bluuebunny/crossref_metadata_2025 huggingface dataset:
Vericiguat: A Novel Soluble Guanylate Cyclase Stimulator for Use in Patients With Heart Failure
Authors: Gupta Rahul , Lin Muling , Maitz Theresa , Egeler David J. , Sood Aayaan , Aronow Wilbert S. , Rajeswaran Yasotha , Ahnert Amy M. , Vyas Apurva V. , Frishman William H. , Lanier Gregg M.
Published: January 2022

Heart failure (HF) affects 6.2 million Americans and is increasing annually in its frequency. Treatment of HF has been at the forefront of medical advancements due to the financial burden on our health care system. As such, changes to the guidelines regarding standard of care have been evolving over the last decade with the recent additions of sacubitril-valsartan and sodium glucose co-transporter-2 inhibitors to standard of care in the treatment of HF. Despite the aforementioned expansions in treatment options, HF continues to have a significant impact on the American health care system. Most recently, a novel drug vericiguat that targets an unprecedented pathway for the treatment of HF was Food and Drug Administration approved for the management of patients with HF with a reduced ejection fraction with a recent hospitalization or need for outpatient intravenous diuretics. In clinical trials, vericiguat was associated with a reduction in death from cardiovascular causes and first hospitalization in comparison to placebo. The aim of this review is to provide a comprehensive literature analysis of the various trials surrounding the approval of vericiguat and to both inform and synthesize the data surrounding the clinical use of vericiguat. The introduction of Vericiguat should be considered as a treatment option in patients to decrease the mortality/morbidity of HF with reduced ejection fraction and to increase the quality of life.
The effects of social distancing and self-isolation on functional outcomes after radical prostatectomy during the coronavirus disease 2019 (COVID-19) pandemic
Authors: Barakat Bara , Schakaki Samer , Vögeli Thomas-Alexander
Published: January 2022

Background:

This study is aimed to analyze the effect of social distancing on functional outcomes (potency, continence recovery, and quality of life) on patients undergoing open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP) during the COVID-19 pandemic.

Materials and methods:

We retrospectively assessed functional outcomes of 55 consecutive patients who underwent radical prostatectomy during the COVID-19 pandemic (group A: 12 ORP and 15 RARP) and compared these data with patients from the previous year (group B: 13 ORP and 15 RARP). Propensity-score matching was performed to analyze variables associated with potency, continence recovery and compared between the groups at 1 and 3months.

Results:

Patients from group A were less interested in postsurgical rehabilitation compared to those from group B (95.7% vs. 56.2%, p 
= 0.042). Continence recovery among group B patients also tended to be higher for RARP (p 
= 0.06) and ORP (p 
= 0.08) at 1 month, although statistical significance was not reached. The cumulative continence recovery at 3 months among group B patients was higher and statistically significantly advantageous for RARP (p 
= 0.00) and ORP (p 
< 0.01). Potency rates among younger group B patients following bilateral nerve-sparing procedures were statistically significantly advantageous for RARP (p 
= 0.026) and ORP (p 
= 0.011).

Conclusions:

Our results highlight the large impact of the COVID-19 pandemic on functional outcomes following radical prostatectomy. Future design and planning of home-based models for improved post-operative care should consider this evidence.
Are Specific Body Sites Prone for Wound Infection After Skin Surgery? A Systematic Review and Meta-Analysis
Authors: Schlager Justin Gabriel , Ruiz San Jose Virginia , Patzer Kathrin , French Lars E. , Kendziora Benjamin , Hartmann Daniela
Published: January 2022

INTRODUCTION

Identifying risk factors for wound infection may guide clinical practice for optimal use of perioperative antibiotic prophylaxis in dermatologic surgery.

OBJECTIVE

To summarize the current evidence whether specific body sites have higher risks for surgical site infections (SSI).

Methods

The systematic literature search included MEDLINE, Embase, CENTRAL, and trial registers. Only observational studies qualified for inclusion and meta-analysis. We assessed the risk of bias according to the Newcastle–Ottawa Scale.

RESULTS

Eighteen studies with 33,086 surgical wounds were eligible. Eight studies were of good, 4 of fair, and 6 of poor quality. The mean infection rate was 4.08%. Meta-analysis showed that the lips had significantly higher infection rates. The lower extremity and ears had or tended toward a higher risk for infection, but studies were clinically heterogeneous. A large prospective trial found that surgical wounds on the hands were at higher risk for infection. The trunk showed the lowest infection rate. The risk for SSI in other body locations was not different or remained uncertain because of substantial heterogeneity among studies.

CONCLUSION

Lips, lower extremities, and probably ears and hands may have a higher risk for wound infection after skin surgery. The trunk showed the lowest infection rate.
Concordance of Data About Sex From Electronic Health Records and the National Death Index
Authors: Blosnich John R. , Boyer Taylor L.
Published: January 2022

Background:

Transgender individuals have greater health risks than cisgender individuals, which may bode for greater mortality. However, research is limited by lack of gender identity information at the time of death. Novel opportunities to combine administrative data with National Death Index (NDI) data may facilitate mortality research about transgender populations, but binary measures of sex and gender may pose problems for analyses. This study explored differences in sex recorded in Veterans Health Administration (VHA) electronic health record (EHR) and NDI data between transgender and cisgender decedents.

Methods:

We used VHA EHR data from fiscal years 2000–2016 to identify deaths among a sample of transgender and cisgender patients. We cross-tabulated sex recorded in the NDI with EHR-based sex from VHA EHR data. We extracted data in 2018 and conducted analyses in 2020.

