bluuebunny/crossref_metadata_2025 huggingface dataset:
Lumbar Spine Surgery and What We Lost in the Era of the Coronavirus Pandemic
Authors: Arnold Paul M. , Owens Linda , Heary Robert F. , Webb Andrew G. , Whiting Mark D. , Vaccaro Alexander R. , Iyer Ravishankar K. , Harrop James S.
Published: September 2021

Study Design:

This was a survey of the surgeon members of the Lumbar Spine Research Society (LSRS).

Objective:

The purpose of this study was to assess trends in surgical practice and patient management involving elective and emergency surgery in the early months of the coronavirus pandemic.

Summary of Background Data:

The novel coronavirus has radically disrupted medical care in the first half of 2020. Little data exists regarding the exact nature of its effect on spine care.

Methods:

A 53-question survey was sent to the surgeon members of the LSRS. Respondents were contacted via email 3 times over a 2-week period in late April. Questions concentrated on surgical and clinical practice patterns before and after the pandemic. Other data included elective surgical schedules and volumes, as well as which emergency cases were being performed. Surgeons were asked about the status of coronavirus disease 2019 (COVID-19) virus testing. Circumstances for performing surgical intervention on patients with and without testing as well as patients testing positive were explored.

Results:

A total of 43 completed surveys were returned of 174 sent to active surgeons in the LSRS (25%). Elective lumbar spine procedures decreased by 90% in the first 2 months of the pandemic, but emergency procedures did not change. Patients with “stable” lumbar disease had surgeries deferred indefinitely, even beyond 8 weeks if necessary. In-person outpatient visits became increasingly rare events, as telemedicine consultations accounted for 67% of all outpatient spine appointments. In total, 91% surgeons were under some type of confinement. Only 11% of surgeons tested for the coronavirus on all surgical patients.

Conclusions:

Elective lumbar surgery was significantly decreased in the first few months of the coronavirus pandemic, and much of outpatient spine surgery was practiced via telemedicine. Despite these constraints, spine surgeons performed emergency surgery when indicated, even when the COVID-19 status of patients was unknown.

Level of Evidence:

Level IV.
Evaluating the Balance Between Privacy and Access in Digital Information Sharing
Authors: Beesley Sarah J. , Powell Alex , Groat Danielle , Butler Jorie , Hopkins Ramona O. , Rozenblum Ronen , Aboumatar Hanan , Butler Allison M. , Sugarman Jeremy , Francis Leslie , Brown Samuel M.
Published: September 2021

OBJECTIVES:

Access to personal health records in an ICU by persons involved in the patient’s care (referred to broadly as “family members” below) has the potential to increase engagement and reduce the negative psychologic sequelae of such hospitalizations. Currently, little is known about patient preferences for information sharing with a designated family member in the ICU. We sought to understand the information-sharing preferences of former ICU patients and their family members and to identify predictors of information-sharing preferences.

DESIGN:

We performed an internet survey that was developed by a broad, multidisciplinary team of stakeholders. Formal pilot testing of the survey was conducted prior to internet survey administration to study subjects.

SETTING:

Internet survey.

Subjects:

Subjects included English-speaking adults who had an ICU experience or a family member with ICU experience between 2013 and 2016. We used panel sampling to ensure an ethnically representative sample of the U.S. population.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

One thousand five hundred twenty surveys were submitted, and 1,470 were included in analysis. The majority of respondents (93.6%) stated that they would want to share present and past medical history, either all or that related to their ICU stay, with a designated family member of their choosing. The majority (79%) would also want their designated family member to be able to access that information from a home computer. Although most respondents preferred to share all types of information, they indicated varying levels of willingness to share specific types of more sensitive information. Information-sharing preferences did not differ by age, sex, ethnicity, or type of prior experience in the ICU (i.e., patient or family member).

CONCLUSIONS:

In the context of an ICU admission, sharing personal health information with a person of the patient’s choosing appears desirable for most patients and family members. Policies and implementation of regulations should take this into consideration.
Exogenous Nicotinamide Adenine Dinucleotide Attenuates Postresuscitation Myocardial and Neurologic Dysfunction in a Rat Model of Cardiac Arrest
Authors: Su Chenglei , Xiao Yan , Zhang Guozhen , Liang Lian , Li Hui , Cheng Cheng , Jin Tao , Bradley Jennifer , Peberdy Mary A. , Ornato Joseph P. , Mangino Martin J. , Tang Wanchun
Published: September 2021

OBJECTIVES:

To investigate the therapeutic potential and underlying mechanisms of exogenous nicotinamide adenine dinucleotide+ on postresuscitation myocardial and neurologic dysfunction in a rat model of cardiac arrest.

DESIGN:

Thirty-eight rats were randomized into three groups: 1) Sham, 2) Control, and 3) NAD. Except for the sham group, untreated ventricular fibrillation for 6 minutes followed by cardiopulmonary resuscitation was performed in the control and NAD groups. Nicotinamide adenine dinucleotide+ (20 mg/kg) was IV administered at the onset of return of spontaneous circulation.

SETTING:

University-affiliated research laboratory.

SUBJECTS:

Sprague-Dawley rats.

INTERVENTIONS:

Nicotinamide adenine dinucleotide+.

