bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics of Tc-MEP Waveforms in Spine Surgery for Patients with Severe Obesity
Authors: Kobayashi Kazuyoshi , Ando Kei , Yoshida Go , Ando Muneharu , Kawabata Shigenori , Yamada Kei , Kanchiku Tsukasa , Fujiwara Yasushi , Taniguchi Shinichirou , Iwasaki Hiroshi , Shigematsu Hideki , Tadokoro Nobuaki , Takahashi Masahito , Wada Kanichiro , Yamamoto Naoya , Funaba Masahiro , Yasuda Akimasa , Ushirozako Hiroki , Hashimoto Jun , Morito Shinji , Takatani Tsunenori , Tani Toshikazu , Matsuyama Yukihiro , Imagama Shiro
Published: May 2021

Study Design.

Prospective multicenter study.

Objective.

The aim of this study was to evaluate transcranial motor evoked potential (Tc-MEP) waveform monitoring in spinal surgery for patients with severe obesity.

Summary of Background Data.

Spine surgeries in obese patients are associated with increased morbidity and mortality. Intraoperative Tc-MEP monitoring can identify neurologic deterioration during surgery, but has not been examined for obese patients.

Methods.

The subjects were 3560 patients who underwent Tc-MEP monitoring during spine surgery at 16 centers. Tc-MEPs were recorded from multiple muscles via needle or disc electrodes. A decrease in Tc-MEP amplitude of ≥70% from baseline was used as an alarm during surgery. Preoperative muscle weakness with manual muscle test (MMT) grade ≤4 was defined as a motor deficit, and a reduction of one or more MMT grade postoperatively was defined as deterioration.

Results.

The 3560 patients (1698 males, 47.7%) had a mean age of 60.0 ± 20.3 years. Patients with body mass index >35 kg/m2 (n = 60, 1.7%) were defined as severely obese. Compared with all other patients (controls), the rates of preoperative motor deficit (41.0% vs. 29.6%, P < 0.05) and undetectable baseline waveforms in all muscles were significantly higher in the severely obese group (20.0% vs. 1.7%, P < 0.01). Postoperative motor deterioration did not differ significantly between the groups. The sensitivity and specificity of the alarm criterion for prediction of postoperative neurologic complications were 75.0% and 83.9% in severely obese patients and 76.4% and 89.6% in controls, with no significant difference between the groups.

Conclusion.

Tc-MEPs can be used in spine surgery for severely obese cases to predict postoperative motor deficits, but the rate of undetectable waveforms is significantly higher in such cases. Use of a multichannel waveform approach or multiple modalities may facilitate safe completion of surgery. Waveforms should be carefully evaluated and an appropriate rescue procedure is required if the alarm criterion occurs.

Level of Evidence: 3
Assessment of changes in penile sensation by electrophysiological study after radical prostatectomy: A pilot study
Authors: Yildiz Ali , Islamoglu Ekrem , Yuksel Mustafa , Erol Ibrahim , Karamik Kaan , Cakir Tuncay , Ates Mutlu , Savas Murat
Published: May 2021

Background:

To evaluate the changes in penile sensation by electrophysiological tests in patients who underwent radical prostatectomy (RP) and to demonstrate the role of dorsal penile nerve injury in postoperative erectile dysfunction.

Materials and methods:

Twenty-six volunteer patients who were eligible for RP were included in the study. Preoperative penile sensory electromyography and the International Index of Erectile Function-5 (IIEF-5) questionnaire were done for each patient. Erectile function assessment and electrophysiological evaluation of penile sensation were repeated at postoperative 3rd and 6th months.

Results:

Postoperative IIEF-5 scores and electromyography values were significantly lower than preoperative findings (p < 0.05). The IIEF-5 scores in the nerve sparing-RP (NS-RP) group were significantly higher than the non-nerve sparing-RP (NNS-RP) group in the postoperative period. Nerve conduction velocity values in the NS-RP group were also higher than the NNS-RP group at the postoperative 3rd and 6th months. However, these changes were not statistically significant (p > 0.05).

Conclusions:

Patients who underwent RP have decreased penile sensation due to cavernous nerve damage and a possible dorsal penile nerve injury. The decrease of penile sensation may be associated with postoperative erectile dysfunction.
The antiurolithic activity of Origanum vulgare on rats treated with ethylene glycol and ammonium chloride: Possible pharmaco-biochemical and ultrastructure effects
Authors: ElSawy Naser A. , Mosa Osama F.
Published: May 2021

Background:

Origanum vulgare (OV) Linn is one of the conventional remedies for urolithiasis. Hence, we tested the potential antiurolithic effect of OV active extract, in order to rationalize its medicinal use.

Materials and methods:

The in vivo study was of male Westar rats receiving lithogenic treatment consisting of two 0.75% ethylene glycol injections with a 1 day interval and then in drinking water given for 3 weeks along with ammonium chloride (NH4Cl) from the 2nd day to the 7th day.

Results:

The active ethanolic extract of OV treatment (20 mg/kg) reversed toxic changes including loss of body weight gain and appetite, raised serum urea and creatinine levels, and raised blood pressure compared to controls.

