bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends and Associations of Menthol Cigarette Smoking Among US Middle and High School Students—National Youth Tobacco Survey, 2011–2018
Authors: Sawdey Michael D , Chang Joanne T , Cullen Karen A , Rass Olga , Jackson Kia J , Ali Fatma Romeh M , Odani Satomi , Courtney-Long Elizabeth A , Armour Brian S , Ambrose Bridget K , Agaku Israel T
Published: March 2020

Introduction

Youth cigarette smoking decreased significantly over the last two decades in the United States. This study provides estimates and trends from 2011 to 2018 and factors associated with youth menthol and non-menthol smoking from 2016 to 2018.

Methods

Using data from the 2011–2018 National Youth Tobacco Surveys, past 30-day (current) menthol and non-menthol cigarette smoking were estimated for all youth (prevalence) and youth smokers (proportions). Trends were examined using Joinpoint regression, calculating the annual percent change (APC). Multivariate logistic regression analyses identified factors associated with menthol smoking.

Results

From 2011 to 2018, menthol cigarette smoking among current youth cigarette smokers significantly decreased from 57.3% to 45.7% (APC: −3.0%), while non-menthol (38.2% to 47.3% [APC: 2.9%]) and unknown menthol status (not sure\missing) (4.5% to 7.0% [APC: 7.1%]) significantly increased. Menthol cigarette smoking among high school, male, female, and non-Hispanic white current cigarette smokers decreased, but remained unchanged among middle school, non-Hispanic black, and Hispanic smokers. Significantly higher proportions of menthol cigarette smokers smoked on ≥20 days, ≥2 cigarettes per day, and ≥100 cigarettes in their lifetime compared to non-menthol smokers. Among current cigarette smokers, non-Hispanic blacks, Hispanics, flavored non-cigarette tobacco users, frequent smokers (≥20 days), those smoking 2–5 cigarettes per day, and those living with someone who uses tobacco had higher odds of menthol cigarette smoking.

Conclusions

In 2018, nearly half of current youth cigarette smokers smoked menthol cigarettes. While menthol cigarette smoking declined from 2011 to 2018 among all youth and among youth smokers, there was no change in menthol cigarette smoking among non-Hispanic black, Hispanic, and middle school cigarette smokers.

Implications

This study finds that overall cigarette and menthol cigarette smoking declined in youth from 2011 to 2018. However, menthol cigarette smoking among non-Hispanic black, Hispanic, and middle school youth cigarette smokers did not change. Information from this study can help inform efforts to reduce menthol cigarette smoking among US youth, particularly racial/ethnic minority populations.
Renovating Christian Charity: Global Catholicism, the Save the Children Fund, and Humanitarianism During The First World War*
Authors: Houlihan Patrick J
Published: March 2020

This article argues that the Vatican’s involvement in the fledgling stages of the Save the Children Fund helped globalize what began as a local British charity, reshaping Christian humanitarianism as a response to total war. Centred on children as irreproachable war victims and the hope of the future, the ideology of Christian charity and the Vatican’s financial networks helped mobilize resources to combat famine across shattered imperial state structures in Central and Eastern Europe. With diplomatic credentials as a peace advocate, Pope Benedict XV (1914–22) symbolically led this new wave of religious humanitarianism. Attempting to stabilize war-torn societies, Christian humanitarianism towards children was an ideology that overcame wartime British anti-Germanism, raising fears about the spectre of Bolshevism after the Russian Revolution of 1917. In contrast to 19th-century religious mobilization that hardened confessional boundaries against the liberal secular state, however, this was a moment when the Catholic Church as a global religious organization intervened for all people, irrespective of faith commitments. Influencing later human rights developments, religiously informed humanitarianism became forgotten in the Vatican’s aggressive anti-communist diplomacy in the inter-war era. Ecumenical religious charity was important for the modern history of humanitarianism and non-governmental organizations.
Comparative Effectiveness of Targeted Intrathecal Drug Delivery Using a Combination of Bupivacaine with Either Low-Dose Fentanyl or Hydromorphone in Chronic Back Pain Patients with Lumbar Postlaminectomy Syndrome
Authors: Ade Timothy , Roh Justin , Sharma Gautam , Mohan Mahesh , DeLozier Sarah J , Janes Jessica L , Hayek Salim M
Published: March 2020

Objective

Targeted intrathecal drug delivery (TIDD) is an effective interventional pain management modality often used in postlaminectomy patients with refractory chronic low back pain. A combination of intrathecal bupivacaine with an opioid is often used. However, intrathecal catheter tip granulomas have occurred with use of morphine or hydromorphone but generally not with fentanyl. The objective of this study was to compare the efficacy of TIDD using bupivacaine/fentanyl vs bupivacaine/hydromorphone in patients with chronic intractable low back pain postlaminectomy.

Materials and Methods

A retrospective comparative analysis of consecutive patients with lumbar postlaminectomy syndrome who were trialed and later received TIDD with a combination of bupivacaine/hydromorphone or bupivacaine/fentanyl between June 2009 and May 2016 at a single tertiary medical center.

Results

We identified a cohort of 58 lumbar postlaminectomy patients receiving a TIDD admixture of either hydromorphone/bupivacaine (30 patients) or low-dose fentanyl/bupivacaine (28 patients) with at least two years of follow-up. The fentanyl group had significantly lower baseline opioid consumption and a lower rate of intrathecal opioid dose escalation. Both groups had similar and significant reductions in pain scores over the two-year follow-up period. No granulomas were observed.

