bluuebunny/crossref_metadata_2025 huggingface dataset:
Timing of Adjuvant Radiotherapy After Keloid Excision: A Systematic Review and Meta-Analysis
Authors: Hsieh Chin-Ling , Chi Kuan-Yu , Lin Wan-Ying , Lee Leon Tsung-Ju
Published: August 2021

BACKGROUND

No consensus exists regarding the appropriate timing of adjuvant radiotherapy administration after surgical excision of keloids.

OBJECTIVE

This study investigated the appropriate timing of adjuvant radiotherapy.

MATERIALS AND METHODS

A systematic review and meta-analysis of randomized controlled trials and observational cohort studies was performed. A pooled estimate of the incidence rate was performed using a random-effects model. Subgroup analyses based on different anatomic region, biologically effective dose, keloid length, and radiotherapy regimen were also conducted.

RESULTS

Sixteen observational cohort studies (1,908 keloid lesions) met the inclusion criteria. The incidence rate was significantly lower in the group treated with electron beam therapy more than 24 hours after surgery (3.80%; 95% confidence interval [CI], 1.78%–8.13%) than that in the group treated with the same therapy within 24 hours of surgery (37.16%; 95% CI, 20.80%–66.37%; p < .0001), but no significant difference was observed between the groups regarding brachytherapy and x-ray treatments.

CONCLUSION

Immediate adjuvant radiotherapy did not significantly reduce the incidence rate of recurrent keloids.
A Cadaveric Study of Dye Spreading: Determining the Ideal Injection Pattern for Masseter Hypertrophy
Authors: Sermswan Peerada , Tansatit Tanvaa , Meevassana Jiraroch , Panchaprateep Ratchathorn
Published: August 2021

BACKGROUND

Masseter hypertrophy is the main cause of an asymmetrical and squared lower facial contour in the Asian community. Botulinum toxin injection technique is crucial to treat this condition.

OBJECTIVE

To improve injection techniques for masseter hypertrophy by elucidating the distribution of the injections within the masseter.

METHODS

Thirty masseter muscles were divided into 6 groups of 5 muscles each. Each group received one 0.2- or 0.3-mL injection at Point A, B, or C according to a three-point technique. Muscle dimensions and dye of the primary and secondary dye spreading were measured.

RESULTS

The average muscle length, width, and thickness were 69.87, 33.50, and 11.23 mm, respectively. The average primary longitudinal and horizontal spreading was 36.56 and 15.60 mm, respectively. No statistically significant difference was found between 0.2- and 0.3-mL injections at each point.

CONCLUSION

The three-point technique best fits in the safe zone and should be the standard injection technique for masseter hypertrophy. Injection at Points B and C may create secondary spreading that affect the risorius muscle and the parotid gland which are the cause of asymmetrical smiling and xerostomia, respectively. The dosage should be adjusted according to the muscle volume and not only the thickness.
Safety of Cohesive Polydensified Matrix Cross-Linked Hyaluronic Acid Volumizing Gel in Temporal Hollows and Cheeks: A Prospective, Open-Label, Postmarket Study
Authors: Pavicic Tatjana , Sattler Gerhard , Prager Welf , Fischer Tanja , Gauglitz Gerd , Hofmann Matthias , Dersch Hanna , Riaz Shahbaz , Kerscher Martina
Published: August 2021

BACKGROUND

Facial aging is characterized by volume loss and progressive hollowing of temples and cheeks. Biodegradable filler materials are preferred over nonabsorbable materials; of these, hyaluronic acid (HA) fillers are the most often used because of their favorable effectiveness and safety profile.

OBJECTIVE

To confirm the safety and effectiveness of Cohesive Polydensified Matrix (CPM)-HA26 gel in the treatment of volume deficiency.

METHODS

Subjects received up to 2 treatments in the temples and/or cheeks. A blinded investigator assessed improvement according to the Merz Temple Volume Scale (MTVS) and Merz Cheek Fullness Assessment Scale (MCFAS). Subjects were followed for 48 weeks after the last treatment.

RESULTS

In total, 87 healthy subjects were enrolled. The proportion of subjects achieving at least a 1-grade improvement on MTVS and/or MCFAS was above 70% for each (MTVS: Weeks 4, 24, and 48 = 95.4%, 94.2%, and 77.0%; MCFAS: Weeks 4, 24, and 48 = 92.3%, 83.1%, and 71.8%). Based on MTVS and MCFAS scores at Visit 5, improvement remained visible at up to 48 weeks. No treatment-related serious AEs occurred.

CONCLUSION

CPM-HA26 demonstrated both a favorable safety and effectiveness profile, with improvement in facial volume evident for up to 48 weeks. It was well tolerated and had a positive, long-lasting effect.
Efficacy and Safety of High-Intensity, High-Frequency, Parallel Ultrasound Beams for Fine Lines and Wrinkles
Authors: Wang Jordan V. , Ferzli Georgina , Jeon Hana , Geronemus Roy G. , Kauvar Arielle
Published: August 2021

BACKGROUND

Ultrasound energy has been used for cutaneous rejuvenation, including treatment of fine lines and wrinkles. Ultrasound waves of high intensity can induce thermal injury in the dermis, which causes tissue coagulation and remodeling.

OBJECTIVE

To examine the safety and utility of a novel ultrasound device that uses high-intensity, high-frequency, parallel ultrasound beams to improve fine lines and wrinkles of the face and neck.

MATERIALS AND METHODS

A prospective, multicenter, clinical study investigated the utility of this novel ultrasound device to improve fine lines and wrinkles. Sixty subjects were enrolled for single treatment to the face and neck.