Conclusions:

The acquired data thus suggested that OV showed antiurolithic effects against renal calcium oxalate crystal deposits by combined mechanisms acting on multiple sites through hypoxaliuric, hypocalciuric, and antioxidant effects.
Cryocrystalglobulinemia—An Uncommon Cutaneous Presentation of Multiple Myeloma and Novel Finding of Transepidermal Elimination of Crystals
Authors: Wee Charlene Li Ping , Lim Joel Hua Liang , Lee Joyce Siong See
Published: May 2021

Cryocrystalglobulinemia (CCG) is a rare subset of type 1 cryoglobulinemia that is classically associated with an underlying paraproteinemia. The cryocrystalglobulins are characterized by extracellular crystals, which are eosinophilic, periodic acid–Schiff positive, and exhibit nonbirefringence under polarized light. This archetypal appearance renders CCG readily diagnosable histologically. Unlike in mixed cryoglobulinemias (types II and III cryoglobulinemia) where there is complement-mediated inflammation amounting to vasculitis, the deposition of crystallized paraproteins within vessels in CCG result in an occlusive vasculopathy and culminate in severe systemic involvement. Aside from cutaneous lesions, the resultant ischemic hypoperfusion manifest frequently with fulminant acute kidney failure, polyarthralgia, peripheral neuropathy, or gastrointestinal ulceration, conferring a poor prognosis. We present an unusual case of a patient diagnosed with immunoglobulin G kappa multiple myeloma that first presented with cutaneous necrosis as a result of CCG and did not have any renal impairment or fatal outcome. We highlight this uncommon entity to underscore the clinical importance of early diagnosis to avoid significant morbidity and mortality. In addition, we also discuss a novel feature of transepidermal elimination of crystalline precipitates demonstrated on his skin biopsy.
Seborrheic Keratosis With Sebaceous Differentiation, a Series of 8 Cases and Critical Review of the Literature
Authors: Hayani Kinan M. , Zelger Bettina G. , Kind Peter , Zelger Bernhard
Published: May 2021

Seborrheic keratosis with sebaceous differentiation (SKSD) can sometimes raise uncertainty, confuse with other even malignant entities, and lead to overestimation of this harmless variant. Retrospective analysis of the cases diagnosed as SKSD and a search of the pertaining literature were conducted. Eight cases of SKSD were found. Histologically, these lesions show a flat to plate-like outgrowth of basaloid cells with solitary or clustered sebocytes at the bottom of the rete ridges and variable sebaceous ducts with luminal cuticula. The lesions differed in the outgrowth subpattern: flat/macular, acanthotic, or reticulated. No association was found with Muir–Torre syndrome, and no malignant transformation was seen in these lesions. Literature search revealed confusingly designated lesions that simply represented SKSD. SKSD can show several growth patterns as classic SK. This entity is either underreported or even underrecognized. This entity is benign; however, according to the literature, exclusion of an associating Muir–Torre syndrome should be warranted. The published literature about this lesion is confusing and inconsistent. We suggest the avoidance of confusing terminology and particularly the terminus epithelioma for such lesions.
Umbilical Endometriosis Disguised by Seborrheic Keratosis on Punch Biopsy
Authors: Svart Alexander C. , Ibrahim Rami M. , Jørgensen Lise P. , Berg Jais O.
Published: May 2021

Endometriosis is a benign condition of the female genital system, characterized by endometrial tissue external to the uterine cavity. Of all cases with endometriosis, the incidence of umbilical endometriosis is only 0.29%. Umbilical endometriosis typical presents with symptoms including cyclical pain, bleeding, and swelling of the nodule. Morphological changes in the epidermis, as in this case, simulating a seborrheic keratosis both clinically and microscopically, can initially mask the underlying endometriosis and prolong the course of treatment. A thorough anamnesis and examination revealing the characteristic symptoms and findings coupled with a representative biopsy is essential to correctly diagnose umbilical endometriosis.
Hypergranulotic Dyskeratotic Acanthoma: Another Histologically Distinctive Acanthoma
Authors: Lee Seung Ho , Griffin Thomas , McGeehin Eleni L. , Lee Jason B.
Published: May 2021

Various acanthomas have been named based on their distinctive histopathologic patterns. Hypergranulotic dyskeratotic acanthoma represents another acanthoma with a distinctive histopathologic pattern that has been rarely reported. In this article, clinical and histological features of hypergranulotic dyskeratotic acanthoma are delineated. A retrospective analysis was performed of cases with diagnosis or suggested diagnosis of hypergranulotic dyskeratotic acanthoma between 2012 and 2017 from 2 dermatopathology laboratories. Forty-eight potentials were identified, of which 18 cases met the inclusion histologic criteria. Most cases came from women (78%) with a mean age of 53 years, and the thigh was the most common site involved. All cases had the following histopathological findings: (1) verrucous or digitated epidermal hyperplasia, (2) hyperkeratosis dominated by basketweave or compact orthokeratosis, (3) hypergranulosis involving the breadth of the lesion, and (4) presence of enlarged, often indistinctly bordered, keratinocytes with cytoplasm characterized by a blue–gray granular peripheral zone sometimes showing outstretched desmosomes and central perinuclear eosinophilic zones, a combination of findings representing slowly evolving dyskeratosis. Retrospective nature and a small sample size are the major limitations of the study. In sum, hypergranulotic dyskeratotic acanthoma can be easily distinguished from other acanthomas based on their repeatable histopathological findings.
MiR-4787-5p Regulates Vascular Smooth Muscle Cell Apoptosis by Targeting PKD1 and Inhibiting the PI3K/Akt/FKHR Pathway
Authors: Wang Lei , Wang Zhengbin , Zhang Rui , Huang Li , Zhao Zhikang , Yang Yuxia , Cui Likun , Zhang Shijie
Published: May 2021