Conclusion

TIDD using a low-dose fentanyl admixture with bupivacaine in patients with postlaminectomy syndrome and refractory chronic low back pain results in similar pain relief to TIDD with hydromorphone and bupivacaine. Low-dose intrathecal fentanyl leads to a lower rate of opioid escalation and may be safer than hydromorphone.
Hamlet and Character in Modernist Criticism
Authors: Murray Nathan
Published: March 2020

This article is a critical history of the conflict over the ‘living character’, especially in the context of the debates over Hamlet between A. C. Bradley, T. S. Eliot and G. Wilson Knight. I argue that Bradley is a nuanced critic, who, far from seeing Hamlet as merely the imitation of a real person, recognizes the role of the reader in filling narrative gaps, smoothing over inconsistencies, and ultimately accepting the incompleteness of the text. I argue that Eliot and Wilson Knight, who attack Hamlet’s character in their writings, should be understood as engaged in the deliberate construction of a teleological metanarrative that presents the destabilized modernist character as the natural culmination of literary history.
Whole exome sequencing in unclassified autoinflammatory diseases: more monogenic diseases in the pipeline?
Authors: Kosukcu Can , Taskiran Ekim Z , Batu Ezgi Deniz , Sag Erdal , Bilginer Yelda , Alikasifoglu Mehmet , Ozen Seza
Published: March 2020

Objective

Autoinflammatory diseases (AIDs) are characterized by recurrent sterile systemic inflammation attacks. More than half of the patients remain genetically undiagnosed with next-generation sequencing panels for common AIDs. In this study, we aimed to define phenotype-genotype correlations in a cohort of unclassified AID patients via whole exome sequencing (WES).

Methods

Patients with features of AIDs were included in this study followed in the Department of Pediatric Rheumatology at Hacettepe University. They were first screened for MEFV with Sanger sequencing and then WES performed for the patients with clinically insignificant results. Pre-analysis of WES data was done by considering the 13 most common AID-related genes. Further bioinformatic analysis was performed if the patient remained genetically undiagnosed.

Results

The median age at disease onset was 1.2 years (range 0.2–16) and at the time of study recruitment was 14 years (range 3.5–17). In our cohort, WES provided a definite or probable disease-causing variant in 4 of 11 patients (36%). Heterozygous mutations for two of these genes were previously associated with neurological defects (ADAM17, TBK1), also homozygous ADAM17 mutations were observed in one family with neonatal inflammatory skin and bowel disease. Besides, two genes (LIG4, RAG1) were associated with immunodeficiency although the patients had presented with inflammatory features. Finally, for one patient, we associated a strong candidate gene (NLRC3) with autoinflammatory features.

Conclusion

WES strategy is cost-effective and provides substantial results for a selected group of undefined AID patients. Our results will contribute to the spectrum of unclassified AIDs.
Origin and evolution of dengue virus type 2 causing outbreaks in Kenya: Evidence of circulation of two cosmopolitan genotype lineages
Authors: Langat Solomon K , Eyase Fredrick Lunyagi , Berry Irina Maljkovic , Nyunja Albert , Bulimo Wallace , Owaka Samuel , Ofula Victor , Limbaso Samson , Lutomiah Joel , Jarman Richard , Distelhorst John , Sang Rosemary C
Published: March 2020

Dengue fever (DF) is an arboviral disease caused by dengue virus serotypes 1-4 (DENV 1-4). Globally, DF incidence and disease burden have increased in the recent past. Initially implicated in a 1982 outbreak, DENV-2 recently reemerged in Kenya causing outbreaks between 2011 and 2014 and more recently 2017–8. The origin and the evolutionary patterns that may explain the epidemiological expansion and increasing impact of DENV-2 in Kenya remain poorly understood. Using whole-genome sequencing, samples collected during the 2011–4 and 2017–8 dengue outbreaks were analyzed. Additional DENV-2 genomes were downloaded and pooled together with the fourteen genomes generated in this study. Bioinformatic methods were used to analyze phylogenetic relationships and evolutionary patterns of DENV-2 causing outbreaks in Kenya. The findings from this study have shown the first evidence of circulation of two different Cosmopolitan genotype lineages of DENV-2; Cosmopolitan-I (C-I) and Cosmopolitan-II (C-II), in Kenya. Our results put the origin location of C-I lineage in India in 2011, and C-II lineage in Burkina Faso between 1979 and 2013. C-I lineage was the most isolated during recent outbreaks, thus showing the contribution of this newly emerged strain to the increased DENV epidemics in the region. Our findings, backed by evidence of recent local epidemics that have been associated with C-I in Kenya and C-II in Burkina Faso, add to the growing evidence of expanding circulation and the impact of multiple strains of DENV in the region as well as globally. Thus, continued surveillance efforts on DENV activity and its evolutionary trends in the region, would contribute toward effective control and the current vaccine development efforts.
High-throughput DNA sequencing of museum specimens sheds light on the long-missing species of theBokermannohyla claresignatagroup (Anura: Hylidae: Cophomantini)
Authors: Lyra Mariana L , Lourenço Ana Carolina C , Pinheiro Paulo D P , Pezzuti Tiago L , Baêta Délio , Barlow Axel , Hofreiter Michael , Pombal José P , Haddad Célio F B , Faivovich Julián
Published: March 2020