Results:

Death occurred for 1109 transgender patients and 7757 cisgender patients. For cisgender decedents, EHR-based sex and NDI-based sex were 100% concordant. For transgender decedents, 46 (4%) were discordant between data sources. Of transgender decedents with female EHR-based sex (n = 259), 17% were indicated as male in NDI data; of those with male EHR-based sex (n = 850), 0.2% were indicated as female in NDI data.

Conclusions:

Data linkage between EHR and the NDI can facilitate transgender mortality research, but examining mortality specific to various transgender identities remains difficult. Improved documentation of sex and gender is needed within US mortality surveillance.
Long-term Exposure to Fine Particulate Matter and Mortality A Longitudinal Cohort Study of 400,459 Adults
Authors: Guo Cui , Yu Tsung , Bo Yacong , Lin Changqing , Chang Ly-yun , Wong Martin C. S. , Yu Zengli , Lau Alexis K. H. , Tam Tony , Lao Xiang Qian
Published: January 2022

Background:

Cohort studies on the association between long-term exposure to fine particulate matter (PM2.5) and mortality have been well established for America and Europe, but limited and inconsistent in Asia with much higher air pollution. This study aims to investigate the associations between ambient PM2.5 and all-cause and cause-specific mortality over a period of rising and then declining PM2.5.

Methods:

We enrolled a total of 400,459 adults from an open cohort between 2001 and 2016, and followed them up until 31 May 2019. We obtained mortality data from the National Death Registry maintained by the Ministry of Health and Welfare in Taiwan. We estimated ambient PM2.5 exposures using a satellite-based spatiotemporal model. We performed a Cox regression model with time-dependent covariates to investigate the associations of PM2.5 with deaths from all causes and specific causes.

Results:

This study identified 14,627 deaths and had a total of 5 million person–years of follow-up. Each 10 µg/m3 increase in PM2.5 was associated with an increased hazard risk of 29% (95% confidence interval: 24%–35%) in all-cause mortality. Risk of death increased by 30% for natural causes, 20% for cancer, 42% for cardiovascular disease (CVD) causes, and 53% for influenza and pneumonia causes, for each 10 µg/m3 increase in PM2.5. Sensitivity analyses generally yielded similar results.

Conclusion:

Long-term exposure to ambient PM2.5 was associated with increased risks of all-cause mortality and deaths from cancers, natural causes, CVD, and influenza and pneumonia. Longitudinal study design should be encouraged for air pollution epidemiologic investigation.
The Bilateral Trans Alar Forehead Flap to Reconstruct the Cocaine Nose: A Case Report
Authors: Taams Karel O. , Taams Stephanie J.
Published: January 2022

Isolated circumferential lining contraction of the midvault and nasal floor is a challenging reconstructive problem. In the cocaine nose, extensive loss of mucosal lining, with or without loss of columella, will result in collapse of the nose into the pyriform fossa. Various techniques have been used to provide nasal lining, but when the defect is extensive a free tissue transfer is advocated. The forehead flap is not able to reach the nasal vestibule when the nasal skin is intact. Transecting the ala creates a shortcut route for the forehead flap to provide lining for the nasal vault, nasal floor, and soft tissue cover for the columella. A bilateral trans alar forehead flap was used to reconstruct the nasal lining and columella in a patient with a severely contracted cocaine nose. An L strut cartilage graft was covered with the forehead flaps, which were divided and inset in the nasal vault separately 3 weeks apart. The bilateral trans alar forehead flap is an excellent alternative to microsurgical reconstruction of the nasal lining and columella in the cocaine nose. Secondary thinning of a wide columella may be indicated, but the forehead skin provides a good color match. The scars on the forehead and the alar scars on the border of subunits of the nose heal well and are minor tradeoffs.
Skin Grafting Using Collagen Fiber Orientation Matching
Authors: Kuwahara Masamitsu , Osaki Shigeyoshi , Asada Hideo
Published: January 2022

Background:

Skin contracture after skin grafting is undesirable. It is generally accepted that full-thickness skin grafts contract less than split-thickness skin grafts. However, unexpected secondary skin-graft contracture sometimes occurs after full-thickness skin grafting. We tried to elucidate the causes of skin contracture from the viewpoint of the orientation of collagen fibers to find a way to reduce skin-graft contracture.

Method:

First, we examined the collagen fiber orientation of the skin over the whole body in Sprague-Dawley rats. Next, two pieces of skin (width: 30 mm × 30 mm; thickness: ca. 2 mm) were stripped off a rat for grafting. The pieces were grafted to different sites so that the collagen fibers of the graft and surrounding skin ran parallel or perpendicular to each other. The collagen fiber orientation before and after the skin grafting was determined using Osaki’s microwave method, a mechanical method, and scanning electron microscopy.

Results:

The rat skin exhibited marked variations in collagen fiber orientation among different sites. The direction of the collagen fiber orientation corresponded to that of minimal mechanical strain. We found that the collagen fiber orientation in skin grafts remained almost unchanged after skin grafting.

Conclusions:

Mismatched collagen fiber orientation between grafts and the surrounding skin is considered to be a cause of secondary contracture after skin grafting. We propose that skin grafts that minimize the difference in collagen fiber orientation between the skin graft and the surrounding skin should be selected.
SHORT-TERM OUTCOMES AFTER INTERIM TREATMENT WITH BROLUCIZUMAB
Authors: Awh Caroline C. , Davis Emily C. , Thomas Mridul K. , Thomas Akshay S.
Published: January 2022

Purpose:

To examine outcomes of eyes with neovascular age-related macular degeneration that were switched to brolucizumab because of an unsatisfactory response to bevacizumab, ranibizumab, and/or aflibercept and then switched back because of the presence or risk of intraocular inflammation.