RESULTS

Fifty-eight subjects completed the study. The mean age was 58 years, and 87.9% were women. Fitzpatrick skin Types I to VI were represented. Assessments compared 12-week follow-up with baseline. Two blinded reviewers agreed in identifying pretreatment and post-treatment photographs for 78% of subjects. There was significant improvement of 1 to 3 Fitzpatrick Wrinkle and Elastosis Scale units in 86% of subjects. For investigator global improvement scores, 88% of subjects had improvement. Overall, 72% of subjects noted improvement, and the majority were satisfied. There were no device-related adverse events.

CONCLUSION

Treatment with a novel ultrasound device that uses high-intensity, high-frequency, parallel ultrasound beams safely improved the clinical appearance of fine lines and wrinkles of the face and neck.
Norepinephrine as a spatial memory reset signal
Authors: Grella Stephanie L. , Gomes Sarah M. , Lackie Rachel E. , Renda Briana , Marrone Diano F.
Published: August 2021

Contextual information is represented in the hippocampus (HPC) partially through the recruitment of distinct neuronal ensembles. It is believed that reactivation of these ensembles underlies memory retrieval processes. Recently, we showed that norepinephrine input from phasic locus coeruleus activation induces hippocampal plasticity resulting in the recruitment of new neurons and disengagement from previously established representations. We hypothesize that norepinephrine may provide a neuromodulatory mnemonic switch signaling the HPC to move from a state of retrieval to encoding in the presence of novelty, and therefore, plays a role in memory updating. Here, we tested whether bilateral dorsal dentate gyrus (dDG) infusions of the β-adrenergic receptor (BAR) agonist isoproterenol (ISO), administered prior to encoding or retrieval, would impair spatial working and reference memory by reverting, the system to encoding (thereby recruiting new neurons) potentially interfering with the retrieval of the previously established spatial ensemble. We also investigated whether dDG infusions of ISO could promote cognitive flexibility by switching the system to encoding when it is adaptive (ie, when new information is presented, eg, reversal learning). We found that intra-dDG infusions of ISO given prior to retrieval caused deficits in working and reference memory which was blocked by pretreatment with the BAR-antagonist, propranolol (PRO). In contrast, ISO administered prior to reversal learning led to improved performance. These data support our hypothesis that norepinephrine serves as a novelty signal to update HPC contextual representations via BAR activation-facilitated recruitment of new neurons. This can be both maladaptive and adaptive depending on the situation.
Nicotinic aspects of the discriminative stimulus effects of arecoline
Authors: Winger Gail
Published: August 2021

Despite the evidence that the muscarinic agonist arecoline is a drug of abuse throughout Southeast Asia, its stimulus characteristics have not been well studied. The goal of this work was to understand more about the mediation of discriminative stimulus effects of arecoline. Arecoline (1.0 mg/kg s.c.) was trained as a discriminative stimulus in a group of eight rats. The ability of various cholinergic agonists and antagonists to mimic or antagonize the discriminative stimulus effects of arecoline and to modify its rate-suppressing effects was evaluated. A muscarinic antagonist, but neither of two nicotinic antagonists, was able to modify the discriminative stimulus effects of arecoline, suggesting a predominant muscarinic basis of arecoline’s discriminative stimulus effects in this assay. However, both nicotine itself and two nicotine agonists with selective affinity for the α4β2* receptor (ispronicline and metanicotine) produced full arecoline-like discriminative stimulus effects in these rats. The discriminative stimulus effects of the selective nicotine agonists were blocked by both the general nicotine antagonist mecamylamine and by the selective α4β2* antagonist, dihydro-beta-erythroidine (DHβE). Surprisingly, only DHβE antagonized the rate-suppressing effects of the selective nicotine agonists. These data indicate a selective α4β2* nicotine receptor component to the behavioral effects of arecoline. Although the nicotinic aspects of arecoline’s behavior effects could suggest that abuse of arecoline-containing material (e.g. betel nut chewing) is mediated through nicotinic rather than muscarinic actions, further research, specifically on the reinforcing effects of arecoline, is necessary before this conclusion can be supported.
Tear Function Alterations and Conjunctival Impression Cytology Findings in Patients With Gout
Authors: Belviranli Selman , Turk Huseyin B. , Oltulu Pembe , Turk Nazli , Mirza Enver , Küçük Adem , Aydemir Harun , Oltulu Refik
Published: August 2021

Objectives:

The aim of this study was to evaluate the tear functions and conjunctival impression cytology (CIC) findings of patients with gout and compare them with healthy controls.

Methods:

Thirty-four patients with gout (group 1) and 32 age-matched and gender-matched healthy individuals (group 2) were included in this cross-sectional study. Schirmer 1 test, tear breakup time (TBUT), Ocular Surface Disease Index (OSDI) score, and CIC grade were evaluated and compared between the groups.

Results:

There was no significant difference between the groups in gender and age (P=0.923 and P=0.078, respectively). The mean of Schirmer 1 test result was significantly lower in group 1 (9.74±6.03 mm) than that in group 2 (17.16±9.33 mm) (P<0.001). The TBUT was also significantly lower in group 1 (7.00±2.09 seconds) than that in group 2 (12.75±5.25 seconds) (P<0.001). The OSDI score (20.04±12.92) was significantly higher in group 1 than that in group 2 (6.19±10.07) (P<0.001). Although 10 patients (29.4%) in group 1 had the CIC grade of 2 to 3, none of the controls had CIC grade 2 to 3. The mean CIC grade in group 1 (1.15±0.89) was significantly higher than that in group 2 (0.47±0.51) (P<0.001).

