bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient-Centered Outcomes Following COVID-19: Frailty and Disability Transitions in Critical Care Survivors*
Authors: Taniguchi Leandro Utino , Avelino-Silva Thiago Junqueira , Dias Murilo Bacchini , Jacob-Filho Wilson , Aliberti Márlon Juliano Romero ,   on behalf of COVID-19 and Frailty (CO-FRAIL) Study Group and EPIdemiology of Critical COVID-19 (EPICCoV) Study Group, for COVID Hospital das Clinicas, University of Sao Paulo Medical School (HCFMUSP) Study Group
Published: January 2022

OBJECTIVES:

As the pandemic advances, the interest in the long-lasting consequences of COVID-19 increases. However, a few studies have explored patient-centered outcomes in critical care survivors. We aimed to investigate frailty and disability transitions in COVID-19 patients admitted to ICUs.

DESIGN:

Prospective cohort study.

SETTING:

University hospital in Sao Paulo.

PATIENTS:

Survivors of COVID-19 ICU admissions.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We assessed frailty using the Clinical Frailty Scale (CFS). We also evaluated 15 basic, instrumental, and mobility activities. Baseline frailty and disability were defined by clinical conditions 2–4 weeks before COVID-19, and post-COVID-19 was characterized 90 days (day 90) after hospital discharge. We used alluvial flow diagrams to visualize transitions in frailty status, Venn diagrams to describe the overlap between frailty and disabilities in activities of daily living, and linear mixed models to explore the occurrence of new disabilities following critical care in COVID-19. We included 428 participants with a mean age of 64 years, 57% males, and a median Simplified Acute Physiology Score-3 score of 59. Overall, 14% were frail at baseline. We found that 124/394 participants (31%) were frail at day 90, 70% of whom were previously non-frail. The number of disabilities also increased (mean difference, 2.46; 95% CI, 2.06–2.86), mainly in participants who were non-frail before COVID-19. Higher pre-COVID-19 CFS scores were independently associated with new-onset disabilities. At day 90, 135 patients (34%) were either frail or disabled.

CONCLUSIONS:

Frailty and disability were more frequent 90 days after hospital discharge compared with baseline in COVID-19 patients admitted to the ICU. Our results show that most COVID-19 critical care survivors transition to poorer health status, highlighting the importance of long-term medical follow-up for this population.
The Prognostic Impact of Radiotherapy Delays in Oropharynx Carcinoma and the Role of p16 Status
Authors: Urban Ryan , Alfaraj Fatimah , Olson Robert , Berthelet Eric , Tran Eric , Wu Jonn , Hamm Jeremy , Hamilton Sarah
Published: January 2022

Objective:

A retrospective analysis was performed to evaluate the prognostic significance of treatment delays (TDs) for oropharynx carcinoma patients treated with definitive radiotherapy (RT), comparing p16+ versus p16− disease.

Materials and Methods:

Patients treated between 2012 and 2016 were analyzed (n=763). TD was defined as the time from pathologic diagnosis to initiation of RT. TD thresholds of ≤60, 61 to 90, and >90 days were used to stratify outcomes. Time on treatment (TOT) delays were estimated based on the RT fractionation. TOT delay of 1 to 3 days was compared with >3 days. Predictors of cancer-specific survival (CSS) and locoregional recurrence (LRR) were evaluated on multivariable analysis.

Results:

Six hundred fifty (85%) patients had p16+ disease. On multivariable analysis, TOT delay of 1 to 3 days versus <1 day was associated with inferior CSS (hazard ratio [HR]=1.81; 95% confidence interval [CI]: 1.02-3.22). TD >90 versus ≤60 days (HR=1.68; 95% CI: 0.98-3.04) and 61 to 90 versus ≤60 days (HR=0.94; 95% CI: 0.60-1.48) was not associated with CSS. TD >90 versus ≤60 days (HR=1.29; 95% CI: 0.66-2.52), TD 61 to 90 versus ≤60 days (HR=0.98; 95% CI: 0.64-1.52), TOT 1 to 3 versus <1 day (HR=0.91; 95% CI: 0.39-2.11), and TOT >3 versus <1 day (HR=1.79; 95% CI: 0.80-3.99) were not associated with LRR. There was no interaction between p16 status and TD in relation to LRR (P=0.27) or CSS (P=0.17).

Conclusions:

TDs were not significantly associated with CSS or LRR. TOT of 1 to 3 days was associated with inferior CSS. p16 status should not be a significant factor when triaging RT start dates.
Effects of CYP2C19, CYP2C9 and CYP3A4 gene polymorphisms on plasma voriconazole levels in Chinese pediatric patients
Authors: Fan Xinghua , Zhang Hong , Wen Zhipeng , Zheng Xiaoli , Yang Yi , Yang Jihong
Published: January 2022

Objectives

Voriconazole is the most commonly used antifungal agent in clinical application. Previous studies suggested that voriconazole was extensively metabolized by CYP450 enzyme system, including CYP2C19, CYP2C9 and CYP3A4, which contributed to the individual variability of the pharmacokinetic process of voriconazole. This study aimed to investigate the effects of CYP2C19, CYP2C9 and CYP3A4 gene polymorphisms on plasma voriconazole concentrations in Chinese pediatric patients.

Methods

This study prospectively evaluated pediatric patients administrating voriconazole for the treatment or prophylaxis of invasive fungal infections from October 2018 to July 2020. Seven single-nucleotide polymorphisms in CYP2C19 (CYP2C19*2, CYP2C19*3, and CYP2C19*17), CYP2C9 (CYP2C9*3, CYP2C9*13) and CYP3A4 (CYP3A4*22, rs4646437) were detected by real-time fluorescent PCR with TaqMan probes. The voriconazole trough plasma concentration was determined by UPLC-MS/MS.