MEASUREMENTS AND MAIN RESULTS:

Hemodynamic and myocardial function were measured at baseline and within 4 hours following return of spontaneous circulation. Survival analysis and Neurologic Deficit Score were performed up to 72 hours after return of spontaneous circulation. Adenosine triphosphate (adenosine triphosphate) level was measured in both brain and heart tissue. Mitochondrial respiratory chain function, acetylation level, and expression of Sirtuin3 and NADH dehydrogenase (ubiquinone) 1 alpha subcomplex, 9 (NDUFA9) in isolated mitochondrial protein from both brain and heart tissue were evaluated at 4 hours following return of spontaneous circulation. The results demonstrated that nicotinamide adenine dinucleotide+ treatment improved mean arterial pressure (at 1 hr following return of spontaneous circulation, 94.69 ± 4.25 mm Hg vs 89.57 ± 7.71 mm Hg; p < 0.05), ejection fraction (at 1 hr following return of spontaneous circulation, 62.67% ± 6.71% vs 52.96% ± 9.37%; p < 0.05), Neurologic Deficit Score (at 24 hr following return of spontaneous circulation, 449.50 ± 82.58 vs 339.50 ± 90.66; p < 0.05), and survival rate compared with that of the control group. The adenosine triphosphate level and complex I respiratory were significantly restored in the NAD group compared with those of the control group. In addition, nicotinamide adenine dinucleotide+ treatment activated the Sirtuin3 pathway, down-regulating acetylated-NDUFA9 in the isolated mitochondria protein.

CONCLUSIONS:

Exogenous nicotinamide adenine dinucleotide+ treatment attenuated postresuscitation myocardial and neurologic dysfunction. The responsible mechanisms may involve the preservation of mitochondrial complex I respiratory capacity and adenosine triphosphate production, which involves the Sirtuin3-NDUFA9 deacetylation.
Increased Incidence of Ventilator-Acquired Pneumonia in Coronavirus Disease 2019 Patients: A Multicentric Cohort Study*
Authors: Vacheron Charles-Hervé , Lepape Alain , Savey Anne , Machut Anaïs , Timsit Jean Francois , Vanhems Philippe , Le Quoc Viet , Egbeola Julia , Martin Maelle , Maxime Virginie , Pugliesi Paul-Simon , Maucort-Boulch Delphine , Friggeri Arnaud ,   REA-REZO Study Group
Published: September 2021

OBJECTIVES:

Little is known about the epidemiology of ventilator-acquired pneumonia among coronavirus disease 2019 patients such as incidence or etiological agents. Some studies suggest a higher risk of ventilator-associated pneumonia in this specific population.

DESIGN:

Cohort exposed/nonexposed study among the REA-REZO surveillance network.

SETTING:

Multicentric; ICUs in France.

PATIENTS:

The coronavirus disease 2019 patients at admission were matched on the age, sex, center of inclusion, presence of antimicrobial therapy at admission, patient provenance, time from ICU admission to mechanical ventilation, and Simplified Acute Physiology Score II at admission to the patients included between 2016 and 2019 within the same surveillance network (1:1).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The overall incidence of ventilator-associated pneumonia, the cumulative incidence, and hazard rate of the first and the second ventilator-associated pneumonia were estimated. In addition, the ventilator-associated pneumonia microbiological ecology and specific resistant pattern in coronavirus disease 2019 exposed and nonexposed patients were compared. Medication data were not collected. A total of 1,879 patients were included in each group. The overall incidence of ventilator-associated pneumonia was higher among coronavirus disease 2019 exposed patients (25.5; 95% CI [23.7–27.45] vs 15.4; 95% CI [13.7–17.3] ventilator-associated pneumonia per 1,000 ventilation days). The cumulative incidence was higher for the first and the second ventilator-associated pneumonia among the coronavirus disease 2019 exposed patients (respective Gray test p < 0.0001 and 0.0167). The microbiological ecology and resistance were comparable between groups with a predominance of Enterobacterales and nonfermenting Gram-negative bacteria. The documented resistance pattern was similar between groups, except for a lower rate of methicillin-resistant Staphylococcus aureus in the coronavirus disease 2019 exposed patient (6% vs 23%; p = 0.013).

CONCLUSIONS:

There was a higher incidence of ventilator-associated pneumonia occurring among coronavirus disease 2019 patient compared with the general ICU population, with a similar microbiological ecology and resistance pattern.
IV Vitamin C in Critically Ill Patients: A Systematic Review and Meta-Analysis
Authors: Patel Jayshil J. , Ortiz-Reyes Alfonso , Dhaliwal Rupinder , Clarke John , Hill Aileen , Stoppe Christian , Lee Zheng-Yii , Heyland Daren K.
Published: September 2021

OBJECTIVES:

To conduct a systematic review and meta-analysis to evaluate the impact of IV vitamin C on outcomes in critically ill patients.

DATA SOURCES:

Systematic search of MEDLINE, EMBASE, CINAHL, and the Cochrane Register of Controlled Trials.

STUDY SELECTION:

Randomized controlled trials testing IV vitamin C in critically ill patients.

Data Abstraction:

Two independent reviewers abstracted patient characteristics, treatment details, and clinical outcomes.

DATA SYNTHESIS:

Fifteen studies involving 2,490 patients were identified. Compared with placebo, IV vitamin C administration is associated with a trend toward reduced overall mortality (relative risk, 0.87; 95% CI, 0.75–1.00; p = 0.06; test for heterogeneity I
2 = 6%). High-dose IV vitamin C was associated with a significant reduction in overall mortality (relative risk, 0.70; 95% CI, 0.52–0.96; p = 0.03), whereas low-dose IV vitamin C had no effect (relative risk, 0.94; 95% CI, 0.79–1.07; p = 0.46; test for subgroup differences, p = 0.14). IV vitamin C monotherapy was associated with a significant reduction in overall mortality (relative risk, 0.64; 95% CI, 0.49–0.83; p = 0.006), whereas there was no effect with IV vitamin C combined therapy. No trial reported an increase in adverse events related to IV vitamin C.