Methods:

Retrospective case series of 51 eyes. Visual acuity and retinal anatomy on optical coherence tomography were recorded at the first brolucizumab injection (T1), the final brolucizumab injection (T2), and 6 months following the final brolucizumab injection (T3).

Results:

At T2, 41 eyes (41/51%, 80%) had decreased subretinal fluid (31 eyes), intraretinal fluid (12 eyes), or pigment epithelial detachment height (12 eyes). At T3, decreased subretinal fluid was sustained in 17 eyes (17/31%, 55%), decreased intraretinal fluid was sustained in eight eyes (8/12%, 67%), and decreased pigment epithelial detachment height was sustained in eight eyes (8/12%, 67%). Mean logarithm of the minimum angle of resolution visual acuity at T1, T2, and T3 was 0.396 (∼20/50), 0.441 (∼20/55), and 0.468 (∼20/59), respectively. During the brolucizumab treatment period, 11 eyes (11/51%, 22%) developed intraocular inflammation, including one case of retinal vasculitis.

Conclusion:

Interim treatment with brolucizumab resulted in anatomical improvements in 41 eyes (41/51%, 80%) that were maintained in 22 of these eyes (22/41%, 54%) for at least 6 months after switching back to the original anti–vascular endothelial growth factor therapeutic. There were no corresponding significant changes in visual acuity.
ROLE OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN DETECTING AND MONITORING INFLAMMATORY CHOROIDAL NEOVASCULARIZATION
Authors: Kongwattananon Wijak , Grasic David , Lin Henry , Oyeniran Enny , Sen H. Nida , Kodati Shilpa
Published: January 2022

Purpose:

To investigate the utility of optical coherence tomography angiography (OCTA) for the detection of inflammatory choroidal neovascularization (iCNV) and monitoring their response to treatment.

Methods:

A retrospective review of patients with a diagnosis of uveitis and associated iCNV with active exudation was performed. Active iCNV was determined by spectral domain OCT and/or fluorescein angiogram. Spectral domain OCTA outer retina to choriocapillaris slabs was evaluated for the presence of iCNV. Follow-up OCTA images were qualitatively assessed to determine whether regression of iCNV occurred after treatment.

Results:

Thirteen eyes of 12 patients were included. The etiologies of uveitis include punctate inner choroidopathy (n = 4), multifocal choroiditis (n = 2), presumed sarcoid uveitis (n = 2), tuberculous choroiditis (n = 1), birdshot chorioretinopathy (n = 1), syphilitic uveitis (n = 1), serpiginous choroiditis (n = 1), and idiopathic panuveitis (n = 1). Inflammatory choroidal neovascularization was detected on en face OCTA in 10 of 13 eyes (76.9%). After iCNV treatment, en face OCTA demonstrated complete regression of iCNV in 5 of 10 eyes (50%), partial regression in 2 of 10 eyes (20%), and no regression in 3 of 10 eyes (30%).

Conclusions:

Optical coherence tomography angiography is an effective modality for detecting iCNV and could provide detailed visualization regarding location, morphologic structure, and flow of the iCNV and its response to therapy.
Hepatitis C Virus Treatment Response to Direct-acting Antivirals Among Adolescents With HIV/HCV Coinfection: Real-world Data From Ukraine
Authors: Malik Farihah , Malyuta Ruslan , Volokha Alla , Bailey Heather , Collins Intira Jeannie , Thorne Claire ,   for the Ukraine Paediatric HIV Cohort
Published: January 2022

Direct-acting antivirals (DAAs) have been approved for treating chronic hepatitis C virus (HCV) in children and adolescents. Although DAAs have been used in real-world settings for the treatment of HCV monoinfected adolescents, few reports of real-world use of DAAs in children and adolescents who are coinfected with human immunodeficiency virus (HIV) are available. We evaluated the real-world safety and effectiveness of DAAs in HIV/HCV coinfected adolescents from the Ukraine Paediatric HIV Cohort Study including all those for whom treatment outcomes were available by April 2021. Overall, 6 coinfected adolescents had received DAA treatment; 4 with sofosbuvir/ledipasvir (SOF/LDV), 1 with SOF/LDV+ribavirin, and 1 with SOF/daclatasvir. No patient discontinued treatment due to adverse events and no serious adverse events were reported. All 6 patients achieved sustained virologic response by 12 weeks after the end of therapy. DAA treatment was well tolerated and effective in adolescents with HIV/HCV coinfection in a real-world setting.
IOL power calculations after LASIK or PRK: Barrett True-K biometer-only calculation strategy yields equivalent outcomes as a multiple formula approach
Authors: Ferguson Tanner J. , Downes Rachel A. , Randleman J. Bradley
Published: January 2022

Purpose:

To compare the accuracy of intraocular lens (IOL) power calculations performed using the biometer-embedded Barrett True-K formula vs a multiple formula approach using the ASCRS postrefractive calculator in eyes with previous myopic or hyperopic refractive surgery.

Setting:

Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.

Design:

Retrospective, consecutive case series.

Methods:

Patients who underwent cataract surgery with a history of corneal refractive surgery were included. For each formula, the IOL prediction error and refractive prediction error was calculated. Main outcome measures included mean absolute error (MAE) and the percentage of eyes within ±0.25 diopters (D), ±0.50 D, and ±1.00 D.

