bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative efficacy of 5 sodium glucose cotransporter 2 inhibitor and 7 glucagon-like peptide 1 receptor agonists interventions on cardiorenal outcomes in type 2 diabetes patients
Authors: Duan Xue-Yan , Liu Shu-Yan , Yin Dao-Gen
Published: August 2021

Background:

Sodium glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have been demonstrated to be able to improve the cardiovascular and renal prognosis in patients with type 2 diabetes (T2D). However, the relative efficacy of various SGLT2 inhibitors and GLP-1 RAs on cardiorenal outcomes is unestablished.

Methods:

We searched PubMed and Embase for relevant cardiovascular or renal outcome trials (CVOTs). Endpoints of interest were major adverse cardiovascular events (MACE), stroke, myocardial infarction (MI), cardiovascular death (CVD), all-cause death (ACD), kidney function progression (KFP), and hospitalization for heart failure (HHF). Bayesian network meta-analysis was conducted to produce pooled hazard ratio (HR) and 95% confidence interval (CI). We calculated the probability values of surface under the cumulative ranking curve to rank active and placebo interventions.

Results:

Fourteen COVTs were included in analysis. Sotagliflozin (HR 0.76, 95% CI 0.61–0.94), subcutaneous semaglutide, and albiglutide lowered MACE versus lixisenatide among others. Sotagliflozin (HR 0.59, 95% CI 0.40–0.89), canagliflozin, and empagliflozin lowered HHF versus subcutaneous semaglutide among others. Dapagliflozin and empagliflozin lowered KFP versus exenatide among others. Empagliflozin and oral semaglutide lowered CVD versus dapagliflozin among others. Sotagliflozin (HR 0.65, 95% CI 0.47–0.91) and albiglutide lowered MI versus ertugliflozin among others. Sotagliflozin (HR 0.56, 95% CI 0.37–0.85) and subcutaneous semaglutide lowered stroke versus empagliflozin among others. Oral semaglutide and empagliflozin lowered ACD versus subcutaneous semaglutide among others. The maximum surface under the cumulative ranking curve values followed sotagliflozin, subcutaneous semaglutide, and albiglutide in lowering MACE; sotagliflozin, canagliflozin, and empagliflozin in lowering HHF; dapagliflozin and empagliflozin in lowering KFP; empagliflozin and oral semaglutide in lowering CVD; sotagliflozin and albiglutide in lowering MI; sotagliflozin and subcutaneous semaglutide in lowering stroke; and oral semaglutide and empagliflozin in lowering ACD.

Conclusions:

This updated network meta-analysis reproduced the findings in the first network meta-analysis, and moreover revealed that sotagliflozin was one of the most effective drugs as for lowering MI, stroke, MACE, and HHF, whereas ertugliflozin was not. These findings will provide the according evidence regarding the usage of specific SGLT2 inhibitors and GLP-1 RAs in T2D patients for prevention of specific cardiorenal endpoints.
Increased expression of Cyclin F in liver cancer predicts poor prognosis
Authors: Zelong Yang , Han Yang , Ting Guo , Yifei Wang , Kun He , Haoran Hu , Yong Chen
Published: August 2021

Background:

Cyclin F (CCNF) dysfunction has been implicated in various forms of cancer, offering a new avenue for understanding the pathogenic mechanisms underlying hepatocellular carcinoma (HCC). We aimed to evaluate the role of CCNF in HCC using publicly available data from The Cancer Genome Atlas (TCGA).

Method:

We used TCGA data and Gene Expression Omnibus (GEO) data to analyze the differential expression of CCNF between tumor and adjacent tissues and the relationship between CCNF and clinical characteristics. We compared prognosis of patients with HCC with high and low CCNF expression and constructed receiver operating characteristic (ROC) curves. In addition, we also explored the types of gene mutations in relevant groups and conducted Gene Set Enrichment Analysis (GSEA).

Results:

The expression of CCNF in liver cancer tissues was significantly increased compared with that in adjacent tissues, and patients with high CCNF expression had a worse prognosis than those with low CCNF expression. Patients with high CCNF expression also had more somatic mutations. High expression of CCNF hampers the prognosis independently. The GSEA showed that the "http://www.gsea-msigdb.org/gsea/msigdb/cards/BIOCARTA_WNT_PATHWAY" Wnt pathway, "http://www.gsea-msigdb.org/gsea/msigdb/cards/BIOCARTA_P53_PATHWAY" P53 pathway, "http://www.gsea-msigdb.org/gsea/msigdb/cards/HALLMARK_PI3K_AKT_MTOR_SIGNALING" PI3K/Akt/mTOR pathway, "http://www.gsea-msigdb.org/gsea/msigdb/cards/HALLMARK_NOTCH_SIGNALING" Notch pathway were enriched in patients with the high CCNF expression phenotype.

Conclusion:

High CCNF expression can be seen as an independent risk factor for poor survival in HCC. Its expression may serve as a target for the diagnosis and treatment of liver cancer.
Effectiveness of oolong tea and simethicone solution for lens cleansing during colonoscopy
Authors: Song Yan , Zhou Guanyu , Tu Mengtian , Zhang Jiancheng , Wang Pu
Published: August 2021

Background and aims:

water is an imperfect agent for lens cleansing during endoscopy due to its incompetence to clean hydrophobic dirt, whereas amphiphilic surfactants have the potential to overcome the limitation of water. The trial was aimed to evaluate the cleansing effectiveness of 2 typical surfactants (simethicone solution and oolong tea) for colonoscopic lens.