CONCLUSIONS:

IV vitamin C administration appears safe and may be associated with a trend toward reduction in overall mortality. High-dose IV vitamin C monotherapy may be associated with improved overall mortality, and further randomized controlled trials are warranted.
Sepsis Among Medicare Beneficiaries: 4. Precoronavirus Disease 2019 Update January 2012–February 2020
Authors: Frank Charles E. , Buchman Timothy G. , Simpson Steven Q. , Sciarretta Kimberly L. , Plopper George E. , Finne Kristen P. , Sowers Nicole , Collier Michael , Chavan Saurabh , Lin Cheng , Oke Ibijoke , Rhodes Kiersten E. , Santhosh Aathira , Chu Steve , MaCurdy Thomas E. , Patel Sandeep A. , Disbrow Gary L. , Kelman Jeffrey A.
Published: September 2021

OBJECTIVES:

To provide updated information on the burdens of sepsis during acute inpatient admissions for Medicare beneficiaries.

DESIGN:

Analysis of paid Medicare claims via the Centers for Medicare and Medicaid Services DataLink Project.

SETTING:

All U.S. acute-care hospitals, excluding federally operated hospitals (Veterans Administration and Defense Health Agency).

Patients:

All Medicare beneficiaries, January 2012—February 2020, with an explicit sepsis diagnostic code assigned during an inpatient admission.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The count of Medicare Part A/B (fee-for-service) plus Medicare Advantage inpatient sepsis admissions rose from 981,027 (CY2012) to 1,700,433 (CY 2019). The proportion of total admissions with sepsis in the Medicare Advantage population rose from 21.43% to 35.39%, reflecting the increasing beneficiary proportion enrolled in Medicare Advantage. In CY2019, 6-month mortality rates in Medicare fee-for-service beneficiaries for sepsis continued to decline, but remained high: 59.9% for septic shock, 35.5% for severe sepsis, 30.8% for sepsis attributed to a specific organism, and 26.5% for unspecified sepsis. Total fee-for-service-only inpatient hospital costs rose from $17.79B (CY2012) to $22.98B (CY2019). We estimated that the aggregate cost of sepsis hospital care for the entire U.S. population was at least $57.47B in 2019. Inclusion of 14 months’ (January 2019—February 2020) newer data exposed new trends: the cost per patient, number of admissions, and fraction of patients with sepsis labeled as present on admission inflected around November 2015, coincident with the change to International Classification of Diseases, 10th Edition, and introduction of the Severe Sepsis and Septic Shock Management Bundle (SEP-1) metric.

CONCLUSIONS:

Sepsis among Medicare beneficiaries precoronavirus disease 2019 imposed immense burdens upon patients, their families, and the taxpayers.
Peculiar Histopathologic Feature of an Erythematous/Morbilliform Eruption in a COVID-19–Positive Patient
Authors: Caputo Valentina , Metze Dieter , Bonoldi Emanuela , Merli Marco , Rongioletti Franco
Published: September 2021

One of the most common patterns of presentations that have been described in COVID-19 patients includes the erythematous/papular/morbilliform eruptions. However, actually, the diffuse exanthems containing macules and papules were not specific to COVID-19, and even histopathology does not show any specific signs that could help to differentiate COVID‐19 skin lesions from non–COVID‐19 causes such as drugs or other viral infections. We present the case of a COVID-19–positive woman with a morbilliform rash, whose skin biopsy showed the presence of some peculiar cytopathic epidermal changes that could represent a possible distinctive histopathological feature related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection The presence of viral particles in the keratinocytes with additional positivity of endothelial cells and eccrine glands by immunohistochemistry using an anti-SARS‐CoV‐2 Spike S1 antibodies supports a causal relation of the lesions with SARS‐CoV‐2 infection.
Podophyllotoxin Cytological Effects on the Epidermis in Condyloma Acuminatum
Authors: Leung Bonnie , Enos Tyler , Vandergriff Travis
Published: September 2021

Podophyllotoxin (PPT) is used to treat condylomata acuminata and works by destabilizing microtubules within epithelial cells, leading to mitotic arrest in metaphase. PPT-induced changes to the epidermis can cause histological findings mimicking dysplasia. Here, we present a case of vulvar condyloma acuminatum treated with PPT, showing ballooning degeneration, necrotic keratinocytes, and mitotic figures. PPT-treated skin may resemble dysplasia or squamous cell carcinoma in situ due to dyskeratosis and frequent mitoses; however, the synchronicity of mitotic figures in early phases of mitosis, as well as the absence of cellular pleomorphism and atypical mitotic figures, allows for distinction from malignancy. This case demonstrates the importance of understanding the histological changes caused by PPT to prevent misdiagnosis and potential overtreatment.
Plasma Cell-Predominant Lichen Planopilaris
Authors: Frew Derek , Oaxaca Gabriel , Habermehl Gabriel , Unwala Rashmi , Bergfeld Wilma
Published: September 2021