The two species of the Bokermannohyla claresignata species group (Anura: Hylidae) have not been collected for the last four decades. It is the only species group of the hyline tribe Cophomantini that has not yet been analysed genetically. Its phylogenetic position is thus uncertain, and it has a combination of adult and larval character states that make this group a crucial missing piece that hinders our understanding of Cophomantini phylogenetics and character evolution. We obtained DNA sequences from a museum larval specimen of Bok. claresignata, using specialized extraction methods and high-throughput DNA sequencing, and combined the molecular phylogenetic results with available phenotypic information to provide new insights into the taxonomy and phylogenetic relationships of its species group. Our phylogenetic results place Bok. claresignata as sister to the Boana pulchella group, supporting its inclusion in Boana, together with Bokermannohyla clepsydra. In light of this new finding, we recognize a newly defined Boana claresignata group to accommodate these species, thus resolving both the polyphyly of Bokermannohyla and the paraphyly of Boana. Considering the phylogenetic relationships of the Boana claresignata group, we also discuss the evolution of suctorial tadpoles and mature oocyte/egg pigmentation in Cophomantini.
Identification of a Novel NtLRR-RLK and Biological Pathways That Contribute to Tolerance of TMV in Nicotiana tabacum
Authors: Wang Jing , Hao Fengsheng , Song Kunfeng , Jin Weihuan , Fu Bo , Wei Yuanfang , Shi Yongchun , Guo Hongxiang , Liu Weiqun
Published: March 2020

Tobacco mosaic virus (TMV) infection can causes serious damage to tobacco crops. To explore the approach of preventing TMV infection of plants, two tobacco cultivars with different resistances to TMV were used to analyze transcription profiling before and after TMV infection. The involvement of biological pathways differed between the tolerant variety (Yuyan8) and the susceptible variety (NC89). In particular, the plant–virus interaction pathway was rapidly activated in Yuyan8, and specific resistance genes were enriched. Liquid chromatography tandem mass spectrometry analysis detected large quantities of antiviral substances in the tolerant Yuyan8. A novel Nicotiana tabacum leucine-rich repeat receptor kinase (NtLRR-RLK) gene was identified as being methylated and this was verified using bisulfite sequencing. Transient expression of TMV-green fluorescent protein in pRNAi-NtLRR-RLK transgenic plants confirmed that NtLRR-RLK was important for susceptibility to TMV. The specific protein interaction map generated from our study revealed that levels of BIP1, E3 ubiquitin ligase, and LRR-RLK were significantly elevated, and all were represented at node positions in the protein interaction map. The same expression tendency of these proteins was also found in pRNAi-NtLRR-RLK transgenic plants at 24 h after TMV inoculation. These data suggested that specific genes in the infection process can activate the immune signal cascade through different resistance genes, and the integration of signal pathways could produce resistance to the virus. These results contribute to the overall understanding of the molecular basis of plant resistance to TMV and in the long term could identify new strategies for prevention and control virus infection.
Hand Dermatitis in Nursing Students
Authors: Özyazicioğlu Nurcan , Sürenler Semra , Aydin Ayla İrem , Atak Meryem
Published: March 2020

OBJECTIVE

To determine the frequency of self-reported hand dermatitis and the factors influencing its prevalence among nursing students.

METHODS

Researchers collected demographic data and used a self-assessment form to identify dermatologic symptoms. The questionnaires were distributed to the students and collected again after the students completed the forms.

RESULTS

Hand dermatitis was present in 20.9% of nursing students. The most common symptoms were irritation/pruritus, redness/cracking, flaking/rash, swelling, and vesicles in hands. The grade of the student, the presence of allergy complaints, and medication used to treat dermatitis were statistically significantly associated with dermatitis prevalence. The use of gloves and cleansing agents used in handwashing were factors linked to hand dermatitis.

CONCLUSIONS

Hand dermatitis increases in parallel with the increase of clinical practice hours among nursing students. Familial and environmental factors also increase the risk of hand dermatitis.
Using VoiceThread to Build a Community of Inquiry in Blended RN-to-BSN Education
Authors: Merriam Deborah , Hobba-Glose Janice
Published: March 2020

VoiceThread, a cloud-based social media tool, was used to create a sense of community in an undergraduate blended nursing leadership course. The purpose of this quasi-experimental study was to explore the use of VoiceThread to build a community of inquiry. The Community of Inquiry and IDEA surveys were completed by 163 students enrolled in an undergraduate nursing leadership course within an RN-BS curriculum. Results indicated using VoiceThread increased student-perceived teacher excellence, supported social presence and teacher presence, and promoted a community of inquiry.
Diagnostic Accuracy of Diaphragm Ultrasound in Detecting and Characterizing Patient–Ventilator Asynchronies during Noninvasive Ventilation
Authors: Vivier Emmanuel , Haudebourg Anne Fleur , Le Corvoisier Philippe , Mekontso Dessap Armand , Carteaux Guillaume
Published: March 2020

Background

Management of acute respiratory failure by noninvasive ventilation is often associated with asynchronies, like autotriggering or delayed cycling, incurred by leaks from the interface. These events are likely to impair patient’s tolerance and to compromise noninvasive ventilation. The development of methods for easy detection and monitoring of asynchronies is therefore necessary. The authors describe two new methods to detect patient–ventilator asynchronies, based on ultrasound analysis of diaphragm excursion or thickening combined with airway pressure. The authors tested these methods in a diagnostic accuracy study.