Methods:

Oolong tea (O-), low concentration simethicone solution (S1-), high concentration simethicone solution (S2-) and distilled water (D-) were used as washing solutions for colonoscopic lens. Study I: The tip of the colonoscope was immersed in lard oil in order to simulate the blur, and photographs were taken toward a standard colonoscopy image in-vitro pre- and post- each cleansing procedure. The blurred areas of each image were quantified and compared. Study II: 395 consecutive patients who were due to colonoscopy examination were enrolled and randomized into O-, S2-, D-group. The volume of washing solution used and cleansing level during the examination procedure, adenoma and polyp detected per colonoscopy, insertion time and withdraw time were analyzed.

Results:

Study I: There were no differences in 4 groups for the blurred areas on images before lens cleansing. The blurred areas after lens cleansing were significantly smaller in 3 groups (O- 8.47 ± 20.91 vs S1- 13.06 ± 10.71 vs S2- 6.76 ± 8.49 vs D- 38.24 ± 29.69, P < .05) than water. The decline range of blurred areas after lens cleansing in oolong tea, low concentration simethicone solution, high concentration simethicone solution groups were significantly higher than that in distilled water group (O- 87.35 ± 20.81 vs S1- 78.12 ± 19.24 vs S2- 89.57 ± 8.50 vs D- 53.39 ± 28.45, P < .05). Study II: The volume of washing solution used in S2-group was significantly smaller than that in O-group and D-group. The cleansing level of the colonoscopic lens of O-group was significantly superior than that of S2-group and D-group.

Conclusions:

The in-vitro test showed oolong tea and simethicone solution can effectively cleans the colonoscopic lens. The clinical trial demonstrated that oolong tea instead of water is effective to provide better visualization during colonoscopy.

Registration: Chictr.org.cn No: ChiCTR1900025606.
Predicting the number of article citations on the topic of pemphigus vulgaris with the 100 top-cited articles since 2011
Authors: Yang Ting-Ya , Chen Chieh-Hsun , Chien Tsair-Wei , Lai Feng-Jie
Published: August 2021

Background:

Pemphigus vulgaris (PV) is a rare autoimmune blistering disease characterized by intraepithelial and mucocutaneous blister formation and erosion. Numerous articles related to PV have been published. However, which articles have a tremendous influence is still unknown, and factors affecting article citation numbers remain unclear. We aimed to visualize the prominent entities using the top 100 most-cited articles on the topic of PV (T100PV), and investigate whether medical subject headings (i.e., MeSH terms) can be used to predict article citations.

Methods:

By searching the PubMed Central (PMC) database, the T100PV abstracts since 2011 were downloaded. Citation analysis was performed to compare the dominant entities in article topics, authors, and research institutes using social network analysis (SNA) and Kano diagrams. We examined the MeSH prediction power against article citations using correlation coefficients (CCs).

Results:

The most cited article (125 times) was authored by Ellebrecht from the University of Pennsylvania in the US. The most productive countries were Germany (28%) and the US (25%). Most articles were published in J Invest Dermatol (16%) and Br J Dermatol (10%). Kasperkiewicz (Germany) and the Normandie University (France) were the most cited authors and research institutes, respectively. The most frequently occurred MeSH terms were administration and dosage, immunology, and metabolism. MeSH terms were evident in the prediction power on the number of article citations (F = 19.77; P < .001).

Conclusion:

A breakthrough was achieved by developing dashboards to display the T100PV. MeSH terms can be used to predict the T100PV citations. These T100PV visualizations can be applied in future studies.
The prognosis and incidence of hepatic encephalopathy of patients with liver cirrhosis treated with proton pump inhibitors
Authors: Sakamaki Akira , Kamimura Kenya , Yokoo Takeshi , Osaki Akihiko , Yoshikawa Seiichi , Arao Yoshihisa , Setsu Toru , Kamimura Hiroteru , Waguri Nobuo , Takeuchi Manabu , Funakoshi Kazuhiro , Terai Shuji
Published: August 2021

Gastrointestinal bleeding, hepatic encephalopathy (HE), and hepatocarcinogenesis are associated with the prognosis of patients with liver cirrhosis (LC). Proton pump inhibitors (PPIs) have been used to prevent bleeding, however the effects of PPIs on overall survival have not yet been elucidated. Therefore, this multicenter retrospective study aimed to assess the effect of PPI on the prognosis and HE occurrence of the patients with liver cirrhosis in Japan.

A total of 456 patients diagnosed with LC at the 4 institutes during the study period (2010–2014) were assessed. PPI-treated and non-treated patients were compared using propensity score matching analysis. Primary and secondary endpoints of the study were set as the occurrence of HE and overall survival, respectively.

A comparison of all cases showed a significantly poorer hepatic reserve function in the PPI-treated patients. The propensity-score matching analysis was performed and 120 PPI-treated patients were 1:1 matched with non-treated patients. The analysis revealed a higher incidence of HE in the PPI-treated than in the non-treated patients (P = .032; hazard ratio [HR], 2.162; 95% confidence interval [CI], 1.066–4.176), but the prognosis of PPI-treated patients was no worse than that of non-treated patients (P = .676; HR, 1.101; 95% CI, 0.702–1.726).

