bluuebunny/crossref_metadata_2025 huggingface dataset:
Postpartum-Specific Vital Sign Reference Ranges
Authors: Green Lauren J. , Pullon Rebecca , Mackillop Lucy H. , Gerry Stephen , Birks Jacqueline , Salvi Dario , Davidson Shaun , Loerup Lise , Tarassenko Lionel , Mossop Jude , Edwards Clare , Gauntlett Rupert , Harding Kate , Chappell Lucy C. , Knight Marian , Watkinson Peter J.
Published: January 2021

OBJECTIVE:

To estimate normal ranges for postpartum maternal vital signs.

METHODS:

We conducted a multicenter prospective longitudinal cohort study in the United Kingdom. We recruited women before 20 weeks of gestation without significant comorbidities and with accurately dated singleton pregnancies. Women recorded their own blood pressure, heart rate, oxygen saturation and temperature daily for 2 weeks postpartum. Trained midwives measured participants' vital signs including respiratory rate around postpartum days 1, 7, and 14.

RESULTS:

From August 2012 to September 2016, we screened 4,279 pregnant women; 1,054 met eligibility criteria and chose to take part. Postpartum vital sign data were available for 909 women (86.2%). Median, or 50th centile (3rd–97th centile), systolic and diastolic blood pressures increased from the day of birth: 116 mm Hg (88–147) and 74 mm Hg (59–93) to a maximum median of 121 mm Hg (102–143) and 79 mm Hg (63–94) on days 5 and 6 postpartum, respectively, an increase of 5 mm Hg (95% CI 3–7) and 5 mm Hg (95% CI 4–6), respectively. Median (3rd–97th centile) systolic and diastolic blood pressure returned to 116 mm Hg (98–137) and 75 mm Hg (61–91) by day 14 postpartum. The median (3rd–97th centile) heart rate was highest on the day of birth, 84 beats per minute (bpm) (59–110) decreasing to a minimum of 75 bpm (55–101) 14 days postpartum. Oxygen saturation, respiratory rate, and temperature did not change in the 2 weeks postbirth. Median (3rd–97th centile) day-of-birth oxygen saturation was 96% (93–98). Median (3rd–97th centile) day-of-birth respiratory rate was 15 breaths per minute (10–22). Median (3rd–97th centile) day-of-birth temperature was 36.7°C (35.6–37.6).

CONCLUSION:

We present widely relevant, postpartum, day-specific reference ranges which may facilitate early detection of abnormal blood pressure, heart rate, respiratory rate, oxygen saturation and temperature during the puerperium. Our findings could inform construction of an evidence-based modified obstetric early warning system to better identify unwell postpartum women.

CLINICAL TRIAL REGISTRATION:

ISRCTN, 10838017.
Comparison of Short-leg and Long-leg Casts for the Treatment of Distal Third Tibial Shaft Fractures in Children
Authors: Barnett Scott A. , Fontenot Bailli , Leonardi Claudia , Gonzales Joseph A. , Gargiulo Dominic , Heffernan Michael J.
Published: January 2021

Background:

Long-leg casts (LLCs) are an established treatment for pediatric tibial shaft fractures including fractures involving the distal third. There is a paucity of literature assessing the use of short-leg cast (SLC) for tibial shaft fractures. The purpose of this study was to determine if SLC were as effective as LLC for the treatment of pediatric distal third tibial shaft fractures.

Methods:

A retrospective review was conducted on consecutive distal third tibial shaft fractures treated at a tertiary pediatric hospital from 2013 to 2018. Exclusion criteria included midshaft and proximal fractures of the tibia, distal fractures that violated the tibial physis or plafond, and pathologic fractures. We compared primary outcomes of time to weight-bearing, time to union, and final angulation between LLC and SLC groups.

Results:

Eighty-five patients aged 5 to 17 years (mean age: 9.2±3.2 y) met inclusion criteria, including 50 LLC and 35 SLC patients. Time to weight-bearing for SLC (3.3±0.6 wk) was shorter compared with LLC (6.4±0.7 wk, P<0.0001). Overall, fractures treated with SLC had a shorter time to the union (7.4±0.9 wk) compared with LLC (9.0±0.9 wk, P=0.026) without statistical differences in final angulation at the time of union. There was a higher percentage of cast complications in the LLC treatment group (12%) compared with SLC (6%).

Conclusions:

SLC demonstrated earlier time to weight-bearing and shorter time to fracture union when compared with LLC. Surgeons should consider SLC and early weight-bearing for the treatment of distal third tibial shaft fractures in children.