Methods

Fifteen healthy subjects were placed under noninvasive ventilation and subjected to artificially induced leaks in order to generate the main asynchronies (autotriggering or delayed cycling) at event-appropriate times of the respiratory cycle. Asynchronies were identified and characterized by conjoint assessment of ultrasound records and airway pressure waveforms; both were visualized on the ultrasound screen. The performance and accuracy of diaphragm excursion and thickening to detect each asynchrony were compared with a “control method” of flow/pressure tracings alone, and a “working standard method” combining flow, airway pressure, and diaphragm electromyography signals analyses.

Results

Ultrasound recordings were performed for the 15 volunteers, unlike electromyography recordings which could be collected in only 9 of 15 patients (60%). Autotriggering was correctly identified by continuous recording of electromyography, excursion, thickening, and flow/pressure tracings with sensitivity of 93% (95% CI, 89–97%), 94% (95% CI, 91–98%), 91% (95% CI, 87–96%), and 79% (95% CI, 75–84%), respectively. Delayed cycling was detected by electromyography, excursion, thickening, and flow/pressure tracings with sensitivity of 84% (95% CI, 77–90%), 86% (95% CI, 80–93%), 89% (95% CI, 83–94%), and 67% (95% CI, 61–73%), respectively.

Conclusions

Ultrasound is a simple, bedside adjustable, clinical tool to detect the majority of patient–ventilator asynchronies associated with noninvasive ventilation leaks, provided that it is possible to visualize the airway pressure curve on the ultrasound machine screen. Ultrasound detection of autotriggering and delayed cycling is more accurate than isolated observation of pressure and flow tracings, and more feasible than electromyogram.

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Considerations in spinopelvic parameters and acetabular component orientation in patients with lumbar spinal fusion following total hip arthroplasty: A retrospective study
Authors: Huerfano Elina , Alzate Ricardo , Muñoz Juan M. , Riveros Emilio A. , Márquez Diego , Páez Rodolfo , Nossa Juan M.
Published: March 2020

Background:

Although several authors have tried to describe the ideal acetabular component position, the influence of the spine on the orientation of the pelvis is not always considered. The aim of this study was to describe the spinopelvic behavior through body postural changes and its influence on acetabular component orientation in patients with previous spinal lumbar fusion who underwent total hip arthroplasty (THA).

Methods:

This is a retrospective case control study of 10 patients with previous lumbar spine fusion who underwent THA (study group) compared with 17 patients without lumbar spine pathology who underwent THA (control group). Spinopelvic parameters and acetabular component orientation were measured in each group on spinopelvic radiographs in standing and sitting positions, and dislocations were recorded.

Results:

From standing to sitting position, the pelvic tilt (PT) increased posteriorly, and the sacral slope (SS) decreased in both groups. However, the mean degree of change of PT was higher in the control than in the study group (−23.64 degrees vs. −12.8 degrees, P=0.017). Regarding acetabular component orientation, from standing to sitting position, the mean degree of change of the ante-inclination angle (AIA) was highest in patients in the control group as compared to the study group (−23.94 degrees vs. −13.9 degrees, P=0.017). Two study group patients and no control group patients experienced hip dislocation.

Conclusions:

The presence of concomitant spine disease should be considered in preoperative planning of THA because procedures such as lumbar spine fusion influence adaptability of spinopelvic parameters and acetabular component orientation in functional body position changes.

Level of Evidence:

Level III.
Effects of Sterilization Techniques on Bioactivity of Polymethyl Methacrylate Antibiotic Beads Containing Vancomycin and Tobramycin
Authors: Shaw James , Gary Joshua , Baker Andrea , Kaplan Heidi , Kim Yesul , Milhoan Madison , Burgess Andrew , Ambrose Catherine
Published: March 2020

Objectives:

Prefabrication and storage of antibiotic beads may decrease surgical time and allow for use in other settings. This study investigated the effects of sterilization technique and storage time on the bioactivity of antibiotic polymethyl methacrylate (PMMA) beads.

Methods:

Uniform beads of PMMA containing 1 g each of tobramycin and vancomycin were sterilized using autoclave, ethylene oxide (ETO), or ultraviolet (UV) light. Beads were made in a sterile fashion as a control. Disks containing eluted antibiotics from each of the 4 groups were placed onto agar plates inoculated withStaphylococcus aureus. Zones of inhibition, a measure of bioactivity for antibiotic eluted, were determined for the experimental groups and control. Repeat testing was performed for beads stored for 1 week, 1, 3, and 6 months.

Results:

Beads sterilized using autoclave, ETO, and UV light showed similar ZOIs after 24 hours of and 1 week of elution compared with the control group. Beads stored for up to 6 months demonstrated similar bioactivity to beads made sterile and tested immediately.

Conclusion:

PMMA beads containing vancomycin and tobramycin made in a sterile fashion and stored for up to 6 months have the same efficacy as the current standard of beads made sterile and used immediately. The elution and bioactivity of vancomycin–tobramycin antibiotic beads are not negatively impacted by the sterilization methods of autoclaving, ETO gas, or UV light. Furthermore, nonsterile beads can be sterilized and stored up to 6 months with an expected efficacy comparable with beads made in a standard sterile fashion.
Role of metabolic imaging in diagnosis of primary, metastatic, and recurrent prostate cancer
Authors: Hadavand Mohammad Amin , Mayer Dirk , Chen Wengen , Wnorowski Amelia , Siddiqui Mohummad Minhaj
Published: March 2020

Purpose of review

The present review describes the current role of metabolic imaging techniques such as multiparametric MRI (mpMRI), magnetic resonance spectroscopic imaging (MRSI), hyperpolarized MRSI, and positron emission tomography (PET) in the diagnosis of primary prostate cancer, surveillance of low-grade disease, detection of metastases, and evaluation of biochemical recurrence after therapy.