This retrospective study showed that PPI administration for the patients with liver cirrhosis may partly be related to the increased incidence of HE but not worsen the patient prognosis.
Radiofrequency and cryoballoon ablation improve cognitive function in patients with atrial fibrillation
Authors: Wang Xinlu , Wang Zefeng , Yan Xiaohan , Huang Manyun , Wu Yongquan
Published: August 2021

Atrial fibrillation is considered to be the most common arrhythmia in the clinic, and it gradually increases with age. In recent years, there has been increasing evidence that atrial fibrillation may exacerbate the progression of cognitive dysfunction. The current guidelines recommend ablation for drug-refractory atrial fibrillation.

We aimed to prospectively analyze changes in cognitive function in patients with atrial fibrillation following treatment using different ablation methods.

A total of 139 patients, with non-valvular atrial fibrillation, were included in the study. The patients were divided into the drug therapy (n = 41) and catheter ablation (n = 98) groups, with the catheter ablation group further subdivided into radiofrequency ablation (n = 68) and cryoballoon (CY) ablation (n = 30). We evaluated cognitive function at baseline, 3- and 12-months follow-up using the Telephone Interview for Cognitive Status-modified (TICS-m) test, then analyzed differences in cognitive function between the drug therapy and catheter ablation groups, to reveal the effect of the different ablation methods.

We observed a significantly higher TICS-m score (39.56 ± 3.198) in the catheter ablation group at 12-month follow-up (P < .001), than the drug treatment group was. Additionally, we found no statistically significant differences in TICS-m scores between the radiofrequency ablation and CY groups at 3- and 12-month postoperatively (P > .05), although the two subgroups showed statistically significant cognitive function (P < .001).

Overall, these findings indicated that radiofrequency and CY ablation improve cognitive function in patients with atrial fibrillation.
Endovascular treatment for transplant renal artery stenosis
Authors: Kim Youngmin , Kim Mi Hyeong , Hwang Jeong Kye , Park Sun Cheol , Kim Ji Il , Jun Kang Woong
Published: August 2021

Transplant renal artery stenosis (TRAS) is the most common (1%–23%) vascular complication following kidney transplantation. The aim of this study was to review our experience with an endovascular approach to treat TRAS.

We retrospectively reviewed kidney transplant recipients who underwent percutaneous transluminal angioplasty (PTA) due to TRAS in our institute from January 2009 to December 2015. We analyzed the patient's baseline characteristics, postoperative renal function, blood pressure evolution, and the number of pre- and post-procedure antihypertensive drugs.

A total of 21 patients (15 men, 6 women) were treated with the endovascular technique. The predominant presentation was graft dysfunction (76.2%). Stenosis or hemodynamic kinking was located at the anastomosis in 7 (33.3%) patients, proximal to the anastomosis in 13 (61.9%) patients, and distal the anastomosis in 1 (4.8%) patient. PTA without stent placement was performed in 7 patients (33.3%), and PTA with stent placement was performed in 14 patients (67.7%). Serum creatinine levels demonstrated no difference between the pre-procedure level and that on discharge day (1.61 mg/dl [0.47–3.29 mg/dl] vs 1.46 mg/dl [0.47–3.08 mg/dl]; P = .33). The glomerular filtration rate also showed no difference between the pre-procedure value and that on discharge day (53.6 ml/min [22.4–145.7 ml/min] vs 57.0 ml/min [17.56 –145 ml/min]; P = .084). Systolic blood pressure and diastolic blood pressure (DBP) varied from 137 mm Hg (120–160 mm Hg) and 84 mm Hg (70–100 mm Hg) pre-procedure to 129 mm Hg (90–150 mm Hg) and 79 mm Hg (60–90 mm Hg) at discharge, respectively (P = .124 and P = .07). The number of antihypertensive medications significantly decreased from 1.5 (0–6) pre-procedure to 0.5 (0–2) at discharge (P = .023). In our study, there were no technical failures, procedure-related complications or deaths. During the follow-up period, the free-from-reintervention rate was 100%, and graft failures occurred in 2 patients (9.5%) due to rejection.

Endovascular procedures for TRAS show a high technical success rate with a low complication rate and a low reintervention rate. PTA showed a trend toward a positive impact on lowering serum creatinine, systolic blood pressure, and diastolic blood pressure and improving estimated glomerular filtration rate, and the number of antihypertensive medications could be significantly reduced after this procedure.
Survival in Pediatric, Adolescent, and Young Adult Patients With Sarcoma in the Military Health System: Comparison With the SEER Population
Authors: Vasta Lauren M. , Zanetti Richard C. , Anderson Ashley B. , Zhu Kangmin , Potter Benjamin K. , Park Amie B. , Lin Jie , Shriver Craig D. , Warwick Anne B.
Published: August 2021

Background:

We sought to compare survival outcomes of sarcomas in the pediatric and adolescent/young adult populations with universal care access in the Military Health System (MHS) to those from the United States general population.