Results:

96 postmyopic eyes and 47 posthyperopic eyes were analyzed. In the postmyopic cohort, the Barrett True-K formula had the lowest MAE (0.36 D), followed by the Haigis-L formula (0.41 D). The Barrett True-K formula had a significantly higher percentage (44.8%) of eyes within ±0.25 D in comparison with the Haigis-L formula (34.4%), which had the second highest percentage (P < .01). In the posthyperopic cohort, the Barrett True-K formula had the lowest MAE (0.41 D), followed by the ASCRS–mean (0.46). The Barrett True-K and ASCRS–mean formulas had the highest percentage of eyes within ±0.25 D (42.6% vs 38.3%, P = .16).

Conclusions:

The Barrett True-K formula built into the biometer performed equivalently to a multiple formula approach on the ASCRS online calculator in both postmyopic and posthyperopic eyes. This approach reduces the potential for transcription error from data entry for lens power calculation approaches that require manual data entry.
Ocular parameter changes after phacoemulsification in pseudoexfoliative eyes: case–control study
Authors: Kassos Ioannis , Tzamalis Argyrios , Dermenoudi Maria , Matsou Artemis , Koronis Spyridon , Ziakas Nikolaos , Anastasopoulos Eleftherios
Published: January 2022

Purpose:

To assess changes of angle morphometric parameters, anterior chamber depth (ACD), intraocular pressure (IOP), and endothelial cell density (ECD) after uneventful phacoemulsification in eyes with pseudoexfoliation syndrome (PEX) compared with those in eyes without PEX and to evaluate the effect of these changes on effective lens position and postoperative refraction.

Setting:

Papageorgiou Hospital, Thessaloniki, Greece.

Design:

Prospective case–control study.

Methods:

Angle opening distance, trabecular-iris space area, and scleral spur angle width were measured using anterior segment optical coherence tomography. ACD was assessed using IOLMaster and ECD using specular microscopy. All parameters were evaluated at baseline and 2 months postoperatively.

Results:

42 patients (42 eyes) with PEX and 39 patients (39 eyes) without PEX who underwent uneventful phacoemulsification were enrolled. All angle parameters and ACD increased significantly after phacoemulsification in both groups (P < .001), with no statistically significant difference between them (P > .05). Percentile change in ACD was greater in PEX eyes (P = .017). Regarding the mean refractive prediction error, no statistically significant differences were found between the study groups (P = .68). A statistically significant trend toward hyperopic shift was noted in the PEX group (P = .039). IOP and ECD diminished postoperatively in both groups, with no statistically significant difference between the study groups (P = .09 and P = .22, respectively).

Conclusions:

PEX, compared with non-PEX eyes, demonstrated a greater anterior chamber deepening and a hyperopic shift after phacoemulsification. These could be related to the zonular laxity in eyes with PEX and imply that PEX eyes may require a modified target refraction to achieve the desired refractive outcome.
Intrastromal corneal ring segments followed by PRK for postkeratoplasty high astigmatism: prospective study
Authors: Bertino Pedro , Magalhães Renata Soares , de Souza Carlos José , Rocha Guilherme , Santhiago Marcony R.
Published: January 2022

Purpose:

To evaluate refractive and topographic results of the association of intrastromal corneal ring segments (ICRS) with photorefractive keratectomy (PRK) for the correction of high (>6.0 diopters [D]) postkeratoplasty astigmatism (PKA).

Setting:

University of São Paulo, São Paulo, Brazil.

Design:

Prospective interventional study.

Methods:

Postpenetrating keratoplasty patients, intolerant to contact lens fitting, and with corneal astigmatism higher than 6.0 D were treated by the combination of ICRS and PRK from January 2017 to June 2019. First, patients underwent femtosecond laser–assisted ICRS implantation to reduce and regularize corneal astigmatism, and 3 months later, submitted to PRK for the residual astigmatism. Outcomes were obtained 12 months after PRK.

Results:

The study comprised 30 eyes of 29 patients. Mean uncorrected distance visual acuity (logMAR) changed from 1.16 ± 0.37 in the preoperative to 0.69 ± 0.40 after ICRS (P < .0001) and to 0.34 ± 0.29 12 months after PRK (P < .0001). Mean spherical equivalent decreased from −5.19 ± 4.81 D in the preoperative to −3.38 ± 4.51 D after ICRS (P < .0001) and to −2.30 ± 2.84 D after PRK (P = .132). Mean topographic astigmatism decreased from 7.88 ± 2.13 D in the preoperative to 5.47 ± 2.29 D after ICRS (P < .0001) and to 4.12 ± 2.93 D after PRK (P = .003). Mean refractive astigmatism decreased from 7.10 ± 1.13 D in the preoperative to 4.61 ± 1.61 D after ICRS (P < .0001) and to 2.58 ± 1.49 D after PRK (P < .0001). After PRK, the mean correction index (CI) for corneal astigmatism was 0.77 ± 0.36. The ICRS/PRK combination resulted in a higher CI than ICRS only, both for corneal and refractive astigmatism. 2 eyes (8%) presented clinically significant opacification. Other complications were endothelial rejection (n = 1, 4%), infectious keratitis (n = 1, 4%), and ICRS extrusion after corneal melting (n = 1, 4%).

Conclusions:

The association of ICRS and PRK was effective for treating high PKA. This strategy improved visual acuity, spherical equivalent, topographic and refractive astigmatism and resulted in a high CI. Safety questions remain open and must be balanced against benefits.
Comparison of astigmatic correction with and without limbal marking during small-incision lenticule extraction
Authors: Wang Boyuan , Wang Yan , Zhang Jiamei
Published: January 2022

Purpose:

To compare clinical outcomes after correction of moderate to high astigmatism through small-incision lenticule extraction (SMILE) with and without limbal marking.