Results

A total of 68 pediatric patients were enrolled in this study. Our results showed that voriconazole plasma concentrations of patients with CYP2C19*2 or CYP2C19*3 allele were significantly higher than that with wild-type carriers (P < 0.0001, P = 0.004, respectively). However, CYP2C9*3 and CYP3A4 rs4646437 were not significantly associated with voriconazole plasma levels. The CYP2C19*17, CYP2C9*13 and CYP3A4*22 alleles were not observed in our study. Additionally, multiple linear regression analysis indicated that CYP2C19*2 and CYP2C19*3 alleles remained predictors of voriconazole plasma concentration (r

2
= 0.428; P < 0.0001). For CYP2C19 metabolizer phenotype, trough concentration of voriconazole was significantly lower in NM group compared with IM (P < 0.0001) and PM (P = 0.004) groups.

Conclusion

Voriconazole plasma levels in pediatric patients are mainly affected by CYP2C19 gene polymorphisms.
The Rectus Abdominis Perforator Turndown Flap for Preserving Rectus Continuity: A DIEP Alternative?
Authors: Rozen Warren M. , Phan Robert , Seifman Marc A. , Ellis Lisa , Hunter-Smith David J.
Published: January 2022

Background:

The deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction has been popularized over the transverse rectus abdominis myocutaneous (TRAM) flap, as it spares rectus abdominis muscle and has low donor site morbidity. This progression to muscle preservation, however, has been associated with an increased difficulty in vascular dissection, perfusion-related complications, and lengthier surgical times. We pilot a technique that may achieve the benefits of the TRAM flap in terms of ease of dissection and vascularity, with the benefits of the DIEP flap in terms of maintaining rectus abdominis continuity.

Methods:

A cohort of six consecutive patients underwent a free TRAM flap for reconstructive surgery. All patients underwent a segmental, periumbilical harvest of rectus abdominis muscle as part of flap design, and the segmental defect was reconstructed with an innervated rectus abdominis perforator turndown (RAPT) flap harvested supraumbilically. Postoperative assessment of rectus continuity was performed clinically, with muscle electromyography and ultrasound.

Results:

In all six cases, there was successful TRAM flap transfer, with no flap-related complications. Rectus abdominis muscle reconstruction with the RAPT flap was achieved, with continuity and function of the rectus muscle confirmed.

Conclusions:

We describe the innervated RAPT flap for reconstitution of rectus continuity after TRAM flap harvest. This technique may achieve the benefits of the TRAM flap in terms of ease of dissection and flap vascularity, and the benefits of the DIEP flap in terms of maintaining rectus abdominis continuity.
Repeated High-Fluence Accelerated Slitlamp-Based Photoactivated Chromophore for Keratitis Corneal Cross-Linking for Treatment-Resistant Fungal Keratitis
Authors: Hafezi Farhad , Munzinger Ana , Goldblum David , Hillen Mark , Tandogan Tamer
Published: January 2022

Purpose:

The purpose of this study was to report a case of fungal keratitis resistant to standard-of-care antimicrobial treatment and successful resolution, thanks to the repeated high-fluence accelerated photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL).

Methods:

This was a case report.

Results:

A 79-year-old male patient with previous Descemet membrane endothelial keratoplasty presented with a corneal ulcer that was resistant to topical antimicrobial therapy and amniotic membrane placement. Fungal keratitis was diagnosed, and the cornea was on the verge of perforation. After over a month of topical and systemic therapy without marked improvement, the patient underwent 2 repeated high-fluence accelerated CXL procedures (7.2 J/cm2 using a UV irradiation of 30 mW/cm2 for 4 minutes) over an interval of 8 days (accumulated fluence of 14.4 J/cm2), which resulted in significant clinical improvement, with consolidation into a quiescent scar.

Conclusions:

PACK-CXL protocols delivering a total UV fluence of 5.4 J/cm2 (as per the original Dresden protocol for corneal ectasia cross-linking) can be an effective primary therapy for initial or superficial corneal infections because approximately half of the energy is absorbed in the first 100 μm of a riboflavin-soaked cornea. However, fungal keratitis may require higher fluences than 5.4 J/cm2 because, unlike ectatic corneas, corneal ulcers are not transparent, and the infection may involve deep stroma. This case illustrates how repeated high-fluence accelerated PACK-CXL can be used to successfully treat fungal keratitis resistant to conventional topical and systemic medications.
The Relationship Between Caffeine Intake and Dry Eye Disease
Authors: Magno Morten Schjerven , Utheim Tor P. , Morthen Mathias Kaurstad , Snieder Harold , Jansonius Nomdo M. , Hammond Christopher J. , Vehof Jelle
Published: January 2022

Purpose:

The aim of this study was to determine the association between caffeine intake and dry eye disease (DED) in the large, population-based LifeLines cohort in the Netherlands.

Methods:

DED was cross-sectionally assessed in 85,302 participants (59% female participants) using the Women's Health Study dry eye questionnaire. Dietary caffeine was calculated from the intake of coffee, tea, cola, and energy drinks. Logistic regression was used to investigate the relationship between DED and caffeine, correcting for demographic variables, smoking status, alcohol intake, and 48 comorbidities of DED.