Methods:

We compared data from the Department of Defense’s (DoD) Automated Central Tumor Registry (ACTUR) and the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER) program on the overall survival of patients 24 years or younger with histologically or microscopically confirmed sarcoma between diagnosed between January 1, 1987, and December 31, 2013. The Kaplan-Meier survival curves were used to compare survival between the 2 patient populations. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) comparing ACTUR relative to SEER.

Results:

The final analysis included 309 and 1236 bone sarcoma cases and 465 and 1860 soft tissue sarcoma cases from ACTUR and SEER, respectively. Cox proportional hazards analysis showed soft tissue sarcoma patients in ACTUR had significantly better overall (HR=0.73, 95% CI=0.55-0.98) and 5-year overall (HR=0.63, 95% CI=0.46-0.86) survival compared with SEER patients, but no significant difference in overall or 5-year overall survival between ACTUR and SEER patients with bone sarcoma.

Conclusion:

Survival data from the ACTUR database demonstrated significantly improved overall survival for soft tissue sarcomas and equivalent survival in bone sarcomas compared with that reported by SEER.
Thought Process Evolved From Rigid to Flexible in a Patient With Bipolar Disorder Via “Return to Work Program”
Authors: Hirakawa Hirofumi , Terao Takeshi , Ishii Nobuyoshi , Sakai Akari , Yamashita Hitomi , Kawatani Michiko , Namba Shiho , Goto Chiharu
Published: August 2021

In the working population, bipolar disorder can have a significant negative effect on professional relationships, attendance, functioning, and loss of productivity. In Japan, workers who take a leave due to depressive episodes receive a work-focused intervention program called the “return to work program” during their leave. A 39-year-old Japanese woman with bipolar II disorder took a third sick leave of absence. We recommended her the return to work program of our university hospital. At the beginning of the program, she had a rigid thought process toward her perceptions of her duties in the workplace and at home. Through the program, mindfulness might identify rigidity, group cognitive-behavioral therapy might correct rigidity, and self-analysis might have regained flexibility. In conclusion, a variety of effects of our return to work program might have enabled her thought process to evolve from rigid to flexible, and she showed successful reinstatement.
The Dual Burden of HIV Infection and First-Episode Psychosis in Africa
Authors: Chhagan Usha , Ntlantsana Vuyokazi , Tomita Andrew , Chiliza Bonginkosi , Paruk Saeeda
Published: August 2021

A systematic review and meta-analysis was conducted to synthesize data on HIV prevalence in individuals with first-episode psychosis (FEP) and to provide an overview of the association of HIV with clinical variables of FEP. Electronic databases were searched for quantitative studies published from January 1986 to November 2019. Meta-analyses were undertaken to calculate the pooled HIV/FEP proportion based on random effects modeling with inverse variance method. Seven HIV/FEP studies from sub-Sahara Africa (SSA) met inclusion criteria. The prevalence of HIV in FEP ranged from 24% to 40%, and FEP in people living with HIV (PLWHIV) ranged from 17% to 29%. The pooled proportion of HIV in FEP was 26% (95% confidence interval [CI], 10%–43%), with significant heterogeneity (n = 3, I
2 = 89%, p < 0.01), and of FEP in PLWHIV was 23% (95% CI, 15%–32%), without significant heterogeneity (n = 3, I
2 = 0%, p = 0.43). There are concerning levels of HIV and FEP comorbidity in SSA, necessitating an integrated health care service.
Low-Cost Earmuff Shown to Significantly Reduce Cast-Saw Noise
Authors: Baes Travis , Ludwigsen Daniel , Sardelli Matthew , Atkinson Patrick , Atkinson Theresa Staton
Published: August 2021

Hearing protection devices reduce cast-saw noise. It would be helpful to identify the devices that are both effective and economical. Prior studies have shown that expensive noise-reduction headphones significantly reduced the anxiety associated with cast removal with a powered oscillating saw. The cost of such headphones, however, is a drawback for some practices and hospitals. It would be helpful to determine whether lower cost ear protection can provide effective cast-saw noise reduction. In addition, it is unclear whether the noise reduction ratings (NRRs), the average sound-level reduction provided by a hearing protection device in a laboratory test, provided by manufacturers accurately characterize the effectiveness for reducing cast-saw noise. Note that noise-cancelling devices do not carry an NRR because they are not designed as hearing protectors. Five ear protection devices with different NNRs were tested. The devices varied greatly in cost and included earplugs, low-cost earmuffs, and noise-cancelling headphones. To standardize the evaluation, each device was fitted to an acoustic mannequin with high-fidelity ear microphones while a fiberglass spica cast was cut. An additional test was run without hearing protection as a control. The low-cost devices significantly reduced the saw noise, with the exception of earplugs, which had highly variable performance. The noise reduction was similar between low-cost earmuffs and the high-cost earphones when the noise-cancelling feature was not active. Active noise cancelling provided further reductions in the noise level. Patients can experience high anxiety during cast removal. The current study shows that low-cost earmuffs significantly reduce cast-saw noise. Patient care settings may be more likely to offer hearing protection that is one twenty-fifth the cost of noise-cancelling headphones. An NRR appears to be a reliable guide for selecting hearing protection that reduces cast-saw noise.
Content Validation for an Emergency Department Fall Risk Assessment Instrument
Authors: Hurwitz Beth , Altmiller Gerry
Published: August 2021

Purpose

There are many falls risk assessment tools available for inpatient use; however, few have been validated for the emergency department population. The purpose of this study was to develop a valid instrument to capture fall risk specific to that population.