Lichen planopilaris (LPP) is a scarring alopecia that is characterized by a lichenoid interface infiltrate with follicular extension. We present a case of LPP composed predominantly of plasma cells in a 52-year-old man. The patient was originally diagnosed with scalp psoriasis 30 years before presentation. Punch biopsies performed at an outside institution 2 years before presentation revealed lymphocyte-predominant LPP. After referral to the senior author's institution due to inadequate response to therapy, biopsies demonstrated a robust, superficial, and deep lichenoid interface dermatitis composed predominantly of plasma cells. Immunohistochemical and special staining for CD138, MUM-1, kappa and lambda light chains, immunoglobulin G4, CD3, CD20, PAX5, CD5, CD7, CD4, CD8, CD43, CD123, Gram, Grocott's methenamine silver stain, treponemal antibody, colloidal iron, and Movat showed a scarring alopecia and were not supportive of a hematolymphoid, infectious, or autoimmune etiology. B-cell clonality studies were below the threshold needed for definitive diagnosis of a clonal process. Doxycycline and hydroxychloroquine were subsequently added to the patient's treatment regimen, leading to an improvement of symptoms. We present this case to bring awareness to this unusual feature and discuss its differential diagnosis.
Telangiectasia Macularis Eruptiva Perstans of the Scalp Mimicking Angiosarcoma
Authors: Lawrence Marc , Sampson James , Oliver Fergus , Restall Paul , Mackenzie Monique
Published: September 2021

We present a case of a 74-year-old man with marked photodamage who was ultimately diagnosed with telangiectasia macularis eruptiva perstans (TMEP) of the scalp. The diagnosis was made more difficult because of the clinical and histological similarity of this case with an early angiosarcoma. TMEP is a benign and indolent rare subtype of cutaneous mastocytosis presenting clinically with red–brown telangiectatic macules, usually symmetrically distributed over the trunk and extremities. Although most cases are limited to the skin, systemic involvement can occur, and this can be a potentially life-threatening disease. Although also rare, in contrast to TMEP, cutaneous angiosarcoma is a highly malignant vascular tumor with a poor prognosis. This case highlights the importance of including TMEP on the differential diagnosis where vascular lesions of the scalp are observed.
Menopausal hormone therapy and risk of incident hypertension: role of the route of estrogen administration and progestogens in the E3N cohort
Authors: Madika Anne-Laure , MacDonald Conor James , Fournier Agnès , Mounier-Vehier Claire , Béraud Guillaume , Boutron-Ruault Marie-Christine
Published: September 2021

Objectives:

Although menopausal hormone therapy (MHT) remains the most effective treatment for vasomotor symptoms of menopause, its association with the development of arterial hypertension remains unclear. We sought to explore associations between different formulations of MHT and incident hypertension among menopausal women in a prospective cohort study.

Methods:

We used the Etude Epidémiologique de femmes de la Mutuelle Générale de l’Education (E3N) cohort, a French prospective population-based study initiated in 1990 on 98,995 women. Out of these, 49,905 menopausal women with complete information on the use of MHT, and without prevalent hypertension at inclusion were included.

Results:

The mean age of the population at baseline was 54.2 ± 4.3 years, and 32,183 (64.5%) reported ever using MHT. Among these women, 10,173 cases of incident hypertension were identified over an average follow-up time of 10.6 years. Compared with women who never used MHT, those who ever used it had an increased risk of incident hypertension (adjusted HR 1.07, 95% CI 1.02-1.12) after adjustment for body mass index and other potential confounders. Oral but not transdermal estrogen use was associated with an increased risk of hypertension (adjusted HR = 1.09; 95% CI: 1.04-1.14 and HR = 1.03; 95% CI: 0.99-1.07, respectively). However, the HRs associated with oral and transdermal estrogens did not differ significantly (P-homogeneity = 0.09). Regarding the role of concomitant progestogens, pregnane and norpregnane derivatives were significantly associated with hypertension risk (HR = 1.12; 95% CI: 1.06-1.19 and HR = 1.06; 95% CI: 1.01-1.13, respectively).

Conclusions:

MHT was associated with a modest but significant increased risk of incident hypertension, especially when using oral estrogen in combination with a progestogen such as pregnane and norpregnane derivatives. Surveillance of blood pressure should be added to the medical surveillance of MHT users.

Video Summary:

http://links.lww.com/MENO/A802.
Staying Close to Home: The Effects of COVID-19 on the Plastic Surgery Residency Match
Authors: Hollins Andrew W. , Zhang Gloria X. , Stoehr Jenna R. , Atia Andrew , Sergesketter Amanda R. , Wickenheisser Victoria A. , Ko Jason H. , Phillips Brett T.
Published: September 2021

Background:

The 2019 novel coronavirus created unique challenges for the integrated plastic surgery match. The goal of this study was to evaluate the trends of the 2020 and 2021 integrated plastic surgery match specifically related to the 2019 novel coronavirus.

Methods:

Three separate individual surveys were designed for integrated plastic surgery program directors and applicants from the 2021 to 2020 match. The surveys were distributed to the email addresses of applicants that applied to our institution’s integrated residency program. Information of current interns and newly matched applicants from program websites and certified social media accounts were recorded.

Results:

We received completed surveys from 19 of the 69 program directors for a response rate of 27.5%. The survey for the 2020 and 2021 match applicants was completed by 25 and 68 applicants, respectively, for a response rate of 6.1% and 21.9%. There was a significant difference in the average number of completed virtual subinternships between applicants that did and did not successfully match into plastic surgery (1.48 versus 0.36, P = 0.01). The rate of students matching at their home institution was the highest in 2021 at 26% compared to 2020 (18%) and 2019 (15%).