Setting:

Tianjin Eye Hospital, Tianjin, China.

Design:

Prospective randomized comparative case series.

Methods:

This prospective randomized control study included 240 unilateral eyes of 240 patients who underwent SMILE with astigmatism of more than 0.75 diopters (D). The eyes were randomly assigned to a marked group (120 eyes) or an unmarked control group (120 eyes). Manifest refraction was observed at the 3-month follow-up timepoint and evaluated using a vector analysis.

Results:

Postoperative astigmatism differed statistically significantly in the marked group (−0.08 ± 0.15 D) and the control group (−0.16 ± 0.24 D) at 3 months (P = .001), and correction index, index of success, angle of error (absolute value), and magnitude of error were also significantly better in the marked group (P < .05). There was a significant positive correlation between index of success and angle of error (absolute value) (P < .001).

Conclusions:

Limbal marking–based manual compensation prior to SMILE was associated with a statistically significant reduction in undercorrection and error of axis in cases of moderate to high astigmatism, although the magnitude of the difference was small.
Assessing the Economics of an Entry-Level Physician Assistant Doctoral Degree
Authors: Miller Anthony A. , Coplan Bettie
Published: January 2022

Purpose:

An entry-level doctoral degree for the physician assistant (PA) profession has been a perennial issue since the master's degree approval in 2000 and the 2009 release of the Clinical Doctorate Summit Report. Many PA counterparts have transitioned to required or optional doctoral degrees for entry into practice. Although the PA profession has not adopted an entry-level doctorate, postgraduate doctoral programs have proliferated. This study's aim was to compare the cost of post-PA doctoral degrees to the estimated cost of an entry-level PA doctorate.

Methods:

Cost of a post-PA doctoral degree was obtained from data on 15 postgraduate doctoral programs associated with PAEA member programs. Historical, aggregated data on PA program characteristics were collected from PAEA Annual Program Survey reports to estimate costs for an entry-level doctorate and to propose a likely model. For comparison, educational program data from health professions that have transitioned to entry-level doctorates were assessed.

Results:

The average cost for postgraduate PA programs is significantly higher than the projected add-on cost for an entry-level PA doctorate, which ranges from $5,731 to $15,563. Directors of post-PA doctorate programs report that enrollments are generally near or at capacity.

Conclusions:

Implementation of an entry-level doctorate by accredited PA educational programs has the potential for significant economic and chronological advantages over postgraduate doctoral programs.
Nonsquamous Lesions of the Vulvar Skin and Subcutaneous Tissue: A Review (Part 2)
Authors: Rastegar Shima , Aisner Seena C. , Heller Debra S.
Published: January 2022

Objective

The aim of this second article was to complete part 1 review of nonsquamous lesions of the vulvar skin and subcutaneous tissue (Journal of Lower Genital Tract Disease, 2021), clinically and pathologically, based on the fifth edition of the World Health Organization tumor classification.

Materials and Methods

A database search of PubMed and Google Scholar was performed between 1970 and 2021, using the search terms “vulva,” “lower genital tract,” and “non-squamous lesions.” The search was limited to “human gynecological pathology.” Full article texts were reviewed, and reference lists were screened for additional articles. We excluded abstracts and articles written in the non-English language.

Results

An initial list of 400 articles was identified. Thirty-seven articles discussed clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue.

Conclusions

Clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue as categorized by the updated World Health Organization classification are presented.
Hypertriglyceridemia: rationale, design and implementation of the Australian Hypertriglyceridemia Registry
Authors: Pang Jing , Li Stephen C.H. , Chan Dick C. , Sullivan David R. , Woodward Ann-Marie , Watts Gerald F.
Published: January 2022

Purpose of review

Hypertriglyceridemia (HTG) is a risk factor for atherosclerotic cardiovascular disease (ASCVD), aortic stenosis, hepatic steatosis and pancreatitis. We briefly review the aetiology and treatment of HTG and familial chylomicronemia syndrome (FCS), as well as the implementation of a clinical quality registry for improving care, the Australian Hypertriglyceridemia (AUSTRIG) Registry.

Recent findings

There is a need to improve the detection of individuals with severe HTG and FCS, who could benefit from more intense and novel treatments to prevent end-organ damage. Patient registries provide valuable data for advancing care of individuals with severe HTG at high risk of acute pancreatitis, steatohepatitis and ASCVD. However, there is a paucity of registries of such patients. We outline the design and implementation of the AUSTRIG Registry.

Clinical registries can be employed in many ways for improving outcomes for patients with HTG, through the collation and analysis of data for enabling health service planning, clinical trials and audits, and for better informing and empowering registrants.
Healthy and unhealthy aging on kidney structure and function: human studies
Authors: Denic Aleksandar , Rule Andrew D. , Glassock Richard J.
Published: January 2022

Purpose of review

This review is intended to provide an up-to-date analysis of the structural and functional alterations of the kidneys that accompany healthy and unhealthy aging in humans. Macro- and micro- structural changes and glomerular filtration rate (whole kidney and single nephron) accompanying aging will be stressed.

Recent findings

Comparative findings concerning distribution of anatomic changes of the kidney healthy and unhealthy aging are reviewed. Challenges concerning definition of chronic kidney disease (CKD) in otherwise healthy aging patients are discussed. The complex interactions of CKD and aging are discussed. The role of podocyte dysbiosis in kidney aging is reviewed.