Recent findings

The natural history of prostate cancer ranges from indolent disease that is optimally monitored by active surveillance, to highly aggressive disease that can be lethal. Current diagnostic methods remain imperfect in noninvasively distinguishing between silent versus aggressive tumors. Hence, there is a high demand for noninvasive imaging techniques that offer insight into biological behavior of prostate cancer cells. Characterization of prostate cancer metabolism is a promising area to provide such insights.

Metabolic imaging may allow for greater detection and ultimately characterization of tumor based on aggressiveness and spread. Hence, it has the potential to monitor tumor activity, predict prognostic outcomes, and guide individualized therapies.
Establishing a Telemedicine Program for Breast Reconstruction
Authors: Xue Erica Y. , Chu Carrie K. , Winocour Sebastian , Cen Nicholas , Reece Edward
Published: March 2020

Telemedicine is an application of modern technology that allows for the remote delivery of healthcare services to diagnose and treat patients. The potential patient benefits of such a program include added convenience, lowered costs, and improved access. From a practical standpoint, establishing a telemedicine program may seem daunting to the plastic surgeon; success requires not only patient and provider adoption, but also integration of new technology. Despite these challenges, breast reconstruction patients are among those who stand to benefit most from telemedicine technology, as this patient population remains vulnerable to limitations to access following an emotion-provoking breast cancer diagnosis. Geographical limitation, especially in rural areas, represents a major barrier to access. To date, the application of telemedicine in caring for breast reconstruction patients has not been described in the literature. In this article, we describe the protocol developed and implemented by our academic plastic surgery group to care for new breast reconstruction candidates and discuss the role of telemedicine in improved access to breast reconstruction care.
Breast Reconstruction in Obese Patients: The Fat Grafted Latissimus versus Abdominal Free Tissue Transfer
Authors: Novak Matthew D. , Blough Jordan T. , Abraham Jasson T. , Shin Hope D. , Yasuda Tai , Ayala Donna , Altman Andrew M. , Saint-Cyr Michel
Published: March 2020

Background:

Immediate fat grafting to the pedicled myocutaneous latissimus dorsi (LD) flap has recently gained in popularity as a means to supplement volume for breast reconstruction. The aim of this study is to compare complication rates of the immediately fat-grafted LD to free tissue transfer in the obese population.

Methods:

In this retrospective cohort, 82 patients (149 breasts) from 2015 to 2019 were included. Patients underwent either unilateral or bilateral breast reconstruction with either LD with immediate fat grafting or abdominal-based free tissue transfer. Included patients had a body mass index ≥ 30 kg/m2 at the time of surgery. Complication data were recorded as minor, major, and medical complications. Procedure characteristics and postoperative data were also studied.

Results:

Minor complication rates between the LD with immediate fat grafting and free tissue transfer cases were similar (26.9% versus 26%, respectively). The free tissue transfer group had a significantly higher rate of major complications (20.3% versus 3.8%; P = 0.048) and medical complications (10.6% versus zero). Finally, the LD with immediate fat grafting group had significantly shorter operating room times, hospital length of stay, and fewer donor-site revisions.

Conclusions:

LD with immediate fat grafting offers the benefit of a totally autologous reconstruction without the risks of abdominal-based microvascular free tissue transfer or an implant. Favorable complication rates, shorter operative times, and shorter hospital length of stay make this reconstructive option a safe alternative to free tissue transfer in the obese population.
Liposuction: Drains, Are They Adequate?
Authors: Taha Ahmed A. , Wahba Mohamed M. , Tahseen Hossam
Published: March 2020

Background:

Seroma following liposuction (especially mega-sessions; more than 5 L) is a common complication that causes much distress to the surgeon and the patient. This will eventually affect the overall satisfaction and patient’s experience regarding liposuction. If not detected promptly, seromas can impair the results.

Methods:

This is a prospective analysis performed by the authors in a private practice. All our patients had mega-liposuction sessions (more than 5 L, range 8–12 L) using Power-assisted Liposuction with Lipomatic by Euromai and VASER. Tumescent infiltration was used. Fifty male patients participated after providing their informed consent. Their mean age was 35 years (range, 21–50) and mean body mass index was 29 (range, 28–33). Patients were divided into 2 groups. Group A consisted of 25 patients with no adjunctive draining procedures done, and group B consisted of 25 patients with drainage procedures done. Patients were followed up every other day for 3 weeks for detection of seroma.

Results:

Seventeen patients had post-operative seroma: 13 in group A and 4 in group B. The volume of seromas was further subdivided into mild (<50 cc), moderate (50–100 cc), and severe (>100 cc).