Design

Using clinical expertise and evidence from the literature, the Hurwitz Fall Risk Assessment Instrument was developed. Seven clinicians with expertise in the area of fall prevention were then recruited to serve as expert content reviewers.

Methods

The content validity index was used to determine consensus of relevance for specific items and the overall scale.

Results

Two rounds of rigorous review yielded a scale content validity index universal agreement calculation of 1, indicating that all items were evaluated as relevant and appropriate for inclusion in an instrument designed to address the unique attributes of emergency department patients.

Conclusions

This study establishes scale content validation for the Hurwitz Fall Risk Assessment Instrument for use in the emergency department population.
Advanced Practice Nursing in Chile and the Role of the Registered Nurse
Authors: Espinoza Pilar , Troncoso Bernardita , Jacobson Lauren , Schober Madrean
Published: August 2021

Purpose/Aims

The aim of this study was to explore the perceptions that experienced and highly specialized nurses have of the clinical nurse specialist (CNS) role through description of the registered nurses' (RNs') experiences.

Design

This study used a qualitative descriptive design.

Methods

Interviews were conducted with 6 RNs (2 managers, 1 chief nursing officer, 2 educators, and 1 clinician) and 32 RNs who participated in 5 focus groups. Participants were purposively sampled from intensive care units and emergency departments from 4 public and private hospitals. The analysis of the narratives and field notes used thematic content analysis.

Results

Common aspects of the CNS competencies and the experienced RN were recognized. These included direct patient care, assessment, and mentoring, with important differences in management, research, and coaching competencies.

Conclusion

The findings could facilitate the development of a master's program for the CNS in Chile. Formally recognizing the skills and clinical experiences of expert RNs may motivate nurses to pursue a master's degree that prepares them for advanced practice.
Septum Resection Versus Expectant Management in Women With a Septate Uterus: An International Multicentre Open-Label Randomized Controlled Trial
Authors: Rikken J. F. W. , Kowalik C. R. , Emanuel M. H. , Bongers M. Y. , Spinder T. , Jansen F. W. , Mulders A. G. M. G. J. , Padmehr R. , Clark T. J. , van Vliet H. A. , Stephenson M. D. , van der Veen F. , Mol B. W. J. , van Wely M. , Goddijn M.
Published: August 2021

(Abstracted from Hum Reprod 2021;36:1260–1267)

Septate uterus, a congenital uterine anomaly, affects approximately 0.2% to 2.3% of women of reproductive age and is associated with increased risk of subfertility, pregnancy loss, and preterm birth. The standard treatment for septate uterus is hysteroscopic septum resection, although various obstetric and gynecologic academic societies differ in their support of the procedure, often citing inadequate evidence of effectiveness for a reason to avoid surgery.
Nonindicated Brain Computed Tomography Scans for Children
Authors: Shi Yue Cherry , Hiscock Harriet , Oakley Ed , Freed Gary , O'Loughlin Rachel
Published: August 2021

Objectives

Clinical guidelines state brain computed tomography (CT) for atraumatic headache or first generalized afebrile, atraumatic seizure as nonindicated in neurologically normal children. We aimed to adapt 2 rigorously validated United States–based measures that examine overuse of CT in children with these conditions, and to determine whether these measures can be used in an Australian setting to determine rates of CT scanning in current practice.

Methods

Within an Australian tertiary pediatric hospital, we successfully adapted the measures from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding system of the United States measures to the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) coding system used in Australia. We conducted a retrospective audit of electronic medical record data from April 1, 2017, to March 31, 2018. Eligible patients were children aged 4 to 17 years who attended one of the hospital outpatient clinics and/or emergency department and/or were admitted to an inpatient ward. The conditions of interest were (1) atraumatic headache and (2) first generalized afebrile, atraumatic seizure.

Results

The measure for afebrile seizure was found to have low accuracy and low feasibility in this setting and was not tested further. The adapted measure for atraumatic headache was highly accurate in determining the encounters of interest; however, manual chart review was required to identify nonindicated brain CTs. Using this measure, 601 encounters for atraumatic headache were identified, of which 98 (16.3%) received at least 1 brain CT. We found that 14.1% of these scans were nonindicated, meaning 2% all atraumatic headache encounters received a nonindicated scan; lower than rates reported in international literature.

Conclusions

Using the tool developed in this study, rigorous measurement of the overuse of CT scans in other settings may determine the reasons for the lower rates observed in this study; inform future interventions to minimize overuse; and provide safer, higher quality care to children.
The Effectiveness of a Pediatric Emergency Medicine Block Education Session for Pediatric Residents
Authors: Wai Shannon S. , Uya Atim , Zimmerman Elise , Ratnayake Kristin , Hollenbach Kathryn , O'Donnell Shannon , Cannavino Christopher
Published: August 2021

Background and Objective

There exists no standardized curriculum for pediatric residents to develop procedural skills during residency training. Many pediatric residency programs are transitioning to block education sessions; the effectiveness of this format for delivering pediatric emergency medicine (PEM) procedural curriculum has not been evaluated. The objective is to determine if a PEM block education session improved pediatric residents' knowledge and confidence in 4 domains: laceration repair, splinting of extremities, resuscitation/airway management, and point-of-care ultrasound.