Conclusions:

The results of this study suggest that ocular surface alterations assessed by CIC and tear function abnormalities are more common in patients with gout.
Evaluating Well-being of Individuals With Chronic Visual Conditions Requiring Regular Eyecare During COVID-19 Lockdown: A Cross-Sectional Study
Authors: Almhdawi Khader A. , Alsalem Munsif Fayiz , Obeidat Donia , Al-Khateeb Laith T. , Al Aqarbah Mohammad Nayef , Alshiyab Wejdan Mahmoud , Arabiat Alaa Adeeb , Bazel Mohammed Abdullah , Al-Share Zaidoon
Published: August 2021

Objectives:

To assess health-related quality of life (HRQoL) and its predictors among individuals with chronic vision conditions during COVID-19 lockdown.

Methods:

A cross-sectional, survey-based study targeted Jordanian adults with a variety of chronic vision conditions requiring regular ophthalmic follow-up. Outcome measures included HRQoL measured by the 12-item Short-Form Health Survey (SF-12), mental health symptoms measured by the Depression Anxiety Stress Scale, and vision ability measured by the National Eye Institute Visual Functioning Questionnaire (VFQ-25) General Vision and Role Limitation subscales. Data were analyzed descriptively and using a multiple variable linear regression model to identify HRQoL predictors.

Results:

A total of 203 participants with a mean age of 52.09 (±15.41) years participated, and SF-12 mean scores were 58.15 for the physical component and 57.48 for the mental component. The level of HRQoL was significantly associated with VFQ-25 Role Limitation subscale, diabetes, the need of ophthalmic follow-up, and stress. The regression model explained 47.1% of the variance in HRQoL (r2=0.471, F=35.57, P<0.001).

Conclusions:

Jordanian individuals with chronic vision conditions demonstrated low levels of HRQoL during COVID-19 lockdown. Participants also showed high levels of mental health symptoms and reported low accessibility to ophthalmic care. Access to nonurgent ophthalmic care in individuals with chronic vision diseases should be carefully planned in future pandemics.
New polynomial regression formula to improve second-eye refractive outcomes in sequential bilateral cataract surgery
Authors: Klein Édouard , Malecaze François , Bart Victor , Barnoud Anouk , Lévy Pierre , Gauthier Laurent , Fournié Pierre
Published: August 2021

Purpose:

To assess a new polynomial regression formula integrating the refractive prediction error of the first-operated eye to improve the intraocular lens power calculation of the second eye in cataract surgery.

Setting:

Centre Hospitalier Universitaire, Toulouse, France.

Design:

Retrospective multicentric dataset study.

Methods:

A polynomial regression formula, WeOptimeye2nd (WO2nd), was developed using a machine-learning algorithm trained on a dataset of 534 patients who underwent sequential bilateral cataract surgery. A separate multicentric dataset was used to retrospectively calculate predicted refraction with WO2nd, SRK/T and Barrett Universal II formulas, and 3 other methods of constant factors (CFs) second-eye refinement (CF0.38, CF0.35, and CF0.5). Mean absolute errors (MAEs) and percentage of eyes within ±0.25, ±0.5, and ±1.0 diopter (D) from predicted spherical equivalent were compared between formulas.

Results:

The study comprised data on 722 patients. In the overall population, WO2nd had the lowest MAE: 0.339 vs 0.347 (P = .137), 0.340 (P = .956), 0.350 (P = .066), 0.399 (P < .001), and 0.410 (P < .001), with CF0.38, CF0.5, and CF0.35, Barrett II, and SRK/T, respectively. WO2nd had the highest percentage of eyes within ±0.5 D of the predicted refraction, and the difference was statistically significant vs SRK/T and Barrett II formulas but not vs CF0.38, CF0.5, and CF0.35. WO2nd performed the best in axial length (AL) < 22 mm with the lowest MAE and a statistically significant difference vs any other formula.

Conclusions:

WO2nd improved the refractive outcome of the second-operated eye and performed well in extreme AL and mean keratometry subgroups.
Outcomes of femtosecond laser–assisted cataract and refractive lens surgery in patients with prior radial keratotomy
Authors: Trinh Tanya , Solomon Benjamin , Mimouni Michael , Cohen Eyal , Gouvea Larissa , Santaella Gisella , Sorkin Nir , AlShaker Sara , Din Nizar , Rootman David S.
Published: August 2021

Purpose:

To investigate outcomes of femtosecond laser (FL)-assisted cataract surgery (FLACS) and refractive lens exchange (RLE) in patients with prior radial keratotomy (RK).

Setting:

Single clinical practice.

Design:

Retrospective observational case series.

Methods:

All patients with prior RK undergoing FLACS- or FL-assisted RLE surgeries over a 6-year period were reviewed. Inclusion criteria were diurnal stability and stable manifest refraction. Exclusion criteria were any other incisional corneal surgery, macular or glaucomatous pathology, or vision loss due to any other cause. Data collected included demographics, visual acuity, laser settings, and complications. Main outcome measures were intraoperative and postoperative complications and visual outcomes. Safety and efficacy indices were evaluated.

Results:

16 eyes of 9 patients were included. Mean age and follow-up time were 59.9 ± 9.9 years (range 44 to 75 years) and 3.3 ± 2.5 months, respectively. The mean number of RK cuts was 11.8 ± 5.3 (range 8 to 20). Mean preoperative uncorrected (UDVA) and corrected distance visual acuity (CDVA) were 0.9 ± 0.4 logMAR (Snellen 20/160) and 0.2 ± 0.3 logMAR (Snellen 20/30), respectively. 2 intraoperative anterior capsule tears were identified. 1 postoperative intraocular lens dislocation occurred. Postoperatively, the mean UDVA and CDVA were 0.2 ± 0.2 logMAR (20/30) and 0.1 ± 0.1 logMAR (20/25), respectively. The safety index was 1.6, and the efficacy index was 1.2.