Vascular smooth muscle cell (VSMC) dysfunction is the main cause of aortic dissection (AD). In this study, we focused on the role and mechanism of miR-4787-5p in regulating VSMC apoptosis. Real-time fluorescence quantitative polymerase chain reaction was used to detect the expression of miR-4787-5p in aorta tissues of AD (n = 10) and normal aortic tissues of donors (n = 10). Cell apoptosis was tested by TUNEL assay and Annexin V FITC/PI staining flow cytometry. The expression of PC1 and the PI3K/Akt/FKHR signaling pathway associated proteins in VSMCs was measured by Western blot. We found that the miR-4787-5p was highly expressed in aorta tissues of AD compared with 10 healthy volunteers. Meanwhile, PI3K/Akt/FKHR signaling pathway was inactive in the aortic tissue of AD. The overexpression of miR-4787-5p significantly induced VSMC apoptosis, and miR-4787-5p knockdown showed the opposite results. In addition, polycystic kidney disease 1 gene, which encodes polycystin-1 (PC1), was found to be a direct target of miR-4787-5p in the VSMCs and this was validated using a luciferase reporter assay. Overexpression of PC1 by a lentivirus packaging PC1-overexpression plasmid (LV-PC1) plasmids markedly eliminated the promotion of miR-4787-5p overexpression on VSMC apoptosis. Finally, it was found that miR-4787-5p deactivated the PI3K/Akt/FKHR pathway, as demonstrated by the down-regulation of phosphorylated (p-)PI3K, p-Akt, and p-FKHR. In conclusion, these findings confirm an important role for the miR-4787-5p/polycystic kidney disease 1 axis in AD pathobiology.
Alar Flare Preservation Using the Sandwich Technique as an Adjunct to Alar Base Reduction
Authors: Abdelkader Rasha , El-Noamany Sameh , Taha Ahmed , Raafat Sarah Sherif
Published: May 2021

Background:

Achieving an aesthetic balance and natural appearance when modifying soft tissues of the nasal tip, alae, and nostrils is fundamental to the success of rhinoplasty surgery. The present study aimed to investigate the ability of a simple “sandwich” technique combined with external alar base reduction to preserve the alar flare and achieve a natural and appealing alar contour.

Methods:

The study included 40 patients who reported dissatisfaction due to excessive nasal flaring. Cartilaginous grafts were harvested from the septum in cases of primary rhinoplasty. Grafts were harvested from the conchal cartilage in cases of secondary rhinoplasty to ensure adequacy of the grafts. The grafts were inserted from the alar wedge excision point along the created pocket to be “sandwiched” in the soft tissue of the alar rim.

Results:

The average preoperative alar flare was 35.2 mm (SD ±1.9 mm), with an average postoperative reduction of 3 mm. Difference between intercanthal distance and postoperative alar flare distance showed a mean of (−0.4 mm) (SD ±1.2 mm) and was highly significant with P < 0.05. A comparison between nasal base width and alar flare measurements was done. Difference between nasal base width and preoperative alar flare distance was (−9.2 mm) (SD ±2.6), and between nasal base width and postoperative alar flare was (−6.3 mm) (SD ±2.1). Postoperatively, overall patient satisfaction was scored 4.1 of 5.

Conclusion:

The use of a trapezoidal graft, in combination with external alar base reduction, markedly improves the basal view while maintaining the natural alar flare and curvature.
Patient, Clinician, and Healthcare Perspectives in Evaluating Care Pathways for Stable Chest Pain
Authors: Kwok Chun Shing , Duckett Simon , Satchithananda Duwarakan , Potluri Rahul , Morgan-Smith Dot , Bellenger Nick , Gunning Mark , Mallen Christian
Published: May 2021

Chest pain is one of the most common reasons for patients to present to healthcare professionals. One of the main challenges with the management of chest pain is the wide differential diagnosis, ranging from minor chest trauma to potentially life-threatening acute myocardial infarction. In a patient-centered health service pathway, the aim is to assess, investigate, diagnose, and treat patients in the safest and most accurate, time, and cost-efficient manner. This report describes the concept of clinical pathways and their importance. It iterates different perspectives of the investigation of chest pain and the barriers to understanding the clinical sequence of events. By considering the patient, clinician, and healthcare service perspective, it is possible to critically evaluate the current stable chest pain pathway. This exercise gives consideration into the way in which patient care could be improved.
mTOR-Mediated Cell Death and Infection
Authors: Li Song , Wang Qijun , Su Bing
Published: May 2021

The battle between pathogens and hosts is an ongoing phenomenon that has been studied for centuries. Although multicellular organisms have developed sophisticated immune systems to defend against pathogens, pathogens are often able to successfully infect their hosts. To enhance their chance of survival, pathogens can hijack the host's metabolism, which serves as a critical control point that can potentially impact infections. Mammalian target of rapamycin (mTOR) is the nutrient sensor and central regulator of metabolism in innate and adaptive immune cells. Rapamycin, a drug targeting the mTOR pathway, has been widely used in clinical practice for decades and is relatively safe. However, some unexpected infections occur after long-term administration of rapamycin, indicating the presence of a close relationship between mTOR signaling and the infection process. In this manuscript, we briefly review the mTOR pathway and the current clinical use of rapamycin; we also summarize the role of the mTOR pathway in immune cell death, including apoptosis, necroptosis, pyroptosis, and ferroptosis, and its impact on anti-infection immunity. Finally, potential application of mTOR inhibitor in coronavirus disease 2019 clinical therapy is discussed.
Is Hyperbaric Oxygen an Effective Treatment for the Prevention of Complications in SARS-CoV-2 Asymptomatic Patients?
Authors: Longobardi Pasquale , Hoxha Klarida , Perreca Fabiana
Published: May 2021