Conclusions:

The results of this study demonstrate that applicants were more likely to match at programs with which they had established previous connections, including home institutions. Applicants also had a higher likelihood to match if they completed a virtual subinternship during the 2021 match. Learning points can be applied to the upcoming application cycle to improve the overall experience.
Comparison of the Effects of Temperature and Dehydration Mode on Glycerin-Based Approaches to SMILE-Derived Lenticule Preservation
Authors: Xia Fei , Zhao Jing , Fu Dan , Qin Bing , Chen Zhi , Zhao Yu , Shen Yang , Hou Jiayun , Zhou Xingtao
Published: September 2021

Purpose:

The aim of this study was to explore the optimal method of small-incision lenticule extraction (SMILE)-derived lenticules, subjected to long-term preservation using glycerol, under a range of temperatures, and using an array of dehydration agents.

Methods:

In total, 108 myopic lenticules were collected from patients undergoing the SMILE procedure. Fresh lenticules served as a control group for this study, whereas all other lenticules were separated into 8 groups, which were preserved at 4 different temperatures (room temperature [RT], 4, −20, and −80°C) with or without silica gel in anhydrous glycerol. Evaluated parameters included thickness, transmittance, hematoxylin and eosin staining, transmission electron microscopy, and immunohistochemistry analyses.

Results:

After a 3-month preservation period, lenticular thickness in these different groups was significantly increased, particularly for samples stored at RT. The mean percentage transmittance of lenticules stored at −80°C with or without silica gel was closest to that of fresh lenticules. Hematoxylin and eosin staining revealed sparsely arranged collagen fibers that were more scattered in preserved lenticules relative to fresh lenticules, particularly in RT samples. Transmission electron microscopy revealed that the fibril bundles densities in lenticules stored at RT were significantly less than those stored at other temperatures. Immunohistochemistry analyses revealed reductions in or loss of CD45 and human leukocyte antigens in all preserved lenticules relative to control samples.

Conclusions:

Of the tested approaches, the preservation of SMILE-derived lenticules over a 3-month period was optimal at −80°C with or without silica gel in anhydrous glycerol.
Bloodstream Infections at Two Neonatal Intensive Care Units in Ghana
Authors: Labi Appiah-Korang , Enweronu-Laryea Christabel C. , Nartey Edmund T. , Bjerrum Stephanie , Ayibor Prosper K. , Andersen Leif P. , Newman Mercy J. , Kurtzhals Jorgen A. L.
Published: September 2021

Background:

Bloodstream infections (BSIs) are a major cause of morbidity and mortality in hospitalized neonates. Data on antibiotic resistance in neonatal BSIs and their impact on clinical outcomes in Africa are limited.

Methods:

We conducted a prospective cohort study at 2 tertiary level neonatal intensive care units (NICUs) in Ghana. All neonates admitted to the NICUs were included from October 2017 to September 2019. We monitored BSI rates and analyzed the effect of BSI and antibiotic resistance on mortality and duration of hospitalization.

Results:

Of 5433 neonates included, 3514 had at least one blood culture performed and 355 had growth of a total of 368 pathogenic microorganisms. Overall incidence of BSI was 1.0 (0.9–1.1) per 100 person days. The predominant organisms were Klebsiella pneumoniae 49.7% (183/368) and Streptococcus spp. 10.6% (39/368). In addition, 512 coagulase negative Staphylococci were isolated but considered probable contaminants. Among K. pneumoniae, resistance to gentamicin and amikacin was 91.8% and 16.4%, respectively, while carbapenem resistance was 4.4%. All-cause mortality among enrolled neonates was 19.7% (1066/5416). The mortality rate was significantly higher in neonates with BSI compared with culture-negative neonates in univariate analysis (27.9%, n = 99/355 vs. 16.5%, n = 520/3148; hazard ratio 1.4, 95% confidence interval 1.07–1.70) but not in multivariate analysis.

Conclusion:

The diversity of etiologic agents and the high-risk of antibiotic resistance suggest that standard empirical treatment is unlikely to improve the outcome of BSIs in low and middle income. Such improvements will depend on access to reliable clinical microbiologic services.
Exercise combined with Acceptance and Commitment Therapy compared with a standalone supervised exercise programme for adults with chronic pain: a randomised controlled trial
Authors: Casey Máire-Bríd , Smart Keith M. , Segurado Ricardo , Hearty Conor , Gopal Hari , Lowry Damien , Flanagan Dearbhail , McCracken Lance , Doody Catherine
Published: September 2021