Conclusions:

High definition liposuction is a demanding procedure by both the surgeon and the patient to achieve the best results and contour. Drainage procedures and drains placement are truly effective methods for minimizing seroma formation, enhancing the recovery, and eventually improving the results.
Characteristics of Iatrogenic Nerve Injury from Orthopedic Surgery Correlate with Time to Subspecialty Presentation
Authors: Lefebvre Rachel , Russo Franco , Navo Paul , Stevanovic Milan
Published: March 2020

Background:

There is no current literature examining iatrogenic nerve injury resulting from orthopedic procedures across subspecialties and anatomic areas. This study uses a single peripheral nerve surgeon’s experience to investigate the variable time to presentation of adult patients with iatrogenic nerve injury after orthopedic surgery.

Methods:

A retrospective review of patients examined in Peripheral Nerve Clinic (PNC) from January 1, 2012, to April 1, 2018, at a single, private, university hospital was performed. Fifty-eight adult patients met inclusion criteria. Charts were reviewed to determine the index orthopedic procedure, peripheral nerve affected, clinical deficits, patient demographics, and time from injury to PNC presentation.

Results:

The average patient age was 51.2 years, and the average time to PNC referral was 10.9 months after the procedure that resulted in nerve injury. The orthopedic procedures included fracture fixation (13), joint arthroplasty (10) knee arthroscopy and ligament reconstruction (9), mass excision (9), shoulder arthroscopy (7), irrigation and debridement (2), removal of deep hardware (2), tendon procedures (2), trigger digit release (2), nerve decompression (1), and release of exertional compartment syndrome (1). Time from injury to PNC presentation was substantially shorter for patients with upper extremity versus lower extremity deficits (5.9 months vs 19.8 months; P = 0.0173) and for patients with motor nerve involvement versus those with isolated sensory nerve injury (4.5 months vs 24.3 months; P = 0.0164).

Conclusions:

Iatrogenic nerve injury is a risk across orthopedic subspecialties. Nerve injuries in the lower extremity and those with isolated sensory deficits have significantly delayed time to subspecialty presentation.
Orthostatic hypotension: a marker of blood pressure variability and arterial stiffness: a cross-sectional study on an elderly population: the 3-City study
Authors: Cremer Antoine , Boutouyrie Pierre , Laurent Stéphane , Gosse Philippe , Tzourio Christophe
Published: March 2020

Background:

Orthostatic hypotension, blood pressure (BP) variability, and arterial stiffness are three markers of cardiovascular risk beyond the average BP. However, the relationships between these three parameters are not well known.

Aim:

To examine the relationships between orthostatic hypotension, BP variability, and arterial stiffness.

Methods and results:

In the Three-City study, a sample of 1151 elderly participants (mean age = 80 ± 3 years) was screened for orthostatic hypotension, undertook home BP and pulse wave velocity (PWV) measurements. We performed logistic regression analyses to look at the associations between orthostatic hypotension and both day-to-day (D-to-D) BP variability quartiles and PWV quartiles. Orthostatic hypotension was detected in 210 participants who were more likely to be hypertensive, exhibit higher BP variability and have increased arterial stiffness. In the multivariate logistic regression analysis, the frequency of orthostatic hypotension increased by 20% with every quartile of D-to-D SBP variability and by 20% with every quartile of PWV. PWV and D-to-D BP variability were not associated. In stratified analysis, the use of beta-blocker changes these relationships: orthostatic hypotension was not associated to PWV anymore but its association with D-to-D SBP variability was apparently stronger.

Conclusion:

In this large sample of elderly individuals, orthostatic hypotension was independently associated with both BP variability and PWV. BP variability being more indicative of a baroreflex dysfunction and PWV being a marker of vascular ageing, these two components would participate to the orthostatic hypotension mechanisms.
Dynamic changes in cardiac function before and early postdelivery in women with severe preeclampsia
Authors: Ambrožič Jana , Lučovnik Miha , Prokšelj Katja , Toplišek Janez , Cvijić Marta
Published: March 2020

Objectives:

In women with severe preeclampsia the period immediately before and early postdelivery carries the greatest risk for cardiac decompensation due to acute changes in loading conditions. The authors aimed to evaluate dynamic changes in hemodynamic and echocardiographic-derived systolic and diastolic function parameters in preeclamptic women compared with healthy controls.

Methods:

Thirty women with severe preeclampsia and 30 healthy controls underwent transthoracic echocardiography 1 day before, 1 and 4 days postdelivery. Fluid responsiveness was assessed by passive leg raising.

Results:

Peak systolic myocardial velocities (s′) and global longitudinal strain (GLS) were significantly lower in preeclamptic group compared with controls only postdelivery (s′: 7.3 ± 0.8 vs. 8.3 ± 0.9 cm/s, P < 0.001; GLS: −21.4 ± 2.0 vs. −23.0 ± 1.4%, P = 0.027). In addition, significant decrease in s′ after delivery was observed only in preeclamptic group (P = 0.004). For diastolic parameters there were differences both before and postdelivery in E/e′ ratio (before: 8.4 ± 2.16 vs. 6.7 ± 1.89, P = 0.002; postdelivery: 8.3 ± 1.64 vs. 6.8 ± 1.27, P = 0.003) and mitral e′ velocity (before: 11.0 ± 2.39 vs. 12.6 ± 1.86, P = 0.004; postdelivery: 11.1 ± 2.28 vs. 14.0 ± 2.40 cm/s, P < 0.001). Significant increase in left ventricular stroke volume (P = 0.005) and transmitral E velocity (P = 0.003) was observed only in control group, reflecting response to volume load after delivery. Accordingly, only the minority of preeclamptic women were fluid responsive (11 vs. 43%, P = 0.014 between groups).