Results:

The mean (SD; range) age of participants was 50.7 years (12.4; 18–96), and 50,339 (59%) were female. The mean (SD) caffeine intake was 285 (182) mg/d. After correcting for demographics, body mass index, smoking status, and alcohol intake, higher caffeine intake was associated with a decreased risk of Women's Health Study-defined DED [odds ratio (OR) 0.971 per 100 mg/d, 95% CI, 0.956–0.986, P < 0.0005]. When additionally adjusting for medical comorbidities, no significant effect was observed (OR 0.985, 95% CI, 0.969–1.001, P = 0.06). Caffeine's effect on DED was similar in male and female participants and independent of sleep quality and stress at work. Decaffeinated coffee intake was significantly associated with an increased risk of DED, when adjusted for caffeinated coffee, demographics, alcohol intake, smoking status, and comorbidities (OR 1.046 per cup/d, 95% CI, 1.010–1.084, P = 0.01). None of the beverages were significantly associated with the risk of DED, when correcting for intake of the other caffeinated beverages, demographics, smoking status, alcohol intake, and all comorbidities.

Conclusions:

Dietary caffeine intake does not seem to be a risk factor for DED in the general population.
Trends in Keratoplasty Procedures During 2 Decades in a Major Tertiary Referral Center in Finland: 1995 to 2015
Authors: Ala-Fossi Olli , Krootila Kari , Kivelä Tero T.
Published: January 2022

Purpose:

The purpose of this study was to analyze trends in number, age-adjusted frequency, and type of keratoplasty in a major tertiary referral center, relative to patient and graft characteristics.

Methods:

A retrospective registry study of 1574 patients who in 1995 to 2015 underwent keratoplasty in the Helsinki University Eye Hospital (HUEH). Graft type and sequence, patient characteristics, and date of surgery were recorded. Main outcome measures were annual number, type, and age-adjusted frequency of keratoplasty; patient and graft characteristics; graft procurement; and national population-adjusted frequency of keratoplasty.

Results:

In HUEH, from 1995 to 2015, a total of 2191 keratoplasties were performed with 48% of the grafts procured intramurally; 76% were primary and 24% regrafts. The age-adjusted frequency of primary penetrating keratoplasty decreased by 52% from 0.96 to 0.46 per 100,000. The corresponding frequency of primary Descemet stripping automated endothelial keratoplasty increased by 367% from 0.3 to 1.4 after 2006, finally accounting for 68% of primary grafts. Men underwent primary penetrating keratoplasty (median 48 vs. 67 yrs, P = 0.0001) and anterior lamellar keratoplasty (median 37 vs. 46 yrs, P = 0.0015) at a younger age than women. Interval to the first regraft was comparable between sexes (median 2.2 vs. 1.9 yrs, respectively, P = 0.17). The national median population-adjusted frequency of keratoplasties was 3.2 per 100,000 from 2009 to 2015, and HUEH accounted for a median of 69% of them.

Conclusions:

The increased frequency of keratoplasty in HUEH resulted from rapid adoption of Descemet stripping automated endothelial keratoplasty after 2006 and was facilitated by centralizing graft procurement to HUEH and the National Cell and Tissue Center Regea.
Recurrence of Varicella-Zoster Virus Keratitis After SARS-CoV-2 Vaccination
Authors: Ryu Kyung Jae , Kim Dong Hyun
Published: January 2022

Purpose:

The purpose of this study was to report a case of acute exacerbation in varicella-zoster virus (VZV) keratitis after SARS-CoV-2 vaccination.

Methods:

An 87-year-old man, with a history of herpes zoster ophthalmicus 10 years ago, was referred for sudden visual impairment in his left eye that started 2 days after his second dose of SARS-CoV-2 mRNA vaccine BNT162b2.

Results:

At presentation, his visual acuity was hand motion. Slitlamp examination revealed diffuse corneal stromal edema and nasal stromal infiltration. After treatment for 2 weeks with oral valacyclovir and topical corticosteroids, the problematic lesion was recovered and his visual acuity was restored to 20/30.

Conclusions:

We believe that this is the first report of possible association between recurrence of VZV keratitis and SARS-CoV-2 vaccination. We believe that T-cell activation by the host response after vaccination may affect the recurrence of VZV keratitis. Physicians should be aware of the potential of recurrence of VZV keratitis associated with the SARS-CoV-2 messenger RNA vaccine.
A Case of Nonclostridial Gas-Producing Soft Tissue Infection in a Neutropenic Leukemia Patient With Literature Review
Authors: Segarra Chanlir , Sampson Mindy , Pla Fernandez Carlos A. , Nanjappa Sowmya , Greene John N.
Published: January 2022

Gas-producing soft tissue infections have been historically attributed to clostridial species; however, organisms in both the Enterobacteriaceae family as well as certain Gram-positive organisms have also been identified as causative organisms. Soft tissue infections are known to progress with an aggressive course, one that often necessitates urgent surgical debridement, amputation, and a prolonged course of antibiotics. If treatment measures are delayed, the clinical course can progress rapidly leading to life-threatening situations. Patients with significant medical comorbidities, such as those with cancer and its associated immunosuppression due to neutropenia and chemotherapy, are at the highest risk for these life-threatening complications. Here we present a case of a 26-year-old patient with relapsed acute lymphocytic leukemia complicated by neutropenia and a right upper extremity gas-forming infection due to Escherichia coli and discuss the gas-producing soft tissue infections other than Clostridia.
Bamlanivimab for the Prevention of Hospitalizations and Emergency Department Visits in SARS-CoV-2–Positive Patients in a Regional Health Care System
Authors: Priest David H. , Blanchette Lisa M. , Hekman Aliza L. , Maddikunta Rahul , Burleson Paula E.
Published: January 2022

Introduction

Bamlanivimab (LY-CoV555) was approved by Emergency Use Authorization by the United States Food and Drug Administration in the ambulatory setting to prevent hospitalizations and emergency department visits. We report a retrospective, case-control study of bamlanivimab use in a regional health care system.