Kidney aging is a complex phenomenon often difficult to distinguish from CKD. Nonetheless, phenotypes of healthy and unhealthy aging are evident. Much more information concerning the molecular characteristics of normal kidney aging and its relevance to chronic kidney disease is needed.
Typology of Family Relationships, Psychological Distress, and Quality of Life in Chinese Patients With Advanced Lung Cancer
Authors: Chen Jieling , Zhu Jingfen , Jian Hong , Zhao Yi , He Shanshan , He Yaping
Published: January 2022

Background

Family relationships affect psychological adjustment and quality of life (QoL) in patients with advanced cancer. The typology of family relationships has not been examined in Chinese patients with advanced cancer.

Objective

The aims of this study were to identify profiles of family relationships and examine their relationships with psychological distress and QoL in Chinese patients with advanced lung cancer.

Methods

A total of 252 Chinese patients with advanced lung cancer at 2 hospitals in Shanghai participated in the study. They completed self-reported questionnaires. Latent profile analysis was used to identify the optimal classification of perceived family relationships based on 3 indicators (cohesiveness, expressiveness, and conflict resolution).

Results

Three profiles of family relationships were identified. The supportive profile (70.6%) showed high cohesiveness, expressiveness, and conflict resolution. The low-expressive profile (15.9%) showed low expressiveness but high cohesiveness and conflict resolution (15.9%). The conflictive profile (13.5%) showed low conflict resolution but high cohesiveness and expressiveness. Compared with supportive families, low-expressive and conflictive families were associated with worse depressive symptoms and anxiety symptoms, which could result in poorer QoL.

Conclusions

Cohesiveness, expressiveness, and conflict resolution could be used to identify family relationship typology in Chinese patients with advanced lung cancer. Family relationship typology was associated with psychological distress and QoL.

Implications for Practice

The findings indicate a need for screening families and provide culturally sensitive family interventions to effectively support families at risk of poor outcomes.
A Multimodal Project to Assess Preceptor Burnout
Authors: Durkin Gregory J. , Cosetta Mary Ann , Mara Colleen , Memmolo Shauna , Nixon Colleen , Rogan Mary Lou , Pignataro Shelly
Published: January 2022

This article describes the assessment of contributing factors to preceptor burnout and strategies to address them. A review of the literature, surveys, and focus groups were conducted, and no single solution to address burnout was found. Findings did not show significant differences related to the number of preceptors, the experience of preceptors, or the experience of new hires. Preceptors expressed the need for ongoing professional development, formalized feedback, resource materials, operational policies, and meaningful recognition.
Developing a Responsive Transferable Model for Delivering Large-Scale Simulation Education to Inpatient Nursing Staff
Authors: Shannon M. Teresa , Taylor Matthew , Copp Katherine , Smith-Millman Marlena , Rogers Jayne E.
Published: January 2022

Implementing large-scale nursing continuing development programs for bedside staff can be operationally challenging. The aim of this project was to establish a sustainable simulation education program that is incorporated into staff nurses’ work schedules and provides provisions to accommodate patient assignment coverage. This article describes the planning, implementation, and evaluation of a simulation program that was successfully delivered to 89% of nurses employed on four inpatient units at an academic medical center.
Retention Outcomes When a Structured Mentoring Program Is Provided as Part of New Graduate Orientation
Authors: Ward-Smith Peggy , Peacock Ashley , Pilbeam Stephanie , Porter Vivian
Published: January 2022

In an effort to reduce attrition among new graduate nurses, mentorship relationship opportunities were infused into the nurse residency orientation program. Specifically trained volunteer mentors were paired with new graduate nurses upon successful completion of their orientation. Activities were focused on transitioning to a professional nurse rather than the clinical skills needed to provide care. This program enhanced retention among new graduate nurses and increased professional activities among mentees.
Molecular Surveillance and Prediction of Antimicrobial Resistance of Neisseria gonorrhoeae in Northern Alberta, Canada, 2015 to 2018
Authors: Pilkie Daralynn , Gratrix Jennifer , Sawatzky Pam , Martin Irene , Singh Ameeta , Prasad Errol , Naidu Prenilla , Mulvey Michael , Wong Tom , Smyczek Petra Andrea
Published: January 2022

Background

The aims of this study was to describe molecular surveillance of Neisseria gonorrhoeae in the North Zone of Alberta (NZ) and to determine its value in predicting antimicrobial resistance.

Methods

Sequence types (STs) and single-nucleotide polymorphism (SNP) assays were performed on nucleic acid amplification testing (NAAT) samples. Sequence types of NAATs were matched to ST of cultures from across Alberta. Antimicrobial resistance prediction of NAATs for cephalosporins, azithromycin, and ciprofloxacin using SNP was compared with matching ST culture results using agar dilution and whole-genome sequencing.

Results

Of 2755 eligible specimens (2492 cases), 61.9% (1646 specimens) were sent for sequence typing, identifying 196 unique ST. Antimicrobial resistance data for 1307 additional cases were available using matching cultures. Decreased susceptibility (DS) to antimicrobials used for gonorrhea treatment was rare in the NZ; according to the SNP assay, none of the specimens had predicted DS to cephalosporins or azithromycin resistance. However, of the NZ NAAT samples tested in this study, 10.7% (131 of 1220) were predicted to have intermediate cephalosporin minimum inhibitory concentrations and 9.6% (115 of 1204) were resistant to ciprofloxacin. Based on cultures, the proportions of resistance in all of Alberta were as follows: DS to cephalosporins, 0.6% (20 of 3373); DS to intermediate cephalosporin, 16.9% (570 of 3373); azithromycin resistance, 1.2% (41 of 3373); and ciprofloxacin resistance, 32.2% (1087 of 3373).