Conclusions:

FLACS- or FL-assisted RLE surgery in RK patients has a high risk for anterior capsule tear and should be avoided. Thickened incisional scars are potential sources of incomplete laser penetrance. Toric lens implantation in RK eyes provide unpredictable astigmatic correction and should also be avoided.
Agreement of intraocular lens power calculation between 2 SS-OCT–based biometers
Authors: Pfaeffli Oliver A. , Weber Adrian , Hoffer Kenneth J. , Savini Giacomo , Baenninger Philipp B. , Thiel Michael A. , Taroni Leonardo , Müller Luzia
Published: August 2021

Purpose:

To assess agreement of measurements by 2 swept-source optical coherence tomography biometers and to evaluate the prediction error (PE) in intraocular lens power calculation with 7 formulas.

Setting:

Tertiary public eye hospital.

Design:

Consecutive observational.

Methods:

Axial length (AL), keratometry (K), anterior chamber depth (ACD), lens thickness (LT), and corneal diameter (CD) were measured with the IOLMaster 700 (Biometer A) and Anterion (Biometer B). Agreement was quantified by the limits of agreement and concordance correlation coefficient (CCC). The PE, the median absolute error, and the mean absolute error of the Barrett Universal II, EVO 2.0, Haigis, Hoffer Q, Holladay 1, Kane, and SRK/T formulas were investigated after constant optimization.

Results:

In 78 eyes from 78 patients, excellent agreement was obtained for AL (CCC >0.99), very good agreement for K, ACD, and LT (CCC >0.95), and strong agreement for CD (CCC >0.72). An additive offset of 0.07 mm was measured for ACD and LT whose mean values were higher with Biometer B (P < .001). No statistically significant difference was found between the PEs and their absolute values when comparing the results of each formula between the 2 biometers.

Conclusions:

Agreement of biometric measurements by the 2 biometers was high, although Biometer B provided higher mean values of ACD and LT by 0.07 mm. In cataract patients with normal eye length, measurements by the 2 biometers did not lead to different refractive outcomes with the 7 formulas investigated.
Instrumented and Standard Measures of Physical Performance in Adults With Chronic Kidney Disease
Authors: Johnstone Laura M. , Roshanravan Baback , Rundell Sean D. , Kestenbaum Bryan , Baker Sarah Fay , Berry Donna L. , McGough Ellen
Published: August 2021

Background:

Chronic kidney disease (CKD) is a common pathology encountered by acute care physical therapists. CKD is associated with reduced physical function and fall risk. The purpose of this study was to (1) examine the test-retest reliability of standard and instrumented physical performance measures and (2) describe the relationship between subjective fall risk and objective physical performance in people with CKD.

Methods:

Twenty-one adults with CKD completed a battery of standard and instrumented physical performance measures 1 week apart. Standard measures were the Short Physical Performance Battery (SPPB), gait speed, 5 times sit-to-stand (FSTS), 2-minute walk test (2MWT), and quadriceps (QS) and grip (GS) strength dynamometry. Instrumented measures included parameters of gait, sit-stand, and postural sway. Intraclass correlation coefficients (ICC) assessed test-retest reliability, and Pearson correlations (adjusted for age) assessed the relationships between the Fall Risk Questionnaire (FRQ) and standard physical performance.

Results:

Excellent to moderate test-retest reliability was demonstrated in the standard and instrumented physical performance measures. A subset of standard measures was significantly associated with the FRQ score.

Conclusions:

This study supports the clinical reliability of a battery of standard physical performance measures and a subset of instrumented parameters for use in adults with CKD. The FRQ may be useful for screening fall risk considering its relationship to objective physical performance.
Preimplantation genetic diagnosis of hereditary hearing loss: a narrative review
Authors: Wu Xiaonan , Guan Jing , Peng Hongmei , Wang Qiuju
Published: August 2021

Preimplantation genetic diagnosis (PGD) uses molecular biological techniques to genetically diagnose embryos before
in vitro
fertilization. The information obtained through PGD can help clinicians select healthy embryos for implantation, prevent the transmission of inherited diseases and help affected families have healthy children. This paper reviews the development of PGD technology, the history of its application to hereditary hearing loss, and the general process of how PGD is applied to screen for hereditary hearing loss. The aim of this review is to demonstrate the reliability of PGD in the primary prevention of hereditary hearing loss, assist clinicians in counseling patients at risk of transmitting an inherited disease, and explore the journey from PGD to
in vitro
fertilization. Given that the application of PGD technology to hereditary hearing loss varies in different countries and regions, there is still a long way to go before PGD is routinely applied for the primary prevention of hereditary hearing loss.
Effect of dipping and nondipping pattern of blood pressure on subclinical left ventricular dysfunction assessed by two-dimensional speckle tracking in hypertensive patients
Authors: Sayed Amro , Razik Nady A. , Galal Ahmed W. , Al Maashani Said , Hamouda Mohamed A. , Rabat Khalid E. , Bendary Ahmed M.
Published: August 2021

Objective

The aim of this study was to evaluate the left ventricular (LV) function by conventional two-dimensional speckle tracking echocardiography (2D STE) to detect subclinical LV systolic dysfunction in patients with dipper and nondipper hypertension.

Methods

One hundred consecutive patients with hypertension were included in our study. Clinical evaluation, baseline laboratory investigations, 24 ambulatory blood pressure monitoring 2D echocardiographic examination and 2D STE were performed for all patients. Patients were classified as dippers and nondippers according to their nighttime MAP (mean arterial blood pressure) reduction rate of ≥10 or <10%, respectively.