Conclusion:

Variations in cardiac parameters in healthy women seem to follow changes in loading conditions before and early after delivery. Different pattern in preeclamptic women, however, may be related to subtle myocardial dysfunction, that becomes uncovered with augmented volume load in early postpartum period.
Self-blood pressure measurement as compared to office blood pressure measurement in a large Indian population; the India Heart Study
Authors: Kaul Upendra , Wander G.S. , Sinha Nakul , Mohan Jagdish C. , Kumar Soumitra , Dani Sameer , Ponde Chandrashekhar K. , Pinto Brian , Dalal Jamshed , Hiremath Jagdish , Kapoor Sunil , Baruah D.K. , Nair Tiny , Alexander Thomas , Mohan Viswanathan , Joshi Shashank , Sivakadaksham N. , Omboni Stefano , Arambam Priyadarshini , Suvarna Viraj , Verberk Willem J.
Published: March 2020

Objective:

India Heart Study (IHS) is aimed at investigating the agreement between office blood pressure measurement (OBPM) and self (S)BPM in a hypertension-naive population.

Methods:

A total of 18 918 individuals (aged 42.6 ± 11.7 years, 62.7% men), visiting 1237 primary care physicians across India, underwent OBPM. They performed SBPM for a period of 1 week using a validated oscillometric BP monitor that was preprogrammed to adhere to a guideline-based SBPM-schedule and blinded to the results. Thereafter, individuals underwent a second OBPM. Available laboratory results were obtained. Thresholds for elevated OBPM and SBPM were 140/90 and 135/85 mmHg, respectively.

Results:

On the basis of first-visit OBPM and SBPM, there were 5787 (30.6%) individuals with normotension; 5208 (27.5%) with hypertension; 4485 (23.7%) with white-coat hypertension (WCH) and 3438 (18.2%) with masked hypertension. Thus, a diagnosis contradiction between SBPM and first-visit OBPM was seen in 9870 (41.9%) individuals. On the basis of second-visit OBPM, the normotension, hypertension, WCH and masked hypertension prevalence values were 7875 (41.6%); 4857 (25.7%); 2397 (12.7%) and 3789 (20.0%). There was poor agreement (kappa value 0.37) between OBPM of visit 1 and 2 with a diagnosis difference in 6027 (31.8%) individuals. The majority of masked hypertension and WCH individuals had BP values close to thresholds.

Conclusion:

There was a poor agreement between OBPM of visit1 and visit 2. Likewise, the agreement between OBPM at both visits and SBPM was poor. SBPM being considered to have a better correlation with patient prognosis should be the preferred method for diagnosing hypertension.
INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY AND ENDOSCOPY-GUIDED EXPLANTATION OF ARGUS II DEVICE
Authors: Cai Cindy X. , Vajzovic Lejla
Published: March 2020

Purpose:

To describe a surgical approach using intraoperative optical coherence tomography and endoscopy for successful Argus II retinal prosthesis system removal.

Methods:

Retrospective review of a patient undergoing Argus II explantation 8 months after initial implantation.

Results:

Successful explantation of the Argus II device was performed in this patient.

Conclusion:

Explantation of the Argus II device can be a difficult surgery, and intraoperative optical coherence tomography and endoscopy can be used to help avoid potential complications.
The Pharmacokinetics of Moxifloxacin in Cerebrospinal Fluid Following Intravenous Administration
Authors: Nohren John , Namtu Katie , Peloquin Charles , Messina Allison , Tuite Gerald , Berman David M.
Published: March 2020

A female infant underwent myelomeningocele repair and developed persistent ventricular dilatation. Cerebrospinal fluid (CSF) indices demonstrated meningitis with cultures growing
Mycoplasma hominis. The infant was treated with multiple antibiotics including moxifloxacin. Moxifloxacin CSF levels were obtained for pharmacokinetic analysis. This case report adds the importance of understanding the pharmacokinetics of CSF moxifloxacin levels among infants.
Gender differences in attention to pain body postures in a social context: a novel use of the bodies in the crowd task
Authors: Walsh Joseph , Eccleston Christopher , Keogh Edmund
Published: March 2020

Pain signals the presence of potential harm, captures attention, and can inhibit performance on concurrent tasks. What is less well known, however, is whether such attentional capture also occurs in a wider social context, such as when observing people in pain. To explore this possibility, we adopted a novel social-cue detection methodology: the bodies-in-the-crowd task. Two experiments are reported that consider whether nonverbal cues of pain, happiness, and anger as expressed through body postures would capture and hold attention. Both experiments recruited 40 (20 male and 20 female) pain-free individuals. Overall, results show that pain postures do not capture attention any more than happiness or anger postures, but disengagement from pain postures was significantly slower across both studies. Gender differences were also found, and were more likely to be found when crowds comprised both men and women. Male pain postures were more likely to capture attention. However, female observers had faster target detection speed, and were quicker to disengage from distractors. They also showed slower disengagement from female expressions overall. Male observers showed no variation based on target or distractor gender. Implications and potential directions for future research are discussed.
Improving Emergency Access to Human Immunodeficiency Virus Prophylaxis for Patients Evaluated After Sexual Assault
Authors: Saadatzadeh Tirajeh , Salas Natalie M. , Walraven Carla , Sarangarm Preeyaporn , Crandall Cameron S. , Crook Joy , Sarangarm Dusadee , Yaple Charles , Stafford Amanda , Wilson Christopher G. , Page Kimberly , Carvour Martha L.
Published: March 2020

Introduction:

Patients evaluated after sexual assault may benefit from nonoccupational postexposure prophylaxis (nPEP) to prevent infection with HIV, yet multiple barriers may prohibit nPEP delivery. The IN-STEP (Integrating nPEP after Sexual Trauma in Emergency Practice) project was designed to improve access to HIV screening and prevention for patients evaluated in the emergency department (ED) of our academic hospital after a sexual assault.