Conclusions

Our results highlight our ability to use culture-independent methods to predict antimicrobial resistance in N. gonorrhoeae.
Coinfection With Chlamydial and Gonorrheal Infection Among US Adults With Early Syphilis
Authors: Dionne-Odom Jodie , Workowski Kimberly , Perlowski Charlotte , Taylor Stephanie N. , Mayer Kenneth H. , McNeil Candice J. , Hamill Matthew M. , Dombrowski Julia C. , Batteiger Teresa A. , Sena Arlene C. , Wiesenfeld Harold C. , Newman Lori , Hook Edward W.
Published: January 2022

Among 865 adults with early syphilis considered for a multicenter treatment trial, 234 (27%) were excluded before enrollment because of bacterial sexually transmitted infection coinfection. Coinfection with Neisseria gonorrhoeae (29%), Chlamydia trachomatis (22%), or both (23%) was common. Study findings highlight the need for comprehensive bacterial sexually transmitted infection screening in patients with syphilis.
Use of Ultrasensitive RNA In Situ Hybridization for Determining Clonality in Cutaneous B-Cell Lymphomas and Lymphoid Hyperplasia Decreases Subsequent Use of Molecular Testing and Is Cost-effective
Authors: Craddock Ashley P. , Kane William J. , Raghavan Shyam S. , Williams Eli S. , Gru Alejandro A. , Gradecki Sarah E.
Published: January 2022

Primary cutaneous B-cell lymphomas (PCBCLs) are diagnostically challenging entities due to significant overlap in clinical and morphologic features with reactive lymphoid proliferations. Traditional methods for evaluating clonality such as immunohistochemistry (IHC) and chromogenic in situ hybridization (CISH) are limited by low sensitivity, which leads to additional costly and time-consuming molecular clonality assays. More recent technology has introduced ultrasensitive bright-field RNA in situ hybridization (BRISH) to the field, which can detect single molecules of light-chain mRNA. The current study evaluated 274 cases of PCBCL in addition to atypical and reactive lymphoid infiltrates, with CISH or BRISH performed on 180 (65.7%). CISH was performed on 105 (58.3%), and BRISH was performed on 75 (41.7%). Significantly fewer immunoglobulin heavy-chain (IGH) rearrangement studies were performed on cases that were evaluated with BRISH as compared with CISH (P=0.02). Subgroup analysis demonstrated that cases with restriction by BRISH were significantly less likely to have subsequent IGH studies performed (P=0.01). The expected costs of cases using CISH versus BRISH were $1053.89 versus $810.32 to the patient and $245.63 versus $225.23 to the laboratory. The use of ultrasensitive BRISH to evaluate clonality in PCBCL reduced the use of IGH rearrangement studies when compared with CISH. In particular, cases with light-chain restriction by BRISH did not result in confirmatory molecular testing. Despite slightly higher costs to the laboratory to perform BRISH, routine use of this methodology can result in cost savings to both the patient and laboratory by decreasing the use of expensive molecular methods.
How Much Do Parents Know About Pain in Their Children?
Authors: Escobar-Castellanos María , Míguez-Navarro María Concepción , García-Mancebo Julia , Fernández-Monteagudo Belén , Pascual-García Patricia , Guerrero-Márquez Gloria , Rivas-García Arístides
Published: January 2022

Objectives

Adequate pain control is essential to the comprehensive management of pediatric patients within the emergency department.

The aim of this study is to evaluate parents' knowledge about pain in the pediatric population patient and secondarily describe erroneous concepts that can affect a correct children's pain management.

Methods

A single-center descriptive study of cross-sectional surveys was performed between October and December 2018, with a previously validated ad hoc and anonymous questionnaire consisting of 9 items. All parents/guardians participating in the study had a child aged 0 to 18 years who had been admitted to the emergency department.

Results

Sixty-nine percent (n = 315) were women, 49.9% (n = 226) had university degrees and only 11% (n = 50) had professions related to the healthcare system. A linear association was observed between the number of correct answers and the level of education (β = 1.04; 95% confidence interval, 0.76–1.32; P < 0.001), as well as between parents with professions related to the healthcare system compared with other professions (61.4% vs 51.2% with P = 0.005). The responses of Spanish parents offered better results than answers obtained from parents from the American continent (56.4% vs 41.4% with P < 0.001). No differences were observed between parents of children with chronic diseases.

Conclusions

In our study, we observed that a considerable percentage of parents hold misconceptions about how children express pain, and therefore, it would be necessary to encourage formation programs for parents to help identify, evaluate, and correctly treat pain in their children.
Ethical Issues in Medical Rehabilitation
Authors: Friedman Alan , Friedman Basil , Lutzky Lena , Friedman Elisha , Strous Rael D. , Treger Iuly
Published: January 2022

Ethical allocation of scare medical resources is a ubiquitous challenge in many, if not all, medical specialties. The field of physical medicine and rehabilitation is no exception and presents its own unique dilemmas. We report on a small inpatient rehabilitation unit at a large university medical center with a large catchment area representing a vast range of socioeconomic classes. The decision of whom to admit is a constant challenge. We review the existing literature regarding ethical considerations in rehabilitation department admission criteria and attempt to analyze criteria used to admit patients to a general physical medicine and rehabilitation ward. Finally, we discuss our medical center approach to the ethical dilemma of admission priority. A systemic search was conducted in six sources (PubMed, Google Scholar, ScienceDirect, Cochrane Library, LILACS, Embase). Searches were limited to English language articles with no date restriction, reflecting all available data. A reviewer applied the inclusion criteria to identify relevant articles.