Methods

A retrospective case-control study for SARS-CoV-2–positive patients receiving bamlanivimab and matched controls between October 2020 and March 2021 was performed. End points included all-cause hospitalization, emergency department visits, and mortality.

Results

No statistically significant difference was noted in all-cause hospitalization, emergency department visits, or mortality, including patients 65 years or older, body mass index of 35 or higher, diagnosis of diabetes mellitus, or cancer (high-risk patients). No difference was seen based on timing of bamlanivimab infusion relative to symptom onset or timing of infusion within the study period.

Conclusions

Based on the evaluated endpoints, there was no benefit from bamlanivimab, regardless of when it was received in a patient's clinical course or when during the study period it was received. A lack of efficacy of monoclonal antibodies in patients infected with COVID-19 variants has been noted, but the impact of local variants on these results could not be assessed given a lack of available variant diagnostic tools. These findings do not support bamlanivimab for the prevention of hospitalization or emergency department visits for patients with mild to moderate SARS-CoV-2 infection.
The Association Between Organizational Justice and Health-Related Productivity Loss Among Korean Employees
Authors: Park Hanul , Lee Dong-Wook , Lee June-Hee , Cho Seong-Sik , Kim Hyoung-Ryoul , Kang Mo-Yeol
Published: January 2022

Objectives:

To investigate the association between organizational justice (OJ) and health-related productivity loss (HRPL) among Korean employees.

Methods:

From January 6, 2020 to February 18, 2020, data were collected using a web-based questionnaire. This study measured HRPL using the Work Productivity and Activity Impairment Questionnaire: General Health version. Procedural and interactional justice were measured using the Korean organizational justice questionnaire. Generalized linear models were used for estimating productivity loss based on tertiles of OJ levels, while the productivity loss of employees in low OJ categories was used as a reference group.

Results:

The nonparametric associations between the OJ levels and the overall HRPL level were observed. High levels of OJ significantly reduced HRPL.

Conclusions:

Our results support the hypothesis that high OJ is associated with improved labor productivity.
Updated Standardized Mortality Ratio Evaluation of Disease Risks of Shipyard Workers Exposed to Low Dose Ionizing Radiation
Authors: Tao Xuguang (Grant) , Curriero Frank C. , Chee Elsbeth M. , Mahesh Mahadevappa
Published: January 2022

Objective:

: To examine the risk of diseases among industrial workers with low and fractionated radiation exposures.

Method:

The 372,047 US male shipyard radiation and non-radiation workers were followed for 54 years and compared with US men using standardized mortality ratio (SMR) method.

Results:

: SMRs for both radiation and non-radiation workers had lower risks of death from all causes (0.74; 95% confidence interval [CI] 0.74 to 0.75 and 0.77; 95% Cl 0.77 to 0.78, respectively) and from all cancers (0.92; 95% CI 0.91 to 0.93 and 0.90; 95% CI 0.89 to 0.91, respectively) compared with US men. Asbestos-related diseases including pleural cancers, mesothelioma, and asbestosis, but not lung cancers, were statistically higher in both radiation and non-radiation workers compared with the US men.

Conclusion:

: US shipyard male radiation and non-radiation workers did not show any elevated mortality risks that might be associated with radiation exposure.
Obesity Among Industrial Workers in Brazil
Authors: Xavier Paula Brustolin , Garcez Anderson , Silva Janaína Cristina da , Cibeira Gabriela Herrmann , Germano Antonino , Olinto Maria Teresa Anselmo
Published: January 2022

Objective:

Estimate the prevalence of obesity and its associated factors among industrial workers.

Methods:

This is a cross-sectional study of secondary data from workers aged 18 to 59 years in the State of Rio Grande do Sul, Brazil.

Results:

A total of 20,820 workers (12,372 men and 8448 women) were investigated. The overall prevalence of obesity was 14.6% (95% CI [confidence interval]: 14.2 to 15.1), 16.4% (95% CI: 15.6 to 17.2) among women and 13.5% (95% ci: 12.9 to 14.1) among men. After adjusting, obesity was significantly associated with increasing age, living with a partner, lower education, and ex-smoking status in both sexes. However, it was associated with lower income in women, and higher income and physical inactivity in men.

Conclusions:

Obesity was prevalent among Brazilian industrial workers and sociodemographic characteristics are important factors related to obesity.
Economic Costs of Pain in the Spanish Working Population
Authors: Sarria-Santamera Antonio , Kuntuganova Anargul , Alonso Marcos
Published: January 2022

Objective:

The objective of this paper is to provide an overview of the epidemiology of pain in the Spanish working population and to investigate the incremental costs of the different levels of pain on medical costs and productivity losses.

Methods:

This is a cross-sectional study of costs of pain in the Spanish working population from a societal perspective using data from a national representative survey.

Results:

Data from the 9919 respondents were analyzed. The prevalence of reported pain was 38.5%: 21.9% mild or very mild; 11.5% moderate; 5.1% severe or extreme. Increased self-reported pain was independently associated with significant increases in direct and indirect costs. Those reporting severe or extreme pain showed excess annual costs of €5118.97 per case, being 85% indirect costs.