Level of Evidence:

Level III—retrospective comparative study.
Risk Factors for Failure of Cast Treatment in Displaced Pediatric Tibial Shaft Fractures
Authors: Öztürk Alper , Arican Gökhun , Demir Kürşat R. , Şibar Kemal , Ersan Önder , Alemdaroğlu Kadir B.
Published: January 2021

Background:

As there is a current increasing tendency to treat displaced tibial shaft fractures in adolescents surgically, it has become more important to predict failure of cast treatment for these patients. In the past, redisplacement of pediatric tibial shaft fractures has been reported at rates of 20% to 40%. Although the efficacy of the three-point index (TPI), gap index, and cast index has been demonstrated for upper extremity fractures in children, to date no index has been shown to accurately predict redisplacement for pediatric tibial shaft fractures. The aim of this study was to determine the predictive factors for redisplacement in pediatric tibial shaft fractures.

Methods:

In all, 157 displaced pediatric tibial shaft fractures were evaluated retrospectively. Patient age, initial and postreduction fracture angulation, shortening and translation, quality of reduction, obliquity of fracture, associated fibular fractures, and 3 indices (TPI, cast index, and gap index) were analyzed. Receiver operating characteristic analysis was performed to determine the cutoff points and logistic regression was used to show the risk factors of redisplacement.

Results:

There were 53 female and 104 male patients with a mean age of 9.1 (5 to 15 y) and 45 patients developed redisplacement during the follow-up. Mean TPI and gap index and initial and postreduction fracture translation were higher in patients with redisplacement, while TPI>0.855 and postreduction translation >18% were the only independent risk factors for fracture redisplacement. No differences were observed regarding associated fibular fracture, quality of reduction, initial/postreduction angulation, and shortening.

Conclusions:

The TPI>0.855 and postreduction translation >18% are independent risk factors for redisplacement of tibial shaft fractures in children. Although the gap index can be useful, the cast index is not an appropriate tool for these fractures.
EDF Casting for Early Onset Scoliosis
Authors: Shafer Cody , Mahajan Rajat , Kishan Shyam
Published: January 2021

Study Design

IRB approved prospective case series.

Objectives

This study attempts to determine the effects of elongation, derotation, and flexion (EDF) casting on pulmonary function. We also attempted to define prognostic factors and determine the ideal amount of traction for casting in patients with early onset scoliosis (EOS).

Summary of Background Data

No literature on effects of serial casting on pulmonary parameters in EOS, or on the ideal amount of traction to be used for EOS Casting.

Methods

Fifty consecutive children with EOS treated by the senior author using EDF casting were studied prospectively. Traction and lung function parameters (compliance, tidal volume, peak inspiratory pressure, and resistance) were measured at different periods during cast application. Etiology, age, weight, Cobb angles, and RVAD were monitored.

Results

All lung function parameters decline during cast application but rise to near baseline levels at the time of next cast application. Near full curve correction was achieved in every patient with (A) idiopathic scoliosis who (B) presented prior to 20 months of age with (C) a moderate main curve at presentation (<45°) and in those (D) without a phase II rib-vertebral relationship at presentation. The best response to casting was seen with 1 pound traction per pound body weight during application.

Conclusion

EDF casting can delay progression or improve curves in patients with larger curves, nonidiopathic scoliosis, and older patients. Idiopathic patients, moderate curve sizes, and younger patients had a better response to casting. Even though lung function declines during cast application, it returns to near baseline levels at the time of the next cast application, suggesting that EDF casting may not have any long-term effects on lung function, and also may protect pulmonary function in EOS from its natural history of progressive deterioration.

Level of Evidence: 4
Cervical Myelopathy
Authors: Lockey Stephen D. , Trent Sarah M. , Kalantar Seyed Babak
Published: January 2021

Study Design:

This was a narrative review.

Objective:

The aim was to discuss current methods and review updated outcome studies regarding posterior decompression in the management of cervical myelopathy.

Summary of Background Data:

Progressive myelopathy in the cervical segments is an indication for urgent surgical management. Although nonoperative treatment is an option in mild to moderate cases, the majority of patients will experience deterioration in neurological function requiring surgical decompression.

Methods:

A review of the literature was performed using PubMed to provide updated information regarding posterior cervical decompression in the management of myelopathy.

Results:

There are numerous studies comparing outcome data between cervical laminectomy and fusion with laminoplasty. While each technique has advantages and disadvantages, both provide adequate decompression and good long-term outcomes in patients meeting appropriate criteria.