This review highlights a number of important ethical issues in evaluation and selection criteria that may assist clinicians in improving selection procedures and standardizing access to inpatient rehabilitation. Further high-quality empirical studies and reviews of ethical admission practice with regard to rehabilitation acceptance are required.
Potential Role of Insulin-Like Growth Factors in Myofascial Pain Syndrome
Authors: Grosman-Rimon Liza , Vadasz Brian , Bondi Moshe , Cohen Marc , Santos Sara , Katz Joel , Clarke Hance , Singh Simranjit , Rimon Jordan , Kumbhare Dinesh , Eilat-Adar Sigal
Published: January 2022

Insulin-like growth factors have diverse functions in skeletal muscles by acting through multiple signaling pathways, including growth regulation and differentiation, anti-inflammation, and antioxidation. Insulin-like growth factors have anti-inflammatory effects and also play roles in nociceptive pathways, determining pain sensitivity, in addition to their protective role against ischemic injury in both the nervous system and skeletal muscle. In skeletal muscle, insulin-like growth factors maintain homeostasis, playing key roles in maintenance, accelerating muscle regeneration, and repair processes. As part of their maintenance role, increased levels of insulin-like growth factors may be required for the repair mechanisms after exercise. Although the role of insulin-like growth factors in myofascial pain syndrome is not completely understood, there is evidence from a recent study that insulin-like growth factor 2 levels in patients with myofascial pain syndrome are lower than those of healthy individuals and are associated with increased levels of inflammatory biomarkers. Importantly, higher insulin-like growth factor 2 levels are associated with increased pain severity in myofascial pain syndrome patients. This may suggest that too low or high insulin-like growth factor levels may contribute to musculoskeletal disorder process, whereas a midrange levels may optimize healing without contributing to pain hypersensitivity. Future studies are required to address the mechanisms of insulin-like growth factor 2 in myofascial pain syndrome and the optimal level as a therapeutic agent.
What Do Rheumatology Patients Want in an After-Visit Summary? A Kano Analysis of Patient Preferences
Authors: Kumar Bharat , Zahn Carleigh , Seeman Lisa , Levins Lori , Davis Benjamin , Swee Melissa
Published: January 2022

Background

After-visit summaries (AVS) are patient-specific documents curated by providers to summarize the content of medical encounters. Despite widespread use, little is known about rheumatology patient preferences for AVS content and style. The aims of this quality improvement project are to identify patient preferences and to design a rheumatology-specific AVS, using the Kano method.

Methods

This quality improvement project consists of 4 parts. First, investigators interviewed veterans and clinic staff to derive a list of potential features. Second, a Kano questionnaire assessing satisfaction with the presence or absence of each feature was distributed to veterans. Third, qualitative and quantitative Kano analyses were performed to categorize features as mandatory, performance, attractive, or indifferent. Fourthly, based on these findings, an AVS was drafted and distributed to Veterans with an associated survey to assess satisfaction with content, visual appeal, and readability.

Results

Nine physicians, 5 veterans, 5 schedulers, 3 nurses, and 3 medical assistants identified 15 features for inclusion in a Kano-style questionnaire. The questionnaire was distributed to 50 Veterans using consecutive sampling. Quantitative Kano analysis demonstrated 4 mandatory, 2 performance, and 3 attractive features that were ultimately included in the AVS; 6 indifferent features were excluded. A postintervention survey of 50 Veterans showed high satisfaction scores in AVS content (4.3/5), visual appeal (4.6/5), and readability (4.4/5).

Conclusions

We developed an AVS that included 9 mandatory, attractive, and performance features, as identified by the Kano method. Veterans were highly satisfied by the content, visual appeal, and readability of the AVS.
Proportionate Cardiovascular Mortality in Chronic Inflammatory Disease in Adults in the United States From 1999 to 2019
Authors: Shah Nischay N. , Wass Sojin , Hajjari Jamal , Heisler Andrew C. , Malakooti Shahdi , Janus Scott E. , Al-Kindi Sadeer G.
Published: January 2022

Background

Despite a rising prevalence of chronic inflammatory disease (CID), the recent trends in cardiovascular disease (CVD) mortality of patients with CID is scarce. In this study, we investigated patterns of CVD mortality in systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), and rheumatoid arthritis (RA) compared with the general population.

Methods

We used the 1999 to 2019 multiple causes of death files from the national center for health statistics to analyze patterns and trends of proportionate CVD mortality in CID compared with the general population.

Results

We analyzed a total of 11,154 CVD deaths in IBD, 58,337 CVD deaths in RA, 6227 CVD deaths in SLE, and 17,826,871 CVD deaths in the general population. Between 1999 and 2019, we found that proportionate CVD mortality decreased significantly in the IBD group (25% to 16%), RA group (34% to 25%), and the general population (41% to 31%), but did not change for the SLE group (15% to 15%). Patients with SLE who died of CVD were approximately 10 years younger compared with CVD decedents with RA, IBD, or general population. The White population had higher proportionate CVD mortality than African American (IBD [19% vs 16%–18%] and SLE [14%–16% vs 12–14%], respectively).

Conclusions

This study identifies current trends in CVD mortality in the CID population and elucidates current demographics in CVD mortality in CID. Although proportionate CVD mortality decreased in the general population, and in patients with RA and IBD, there was no change among patients with SLE. Further studies are needed to elucidate these differences.