A prospective, 2-armed, parallel group randomised controlled trial (RCT) was conducted to compare the effectiveness of Acceptance and Commitment Therapy (ACT) combined with a supervised exercise programme with a supervised exercise programme alone for adults with chronic pain. One hundred seventy-five participants were individually randomised to receive either the combined Exercise and ACT (ExACT) intervention or supervised exercise alone. Those allocated to the ExACT group attended 8 weekly sessions with a psychologist based on the ACT approach, in addition to supervised exercise classes led by a physiotherapist. The control group attended weekly supervised exercise classes but did not take part in an ACT programme. Both groups were followed up postintervention and again after 12 weeks. The primary outcome was pain interference at 12-week follow-up. Estimates of treatment effects at follow-up were based on intention-to-treat analyses, implemented using a linear mixed-effects model. The findings of this RCT showed no difference in the effectiveness of ExACT, compared with a supervised exercise programme alone for the primary outcome pain interference at 12-week follow-up (mean difference −0.18, 95% confidence interval −0.84 to 0.48, P = 0.59, d = 0.11). ExACT group participants reported superior outcomes for pain self-efficacy, pain catastrophising, and committed action, compared with the control group, but there were no differences between the groups for other secondary outcomes or treatment process measures. Higher levels of treatment satisfaction and global impression of change were reported by ExACT group participants. Exercise combined with Acceptance and Commitment Therapy was not superior to a standalone supervised exercise programme for reducing pain interference in adults with chronic pain.
Association of multiple preventive therapies postdischarge and long-term health outcomes after acute myocardial infarction
Authors: Chen Chih-Wei , Lin Yi-Cheng , Shih Chun-Ming , Chen Wan-Ting , Lin Feng-Yen , Bi Wei-Fung , Kao Yung-Ta , Chiang Kuang-Hsing , Chan Chao-Shun , Hsu Chien-Yi , Yang Tsung-Lin , Hsiao Cheng-Yi , Hsiao Bu-Yuan , Chien Li-Nien , Huang Chun-Yao
Published: September 2021

Background:

Statins, beta-blockers, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers have been advocated by guidelines as secondary prevention medications to improve the long-term outcomes of post-acute myocardial infarction (AMI) patients. However, adequate drug adherence has always been challenging, and different treatment regimens may lead to divergent outcomes that remain unclear under current myocardial infarction (MI) care standards. This study investigated the association between use of different preventive regimens post-AMI and patients’ long-term outcomes.

Methods:

This cohort study used data files from the Taiwan National Health Insurance Research Database. A total of 77 520 people who were hospitalized with AMI between 2002 and 2015 were assessed. On the basis of medication possession ratio (MPR) to individual medications, eight treatment groups were examined in this study. Receiving therapy was defined as MPR ≥40%. We investigated the association between different treatment groups and all-cause mortality in 24 months.

Results:

Overall, 51 322 patients with ST-elevation MI and 26 198 with non-ST-elevation MI were included in the study. Patients received all three preventive medications show the lowest mortality in 24 months follow-up periods among all treatment groups. Patients who did not usage of any of these three preventive medications had the highest mortality in 24 months (adjusted hazard ratio, 1.78; 95% CI, 1.64-1.93). This mortality rate had the same pattern across the three cohort generations (2002-2005, 2006-2010, and 2011-2015).

Conclusion:

In this large population-based real-world study, usage of three preventive therapies post-MI was associated with the lowest rate of all-cause mortality.
Exploring How Sexual Assault Nurse Examiners Practise Trauma-Informed Care
Authors: Poldon Suzanne , Duhn Lenora , Camargo Plazas Pilar , Purkey Eva , Tranmer Joan
Published: September 2021

Background

Sexual violence is a term describing sexual acts where consent is not freely given. Registered nurses employed as sexual assault nurse examiners (SANEs) provide care to address the medical and legal needs of victims/survivors of sexual violence. Trauma-informed care (TIC) is an approach recommended when caring for individuals who have experienced trauma.

Purpose

The study purpose was to understand how SANEs incorporate trauma-informed approaches in the care of adult and postpubescent adolescent victims/survivors of sexual violence.

Methods

Eight SANEs were purposively recruited to participate in online semistructured interviews. Interview data were analyzed using qualitative interpretive description.

Results

Six themes emerged from the analysis: (a) the importance of understanding the patient's experience; (b) personalized connection: developing a safe nurse–patient relationship; (c) choice: the framework of how we do things; (d) rebuilding strengths and skills to support healing and posttraumatic growth; (e) a wonderful way to practise: facilitators and benefits of trauma-informed practice; and (f) challenges to trauma-informed practice.

Conclusions

These findings indicate the perceived value of TIC and the need for enhanced support of providers who deliver TIC. More research is warranted to strengthen the evidence about trauma-informed practice in SANE programs and across healthcare settings.
Bronchoscopy in Critically Ill COVID-19 Patients
Authors: Serra Mitjà Pere , Centeno Carmen , Garcia-Olivé Ignasi , Antuori Adrià , Casadellà Maria , Tazi Rachid , Armestar Fernando , Fernández Ester , Andreo Felipe , Rosell Antoni
Published: September 2021

Background:

Bronchoscopy is a widely use technique in critically ill patients. Nosocomial coinfections are a cause of morbidity and mortality in intensive care units.

Objectives:

Our aim was to describe bronchoscopy findings and analyze microbiological profile and probably coinfection through bronchial aspirate (BA) samples in patients with coronavirus disease 2019 pneumonia requiring intensive care unit admission.

Methods:

Retrospective observational study analyzing the BA samples collected from intubated patients with coronavirus disease 2019 in a referral Hospital (Spain).

Results:

One hundred fifty-five consecutive BA samples were collected from 75 patients. Ninety (58%) were positive cultures for different microorganisms, 11 (7.1%) were polymicrobial, and 37 (23.7%) contained resistant microorganisms. There was a statistically significant association between increased days of orotracheal intubation and positive BA (18.9 vs. 10.9 d, P<0.01), polymicrobial infection (22.11 vs. 13.54, P<0.01) and isolation of resistant microorganisms (18.88 vs. 10.94, P<0.01). In 88% of the cases a new antibiotic or change in antibiotic treatment was made.