Is hyperbaric oxygen therapy (HBO2T) useful to counteract severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in positive asymptomatic patients? Asymptomatic persons seem to account for approximately 45% of SARS-CoV-2 infections, and they can transmit the virus to others for an extended period, perhaps longer than 14 days. In patients dying from SARS-CoV-2 infection, the mean number of concomitant diseases was 3.6 (median 3, standard deviation 2.1). Many of these diseases are correlated with the nitric oxide synthase genetic polymorphism and reduced nitric oxide synthesis [risk for coronary heart disease: odds ratio (95% confidence interval) = 2.74 (1.78–3.85)]. HBO2T significantly increases the production of nitric oxide and free radicals which, in laboratory tests, inhibit the replication of the SARS-CoV. HBO2T upregulates hypoxia inducible factor, which promotes the expression of human antiviral peptides: defensins and cathelicidins, both effective to block the virus. Thus, HBO2T regulates the inflammatory response. We share our pilot study conclusions as a basis for clinical trials.
Ablative Carbon Dioxide Laser Treatment for Papular Scars of Nose and Chin Due to Acne: A Case Series
Authors: Fonseka Sanjeewani , Wickramaarachchi Dasun Chathumina , Bandara Dilan Dileepa Jayarathne
Published: May 2021

Introduction:

Papular scarring of the nose and chin due to acne is an under-reported, under-recognized, and under-treated condition. Ablative carbon dioxide laser therapy (10,600 nm, continuous mode, energy of 15 W) under local anesthesia is one of the choice. Here, we report series of patients with papular acne scars successfully treated with ablative carbon dioxide laser.

Cases presentation:

Five patients with papular scars of the nose and chin due to acne were treated at an outpatient dermatology clinic. All had type V skin according to the Fitzpatrick skin classification. Ablative carbon dioxide laser therapy (10,600 nm, continuous mode, energy of 15 W) was performed under topical anesthesia. The patients were re-examined at 2- to 3-week intervals, and laser treatment was repeated as needed.

Discussion:

All of the five patients showed encouraging results. Good cosmetic results were achieved in all patients. The drawbacks of treatment were mild to moderate pain during the procedure and the need for post-treatment skin care.

Conclusion:

Ablative carbon dioxide laser therapy can potentially be used as a safe and effective treatment for papular scars of the nose and chin due to acne.
Prevalence of Childhood Maltreatment and Posttraumatic Stress Symptoms Among Male Inmates in Iceland
Authors: Gunnthorsdottir Hrafnhildur , Kristofersson Gisli Kort , Gunnarsdottir Elin Dianna
Published: May 2021

Introduction

Childhood maltreatment is highly correlated with adult criminal behavior, and the prevalence of childhood maltreatment within prison populations is high. Furthermore, studies have repeatedly shown a higher prevalence of posttraumatic stress disorder (PTSD) symptoms in samples of prisoners compared with the general public.

Purpose and Methodology

The aims of the current study were to determine the frequency of childhood maltreatment among male inmates in Iceland and the percentage of male inmates meeting screening criteria for PTSD. The Icelandic versions of the Childhood Trauma Questionnaire–Short Form and the PTSD Symptom Scale–Self-Report (PSS-SR) were used in the study.

Results

Results show a high prevalence of childhood maltreatment among the sample (N = 48), where 87% of participants reported having experienced at least one of the five categories listed (M = 2.33, SD = 1.68). Approximately 52% had experienced emotional abuse, 27% had experienced physical abuse, 48% had experienced sexual abuse, and over half reported experiencing neglect in their childhood. Two thirds of the participants were above the cutoff score for PTSD on the PTSD Symptom Scale–Self-Report, all of whom expressed a reduced quality of life and/or functional impairment because of their symptoms.

Discussion

The results indicate that most male inmates in Icelandic prisons were maltreated during their childhood and that many of them report severe posttraumatic stress symptoms.

Conclusion

By integrating trauma-focused interventions into Iceland's Prison Service, mental health nurses and other mental health professionals have an opportunity to profoundly affect prisoners' functioning and quality of life, thereby potentially reducing the likelihood of recidivism for a large part of this population in the future.
Association of ACO Shared Savings Success and Serious Illness Spending
Authors: Kaufman Brystana G. , Anderson David , Bleser William K. , Muhlestein David B. , Smith Nathan , Clough Jeffrey , McClellan Mark B. , Saunders Robert
Published: May 2021

