI was normal in the remaining 19 afflicted eyes. Among the 6 groups, no statistical differences were found in the TIOVP (P = 0.071), prevalence of m.11778G>A (P = 0.234), and BCVA (P = 0.076). As T2 HS extended, the BCVA gradually decreased. Nineteen of the 54 afflicted eyes revealed contrast enhancement, with the TIOVP ranging from 0.25 to 6 months.

Conclusions:

T2 HS was common in the pregeniculate visual pathway in LHON. It was not correlated with the prevalence of m.11778G>A and did not benefit in disease staging. As it extended, the BCVA gradually decreased. Contrast enhancement was relatively rare, always occurring in the subacute stage.
Metastatic Breast Cancer Presenting as Progressive Ophthalmoplegia 30 Years After Initial Cancer Diagnosis
Authors: Karimaghaei Sam , Raviskanthan Subahari , Mortensen Peter W. , Malik Amina I. , Lee Andrew G.
Published: August 2021

A 60 year-old woman presented with painless progressive ophthalmoplegia of the right eye. She had a history of left-sided breast carcinoma 30 years ago that was managed with mastectomy only, with appropriate serial follow-up investigations. On examination, her visual acuity was 20/400 in the right eye and 20/20 in the left. She had a right relative afferent pupillary defect. Ocular examination was significant for 2 mm of ptosis, complete ophthalmoplegia, and 2+ chemosis in the right eye. The left eye was normal. MRI of the brain and orbits showed bilateral retrobulbar infiltrative disease in the right eye greater than that in the left eye. Right orbitotomy and biopsy confirmed an infiltrative signet ring cell/histiocytoid carcinoma consistent with metastatic lobular breast carcinoma. Given that recurrence of breast cancer is most common during the second year after the initial disease and rarely reported beyond 20 years after the initial diagnosis, our patient's delayed recurrence 30 years after the treatment of initial disease is unusual and rare. However, it highlights the importance of including metastatic cancer in the differential diagnosis for ophthalmoplegia.
Clinical Correlation Between Vertical Gaze Palsy and Midbrain Volume in Progressive Supranuclear Palsy
Authors: Buch Karen A. , Bouffard Marc A. , Kardon Randy H. , Wills Anne-Marie A. , Privitera Claudio M. , Sharma Mansi , Wray Shirley H.
Published: August 2021

Background:

Supranuclear vertical gaze palsies and slowed vertical saccades are characteristic clinic features of progressive supranuclear palsy (PSP). The “hummingbird sign,” reflective of midbrain atrophy, is a classic radiographic sign of PSP. Correlation between eye movement abnormalities and radiographic findings in PSP has been reported previously. However, due to the use of clinical criteria not commonly employed in neuro-ophthalmic practice and neuroimaging techniques that are not widely available, it remains unclear whether correlation between midbrain structure and characteristic ocular-motor disturbances can be helpful to neuro-ophthalmologists seeking to adjudicate difficult or unusual diagnostic cases.

Methods:

Patients with a diagnosis of probable PSP according to Movement Disorders Society criteria were studied retrospectively. A neuroradiologist calculated brainstem volumes in enrolled participants and normal controls. Spearman correlations were used to correlate the extent of eye movement limitation as assessed by 2 neuro-ophthalmologists with brainstem volumes.

Results:

Fourteen participants with PSP and 15 healthy controls with similar age and gender distribution were enrolled and evaluated retrospectively. All 14 participants with PSP had undergone MRIs. Midbrain atrophy significantly correlated with the PSP rating scale (P < 0.001). PSP patients had significantly reduced volumes in the midbrain (P −0.0026), tegmentum (0.0001), tectum (0.0001), and medulla (P = 0.0024) compared with normal controls. Notes documenting quantified ocular motor function were available in 7 of 14 participants with PSP. Midbrain atrophy significantly correlated with in the extent of upward gaze limitation (P = 0.03).

Conclusions:

The severity of upward gaze limitation correlates with the severity of midbrain atrophy in patients with PSP. Recognition of this correlation may help to adjudicate diagnostic dilemmas and guide further evaluation.
Junctional Scotoma and Patterns of Visual Field Defects Produced by Lesions Involving the Optic Chiasm
Authors: Donaldson Laura C. , Eshtiaghi Arshia , Sacco Simone , Micieli Jonathan A. , Margolin Edward A.
Published: August 2021

Background:

Lesions of the optic chiasm (OC) typically produce bitemporal hemianopia (BTH) on visual field (VF) testing, whereas lesions located at the nasal optic nerve–chiasmal (ON-OC) junction have been proposed to produce junctional scotoma (JXS), a central defect in the ipsilateral eye with temporal field loss in the contralateral eye. In this study, we investigated whether the pattern of VF loss in patients with chiasmal compression predicted the appearance of the causative lesion on neuroimaging and described the clinical presentation of these patients with different types of VF defect.

Methods:

Retrospective chart review of patients seen in tertiary neuro-ophthalmology practice over 6 consecutive years with lesions abutting or displacing the OC was performed. Lesion size and location relative to the OC on neuroimaging was determined and correlated with VF defects as well as optical coherence tomography (OCT) of the peripapillary retinal nerve fiber layer and macular ganglion cell complex (GCC).

Results:

Fifty-three patients were enrolled. VFs demonstrated JXS (n = 18), BTH (n = 14), monocular VF defect (n = 4), and no VF defect (n = 17); 64.7% of cases with normal VFs had radiologic OC compression. Lesion volume was highest in the JXS group, and these patients also had the poorest presenting visual acuity. All patients with JXS showed involvement of the ON–OC junction; however, not all cases showed compression of the OC from the nasal direction (15 of 18), and 17 of 18 also showed compression of one or both prechiasmatic ONs. Compression of the ON–OC junction was also seen in 79% of BTH, 100% of monocular VF defect, and 59% of no VF defect cases. Fifty percent of patients with normal VFs already had thinning of the GCC on OCT. GCC thinning was most pronounced nasally in the BTH group, but diffuse bilateral thinning was found in 38% of cases compared with 60% of JXS. VFs improved in 6 of 6 patients with BTH but only in 5 of 8 JXS cases after treatment.

Conclusions:

JXS is more often seen with larger lesions and when there is compression of both the prechiasmatic ON and ON–OC junction. These patients have worse presenting visual acuity and poorer outcomes. Not all patients with radiologic compression had VF defects, although 50% of patients with normal VFs had evidence of compression on the macular GCC analysis, emphasizing the importance of macular OCT in the evaluation of patients with lesions involving the OC.