Conclusions:

Spain is paying a heavy price for the high prevalence of pain in its working population.
Understanding Public Perceptions Regarding Cochlear Implant Surgery in Adults
Authors: Zhang Lisa , Ding Andy S. , Xie Deborah X. , Creighton Francis X.
Published: January 2022

Background and Objective:

Approximately 6% of adults eligible for cochlear implantation (CI) undergo surgery. This study aims to understand how general perceptions about CI contribute to barriers causing this low utilization rate.

Methods:

Participants completed an online survey regarding their perceptions about cochlear implantation. They were asked to rank CIQOL-10 Global priorities and corresponding risk tolerance for minor complications (changes in taste, vertigo) and major complications (infections requiring hospitalization, meningitis, reimplantation, facial paralysis, and cerebrospinal fluid [CSF] leak).

Results:

A total of 615 responses (female 55%, mean age 39 years [range 20–78]) were included. Respondents identified issues with insurance (46%) and fear of undergoing surgery (21%) as barriers preventing eligible adults from receiving CI. Regarding surgical risk, respondents significantly underestimated rates of minor complications (p < 0.0001) and almost all major complications (all p < 0.0001) while overestimating rates of serious infections and need for reimplantation (both p < 0.005). The ability to hear strangers in noisy environments was identified as the highest priority for CI (26%). Individuals who knew someone with a cochlear implantation were willing to tolerate higher rates of all minor and major complications (all p < 0.05). Healthcare workers were similarly willing to tolerate significantly higher rates of meningitis, facial paralysis, and CSF leak to achieve their highest priority (all p < 0.05).

Conclusions:

Respondents identify insurance coverage and fear of surgery as primary reasons for low utilization of adult CI in the United States. However, healthcare workers or those who knew someone with a cochlear implantation indicated significantly higher rates of risk tolerance to achieve their highest quality of life priorities, indicating the potential that the benefits of cochlear implantation are underappreciated in the general population.
The pulmonary microbiome: recent advances in understanding its role in chronic lung allograft dysfunction
Authors: Mitchell Alicia B. , Glanville Allan R.
Published: January 2022

Purpose of review

Lung transplantation presents a rescue therapy for those with end-stage lung disease. Survival in lung transplant patients remains limited due to chronic lung allograft dysfunction (CLAD), a range of pathologic manifestations leading to graft loss. The mechanisms underlying CLAD remain poorly understood, and the lung microbiome has been suggested as a potential contributor to this condition. This review aims to explore how the pulmonary microbiome is impacted by lung transplantation, and how alterations in this microbiome may contribute to the pathogenesis of CLAD.

Recent findings

The pulmonary microbiome is made up of a range of microorganisms, and it varies considerably in lung transplant patients when compared with healthy controls. The lung microbiome changes over the early transplant period, and the composition of species appears to have an impact on inflammatory responses within the lungs. A number of studies have shown that an increase in bacterial biomass in the allograft, and enrichment with the genera Proteobacteria, or more specifically, Pseudomonas species, is associated with CLAD.

This area of research is still in its infancy; however, the suggestion that changes in the composition of the microbiome and enrichment with certain species may predispose to the pathologic changes that underlie CLAD indicate that modulation of the microbiome may be of use in potential future therapeutics.
Short cephalomedullary nail toggle: a closer examination
Authors: George Albert V. , Bober Kamil , Eller Erik B. , Hakeos William M. , Hoegler Joseph , Jawad Ali H. , Guthrie S. Trent
Published: January 2022

Objectives:

In patients with wide femoral canals, an undersized short nail may not provide adequate stability, leading to toggling of the nail around the distal interlocking screw and subsequent loss of reduction. The purpose of this study was to identify risk factors associated with nail toggle and to examine whether increased nail toggle is associated with increased varus collapse.

Design:

Retrospective cohort study.

Setting:

Level 1 and level 3 trauma center.

Patients/Participants:

Seventy-one patients with intertrochanteric femur fractures treated with short cephalomedullary nails (CMN) from October 2013 to December 2017.

Intervention:

Short CMN.

Main Outcome Measurements:

Nail toggle and varus collapse were measured on intraoperative and final follow-up radiographs. Risk factors for nail toggle including demographics, fracture classification, quality of reduction, Dorr type, nail/canal diameter ratio, lag screw engaging the lateral cortex, and tip-apex distance (TAD) were recorded.

Results:

On multivariate regression analysis, shorter TAD (P = .005) and smaller nail/canal ratio (P < .001) were associated with increased nail toggle. Seven patients (10%) sustained nail toggle >4 degrees. They had a smaller nail/canal ratio (0.54 vs 0.74, P < .001), more commonly Dorr C (57% vs 14%, P = .025), lower incidence of lag screw engaging the lateral cortex (29% vs 73%, P = .026), shorter TAD (13.4 mm vs 18.5 mm, P = .042), and greater varus collapse (6.2 degrees vs 1.3 degrees, P < .001) compared to patients with nail toggle < 4 degrees.

Conclusions:

Lower percentage nail fill of the canal and shorter TAD are risk factors for increased nail toggle in short CMNs. Increased nail toggle is associated with increased varus collapse.

Level of evidence: Therapeutic Level III
Screening for Factors Influencing Parental Psychological Vulnerability During a Child’s PICU Admission*
Authors: Woolgar Francesca A. , Wilcoxon Lucy , Pathan Nazima , Daubney Esther , White Deborah , Meiser-Stedman Richard , Colville Gillian A.
Published: January 2022

OBJECTIVES:

To identify the risks of developing post-traumatic stress disorder (PTSD) and/or depression in parents following their child’s PICU admission using a brief screening instrument and to examine the associations with these risks.