Methods

Pediatric residents at the University of California at San Diego participated in a 4-hour PEM block education session during which they rotated through 4 interactive stations: laceration repair, splinting of extremities, resuscitation/airway management, and point-of-care ultrasound. Residents' knowledge was assessed using 2 distinct multiple-choice tests, each consisting of 20 questions (5 questions per domain). Residents were block randomized to take one version of the test as the pretest and the other version as the posttest. Residents' confidence was assessed for each domain using a standardized 5-point confidence tool before and after the block education session.

Results

Forty-five residents attended the PEM block education session. Forty-three residents completed both the preknowledge and postknowledge tests. The PEM block education session resulted in an almost 14% increase in knowledge test when comparing preknowledge and postknowledge scores (P < 0.0001). Significant improvement in resident confidence was seen in all 4 domains (P < 0.0001).

Conclusions

The PEM block educational session improved both pediatric residents' knowledge and confidence in domains frequently encountered in the pediatric emergency department.
Optimal Management of Chronic Lymphocytic Leukemia and Economic Constraints
Authors: Cuneo Antonio , Cavazzini Francesco , Cavallari Maurizio , Foà Robin , Rigolin Gian Matteo
Published: August 2021

In this article, we carry out an overview on the management options available for chronic lymphocytic leukemia (CLL) patients and discuss possible treatment decisions, taking into account the issue of sustainability and availability. Targeted agents have shown to be superior compared with chemoimmunotherapy (CIT) in terms of progression-free survival in high-risk CLL. In the majority of studies, however, continuous treatment was compared with fixed-duration CIT and no overall survival or progression-free survival-2 (time from randomization to second progression or death) advantage could be documented. Meanwhile, a substantial financial burden on both patients and payers has raised issues about affordability and adherence to treatment. Therefore, value-based pricing of new drugs has been used to set up price negotiation policies in several countries, and fixed-duration therapy has shown to be less costly than continuous treatment. Thus, CIT continues to have a role in the treatment of CLL patients with a favorable genetic profile, that is, with a mutated IGHV gene profile and a wild-type TP53. Targeted treatment represents the preferred choice in patients with an unmutated IGHV gene configuration and/or a TP53 disruption, provided that adherence to treatment is guaranteed and bearing in mind that should costly drugs not be available for frontline treatment, new agents can be very effective as first salvage treatment.
Biofilm Management in Wound Care
Authors: Sen Chandan K. , Roy Sashwati , Mathew-Steiner Shomita S. , Gordillo Gayle M.
Published: August 2021

Learning Objectives:

After studying this article, the participant should be able to: 1. Understand the basics of biofilm infection and be able to distinguish between planktonic and biofilm modes of growth. 2. Have a working knowledge of conventional and emerging antibiofilm therapies and their modes of action as they pertain to wound care. 3. Understand the challenges associated with testing and marketing antibiofilm strategies and the context within which these strategies may have effective value.

The Centers for Disease Control and Prevention estimate for human infectious diseases caused by bacteria with a biofilm phenotype is 65 percent and the National Institutes of Health estimate is closer to 80 percent. Biofilms are hostile microbial aggregates because, within their polymeric matrix cocoons, they are protected from antimicrobial therapy and attack from host defenses. Biofilm-infected wounds, even when closed, show functional deficits such as deficient extracellular matrix and impaired barrier function, which are likely to cause wound recidivism. The management of invasive wound infection often includes systemic antimicrobial therapy in combination with débridement of wounds to a healthy tissue bed as determined by the surgeon who has no way of visualizing the biofilm. The exceedingly high incidence of false-negative cultures for bacteria in a biofilm state leads to missed diagnoses of wound infection. The use of topical and parenteral antimicrobial therapy without wound débridement have had limited impact on decreasing biofilm infection, which remains a major problem in wound care. Current claims to manage wound biofilm infection rest on limited early-stage data. In most cases, such data originate from limited experimental systems that lack host immune defense. In making decisions on the choice of commercial products to manage wound biofilm infection, it is important to critically appreciate the mechanism of action and significance of the relevant experimental system. In this work, the authors critically review different categories of antibiofilm products, with emphasis on their strengths and limitations as evident from the published literature.
Efficacy of the Müller Muscle-Conjunctival Resection for the Correction of Unilateral Ptosis following External Levator Operations in Patients with Bilateral Involutional Ptosis
Authors: Mangan Mehmet Serhat , Cakir Akin , Ercalik Nimet Yesim , Tekcan Hatice , Balci Sevcan , Ozcelik Kose Alev , Imamoglu Serhat , Turan Vural Ece
Published: August 2021