Conclusion:

Bronchoscopy in critically ill patient was safe and could be useful to manage these patients and conduct the microbiological study, that seems to be higher and different than in nonepidemic periods. The longer the intubation period, the greater the probability of coinfection, isolation of resistant microorganisms and polymicrobial infection.
Management of the patient with the open abdomen
Authors: Einav Sharon , Zimmerman Frederic S. , Tankel James , Leone Marc
Published: September 2021

Purpose of review

The aim of this study was to outline the management of the patient with the open abdomen.

Recent findings

An open abdomen approach is used after damage control laparotomy, to decrease risk for postsurgery intra-abdominal hypertension, if reoperation is likely and after primary abdominal decompression.

Temporary abdominal wall closure without negative pressure is associated with higher rates of intra-abdominal infection and evisceration. Negative pressure systems improve fascial closure rates but increase fistula formation. Definitive abdominal wall closure should be considered once oedema has subsided and the patient has stabilized. Delayed abdominal closure after trauma (>24–48 h) is associated with less achievement of fascial closure and more complications. Protective lung ventilation should be employed early, particularly if respiratory compromise is evident. Conservative fluid management and less sedation may decrease delirium and increase definitive abdominal closure rates. Extubation may be performed before definitive abdominal closure in selected patients. Antibiotic therapy should be brief, targeted and guideline concordant. Survival depends on the underlying disease, the closure method and the course of hospitalization.

Changes in the treatment of patients with the open abdomen include negative temporary closure, conservative fluid management, early protective lung ventilation, decreased sedation and extubation before abdominal closure in selected patients.
Current models of apolipoprotein A-I lipidation by adenosine triphosphate binding cassette transporter A1
Authors: Hafiane Anouar , Gianopoulos Ioanna , Sorci-Thomas Mary G. , Daskalopoulou Stella S.
Published: September 2021

Purpose of review

The primary cardioprotective function of high-density lipoprotein (HDL) is to remove excess cellular free cholesterol (FC) from peripheral tissues and deliver it to the liver. Here, we summarize recent research that examines apolipoprotein A-I (apoA-I) lipidation models by adenosine triphosphate binding cassette transporter A1 (ABCA1) and discuss its relevance in atherosclerotic cardiovascular disease (ASCVD).

Recent findings

The first step in HDL formation involves the interaction between apoA-I and ABCA1, where ABCA1 mediates the removal of FC and phospholipids from lipid-laden macrophages to form discoidal nascent HDL (nHDL). However, there are currently no clear-cut systematic models that characterize HDL formation. A number of recent studies have investigated the importance of apoA-I C- and N-terminal domains required for optimal cholesterol efflux and nHDL production. Furthermore, functional ABCA1 is required for direct or indirect binding to apoA-I where ABCA1 dimer-monomer interconversion facilitates apoA-I lipidation from plasma membrane microdomains. Microparticles are also another lipid source for apoA-I solubilization into nHDL.

ApoA-I and ABCA1 are key factors in macrophage-mediated cholesterol efflux and nHDL production. Understanding of the key steps in HDL formation may unlock the therapeutic potential of HDL and improve clinical management of ASCVD.
Odyssey toward an understanding of acquired postinflammatory lentiginosis
Authors: Yan Albert C.
Published: September 2021

Purpose of review

Acquired postinflammatory lentiginosis is a phenomenon that has been previously termed ‘induction of lentiginosis in assorted dermatoses’ or the ILIAD phenomenon.

Recent findings

Although some cases have been described as arising exclusively in those who applied topical calcineurin inhibitors (TCIs), other patients have presented with similar findings in other nonatopic disorders (contact dermatitis, psoriasis, lichen planus, focal dermal hypoplasia), and without antecedent use of TCIs.

Inflammatory skin disorders can produce localized areas of cutaneous lentiginosis, particularly as the inflammation retreats in response to treatment. This post-inflammatory lentiginosis or ILIAD phenomenon may be potentiated by use of topical and systemic anti-inflammatory medications, including TCIs, topical corticosteroids, methotrexate, and systemic biologic agents. Although this phenomenon has not been associated with melanocytic neoplasia, ongoing periodic monitoring for dysplastic changes is reasonable.
Prevalence, Factor Structure, and Heritability of Avoidant Personality Disorder
Authors: Reich James , Schatzberg Alan
Published: September 2021

To review the community prevalence, factor structure, and heritability of avoidant personality disorder (AVPD), we reviewed the literature of empirical studies reported between years 1980 and 2020. Community point prevalence rates ranged from 0.8% to 5%, with one study of women older than 25 years finding a lifetime rate of 9.3%. A weighted point prevalence for studies involving both men and women was 3.3%. All factor analytic studies indicated a one factor solution. The themes were social inadequacy, feeling inferior, and fears of social rejection. Family studies of heritability for AVPD ranged from 0.18 to 0.56. Twin studies ranged from 0.28 to 0.71. The weighted average for heritability was 0.55. AVPD is an important clinical issue because it is prevalent in the community and has high morbidity and high heritability. Its single factor seems to suggest evaluation and treatment should be straightforward, but despite this, it tends to be underdiagnosed and undertreated.
Discrimination and Sympathy for Violent Radicalization Among College Students in Quebec (Canada)
Authors: Miconi Diana , Frounfelker Rochelle L. , Whiteley Tessa , Mekki-Berrada Abdelwahed , Rousseau Cécile
Published: September 2021