Conclusions:

Posterior decompression is an important approach for spine surgeons to have in their toolkits when treating cervical myelopathy.
Rule 50: A Reproducible Technique to Minimize Graft-tunnel Mismatch During ACL Reconstruction Using Bone-Tendon-Bone (BTB) Graft
Authors: Hazzard Sean , Lonati Danielle , Kolosky Michael , Asnis Peter
Published: January 2021

Introduction:

The use of bone-tendon-bone grafts are a popular option for anterior cruciate ligament (ACL) reconstruction. Graft-tunnel mismatch is a technical pitfall of using this type of graft.

Objective:

The primary objective of this study was to provide results of a simple technique to minimize graft-tunnel-mismatch that we call “Rule 50.” Rule 50 is a technique of estimating the length of the femoral socket (20 mm) with the length of the native ACL (30 mm) and using this to alter the length of the tibial tunnel using a calibrated drill guide.

Materials and Methods:

Prospectively, 103 consecutive ACL reconstructions (68 autograft, 35 allograft) were analyzed. Any excess graft was cut flush with the distal tibial cortex and measured to evaluate how much graft was implanted and how much was removed.

Results:

At least 20 mm of tibial-sided bone plug from the grafts were implanted 100% of the time (regardless of patient height or total graft length) with an average of 30.63 to 31 mm of tibial bone plug implanted. This accounted for 86% to 92% of the harvested tibial bone plugs, respectively, implanted. Aperture fixation was accomplished in 100% of the cases.

Conclusion:

Rule 50 is a reproducible method to maximize the amount of bone from a bone-tendon-bone graft within the tibial tunnel to minimize graft-tunnel mismatch and can provide a minimum of 20 mm of distal bone 100% of the time.
Life-Threatening Hemoptysis in a Pediatric Referral Center
Authors: Moynihan Katie M. , Ge Shirley , Sleeper Lynn A. , Lu Minmin , Andren Kristofer G. , Mecklosky Jessica , Rahbar Reza , Fynn-Thompson Francis , Porras Diego , Arnold John , Kelly Daniel P. , Agus Michael S. D. , Thiagarajan Ravi R. , Alexander Peta M. A.
Published: January 2021

OBJECTIVES:

Hemoptysis is uncommon in children, even among the critically ill, with a paucity of epidemiological data to inform clinical decision-making. We describe hemoptysis-associated ICU admissions, including those who were critically ill at hemoptysis onset or who became critically ill as a result of hemoptysis, and identify predictors of mortality.

DESIGN:

Retrospective cohort study. Demographics, hemoptysis location, and management were collected. Pediatric Logistic Organ Dysfunction-2 score within 24 hours of hemoptysis described illness severity. Primary outcome was inhospital mortality.

SETTING:

Quaternary pediatric referral center between July 1, 2010, and June 30, 2017.

PATIENTS:

Medical/surgical (PICU), cardiac ICU, and term neonatal ICU admissions with hemoptysis during or within 24 hours of ICU admission.

INTERVENTIONS:

No intervention.

MEASUREMENTS AND MAIN RESULTS:

There were 326 hemoptysis-associated ICU admissions in 300 patients. Most common diagnoses were cardiac (46%), infection (15%), bronchiectasis (10%), and neoplasm (7%). Demographics, interventions, and outcomes differed by diagnostic category. Overall, 79 patients (26%) died inhospital and 109 (36%) had died during follow-up (survivor mean 2.8 ± 1.9 yr). Neoplasm, bronchiectasis, renal dysfunction, inhospital hemoptysis onset, and higher Pediatric Logistic Organ Dysfunction-2 score were independent risk factors for inhospital mortality (p < 0.02). Pharmacotherapy (32%), blood products (29%), computerized tomography angiography (26%), bronchoscopy (44%), and cardiac catheterization (36%) were common. Targeted surgical interventions were rare. Of survivors, 15% were discharged with new respiratory support. Of the deaths, 93 (85%) occurred within 12 months of admission. For patients surviving 12 months, 5-year survival was 87% (95% CI, 78–92) and mortality risk remained only for those with neoplasm (log-rank p = 0.001).

CONCLUSIONS:

We observed high inhospital mortality from hemoptysis-associated ICU admissions. Mortality was independently associated with hemoptysis onset location, underlying diagnosis, and severity of critical illness at event. Additional mortality was observed in the 12-month posthospital discharge. Future directions include further characterization of this vulnerable population and management recommendations for life-threatening pediatric hemoptysis incorporating underlying disease pathophysiology.
Continuing Education Outcomes for Advance Care Planning: A Systematic Review of the Literature
Authors: Pearse Wendy , Saxon Robyn , Plowman Greg , Hyde Mervyn , Oprescu Florin
Published: January 2021

Introduction:

Advance care planning (ACP) is a process of considering future health and care needs for a time when a person may be unable to speak for themselves. Health professional continuing education programs have been proposed for facilitating patient participation in ACP; however, their impacts on participants, patient and clinical outcomes, and organizational approaches to ACP are not well understood.