Results

Of 100 patients, 71% were nondippers while 29% were dippers. Nondippers had a significantly lower global longitudinal strain (LS) value (−22.45 ± 3.26 vs. −18.2 ± 3.3, P < 0.001), global circumferential strain (CS) value (−24.23 ± 3.56 vs. −19.16 ± 8.25, P < 0.001) and global radial strain (RS) value (35.04 ± 11.16 vs. 29.58 ± 8.44, P = 0.009). It was found that nondipper status was associated with worsening of LS by 2.737, (P = 0.001), CS by 3.446, (P = 0.002), RS by −3.256, (P = 0.158) and DM also was found associated with worsening of LS by 1.849, (P = 0.062), CS by 3.284 (P = 0.018), RS by −2.499 (P = 0.381).

Conclusion

The nondipping hypertension pattern is associated with subclinical LV systolic dysfunction as shown by the impaired global myocardial strain in all three directions.
Clinical and molecular characterization of an almost complete ring chromosome 4 in two sisters, with recurrence due to gonadal mosaicism
Authors: Phillips Eliza A. , Caluseriu Oana , Schlade-Bartusiak Kamilla , Chernos Judy , McLeod D. Ross , Thomas Mary Ann
Published: August 2021

Autosomal ring chromosomes are rare cytogenetic findings that arise from breakage and fusion of the chromosome ends. Rings are mitotically unstable, usually sporadic and associated with a ‘ring syndrome’, characterized by a variable phenotype: growth retardation, no significant dysmorphisms and normal to moderately disabled intelligence. We describe the clinical features and molecular characterization of two sisters with ring chromosome 4. Karyotype analysis was performed on both sisters and parents. Chromosome microarray was performed on both sisters to delineate the breakpoint imbalance. Both sisters had a large ring 4 chromosome in the majority of cells analyzed on karyotype. Microarray results were identical in the sisters, showing a 55.8 kb duplication on the terminal 4p arm and a 1.5 Mb deletion on the terminal 4q arm. No genes of interest were identified in these regions. Parental karyotypes on lymphocytes and fibroblasts were normal, with no finding of mosaicism for the ring 4 chromosome. Polymorphic marker analysis revealed the maternal origin of the ring. To our knowledge, this is the first reported instance of a ring 4 chromosome recurring in siblings after extensive parental testing, which suggests this was due to maternal gonadal mosaicism.
Overall Impact of Coronavirus Disease 2019 Outbreak in Children With Functional Abdominal Pain Disorders
Authors: Strisciuglio Caterina , Martinelli Massimo , Lu Peter , Bar Lev Michal Rozenfeld , Beinvogl Beate , Benninga Marc A. , Di Lorenzo Carlo , Fiori Nastro Francesca , Nurko Samuel , Pearlstein Haley , Rosen Rachel , Shamir Raanan , Staiano Annamaria
Published: August 2021

Objective:

We aimed to assess how the first phase of coronavirus disease 2019 (COVID‐19) pandemic influenced symptoms in children with functional abdominal pain disorders (FAPDs) and to characterize their quality of life (QoL), anxiety and global health.

Methods:

This was a multicenter, observational, international study conducted between April and July 2020 at six different referral centers. Children diagnosed with FAPDs between October 2019 and February 2020 were enrolled and prospectively interviewed at 4 months of follow‐up during the first pandemic phase (Quarantine group). Patients were asked to complete PedsQL 4.0 Generic Core Scale and PROMIS Anxiety and Global Health questionnaires. A cohort of children diagnosed with FAPDs between October 2018 and February 2019 was used as a Control group.

Results:

Three‐hundred‐fifty‐six children were enrolled of whom 180 (mean age at diagnosis: 14 ± 2.8 years) in the Quarantine group and 176 (mean age at diagnosis: 13 ± 2.8 years) in the Control group. At 4 months of follow‐up, we observed a significant reduction of children reporting >5 episodes of abdominal pain per month when compared to baseline, in both groups (Quarantine group: 63.9% vs 42.2%, P < 0.001; Control group: 83.5% vs 50%, P < 0.001). The Quarantine group had median QoL values of 84.8 with 16.6% of children showing high anxiety values and 55% having decreased global health score.

Conclusions:

We demonstrated symptoms’ improvement at 4 months of follow‐up in both cohorts. During the first months of the COVID‐19 quarantine children with FAPDs showed satisfactory QoL and anxiety scores, suggesting positive effects of school closure and increased parental attention.
Traumatized Refugees in Psychotherapy
Authors: Opaas Marianne , Hartmann Ellen J.
Published: August 2021

This pre- and posttreatment study of 22 severely traumatized adult refugees spanned a mean of 6.5 years. Changes in personality functioning, mental health, and well-being were examined using the Rorschach Performance Assessment System, Harvard Trauma Questionnaire, Hopkins Symptom Checklist–25, and the World Health Organization’s Quality of Life–BREF questionnaire. A paired samples t-test revealed significant improvement after psychotherapy in traumatic ideation and initial severe disruptions in thought processes, reality testing, perception, self and other representations, and relational capacity (Cohen’s d = 0.46–0.59). Symptoms of anxiety, depression, and posttraumatic stress were significantly reduced (d = 0.54–0.84), quality of life in the physical health and psychological health domains increased significantly (d = 0.87 and 0.97), and percentage of participants with exile language proficiency and work/study status increased significantly. The findings demonstrate the potential of psychotherapy to contribute to normalizing perceptual, cognitive, and relational capacities in severely traumatized refugees, paramount to well-being and functioning in exile.
Is Gratitude Associated With Suicidal Ideation in Veterans With Mental Illness and Student Veterans With PTSD Symptoms?
Authors: Umucu Emre , Lo Chu-Ling , Lee Beatrice , Vargas-Medrano Javier , Diaz-Pacheco Valeria , Misra Kiran , Martin Sarah L. , Thompson Peter M. , Gadad Bharathi S.
Published: August 2021