EXECUTIVE SUMMARY

Accountable care organizations (ACOs) need confidence in their return on investment to implement changes in care delivery that prioritize seriously ill and high-cost Medicare beneficiaries. The objective of this study was to characterize spending on seriously ill beneficiaries in ACOs with Medicare Shared Savings Program (MSSP) contracts and the association of spending with ACO shared savings. The population included Medicare fee-for-service beneficiaries identified with serious illness (N = 2,109,573) using the Medicare Master Beneficiary Summary File for 100% of ACO-attributed beneficiaries linked to MSSP beneficiary files (2014–2016). Lower spending for seriously ill Medicare beneficiaries and risk-bearing contracts in ACOs were associated with achieving ACO shared savings in the MSSP. For most ACOs, the seriously ill contribute approximately half of the spending and constitute 8%–13% of the attributed population. Patient and geographic (county) factors explained $2,329 of the observed difference in per beneficiary per year spending on seriously ill beneficiaries between high- and low-spending ACOs. The remaining $12,536 may indicate variation as a result of potentially modifiable factors. Consequently, if 10% of attributed beneficiaries were seriously ill, an ACO that moved from the worst to the best quartile of per capita serious illness spending could realize a reduction of $1,200 per beneficiary per year for the ACO population overall. Though the prevalence and case mix of seriously ill populations vary across ACOs, this association suggests that care provided for seriously ill patients is an important consideration for ACOs to achieve MSSP shared savings.
Examining the Business Case for Patient Experience: A Systematic Review
Authors: Quigley Denise D. , Reynolds Kerry , Dellva Stephanie , Price Rebecca Anhang
Published: May 2021

EXECUTIVE SUMMARY

Hospitals, physician groups, and other healthcare providers are investing in improved patient care experiences. Prior reviews have concluded that better patient care experiences are associated with less healthcare utilization and better adherence to recommended prevention and treatment, clinical outcomes, and patient safety within hospitals. No comprehensive review has examined the business case for investing in patient experiences. This article reviews the literature on associations between patient experience—measured from the perspective of patients and families—and business outcomes, including patient allegiance and retention, complaints, lawsuits, provider job satisfaction, and profitability. We searched U.S. English-language peer-reviewed articles from January 1990 to July 2019. We followed the preferred reporting items for systematic reviews and meta-analyses guidelines and undertook a full-text review of 564 articles, yielding the inclusion of 40 articles. Our review found that patients with positive care experiences are more likely to return to the same hospital and ambulatory settings for future healthcare needs, retain their health plan, and voice fewer complaints. Associations between patient experiences and profitability or provider job satisfaction were limited/mixed. This suggests that providers can pursue better patient care experiences for the intrinsic value to patients, while also recognizing it is good for intermediate business outcomes: specifically increased recommendations, better patient retention, and fewer complaints. Nursing and physician care, broadly defined, are the only specific aspects of patient experience consistently associated with retention, with evidence pointing to communication and trust as parts of care linked to the intent to return. These aspects of patient experience are also the largest contributors to the overall ratings of a provider or facility.
Learning During Crisis: The Impact of COVID-19 on Hospital-Acquired Pressure Injury Incidence
Authors: Polancich Shea , Hall Allyson G. , Miltner Rebecca , Poe Terri , Enogela Ene M. , Montgomery Aoyjai P. , Patrician Patricia A.
Published: May 2021

The impact of COVID-19, on the health and safety of patients, staff, and healthcare organizations, has yet to be fully uncovered. Patient adverse events, such as hospital-acquired pressure injuries (HAPIs), have been problematic for decades. The introduction of a pandemic to an environment that is potentially at-risk for adverse events may result in unintended patient safety and quality concerns. We use the learning health system framework to motivate our understanding of the impact of the COVID-19 pandemic on the incidence of HAPIs within our health system. Using a retrospective, observational design, we used descriptive statistics to evaluate trends in HAPI from March to July 2020. Hospital-acquired pressure injury numbers have fluctuated from a steady increase from March–May 2020, hitting a peak high of 90 cases in the month of May. However, the trend in the total all stage HAPIs began to decline in June 2020, with a low of 51 in July, the lowest number since March 2020. Patients evaluated in this study did not have a longitudinal increase in HAPIs from March–July 2020 during the COVID-19 pandemic, despite similarities in illness severity between the two time points. Our experience has demonstrated the ability of our organizational leaders to learn quickly during crisis.
American Medical Society for Sports Medicine Sports Ultrasound Curriculum for Sports Medicine Fellowships
Authors: Hall Mederic M. , Bernhardt David T. , Finnoff Jonathan T. , Hoffman Douglas F. , Hrubes Melody R. , Mautner Kenneth R. , Rao Ashwin L. , Ray Jeremiah W. , Smith Jay , Waterbrook Anna L.
Published: May 2021

Sports ultrasound is commonly used by sports medicine physicians to enhance diagnostic and procedural accuracy. This expert consensus statement serves as an update to the 2015 American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships. Although written in the context of the American sports medicine fellowship training model, we present a stepwise progression in both diagnostic and interventional sports ultrasound that may be applicable to the broader sports medicine community. The curriculum is divided into 12 units with each unit including didactic instructional sessions, practical hands-on instruction, independent scanning practice sessions, and mentored clinical experience. To assist with prioritization of learning, we have organized relevant pathology and procedures as essential, desirable, and optional. The expanded content can serve as an outline for continuing education postfellowship or for any physician to further advance their sports ultrasound knowledge and skill. We also provide updated scanning protocols, sample milestones, and a sample objective structured clinical examination (OSCE) to aid fellowships with implementation of the curriculum and ongoing assessment of fellow progress.
Depression, Anxiety, and Stress in Doctor of Physical Therapy Students: Analysis of Incidence and Lived Experiences
Authors: Bogardus Jennifer M. , Blackinton Mary , Litwin Bini , Morrow Nelson Terri , Mitchell Katy
Published: May 2021

Introduction.

This study was a mixed-methods, multisite design, which aimed to determine incidence and severity of depression, anxiety, and stress in Doctor of Physical Therapy (DPT) students and to explore the lived experience of students managing mental illness while completing their academic requirements.