Methods:

The IN-STEP team identified and addressed four key areas for improvement: (1) training of ED providers to perform nPEP assessments; (2) access to HIV testing in the ED; (3) provision of nPEP medications, using a patient-centered approach; and (4) continuity of care between the ED and follow-up sites in the community. Improvements were implemented using parallel plan-do-study-act cycles corresponding to these four key areas.

Results:

IN-STEP resulted in significant systems improvements in HIV screening, prevention, and continuity of care. This program not only improved the care of patients affected by sexual assault but also those evaluated for HIV due to other indications.

Conclusions:

Involvement of a multidisciplinary leadership team, clear delineation of a patient-centered project focus, and coordination across four parallel areas for improvement were useful for completing this complex effort.
Developing a screening tool to identify harmful sibling aggression in a primary care setting
Authors: Hudson Gregory R. , Bowie Bonnie H.
Published: March 2020

Background:

Despite the possibility of adversely affecting the mental health of children, sibling aggression, the most common form of family violence, is often dismissed as normal or less harmful than other types of violence. Currently, there is no easily administered screening method for sibling aggression.

Purpose:

The goal of this project was to develop and test a brief sibling aggression screening tool for use in pediatric primary care.

Methods:

The project was implemented in four phases: phase I reviewed the literature for adolescent and child aggression screening tools and to create a draft for expert content analysis. Phase II used a focus group of family mental health providers to modify draft items for the screening tool (N = 5). In phase III, the first draft of a screening tool was critiqued by individual pediatric providers (N = 8) for clarity and feasibility of use in pediatric primary care. In phase IV, the screening tool was piloted by one provider in pediatric clinical practice, who used the tool with six children over 3 weeks.

Results:

All providers in phase II (N = 13) identified sibling aggression as an underassessed area of pediatric care. All providers in phase III found the revised questions to be clearly stated and child friendly; 75% (N = 6) agreed they could incorporate the questions into their current assessment, 25% disagreed citing limited time and resources. Pilot testing with six children demonstrated feasibility for use in pediatric primary care.

Implications for practice:

Utilization of a brief screening tool to assess for sibling aggression may help providers to identify and therapeutically respond to the most common type of childhood violence.
ABCA3 mutations in adult pulmonary fibrosis patients: a case series and review of literature
Authors: Klay Dymph , Platenburg Mark G.J.P. , van Rijswijk Rein H.N.A.J. , Grutters Jan C. , van Moorsel Coline H.M.
Published: March 2020

Purpose of review

The current review aims to recognize the variability in clinical presentation of adult patients with bi-allelic ABCA3 mutations, create more depth in ABCA3 mutations reported and highlight the influence of environmental factors on disease course.

Recent findings

Mutations in ABCA3 are predominantly linked to neonatal and pediatric interstitial lung disease (ILD) with a minority surviving beyond puberty. Here, we present three patients with ABCA3 mutations who present with disease at the age of 19, 61 and 77. Moreover, we identified c.4451G>C (p.R1484P), c.1675G>A (p.G559R) and c.4745C>G (p.T1582S) as three novel ABCA3 mutations. In addition, we identified six additional patients with ABCA3 mutations in literature who reached an age above 18. Furthermore, we discuss the influence of infections, drugs and smoking on disease course.

Although extremely rare, patients with bi-allelic mutations in ABCA3 may present at adulthood. Late onset of disease may be influenced by type of mutation or environmental factors.
Analysis on plausible factors related to the prognosis of stage IV esophageal cancer
Authors: Li Chenghui , Wang Zhiqiu , Duan Aixiong , Jiang Qian
Published: March 2020

To investigate factors related to poor prognosis of patients with stage IV esophageal cancer and to provide some bases on which proper therapeutic schemes could be formulated for stage IV esophageal cancer patients with performance status (PS) score between 0 and 2.

Clinical data of 60 patients with stage IV esophageal cancer were retrospectively analyzed, and the relationships of clinical characteristics and therapeutic methods with patients’ prognosis were explored. Univariate analysis on factors possibly affecting the prognosis of patients with stage IV esophageal cancer was performed using Log-rank test, and independent risk factors for the prognosis were estimated in multivariate Cox regression analysis through embracing variables which showed statistical significance in univariate analyses.

According to univariate analysis results, nutritional status, anemia, therapeutic method, esophageal stent, and visceral metastasis were main influencing factors for the prognosis of stage IV esophageal cancer (P < .05). While in multivariate Cox regression analysis, visceral metastasis was revealed to be an independent risk factor for poor prognosis in patients with stage IV esophageal cancer.

Visceral metastasis is an independent risk factor for poor prognosis in patients with stage IV esophageal cancer. Optimizing therapeutic modes according to with or without combined visceral metastasis possesses certain clinical significance in prolonging survival time and in improving the quality of life among patients with stage IV esophageal cancer.