The present study examines the moderating role of total, intrinsic, and extrinsic religiosity in the relation between perceived discrimination and sympathy for violent radicalization (VR) among college students in Quebec, Canada. A total of 931 students responded to an online questionnaire and were included in this study. Linear mixed-effects models were conducted to account for the clustered nature of the data, and moderation was assessed via interaction analysis using cross-product terms in the models. Findings indicated that both intrinsic and extrinsic religiosity had a protective role in the link between perceived discrimination and sympathy for VR and buffered the effects of sadness in response to discrimination on sympathy for VR, but not the effects of anger in response to discrimination. These results provide evidence of the protective role of religiosity in Canada, a social context characterized by an increase in religious discrimination, but which also supports religious diversity.
The Impact of Nurse Navigator-Led Preoperative Education on Hospital Outcomes Following Posterolateral Lumbar Fusion Surgery
Authors: Turcotte Justin , Menon Nandakumar , Andersen Kristina , Stone Deborah , Patton Chad
Published: September 2021

Beyond the spine-specific pathology, patient factors such as associated medical and psychosocial conditions, understanding of the treatment process, and the degree of patient activation—defined as the ability of the individual to utilize the available information and actively engage in making their healthcare decisions—can influence outcomes after posterolateral lumbar fusion (PLF) surgery. A retrospective observational cohort study of 177 patients undergoing PLF at a single institution was conducted. Patient demographics, medical and psychosocial risk factors, and outcomes were compared between patients who attended a nurse navigator-led group preoperative education course and those who did not. Patients attending the course were younger, more likely to undergo one-level fusion, less likely to undergo 5- or more-level fusion, and had less comorbidity burden as measured by the hierarchical condition categories score. No differences in psychosocial risk factors were observed between groups. Course attendees had a significantly shorter length of stay (2.12 vs. 2.60 days, p = .042) and decreased average hospital cost (U.S. $10,149 vs. U.S. $14,792, p < .001) than those who did not attend; no differences in other outcomes were observed. After controlling for differences in risk factors, patients enrolled in a preoperative education course demonstrated a statistically significant reduction in hospital cost (β=−4,143, p < .001). Preoperative education prior to PLF surgery may reduce hospital cost, possibly through increased patient activation. Given the relatively high prevalence of psychosocial risk factors in this and similar patient populations, optimizing patient activation and engagement is important to achieve high value care. Based on our findings, nurse navigator-led preoperative education appears to be valuable in this patient population and should be included in enhanced recovery protocols.
Metastatic Patterns of Duodenopancreatic Neuroendocrine Tumors in Patients With Multiple Endocrine Neoplasia Type 1
Authors: Hackeng Wenzel M. , van Beek Dirk-Jan , Kok Aranxa S.M. , van Emst Madelon , Morsink Folkert H.M. , van Treijen Mark J.C. , Borel Rinkes Inne H.M. , Dreijerink Koen M.A. , Offerhaus G. Johan A. , Valk Gerlof D. , Vriens Menno R. , Brosens Lodewijk A.A.
Published: September 2021

Patients with multiple endocrine neoplasia 1 syndrome (MEN1) often develop multifocal duodenopancreatic neuroendocrine tumors (dpNETs). Nonfunctional pancreatic neuroendocrine tumors (PanNETs) and duodenal gastrinomas are the most frequent origins of metastasis. Current guidelines recommend surgery based on tumor functionality, size ≥2 cm, grade or presence of lymph node metastases. However, in case of multiple primary tumors it is often unknown which specific tumor metastasized. This study aims to unravel the relationship between primary dpNETs and metastases in patients with MEN1 by studying endocrine differentiation. First, it was shown that expression of the endocrine differentiation markers ARX and PDX1 was concordant in 18 unifocal sporadic neuroendocrine tumors (NETs) and matched metastases. Thereafter, ARX, PDX1, Ki67 and gastrin expression, and the presence of alternative lengthening of telomeres were determined in 137 microscopic and macroscopic dpNETs and 36 matched metastases in 10 patients with MEN1. ARX and PDX1 H-score clustering was performed to infer relatedness. For patients with multiple metastases, similar intrametastases transcription factor expression suggests that most metastases (29/32) originated from a single NET of origin, while few patients may have multiple metastatic primary NETs. In 6 patients with MEN1 and hypergastrinemia, periduodenopancreatic lymph node metastases expressed gastrin, and clustered with minute duodenal gastrinomas, not with larger PanNETs. PanNET metastases often clustered with high grade or alternative lengthening of telomeres-positive primary tumors. In conclusion, for patients with MEN1-related hypergastrinemia and PanNETs, a duodenal origin of periduodenopancreatic lymph node metastases should be considered, even when current conventional and functional imaging studies do not reveal duodenal tumors preoperatively.
Linear Mixed Effect Models for Rehabilitation Research
Authors: Hamner J. W. , Tan Can Ozan
Published: September 2021

The growing emphasis on evidence-based methods in rehabilitation medicine calls for increase in the sophistication of study design and analytic methods across the discipline. To properly evaluate new treatment options, a physiatrist needs to be able to separate treatment effects from parallel changes that occur over time and variations that may be due to subject demographics. Simplettests may not be appropriate where observations may vary randomly across different institutions participating in a multicenter trial, or the same rehabilitation course may lead to different outcomes because of various factors. In the analysis of any rehabilitation program, these random variations must be accounted for to receive accurate results. In this short review, we focus in one of the most common approaches that are appropriate to account for these variations, namely, linear mixed effect models.