DESIGN:

A cross-sectional parental survey.

SETTING:

A general 13-bed PICU at a large teaching hospital.

SUBJECTS:

One hundred and seven parents of 75 children admitted to the PICU.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

All parents completed the 10-item Posttraumatic Adjustment Screen (PAS) before discharge. The PAS assesses risk factors known to be associated with poorer psychological outcome, including psychosocial variables pretrauma and peritrauma, and acute stress. Parents’ scores on the PAS indicated that 64 (60%) were at risk of developing PTSD and 80 (75%) were at risk of developing depression following their child’s admission. Univariate analyses suggested that psychosocial variables, such as preexisting stressors and a history of previous mental health problems, were more strongly associated with PAS risk scores for PTSD and depression than medical or sociodemographic factors. In logistic regression analyses, a history of previous mental health problems was significantly associated with risk of developing PTSD and depression (p < 0.001) explaining 28% and 43% of the variance in these outcomes.

CONCLUSIONS:

This study suggests that a significant number of parents on PICU are potentially at risk of developing PTSD and/or depression postdischarge and that psychosocial factors, pretrauma and peritrauma, are stronger determinants of this risk, and of acute distress, than other variables. Identification of vulnerable parents during admission, using a measure such as the PAS, could facilitate the targeting of support and monitoring, acutely and postdischarge, at those who might be most likely to benefit.
Mealtime Support: A Pilot Case Series study of an Effective, Cost-saving Outpatient Hunger-Based Feeding Program for Tube Dependency
Authors: Huynh Geraldine , Vishram Alysha , Graham-Parker Carol , Blatz Debbie , Carroll Matthew , Turner Justine
Published: January 2022

Background:

Tube feeding is essential for children who cannot meet nutritional requirements orally. Over time, this can lead to tube dependency with negative impacts on the quality of life of children and families.

Objective:

We aimed to examine the efficacy of a multidisciplinary child-led, hunger-based approach called “Mealtime Support” at the Stollery Children’s Hospital in Edmonton. Nutritional outcomes, parental satisfaction, and cost implications were evaluated over 9 months postprogram completion per child.

Methods:

The ambulatory meal program was delivered 2–3 times a day, for 2 weeks, by an occupational therapist and dietitian, under medical supervision. Hunger was promoted by reducing tube fed calories by 80% before commencement. Caregivers completed 12-question subjective surveys pre- and postintervention. Microcosting methods compared costs between the program and ongoing tube feeding.

Results:

From 2016 to 2017, 6 children were enrolled and 5 completed the program. At 1-month postintervention, 4/5 of the children were 100% orally fed. Parents reported improvement in mealtime struggles (P = 0.005), reduction in worry about their child’s eating (P = 0.005), and improvement in their child’s appetite/variety foods eaten (P = 0.004). Over 2 years, the potential cost savings were estimated at $43,471.00. By 6 months, all feeding tubes were removed.

Conclusions:

Mealtime support was safe and successful in reducing tube dependency and cost-effective compared to no intervention or hospital based programs, which suggests that there is a need to develop and fund Canadian outpatient feeding programs.
Characteristics and Frequency of Pediatric Inflammatory Bowel Disease-Associated Pancreatitis: A Japanese Nationwide Survey
Authors: Hosoi Kenji , Minowa Kei , Suzuki Mitsuyoshi , Kudo Takahiro , Ohtsuka Yoshikazu , Tomomasa Takeshi , Tajiri Hitoshi , Ishige Takashi , Yamada Hiroyuki , Arai Katsuhiro , Yoden Atsushi , Ushijima Kosuke , Aomatsu Tomoki , Nagata Satoru , Uchida Keiichi , Takeuchi Kazuo , Shimizu Toshiaki
Published: January 2022

Objective:

Acute pancreatitis (AP) develops in approximately 2% of patients with the diagnosis of inflammatory bowel disease (IBD), but the characteristics and frequency of childhood-onset IBD-associated AP in Japan have not been studied. The present study aimed to clarify the characteristics of IBD-associated AP in Japan.

Methods:

A nationwide survey of pediatric patients with IBD (age, <17 years) was conducted from December 2012 to March 2013 at 683 hospitals and medical centers in Japan. A secondary survey was also sent to the centers with the target patients to evaluate their characteristics.

Results:

The response rate to the first part of the survey was 61.2% (n = 418). In total, 871 patients with Crohn disease and 1671 patients with ulcerative colitis were enrolled. The second part of the survey found that 11 (1.3%) patients with Crohn disease and 23 (1.4%) patients with ulcerative colitis experienced IBD-associated AP caused by medication (n = 18, 53%), a primary disease (n = 11, 32%), autoimmune pancreatitis (n = 1, 3%), or an anatomical abnormality (n = 1, 3%). All the patients had only mild AP.