The present study is aimed to identify the effect of gratitude as an adaptive regulating mechanism from suicidal ideation (SI) for veterans with mental illness (study 1) and student veterans with posttraumatic stress disorder (PTSD) symptoms (study 2) in the United States. Descriptive statistics and regression analyses were used to examine sociodemographic characteristics and relationships between gratitude and SI. Our study 1 consisted of 156 veterans with mental illness. The mean age for study 1 was 37.85. Our study 2 consisted of 232 student veterans with PTSD symptoms. The mean age for study 2 was 28.43. Higher gratitude scores in study 1 and study 2 were significantly associated with lower SI scores after adjusting for demographics and depression. This study partially supports the association between gratitude and SI in veterans with mental illness. Based on the results from this study, gratitude interventions may be effective in reducing SI when working with veterans with mental illness.
Conditional Process Modeling of the Relationship Among Self-Reliance, Loneliness, and Depressive Symptoms, and the Moderating Effect of Feeling Understood
Authors: Ogrodniczuk John S. , Oliffe John L. , Kealy David , Seidler Zac E. , Black Nick , Rice Simon M.
Published: August 2021

Self-reliance features as one of the notable male norms espoused by traditional masculine socialization. Strict adherence to a self-reliant attitude has been found to confer risk for depression and suicidality among men. Yet, little research has investigated the factors that may contribute to self-reliance having a negative impact for men. Using data from a large sample of Canadian men (N = 530), the present study examined the association between self-reliance and depression, while also assessing the roles of loneliness and not feeling understood as contributing factors in this process. Findings indicated that the moderated mediation model was significant, pointing to loneliness as a significant mediator in the association between self-reliance and depression. Furthermore, the findings revealed that not feeling understood moderated the relationship between self-reliance and loneliness, indicating that this association applies mainly to those men who do not feel understood by at least one important person in their life.
Assessment of a Situation Awareness Quality Improvement Intervention to Reduce Cardiac Arrests in the PICU
Authors: Dewan Maya , Soberano Blaise , Sosa Tina , Zackoff Matthew , Hagedorn Philip , Brady Patrick W. , Chima Ranjit S. , Stalets Erika L. , Moore Lindsey , Britto Maria , Sutton Robert M. , Nadkarni Vinay , Tegtmeyer Ken , Wolfe Heather
Published: August 2021

OBJECTIVES:

To use improved situation awareness to decrease cardiopulmonary resuscitation events by 25% over 18 months and demonstrate process and outcome sustainability.

DESIGN:

Structured quality improvement initiative.

SETTING:

Single-center, 35-bed quaternary-care PICU.

PATIENTS:

All patients admitted to the PICU from February 1, 2017, to December 31, 2020.

INTERVENTIONS:

Interventions targeted situation awareness and included bid safety huddles, bedside mitigation signs and huddles, smaller pod-based huddles, and an automated clinical decision support tool to identify high-risk patients.

MEASUREMENTS AND MAIN RESULTS:

The primary outcome metric, cardiopulmonary resuscitation event rate per 1,000 patient-days, decreased from a baseline of 3.1–1.5 cardiopulmonary resuscitation events per 1,000 patient-days or by 52%. The secondary outcome metric, mortality rate, decreased from a baseline of 6.6 deaths per 1,000 patient-days to 3.6 deaths per 1,000 patient-days. Process metrics included percent of clinical deterioration events predicted, which increased from 40% to 67%, and percent of high-risk patients with shared situation awareness, which increased from 43% to 71%. Balancing metrics included time spent in daily safety huddle, median 0.4 minutes per patient (interquartile range, 0.3–0.5), and a number needed to alert of 16 (95% CI, 14–25). Neither unit acuity as measured by Pediatric Risk of Mortality III scores nor the percent of deaths in patients with do-not-attempt resuscitation orders or electing withdrawal of life-sustaining technologies changed over time.

CONCLUSIONS:

Interprofessional teams using shared situation awareness may reduce cardiopulmonary resuscitation events and, thereby, improve outcomes.
Streptococcal Pharyngitis
Authors: Thompson Jennifer M. , Zagel Alicia L. , Spaulding Alicen B. , Krause Ernest A. , Arms Joseph L.
Published: August 2021

Objectives

The Infectious Diseases Society of America (IDSA) guidelines regarding group A streptococcal (GAS) pharyngitis advise against routine testing for patients younger than 3 years, patients without pharyngitis, and patients with symptoms suggesting a viral infection. Group A streptococcal testing may be overused in some clinical settings; thus, we conducted this study to evaluate compliance with the IDSA guidelines in a pediatric emergency department (ED) setting.

Methods

This retrospective cohort study describes patients younger than 18 years presenting to 2 urban pediatric EDs in 2016 who underwent rapid antigen detection testing for GAS pharyngitis. Testing was classified as noncompliant with the IDSA guidelines if the chief complaint was not indicative of GAS infection and/or the patient age was younger than 3 years. Appropriate nonparametric tests compared groups by IDSA testing compliance status.

Results

A total of 13,585 patient encounters met inclusion criteria; 5255 (39%) were noncompliant with the IDSA testing guidelines, the majority due to a chief complaint inconsistent with GAS pharyngitis (67%) and secondarily due to the age of younger than 3 years (48%). Among the patients with noncompliant testing, 51% were prescribed an antibiotic, and return encounters were more likely to occur (13% vs 10%, P < 0.001). Return encounters more commonly resulted in respiratory diagnoses in those with noncompliant GAS testing (60% vs 45%, P < 0.001).