Methods.

Surveys were emailed to DPT programs and forwarded to students. Students enrolled in 238 DPT programs across the United Sates were eligible for inclusion. A total of 1,238 students completed both surveys. Of those who completed the surveys, 20 volunteers were randomly selected for and completed telephone interviews. Doctor of Physical Therapy students (N = 1,228) completed 2 surveys, including the Depression, Anxiety, and Stress Scale (DASS); 20 of these students volunteered to interview. Students who volunteered were invited to participate based on the DASS results. A total of 20 semi-structured interviews were completed.

Results.

Doctor of Physical Therapy students were found to have higher DASS scores than their age-matched peers in Depression t(1,227) = 2.91, P = .029; Anxiety t(1,227) = 7.33, P ≤ .005; and Stress t(1,227) = 10.76, P ≤ .005. First-year students were found to have significantly higher levels of anxiety (P = .001) and stress (P = .019) as compared with third-year students. Four major themes emerged from the interview data. Theme 4-Fear of Failure Drives Perfection was familiar to the construct of social perfectionism (SP), which has been linked to maladaptive tendencies and mental health disorders, including suicidal ideation.

Discussion/Conclusions.

Doctor of Physical Therapy students have statistically higher DASS scores when compared with their age-matched peers. First-year students seem to be at higher risk for developing anxiety and stress. The construct of SP may influence the depression, anxiety, and stress described by DPT students. Doctor of Physical Therapy programs may want to consider methods to identify maladaptive perfectionism and strategies to enhance students’ ability to manage factors affecting their mental health based on the qualitative findings of this study.
Admissions Holistic Review of Socioeconomic Factors Fosters Diversity in a Doctor of Physical Therapy Program
Authors: Coleman-Salgado Bryan
Published: May 2021

Background and Purpose.

Holistic admissions practices may be used to increase diversity in Doctor of Physical Therapy (DPT) programs by consideration of race and ethnicity, educational disadvantaged background, low socioeconomic status, and for persons from geographically underrepresented areas. This study describes the holistic review practices in the DPT program at California State University, Sacramento (CSUS) reports the profile of socioeconomic disadvantage (SED), race, and ethnicity; analyzes the relationships between SED and racial identity; and reports acceptance rates by race and SED. The purpose of this study was to strengthen the evidence-based inclusion practices in the program's admissions processes and to offer a model to DPT programs that are seeking to assess and utilize admissions practices to increase the racial, ethnic, and socioeconomic diversity of the physical therapy profession.

Case Description.

The holistic review process at CSUS included weighting 4 Skills and Background Characteristics (SBCs) in determining admissions rankings that encompass the socioeconomic variables of the American Council of Academic Physical Therapy's definition of underrepresented minorities (URMs): 1) second language skills, 2) economic background, 3) educational background, and 4) environmental background. Admissions data were collected on all matriculated students in the first 8 years of the program and all qualified applicants in the last 3 years. Retrospective data analyses explored the relationships between SBC scores, race/ethnicity, and acceptance into the DPT program.

Outcomes.

Nearly 1 in 3 matriculants were the first in their family to graduate from college, and nearly 40% claimed a race/ethnicity other than White alone. Total SBC scores were found to be statistically significantly associated with racial identity and for underrepresented racial minorities (URRMs). Economic, educational, and environmental disadvantages were statistically significantly associated with URRMs. Acceptance into the program was found to be significantly associated with fluency and all SED variables.

Discussion and Conclusion.

Admissions weighting of SBC factors led to increased linguistic, socioeconomic, and racial diversity. Methods used in this study may serve as a model to other US Doctor of Physical Therapy programs that are seeking to offset the disadvantages that URMs have in gaining acceptance into physical therapist education programs. The expanded use of data-driven holistic admissions practices may contribute to the racial, ethnic, and socioeconomic diversity of the physical therapy profession.
Validation of the YuWell YE900 oscillometric blood pressure monitor for professional office use in adults and children according to the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018)
Authors: Zhang Hui-Jie , Zhang Juan , Wang Su-Lan , Zhang Jin , Teng Li-Ni , Zhang Shu-Juan , Zhou De-Jun , Long Ming-Zhi
Published: May 2021

Objective

To evaluate the accuracy of the YuWell YE900 oscillometric upper-arm professional office blood pressure monitor in adults and children according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018).

Methods

Subjects were recruited to fulfill the age, sex, blood pressure and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in adults and children (aged 3–12 years) using the same arm sequential blood pressure measurement method. Three cuffs of the test device were used for arm circumference 18–22 cm (small), 22–32 cm (medium) and 32–42 cm (large).

Results

Ninety-two subjects were recruited, and 85 (50 adults and 35 children) were analyzed. For validation criterion 1, the mean ± SD of the differences between the test device and reference blood pressure readings was 1.7 ± 6.62/3.1 ± 5.76 mmHg (systolic/diastolic). For validation criterion 2, the SD of the averaged blood pressure differences between the test device and reference blood pressure per subject was 5.25/5.13 mmHg (systolic/diastolic).