Conclusions:

IBD-associated AP was not very frequent and was generally mild. The major cause of the pancreatitis was the medication used to treat the IBD.
Atypical Findings of Shwachman-Diamond Syndrome in Early Infancy: A Diagnostic Challenge
Authors: Marsico Concetta , Scozzarella Andrea , Capretti Maria Grazia , Carfagnini Filomena , Facchini Elena , Arcuri Santo , Aceti Arianna
Published: January 2022

Shwachman-Diamond syndrome (SDS) is a rare autosomal recessive disorder characterized by hematological abnormalities, exocrine pancreatic insufficiency, and skeletal dysplasia. We describe a 2-month-old girl with intrauterine and extrauterine growth restriction who presented with an isolated severe anemia requiring red blood cell transfusion, without gastrointestinal symptoms, history of infection, or congenital abnormalities. An abdominal ultrasound revealed a reduced pancreatic thickness and abnormal echogenicity without fat infiltration, further confirmed by MRI. Because of this peculiar pancreatic appearance, pancreatic function was investigated and revealed exocrine insufficiency. Genetic testing confirmed SDS diagnosis. The typical clinical, laboratory, and imaging features of SDS are often lacking in the first months of life, and this may delay diagnosis. In early infancy, low birth weight and lack of catch-up growth, isolated hematological abnormalities other than neutropenia and atypical pancreatic imaging may lead to SDS diagnosis even when the most common diagnostic criteria are not fulfilled.
Gene Expression Scoring of Immune Activity Levels for Precision Use of Hydrocortisone in Vasodilatory Shock
Authors: Yao Lijing , Rey Diego Ariel , Bulgarelli Lucas , Kast Rachel , Osborn Jeff , Van Ark Emily , Fang Li Tai , Lau Bayo , Lam Hugo , Teixeira Leonardo Maestri , Neto Ary Serpa , Bellomo Rinaldo , Deliberato Rodrigo Octávio
Published: January 2022

Purpose:

Among patients with vasodilatory shock, gene expression scores may identify different immune states. We aimed to test whether such scores are robust in identifying patients’ immune state and predicting response to hydrocortisone treatment in vasodilatory shock.

Materials and Methods:

We selected genes to generate continuous scores to define previously established subclasses of sepsis. We used these scores to identify a patient's immune state. We evaluated the potential for these states to assess the differential effect of hydrocortisone in two randomized clinical trials of hydrocortisone versus placebo in vasodilatory shock.

Results:

We initially identified genes associated with immune-adaptive, immune-innate, immune-coagulant functions. From these genes, 15 were most relevant to generate expression scores related to each of the functions. These scores were used to identify patients as immune-adaptive prevalent (IA-P) and immune-innate prevalent (IN-P). In IA-P patients, hydrocortisone therapy increased 28-day mortality in both trials (43.3% vs 14.7%, P = 0.028) and (57.1% vs 0.0%, P = 0.99). In IN-P patients, this effect was numerically reversed.

Conclusions:

Gene expression scores identified the immune state of vasodilatory shock patients, one of which (IA-P) identified those who may be harmed by hydrocortisone. Gene expression scores may help advance the field of personalized medicine.
Taking Stock and Looking Ahead
Authors: Popov Vitaliy , Ruis Andrew R. , Cooke James M.
Published: January 2022

Introduction

Since 2005, the American College of Surgeons Accredited Educational Institutes has provided accreditation of surgically focused simulation centers with the added benefit of identifying best practices defined as areas far exceeding the accreditation standards or novel methods of advancing high-quality, impactful education. This study aimed to examine the evolution of the best practices observed by accreditors during site visits over the 8-year period.

Methods

Accreditation included the completion of an application form followed by a site visit by a simulation expert and review of all materials by an accreditation committee to identify areas out of compliance along with areas far exceeding accreditation standards. These are termed “best practices.” To evaluate the evolution of accreditation feedback and embedded associations, the compiled list of 337 best practices identified from all 247 site visits over an 8-year period was analyzed and visualized using epistemic network analysis, a quantitative ethnographic technique for modeling the structure of connections in qualitative data.

Results

The overall association network of the data indicates that the strongest associations were between assessment, curriculum development, faculty development, research, and teaching methods, demonstrating a highly interconnected model of accreditation feedback. Best practices evolved from an early focus on teaching methods, faculty, and curriculum development to more advanced educational topics including assessment, research, resources, and overall center governance. Distribution of associations also increased over the 8-year period with more nuanced and interconnected statements demonstrating higher-level feedback including explanations, contributing factors, impact on other areas, and, in some cases, recommendations to share best practices outside the organization.

Conclusions

The epistemic network analysis of this 8-year database of simulation center feedback provides a novel perspective on an organization and the evolving field of simulation from an optional to essential modality in healthcare professions education.
Improved Survival With Higher-risk Donor Grafts in Liver Transplant With Acute-on-chronic Liver Failure
Authors: Kitajima Toshihiro , Kuno Yasutaka , Ivanics Tommy , Lu Mei , Moonka Dilip , Shimada Shingo , Shamaa Tayseer , Abouljoud Marwan S. , Nagai Shunji
Published: January 2022

Background.

Use of higher-risk grafts in liver transplantation for patients with acute-on-chronic liver failure (ACLF) has been associated with poor outcomes. This study analyzes trends in liver transplantation outcomes for ACLF over time based on the donor risk index (DRI).

Methods.

Using the Organ Procurement and Transplantation Network and the United Network for Organ Sharing registry, 17 300 ACLF patients who underwent liver transplantation between 2002 and 2019 were evaluated. Based on DRI, adjusted hazard ratios for 1-y patient death were analyzed in 3 eras: Era 1 (2002–2007, n = 4032), Era 2 (2008–2013, n = 6130), and Era 3 (2014–2019, n = 7138). DRI groups were defined by DRI <1.2, 1.2–1.6, 1.6–2.0, and >2.0.

Results.