Conclusions

Nearly 40% of all pediatric ED encounters with GAS testing were noncompliant with the IDSA guidelines and were associated with greater return encounter rates. Potential negative outcomes from noncompliant GAS testing include misdiagnosis, inappropriate use of antibiotics, allergic reactions, and loss of school days. Informed interventions to reduce unnecessary GAS testing are warranted.
Recommendations on the Management of Interhospital Transport of Pediatric Patients With Mediastinal Mass
Authors: Leung Karen Ka Yan , Ku Shu Wing , Hon Kam Lun , Chigaru Linda , Chiang Alan K. S. , Kan Elaine Y.L. , Oberender Felix
Published: August 2021

Purpose

Children with mediastinal masses often present with insidious symptoms to nonspecialist centers and require interhospital transport to oncology centers for definitive care. We evaluated clinical characteristics and patient outcomes and proposed a management protocol.

Materials and Methods

This is a retrospective review of all children with mediastinal mass at the pediatric intensive care unit of the Hong Kong Children's Hospital between April 2019 and March 2020.

Results

Ten children with a median age of 14.5 years (interquartile range, 9.3–17.0 years) were included. Leukemia and lymphoma accounted for the majority of cases (n = 6, 60%). Nearly all patients (n = 9, 90%) required interhospital transport before definitive treatment could be instituted. There were no deaths, but 2 patients were transported with significant respiratory compromise. Among patients requiring more than 1 interhospital transport, there was a higher incidence of shortness of breath (100% vs 40%; odds ratio, 33; P = 0.048) and orthopnea (80% vs 0%; odds ratio, 33; P = 0.048), whereas none had a neck mass (0% vs 80%; odds ratio, 0.03; P = 0.048).

Conclusions

Children with mediastinal mass are at risk of life-threatening cardiorespiratory compromise. Pretransport assessment, planning, and stabilization along with clear management plans for deterioration during transport are crucial especially for patients who are symptomatic at time of presentation, to reduce risks associated with delays in arriving at the specialist point of care for definitive treatment.
The Preliminary Criterion Validity of the Activ8 Activity Monitor to Measure Physical Activity in Youth Using a Wheelchair
Authors: Lankhorst Kristel , Sol Marleen , van den Berg-Emons Rita , Horemans Herwin , de Groot Janke
Published: August 2021

Purpose:

The aim of this study was to assess the criterion validity of the Activ8 to detect “active wheelchair use” and to distinguish 6 types of wheelchair activities using video recordings as a gold standard.

Methods:

Ten participants who use a manual wheelchair were participants in this study. Data of 2 participants were used for adapting the algorithm and data of 7 participants were used for assessing the criterion validity.

Results:

Criterion validity for detecting “active wheelchair use” had a relative time difference of 7.4%, agreement of 96%, sensitivity of 98.3%, and positive predictive value of 90%. Results for distinguishing 6 types of wheelchair activities had an agreement of 73%, sensitivity of 67.1%, and positive predictive value of 65.5%.

Conclusions:

The Activ8 is able to detect “active wheelchair use” in youth using a manual wheelchair. Further development of the algorithm is necessary to distinguish between different types of wheelchair activities.
Minimally Invasive Compared to Open Colorectal Cancer Resection for Older Adults
Authors: Behman Ramy , Chesney Tyler , Coburn Natalie , Haas Barbara , Bubis Lev , Zuk Victoria , Ashamalla Shady , Zhao Haoyu , Mahar Alyson , Hallet Julie ,   on behalf of the REcovery after Surgical Therapy for Older adults Research – Cancer (RESTORE-Cancer) group
Published: August 2021

Objective:

We sought to compare long-term healthcare dependency and time-at-home between older adults undergoing minimally invasive surgery (MIS) for colorectal cancer (CRC) and those undergoing open resection.

Background:

Although the benefits of MIS for CRC resection are established, data specific to older adults are lacking. Long-term functional outcomes, central to decision-making in the care for older adults, are unknown.

Methods:

We performed a population-based analysis of patients ≥70years old undergoing CRC resection between 2007 to 2017 using administrative datasets. Outcomes were receipt of homecare and “high” time-at-home, which we defined as years with ≤14 institution-days, in the 5years after surgery. Homecare was analyzed using time-to-event analyses as a recurrent dichotomous outcome with Andersen-Gill multivariable models. High timeat-home was assessed using Cox multivariable models.

Results:

Of 16,479 included patients with median follow-up of 4.3 (interquartile range 2.1–7.1) years, 7822 had MIS (47.5%). The MIS group had lower homecare use than the open group with 22.3% versus 31.6% at 6 months and 14.8% versus 19.4% at 1 year [hazard ratio 0.87,95% confidence interval (CI) 0.83–0.92]. The MIS group had higher probability ofhigh time-at-home than open surgery with 54.9% (95% CI 53.6%–56.1%) versus 41.2% (95% CI 40.1%–42.3%) at 5years (hazard ratio 0.71, 95% CI 0.68–0.75).

Conclusions:

Compared to open surgery, MIS for CRC resection was associated with lower homecare needs and higher probability of high time-at-home in the 5 years after surgery, indicating reduced long-term functional dependence. These are important patient-centered endpoints reflecting the overall long-term treatment burden to be taken into consideration in decision-making.
Establishing the Essential Role of Household Extenders for Surgeon Wellbeing
Authors: Mavroudis Catherine L. , Bergmark Regan W. , Waljee Jennifer , Wick Elizabeth , Yeo Heather , Wirtalla Christopher , Kelz Rachel R.
Published: August 2021

Objective:

The aim of this study was to investigate the association between a change in household support during the Covid-19 pandemic and surgeon stress.