Conclusion

The YuWell YE900 professional electronic blood pressure monitor has passed the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in adults and children and can be recommended for clinical use.
Clinical impact of blood pressure variability in patients with COVID-19 and hypertension
Authors: Nam Jong-Ho , Park Jong Il , Kim Byung-Jun , Kim Hun-Tae , Lee Jung-Hee , Lee Chan-Hee , Son Jang-Won , Kim Ung , Park Jong-Seon , Shin Dong-Gu , Hong Kyung Soo , Jang Jong Geol , Ahn June Hong , Jin Hyun Jung , Choi Eun Young , Shin Kyeong-Cheol , Chung Jin Hong , Lee Kwan Ho , Hur Jian , Hong Young-Hoon , Lee Choong-Ki
Published: May 2021

Objective

This study aimed to investigate the relationship between blood pressure variability (BPV) and clinical outcomes in patients with coronavirus disease 2019 (COVID-19) and hypertension.

Methods

A total of 136 patients hospitalized with COVID-19 were enrolled in this study. Patients were grouped according to the presence of hypertension and BPV. Mean arterial pressure (MAP) measured at 8 a.m. and 8 p.m. was analyzed, and BPV was calculated as the coefficient of variation of MAP (MAPCV). High BPV was defined as MAPCV values above the median. We compared the age, level of C-reactive protein (CRP), creatine kinase-MB (CK-MB), N-terminal pro-B type natriuretic peptide (NT-proBNP), creatinine and in-hospital mortality and investigated the relationship among the groups.

Results

COVID-19 patients with hypertension were older (70 ± 12 vs. 53 ± 17 years; P < 0.001), had higher levels of CRP (9.4 ± 9.2 vs. 5.3 ± 8.2 mg/dL; P = 0.009), MAPCV (11.4 ± 4.8 vs. 8.9 ± 3.2; P = 0.002), and higher in-hospital mortality (19.6% vs. 5.9%; P = 0.013) than those without hypertension. There was a proportional relationship between BPV and age, levels of CRP, CK-MB, NT-proBNP, creatinine and in-hospital mortality (all, P < 0.05). In Cox regression analysis, advanced age [≥80 years, hazard ratio (HR) 10.4, 95% confidence interval (CI) 2.264–47.772, P = 0.003] and higher MAPCV (HR 1.617, 95% CI, 1.281–2.040, P < 0.001) were significantly associated with in-hospital mortality.

Conclusion

High BPV in COVID-19 patients with hypertension is significantly associated with in-hospital mortality. Advanced age and systemic inflammation are proportional to high BPV. Additional attention is needed for COVID-19 patients with hypertension and high BPV.
Laboratory manifestations and pathophysiological aspects of coronavirus disease 2019 pandemic: focusing on the digestive system
Authors: Galanopoulos Michail , Karianakis Grigorios , Amorginos Kyriakos , Doukatas Aris , Gkeros Filippos , Tsoukalas Nikolaos , Papanikolaou Ioannis , Viazis Nikos , Liatsos Christos
Published: May 2021

Since December 2019, the severe acute respiratory syndrome coronavirus 2 has constituted a serious threat to global health. So far, there is little published evidence on the laboratory features of coronavirus disease 2019 (COVID-19). We have reviewed laboratory findings from multiple studies, mostly relating to the digestive system, since the virus outbreak. Laboratory data from older coronaviruses endemics, as well as other RNA viruses, were also reported. Although the main route of transmission is considered to be respiratory droplets, the distribution of ACE2 receptors in the gastrointestinal tract in combination with the detection of the virus in feces may imply a potential fecal–oral transmission route, and thus, emphasis should be given to patients with gastrointestinal symptoms. Interestingly, there is evidence that severe acute respiratory syndrome coronavirus 2 displays similar laboratory and clinical findings with older members of the coronavirus family, and so, comparable diagnostic and therapeutic approaches may be used. Regarding laboratory abnormalities, lymphopenia appears to be the most common finding, together with coagulation disorders and inflammatory markers elevation, reflecting a sustained systemic response. Abnormal liver and, occasionally, pancreatic tests are also common and even more severe in patients with gastrointestinal symptoms or diseases. Thus, the aim of this study is to focus on the laboratory and pathophysiologic side of this novel disease in order to strengthen current knowledge and urge further research. Detailed investigation of numerous studies may suggest a common laboratory pattern between COVID-19 patients. It is important for clinicians not to underestimate patients with gastrointestinal comorbidities, as they have been associated with severe COVID-19 disease.
Infectious risk of vedolizumab compared with other biological agents in the treatment of inflammatory bowel disease
Authors: Innocenti Tommaso , Roselli Jenny , Lynch Erica N. , Apolito Pasquale , Parisio Laura , Bagnoli Siro , Macrì Giuseppe , Rogai Francesca , Tarocchi Mirko , Milani Stefano , Galli Andrea , Milla Monica , Dragoni Gabriele
Published: May 2021

Background and aims

Vedolizumab is a gut-selective anti-integrin (α4β7) antibody for the treatment of inflammatory bowel disease with a well-known optimal safety profile. We aimed to compare its risk of infections with that of anti-TNF drugs and ustekinumab in patients with both ulcerative colitis and Crohn’s disease.

Methods

All Crohn’s disease and ulcerative colitis patients undergoing biological treatment at our centre between 2013 and 2019 were retrospectively included. All infectious complications were registered, considering both inpatient and outpatient events. A comparison of the exposure-adjusted infection rates of vedolizumab, anti-TNF drugs and ustekinumab was carried out, with a specific focus on the rate of gut infections. All infection rates were expressed in events per patient-years (PYs).