Methods:

This systematic literature review examined interventional studies of education programs conducted with health professionals and care staff across a broad range of settings. Five electronic databases were searched up to June 2020, and a manual search of reference lists was conducted. The quality of studies was appraised by the first, second, and third authors.

Results:

Of the 7993 articles identified, 45 articles met the inclusion criteria. Program participants were predominantly medical, nursing, and social work staff, and students. Interventions were reported to improve participants' self-perceived confidence, knowledge, and skills; however, objectively measured improvements were limited. Multimodal programs that combined initial didactic teaching and role-play simulation tasks with additional activities were most effective in producing increased ACP activity in medical records. Evidence for improved clinical outcomes was limited.

Discussion:

Further studies that use rigorous methodological approaches would provide further evidence about what produces improved patient and clinical outcomes. Needs analyses and quality indicators could be considered to determine the most appropriate and effective education resources and monitor their impacts. The potential contribution of a broader range of health professionals and interprofessional learning approaches could be considered to ultimately improve patient care.
Building Your “Educational Peloton:” Cycling Together for Success During Uncertain Times
Authors: Berkowitz Lori R. , Dzara Kristina , Simpkin Arabella L.
Published: January 2021

Burnout is a pervasive concern that negatively impacts physicians, patients, and healthcare organizations. Stress, uncertainty, clinical demands, and rapidly changing teams threaten the learning environment, where connection is key to resilience. The COVID-19 pandemic amplifies these challenges. Building an “educational peloton” to provide a safe and protective educational community may help optimize learning and team performance. Easily implementable strategies include: (1) Maximize learning opportunities, particularly small ones; (2) Ensure quality feedback; and (3) Facilitate collegiality. Intentionally nurturing an “educational peloton”—especially during times of uncertainty and change—can help drive engagement and work satisfaction, which can improve patient safety and healthcare outcomes, as well as boost human connection and promote community.
Leadership Development Projects: Bidirectional Impact on Faculty and Institutions
Authors: Lewis Vivian , Baldwin Constance D. , Morahan Page S. , Thorndyke Luanne E. , Gusic Maryellen E.
Published: January 2021

Introduction:

The Hedwig von Ameringen Executive Leadership in Academic Medicine program (ELAM) is a national professional development program for women that includes institutional action projects (IAPs). Although benefits of ELAM participation are well documented, the value of the IAPs has not been specifically evaluated. We explored the experience of ELAM Fellows and leaders from one institution to elucidate how institutional factors influence project implementation and outcomes.

Methods:

Fellows and deans participated in semistructured interviews. We analyzed the transcripts qualitatively to develop themes and describe factors that influenced IAP implementation and outcomes. We used the New World Kirkpatrick Model, an updated version of the widely used Kirkpatrick model of educational program evaluation, as a framework to elucidate how participants applied their leadership learning through project work, and to analyze early results of projects that indicated institutional impact.

Results:

Project work had bidirectional impact on the fellows in the program and on the institution itself. Project enablers included: focusing projects on institutional priorities, obtaining sustainable support, and navigating institutional complexity. Leading indicators of institutional outcomes included contributions to institutional leadership and culture, and mutual enhancement of the reputation of the fellow and of the institution.

Discussion:

By examining enablers and barriers for institutionally based projects conducted in a national leadership development program, we identified the drivers that facilitated application of leadership learning. Leading indicators of project outcomes reflected bidirectional impact on fellows and the institution, demonstrating outcomes at the highest levels of the New World Kirkpatrick Model.
A National Survey of Provider's Preparedness to Care for Persons Living With HIV Aged ≥50 Years
Authors: Sangarlangkarn Aroonsiri , Rizza Stacy A. , Mahmood Maryam , Cummins Nathan W. , Temesgen Zelalem
Published: January 2021

Introduction:

With increasing longevity among persons living with HIV (PLWH), HIV providers must manage age-related diseases despite limited geriatric training. We surveyed HIV providers to assess perceived preparedness in caring for aging PLWH and knowledge gaps.

Methods:

We surveyed HIV providers from October to December 2018 on preparedness (1 = strongly unprepared to 5 = strongly prepared), topics of interest, and participant characteristics including the number of years after training, number of PLWH aged ≥50 years seen/month, degree types (MD/DO versus others), and practice setting (academic versus nonacademic). We grouped “strongly prepared/somewhat prepared” responses as “prepared” and “neutral/somewhat unprepared/strongly unprepared” as “unprepared.” The effects of participant characteristics on preparedness were determined using chi-square test.