Patients with aponeurotic blepharoptosis who are treated with external levator advancement may experience complications such as upper eyelid height asymmetry and often require revision surgery. The authors assessed the efficacy of Müller muscle-conjunctival resection in cases with upper eyelid height asymmetry following bilateral external levator advancement. The authors used retrospective analysis of 11 cases between September of 2016 and October of 2018 with eyelid asymmetry following bilateral external levator advancement. Following a positive phenylephrine test, these patients underwent unilateral Müller muscle-conjunctival resection revision surgery to treat the undercorrected eyelid. Preoperative and postoperative marginal reflex distance 1, symmetry outcomes, and clinical outcomes of patients were evaluated after the Müller muscle-conjunctival resection. The average patient age was 54.81 ± 3.95 years (range, 37 to 69 years; median, 56 years); seven patients (63.6 percent) were women. Hering dependency was seen in all patients before the external levator advancement. A total of three patients underwent bilateral external levator advancement simultaneously, and eight patients underwent bilateral external levator advancement sequentially. The phenylephrine test was positive in all patients before the Müller muscle-conjunctival resection. Symmetry outcomes were assessed after the revision surgery as perfect (<0.5 mm), good (≥0.5 to <1 mm), or fair (≥1 mm) in four patients, six patients, and one patient, respectively. An optimal correction was noted in 13 of the 22 eyelids after the revision surgery, whereas eight of the 22 eyelids had minimal undercorrection, and one eyelid had minimal overcorrection. Müller muscle-conjunctival resection revision surgery for treatment of the ptotic eyelid following bilateral external levator advancement is viable and may represent a new alternative among the limited revision techniques.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
A 17-Year Experience in Hand and Digit Replantation at an Academic Center
Authors: Billington Alicia R. , Ogden Benjamin W. , Le Nicole K. , King Kathryn S. , Rotatori R. Maxwell , Kim Ryan L. , Nydick Jason
Published: August 2021

Background: Results

of replantation surgery following upper extremity traumatic amputation are extensively described in the literature, with success rates varying from 57 to 100 percent. The purpose of this study was to evaluate replantation success rate at a Level I trauma center over a 17-year period and to assess definable factors contributing to these results.

Methods:

A retrospective review of all digit and hand replantations at a Level I trauma center was performed using CPT codes from 2001 through 2018. Descriptive analyses, Mann-Whitney test, Kruskal-Wallis test, and logistic regressions were used. Significance was defined asp≤ 0.05.

Results:

Analysis consisted of 76 patients with 101 amputated parts (93 digits and eight hands). Fifty-six single digit amputations (30 percent success rate), 37 multidigit injuries (22 percent digit success rate), and eight hand amputations (50 percent success rate) were attempted. The overall success rate was 25 of 76 patients (33 percent) and 29 of 101 parts (29 percent). The most common mechanism of injury was laceration (n= 56), followed by crush (n= 30), and avulsion (n= 11), with repair of laceration-type injuries having the greatest success rate (36 percent).

Conclusions:

The authors report a lower success rate of hand and digit replantation than previously described in the literature. Whole hand and thumb replantations resulted in the highest survival rate in our series. Laceration mechanism showed a higher success rate than crush or avulsion-type injuries. The authors’ modest results highlight the importance of effective internal auditing of low-volume replantation centers such as their own. Quality improvement measures are proposed for higher future success in replantation surgery at the authors’ institution.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Safety of Contemporary Resorbable Fixation Systems for Craniofacial Reconstruction in Pediatric Patients
Authors: Kalmar Christopher L. , Bushold Julia , Carlson Anna R. , Zapatero Zachary D. , Kosyk Mychajlo S. , Swanson Jordan W. , Taylor Jesse A. , Bartlett Scott P.
Published: August 2021

Background:

Resorbable hardware allows adequate strength for maintaining the relative position of the craniofacial skeleton during osseous healing, and allowing subsequent growth in pediatric patients. The purpose of this study was to determine the complication profile of the latest copolymer of resorbable plates for craniofacial reconstruction in pediatric patients.

Methods:

Retrospective query of the operative billing record was performed for use of the DePuy Synthes Rapidsorb Fixation System at the authors’ tertiary children’s hospital from 2015 to 2019. Three hundred twenty-five patients were randomly selected for analysis of complications within the first postoperative year.

Results:

Median age at craniofacial reconstruction was 3.0 years, with 127 procedures (39.9 percent) performed for an intracranial mass and 141 procedures (44.3 percent) performed for craniosynostosis. Overall, 7.9 percent patients had a postoperative wound complication. The most common complications were dehiscence (3.8 percent), hematoma/seroma (3.5 percent), and infection (2.5 percent). There were no instances of extrusion, plate fracture, or screw loosening. Hardware complications in the temporoparietal region were more likely to occur at incision sites (p = 0.001), whereas wound complications at the frontal region were more likely to occur away from incision sites (p < 0.001). There were no differences in complications between plates secured with resorbable screws or with the resorbable injectable polymer system (p ≥ 0.161 for all). Radiotherapy was significantly implicated in development of clinical infection (p = 0.001), culture-positive infection (p < 0.001), readmission (p = 0.007), reoperation (p = 0.003), and plate removal (p = 0.007).