Background:

The hours and unpredictability of surgical practice often necessitate the employment of household extenders (eg, child caregivers) to maintain a safe home environment for surgeons and their families. The Covid-19 pandemic destabilized these relationships and provided an opportunity to reflect on the role that household extenders play in a surgical household.

Methods:

A multi-institutional telephone survey of surgeons practicing at five geographically diverse academic institutions was conducted (May 15, 2020–June 5, 2020). Surgeons were classified by change in household extenders (HE) during the pandemic (decrease, increase, no change, or none). The primary outcome was self-reported surgeon stress level. Multivariable linear regression was used to examine the relationship between change in HE and surgeon stress, adjusting for training and relationship status, the presence of pets and children in the household, and study site.

Results:

The majority (182, 54.3%) of surgeons employed HE before the pandemic; 121 (36.1%) reported a decrease in HE during the pandemic, 9 (2.7%) reported an increase, and 52 (15.5%) reported no change. Stress scores varied significantly by change in HE group (P = 0.016). After controlling for potential confounders, having an increase in HE was associated with a higher stress score (+1.55 points) than having no decrease in HE (P = 0.033), and having a decrease in HE was associated with a higher stress score (+0.96 points) than having no decrease (P = 0.004).

Conclusions:

Household extenders play a vital and complex role in enabling the healthcare workforce to care of the population. Surgeons who experienced a change in household extenders reported the highest stress levels. We suggest that health systems should proactively support surgeons by supporting the household extender workforce.
COVID-19 Vaccination Associated With Reduced Postoperative SARS-CoV-2 Infection and Morbidity
Authors: Prasad Nikhil K. , Lake Rachel , Englum Brian R. , Turner Douglas J. , Siddiqui Tariq , Mayorga-Carlin Minerva , Sorkin John D. , Lal Brajesh K.
Published: August 2021

Objective:

The purpose of this study was to determine the effect of COVID-19 vaccination on postoperative mortality, pulmonary and thrombotic complications, readmissions and hospital lengths of stay among patients undergoing surgery in the United States.

Background:

While vaccination prevents COVID-19, little is known about its impact on postoperative complications.

Methods:

This is a nationwide observational cohort study of all 1,255 Veterans Affairs facilities nationwide. We compared patients undergoing surgery at least 2 weeks after their second dose of the Pfizer BioNTech or Moderna vaccines, to contemporary propensity score matched controls. Primary endpoints were 30-day mortality and postoperative COVID-19 infection. Secondary endpoints were pulmonary or thrombotic complications, readmissions, and hospital lengths of stay.

Results:

30,681 patients met inclusion criteria. After matching, there were 3,104 in the vaccination group (1,903 received the Pfizer BioNTech, and 1,201 received the Moderna vaccine) and 7,438 controls. Full COVID-19 vaccination was associated with lower rates of postoperative 30-day COVID-19 infection (Incidence Rate Ratio and 95% confidence intervals, 0.09 [0.01,0.44]), pulmonary complications (0.54 [0.39, 0.72]), thrombotic complications (0.68 [0.46, 0.99]) and decreased hospital lengths of stay (0.78 [0.69, 0.89]). Complications were also low in vaccinated patients who tested COVID-19 positive before surgery but events were too few to detect a significant difference compared to controls.

Conclusion:

COVID-19 vaccination is associated with lower rates of postoperative morbidity. The benefit is most pronounced among individuals who have never had a COVID-19 infection before surgery.
Nationwide Cross-sectional Analysis of Endoscopic Thoracic Sympathectomy to Treat Hyperhidrosis Over 12 years in Brazil
Authors: Louzada Andressa Cristina Sposato , da Silva Marcelo Fiorelli Alexandrino , Portugal Maria Fernanda Cassino , Teivelis Marcelo Passos , Jerussalmy Claudia Szlejf , Amaro Edson , de Campos Jose Ribas Milanez , Wolosker Nelson
Published: August 2021

Objective:

To analyze the number of endoscopic thoracic sympathectomies performed to treat hyperhidrosis in the Universal Public Health System of Brazil, the government reimbursements, and the in-hospital mortality rates.

Background:

Even though endoscopic thoracic sympathectomy has been widely performed for the definitive treatment of hyperhidrosis, no series reported mortality and there are no population-based studies evaluating its costs or its mortality rate.

Methods:

Data referring to endoscopic thoracic sympathectomy to treat hyperhidrosis between 2008 and 2019 were extracted from the database of the Brazilian Public Health System, which insures more than 160 million inhabitants.

Results:

Thirteen thousand two hundred one endoscopic thoracic sympathectomies to treat hyperhidrosis were performed from 2008 to 2019, with a rate of 68.44 procedures per 10 million inhabitants per year. There were 6 in-hospital deaths during the whole period, representing a mortality rate of 0.045%. The total expended throughout the years was U$ 6,767,825.14, with an average of U$ 512.68 per patient.

Conclusions:

We observed a rate of 68.44 thoracoscopic sympathectomies for hyperhidrosis' treatment per 10 million inhabitants per year. The inhospital mortality rate was very low, 0.045%, though not nil. To our knowledge, no published series is larger than ours and we are the first authors to formally report deaths after endoscopic thoracic sympathectomies to treat hyperhidrosis. Moreover, there is no other population-based study addressing costs and mortality rates of every endoscopic thoracic sympathectomy for the treatment of any site of hyperhidrosis in a given period.