ACLF patients had significantly lower risks of patient death within 1 y in Era 2 (adjusted hazard ratio, 0.69; 95% confidence interval, 0.61-0.78; P < 0.001) and Era 3 (adjusted hazard ratio, 0.48; 95% confidence interval, 0.42-0.55; P < 0.001) than in Era 1. All DRI groups showed lower hazards in Era 3 than in Era 1. Improvement of posttransplant outcomes were found both in ACLF-1/2 and ACLF-3 patients. In ACLF-1/2, DRI 1.2 to 1.6 and >2.0 had lower adjusted risk in Era 3 than in Era 1. In ACLF-3, DRI 1.2 to 2.0 had lower risk in Era 3. In the overall ACLF cohort, the 2 categories with DRI >1.6 had significantly higher adjusted risks of 1-y patient death than DRI <1.2. When analyzing hazards in each era, DRI > 2.0 carried significantly higher adjusted risks in Eras 1 and 3‚ whereas DRI 1.2 to 2.0 had similar adjusted risks throughout eras. Similar tendency was found in ACLF-1/2. In the non-ACLF cohort, steady improvement of posttransplant outcomes was obtained in all DRI categories. Similar results were obtained when only hepatitis C virus-uninfected ACLF patients were evaluated.

Conclusions.

In ACLF patients, posttransplant outcomes have significantly improved, and outcomes with higher-risk organs have improved in all ACLF grades. These results might encourage the use of higher-risk donors in ACLF patients and provide improved access to transplant.
Association between urbanization and Internet addiction
Authors: Ko Chih-Hung , Yen Ju-Yu , Lin Pai-Cheng
Published: January 2022

Purpose of review

Understanding the association between urbanization and Internet addiction is essential to the design and implementation of Internet addiction prevention measures in urban areas. This epidemiological review explores the urbanization-Internet addiction association and its potential underlying factors.

Recent findings

Nine studies have reported that Internet addiction prevalence is higher in urban areas, but three studies have noted the opposite. Psychiatric disorders and stress are the most commonly mentioned factors underlying the association. The effects of urbanization on Internet availability, Internet cafes, online gaming, outdoor or interactive activities, and family regulation and monitoring have been suggested to lead to higher Internet addiction risk. The ongoing COVID-19 pandemic, obesity, sleep problems, and the migration of parents to urban areas in search of work have strengthened the effect of urbanization on Internet addiction.

Early assessment and treatment provided by mental health services are crucial for mitigating the effect of urbanization on Internet addiction risk. Cities should be designed to provide adequate space for physical and interactive activities. To promote outdoor activities, air pollution, traffic congestion, and crime should be controlled. Prospective face-to-face studies involving analysis of data on pollution, traffic, and Internet addiction could provide evidence to elucidate the urbanization- Internet addiction association.
The thermal consequences of primate birth hour and its evolutionary implications
Authors: McFarland Richard , Henzi S. Peter , Fuller Andrea , Hetem Robyn S. , Young Christopher , Barrett Louise
Published: January 2022

Most primates, including humans, give birth during the inactive phase of the daily cycle. Practical constraints therefore limit our knowledge of the precise timing of nocturnal birth in wild diurnal primates and so limit our understanding of selective pressures and consequences. We measured maternal core body temperature (

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) across 24 births in a population of wild vervet monkeys using biologgers. We identified distinct perturbations in

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during the birth period, including declining

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during labour and the rapid recovery of

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post-parturition. Vervet monkeys typically gave birth during their inactive phase in synchrony with the nadir of the maternal nychthemeral

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rhythm but also showed remarkable inter-individual variability in their absolute

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during birth. Our findings support the view that selection may have favoured a nocturnal timing of primate birth to coincide with lower night-time

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and environmental temperatures, which improve thermal efficiency during birth.
Suspension feeders: diversity, principles of particle separation and biomimetic potential
Authors: Hamann Leandra , Blanke Alexander
Published: January 2022

Suspension feeders (SFs) evolved a high diversity of mechanisms, sometimes with remarkably convergent morphologies, to retain plankton, detritus and man-made particles with particle sizes ranging from less than 1 µm to several centimetres. Based on an extensive literature review, also including the physical and technical principles of solid–liquid separation, we developed a set of 18 ecological and technical parameters to review 35 taxa of suspension-feeding Metazoa covering the diversity of morphological and functional principles. This includes passive SFs, such as gorgonians or crinoids that use the ambient flow to encounter particles, and sponges, bivalves or baleen whales, which actively create a feeding current. Separation media can be flat or funnel-shaped, built externally such as the filter houses in larvaceans, or internally, like the pleated gills in bivalves. Most SFs feed in the intermediate flow region of Reynolds number 1–50 and have cleaning mechanisms that allow for continuous feeding. Comparison of structure–function patterns in SFs to current filtration technologies highlights potential solutions to common technical design challenges, such as mucus nets which increase particle adhesion in ascidians, vanes which reduce pressure losses in whale sharks and changing mesh sizes in the flamingo beak which allow quick adaptation to particle sizes.
When to end a lock down? How fast must vaccination campaigns proceed in order to keep health costs in check?
Authors: Gros Claudius , Czypionka Thomas , Gros Daniel
Published: January 2022

We propose a simple rule of thumb for countries which have embarked on a vaccination campaign while still facing the need to keep non-pharmaceutical interventions (NPI) in place because of the ongoing spread of SARS-CoV-2. If the aim is to keep the death rate from increasing, NPIs can be loosened when it is possible to vaccinate more than twice the growth rate of new cases. If the aim is to keep the pressure on hospitals under control, the vaccination rate has to be about four times higher. These simple rules can be derived from the observation that the risk of death or a severe course requiring hospitalization from a COVID-19 infection increases exponentially with age and that the sizes of age cohorts decrease linearly at the top of the population pyramid. Protecting the over 60-year-olds, which constitute approximately one-quarter of the population in Europe (and most OECD countries), reduces the potential loss of life by 95 percent.