Conclusion:

Resorbable cranial hardware has an overall favorable complication profile for craniofacial reconstruction in pediatric patients undergoing surgical intervention for craniosynostosis or intracranial mass resection.
Rethinking the Collateral Vasculature Assessment in Acute Ischemic Stroke
Authors: Faizy Tobias Djamsched , Heit Jeremy Josef
Published: August 2021

Occlusion of a cervical or cerebral artery results in disruption of blood flow to the brain and may result in irreversible infarction. Intracranial pial collaterals are a network of arteries that may preserve blood flow to otherwise critically hypoperfused brain areas until vessel recanalization is achieved. The robustness of these arterial collaterals is pivotal for the survivability of ischemic brain tissue and is associated with treatment success and long-term clinical outcome. More recently, the importance of venous outflow from ischemic brain tissue has been appreciated. Arterial collaterals and venous outflow are evaluated by neuroimaging parameters, and recent imaging advances have enabled a more comprehensive assessment of the entire collateral cascade in patients with acute ischemic stroke. Here we review novel imaging biomarkers for the assessment of arterial collaterals, tissue-level collateral blood flow, and venous outflow. We also summarize how a more comprehensive assessment of the cerebral blood flow leads to a better prediction of treatment efficacy and improved clinical outcomes.
Treatment of Severe Postburn Contracture of the Elbow via Distraction With External Circular Frame in Pediatric Patient
Authors: Chen Youbai , Niu Zehao , Yin Xiangye , Li Yan , Han Yudi , Chai Mi , Li Dan , Tao Ran , Guo Lingli , Lei Yonghong , Han Yan
Published: August 2021

Background

Although external circular frame (ECF) has been widely used for the correction of knee and ankle deformities, few studies reported the use of ECF for the treatment of severe postburn elbow contracture and stiffness (SPECS). The purpose of this retrospective study was to investigate the effectiveness and safety of the distraction using ECF in treating SPECS.

Methods

After institutional review board approval, we implemented a retrospective single-center case series study composed of consecutive patients treated for SPECS at Chinese PLA General Hospital between January 2010 and January 2018. After scar release and skin grafting, distraction with ECF was performed for 4 to 6 weeks, and the frame was retained for 2 more weeks before removal. Four weeks of splinting and at least 1 year of rehabilitation were recommended. Patient demographics, active and passive range of motion (ROM) of the elbow at different time points (preoperative, postdistraction, and final follow-up), and complications were collected from the electronic medical record. The primary outcome was the long-term improvement of the ROM. Other outcomes included complications and recurrence.

Results

The ECF was used to treat SPECS in 6 patients (3 males and 3 females, average age of 11.7 ± 2.6 years). Scar release and distraction with ECF significantly increased both active (from 3° preoperative to 38.7° postdistraction) and passive (from 3.5° preoperative to 48.3° postdistraction) ROM over an average distraction duration of 5.2 weeks. The long-term improvement of active and passive ROM was 38° ± 13.4° and 46° ± 14.7°, respectively, over a median follow-up of 4.1 years. Pin-tract infection occurred in 2 patients and were treated with local wound care and oral antibiotics. A tendon readhesion developed in 1 of the 6 patients because of noncompliance with splinting and physiotherapy, and was treated with revision surgery.

Conclusions

The 3C strategy (i.e., contracture release, coverage of the defect with skin grafting, and correction of articular angle with gradual distraction using the ECF) is able to increase the ROM with minor complications. We recommend distraction with ECF as part of the treatment arsenal, particularly for severe contractures in which 1-stage correction is unfeasible because of considerable soft tissue shortening.
The Impact of COVID-19 on Plastic Surgery Home Program Match Rates
Authors: Faletsky Adam , Zitkovsky Helen , Guo Lifei
Published: August 2021

Background

Historically, integrated plastic surgery is one of the most competitive specialties in the residency match. In the 2020–2021 residency application cycle, plastic surgery programs were forced to adjust how they select applicants because of the COVID-19 pandemic disrupting visiting subinternships. We hypothesize that a higher proportion of plastic surgery applicants matched at their home institution during the 2020–2021 application cycle secondary to the implementation of COVID-19–related restrictions.

Methods

Between March 24 and 27, 2021, we used publicly available, online plastic surgery–specific spreadsheets to analyze plastic surgery applicant information over the course of 3 application cycles (2018–2019, 2019–2020, and 2020–2021) for the top 50 plastic surgery programs. We collected data corresponding to the matched plastic surgery applicants' medical school, the institution at which they matched, and whether they had previous communication with their matched program.

Results

Our search yielded information on 128 applicants from the 2019 match cycle, 129 applicants from the 2020 match cycle, and 133 applicants from the 2021 application cycle. In 2019 and 2020, 15 (11.7%) and 22 (17.1%) plastic surgery applicants matched at their home program, respectively. In 2021, 32 (24.1%) of plastic surgery applicants matched at their home program (P = 0.032). When stratified by reputation rank, home program match rates among programs ranked 1–25 in 2021 had a large increase over the 2020 match cycle (28.4% vs 16.7%), whereas the home match rates of programs ranked 26–50 in 2021 (17.3%) held level with that of 2020 (17.6%). Conversely, for those not matched to their home programs, only 20 (19.8%) in 2021 reported having had any prior contact with their matched programs compared with 54 (50.5%) in 2020 (P < 0.001).

Conclusions

The 2020–2021 plastic surgery application cycle matched a significantly higher proportion of applicants at their home institution. With the temporary discontinuation of visiting subinternships during the 2020–2021 application cycle, it is likely that both plastic surgery programs and applicants compensate for this loss of in-person exposure by turning to home applicants and home institutions, respectively.