Results

The overall exposure-adjusted infection rate was 11.5/100 PYs. The most common infections were respiratory tract infections, cutaneous infections, HSV infections/reactivations and gut infections. The rate of serious infections was 1.3/100 PYs. The infection rate of vedolizumab was 17.5/100 PYs, with Crohn’s disease patients having a lower infection risk compared with ulcerative colitis patients (P = 0.035). Gut infections were observed in 3.0% of the whole patient population (1.5/100 PYs) and were more common in the vedolizumab group (P = 0.0001).

Conclusions

Our study confirms the good safety profile of vedolizumab. Among patients treated with vedolizumab, those with ulcerative colitis have a higher risk of developing infectious complications. Patients treated with vedolizumab have a higher risk of gut infections compared with patients treated with anti-TNF drugs or ustekinumab. Presumably, this is due to the gut-selective mechanism of action of vedolizumab.
Work productivity loss is determined by fatigue and reduced quality of life in employed inflammatory bowel disease patients: a prospective multicentre cohort study
Authors: van Gennep Sara , Gielen Marieke E. , Rietdijk Svend T. , de Boer Nanne K.H. , Duijvestein Marjolijn , Gecse Krisztina B. , Ponsioen Cyriel Y. , D’Haens Geert R. , de Boer Angela G.E.M. , Löwenberg Mark
Published: May 2021

Objective

Inflammatory bowel disease (IBD) patients experience problems at work resulting in work productivity loss driving indirect healthcare costs. We aimed to find determinants for work productivity loss in employed IBD patients while correcting for disease severity according to prior and active maintenance treatment.

Methods

In this longitudinal multicentre cohort study, 510 employed IBD patients completed online questionnaires during 18 months follow-up. Work productivity, fatigue and health-related quality of life (HRQL) were measured using the Work Productivity and Activity Impairment questionnaire, the Multidimensional Fatigue Inventory (score 20–100) and Short-Inflammatory Bowel Disease Questionnaire (score 10–70). Linear mixed model analyses including random, repeated and fixed effects were performed.

Results

Fatigue (β 0.22; 95% CI, 0.12–0.32) and reduced HRQL (β −1.15; 95% CI, −1.35 to −0.95) were the strongest determinants for work productivity loss in employed IBD patients. Clinical disease activity (β 9.50, 95% CI 6.48–12.51) and corticosteroid use (β 10.09, 95% CI 5.25–15.84) were associated with work productivity loss in the total IBD group and ulcerative colitis subgroup, but not in Crohn’s disease patients. History of IBD-related surgery (β 9.41; 95% CI, 2.62–16.20) and vedolizumab use (β 12.74; 95% CI, 3.63–21.86) were significantly associated with work productivity loss in the ulcerative colitis subgroup.

Conclusions

Fatigue and reduced HRQL were the strongest determinants for work productivity loss in employed IBD patients while correcting for disease severity and activity. These results underline the importance of monitoring fatigue and HRQL in routine care to reduce work productivity loss and indirect costs.
A simple nomogram identifies patients with refractory ascites with worse outcome after transjugular intrahepatic portosystemic shunt
Authors: Aicart-Ramos Marta , Ibáñez-Samaniego Luis , Hernández-Gea Virginia , Martínez-Lozano Helena , Rodríguez-de-Santiago Enrique , Catalina María-Vega , Martínez González Javier , Echenagusia-Boyra Miguel-Jesús , Mezzano Puentes Gabriel , Ferrusquía-Acosta José , Olavarría Andreína , Blázquez Sánchez Javier , García-Pagán Juan Carlos , Bañares Rafael , Albillos Agustín
Published: May 2021

Objectives

Transjugular intrahepatic portosystemic shunt (TIPS) is increasingly used in the management of refractory ascites. Controversy exists regarding the predictive factors of unfavorable outcomes, useful for patient selection. The primary aim was to identify predictive factors of 1-year survival or recurrent severe hepatic encephalopathy in patients with cirrhosis undergoing covered TIPS for refractory ascites. The secondary aim was overall survival.

Methods

Observational, retrospective, multicentric study, that included all cirrhotic patients treated with covered-TIPS for refractory ascites since 2001. Demographic, clinical, laboratory and hemodynamic data were collected at baseline and consecutively until dead, liver transplant or end of follow-up. The Cox model was used to identify predictive factors of overall survival. A Fine–Gray competing risk regression model was used to identify predictive factors of 1-year mortality or recurrent hepatic encephalopathy. A predictive nomogram was created based on those factors.

Results

In total 159 patients were included. Predictive factors of survival or recurrent severe encephalopathy were renal dysfunction [hazard ratio, 2.12 (95% CI, 1.11–4.04); P = 0.022], albumin [hazard ratio, 0.58 (95% CI, 0.34–0.97); P = 0.036], serum sodium [hazard ratio, 0.94 (95% CI, 0.89–0.98); P = 0.008] and international normalized ratio [hazard ratio 4.27 (95% CI, 1.41–12.88); P = 0.010]. In the competing risk analysis, predictive factors of 1-year mortality/recurrent severe encephalopathy in multivariate analysis were age [sub-distribution hazard ratio (sHR) 1.05 (95% CI, 1.02–1.09); P = 0.001], creatinine [sHR 1.55 (95% CI, 1.23–1.96); P = 0.001] and serum sodium [sHR 0.94 (95% CI, 0.90–0.99); P = 0.011] at baseline.

Conclusions

Age, creatinine and sodium baseline levels strongly influence 1-year survival/recurrent severe hepatic encephalopathy in patients with cirrhosis undergoing covered TIPS for refractory ascites. A simple nomogram accurately and easily identifies those patients with worse prognosis.