Results:

Of 226 participants, 54% were physicians, 27% were NP/PA, 19% were PharmD, and 40% practiced in academic settings. The average preparedness score was 3.37 out of 5.0. Approximately half of participants (56%) were classified as “prepared.” The mode number of years in practice was “10 to <20” (22%); mode number of PLWH aged ≥50 years seen/month was “1 to 25” (50%). HIV-associated neurocognitive disorder (73%) and geriatric syndrome screening (63%) were the most chosen areas of interest. Unprepared participants were interested in topics of cardiovascular disease (odds ratio [OR], 2.38; P = .002) and palliative care (OR, 1.92; P = .02). Having >20 years after training increased preparedness (“20 to <30” years versus “none”: OR, 3.37; P = .03; “≥30 years” versus “none”: OR, 3.66; P = .04).

Conclusion:

Approximately half of the surveyed HIV providers felt prepared to care for aging PLWH. HIV-associated neurocognitive disorder, geriatric syndrome screening, cardiovascular diseases, and palliative care were areas of interest. Having >20 years after training increases preparedness.
Preliminary adipose removal did not prevent diet-induced metabolic disorders in mice
Authors: Liu Lin , Liang Chen-Xi , Wang Xiao-Wei , Pei Ke-Xin , Ma Xin-Di , Zhang Chun-Xi , Dong Jing-Hui , Gao Ming-Ming , Liao Jia-Wei
Published: January 2021

Background:

Obesity is a fundamental factor in metabolic disorders such as hyperlipidemia, insulin resistance, fatty liver, and atherosclerosis. However, effective preventive measures are still lacking. This study aimed to investigate different surgical protocols for removing partial adipose tissue before the onset of obesity and determine whether, and by which protocol, preliminary adipose removal could exert potent preventive effects against diet-induced metabolic disorders.

Methods:

Male low-density lipoprotein receptor (LDL-R) knockout (KO) mice were randomly divided into four groups and subjected to epididymal fat removal (Epi-FR) surgery, subcutaneous fat removal (suQ-FR) surgery, both subcutaneous and epididymal fat removal (Epi + suQ-FR) surgery, or sham-operation. After 1 week of recovery, all mice were given a high-fat diet (HFD) for 10 weeks to induce metabolic disorders.

Results:

In the Epi-FR group and the sham-operated group, the mean numbers of the residual subcutaneous fat were 28.59 mg/g and 18.56 mg/g, respectively. The expression of relative genes such as Pparg, Cebpa, Dgat2, Fabp4 and Cd36 in the residual subcutaneous fat increased 2.62, 3.90, 3.11, 2.06, 1.78 times in the Epi-FR group compared with that in the sham-operated group. Whereas in the other fat-removal groups, the residual fat depots had no significant change in either size or gene expression, as compared with those of the sham-operated group. Plasma lipid and glucose levels and insulin sensitivity, as detected by the glucose tolerance test, were not significantly alleviated in the three fat removal groups. Liver mass or lipid content was not attenuated in any of the three fat removal groups. The atherosclerosis burdens in the entire inner aorta and aortic root did not decrease in any of the three fat removal groups.

Conclusions:

Our data suggest that removal of epididymal adipose or subcutaneous adipose alone or in combination before the onset of obesity did not protect against hyperlipidemia, insulin resistance, fatty liver, or atherosclerosis in LDL-R KO mice fed with a HFD. Hence, adipose removal possibly does not represent a potential approach in preventing obesity-related metabolic disorders in the obesity-susceptible population.
Postoperative Observation Versus Radiotherapy for Pathologic N1 Oral Cavity Squamous Cell Carcinoma
Authors: Xiang Michael , Holsinger Floyd Christopher , Gensheimer Michael F. , Divi Vasu , Pollom Erqi L. , Colevas Alexander Dimitrios , Le Quynh-Thu , Beadle Beth M.
Published: January 2021

Objectives:

To investigate the benefit of postoperative radiotherapy (PORT) for low-volume (pN1) nodal disease after resection of oral cavity squamous cell carcinoma.

Materials and Methods:

The National Cancer Database was queried for adults with nonmetastatic squamous cell carcinoma of the oral cavity treated by surgical resection with pathologic stage T1-2 N0-2 (American Joint Committee on Cancer 7th edition) and with the maximal exclusion of standard indications for PORT. Overall survival was compared within pN1 for observation versus PORT and then compared for pN1 versus pN0 and versus pN2 stratified by receipt of observation or PORT. Multivariable Cox regression was used to adjust for potential confounders between PORT and survival, including comorbidity and age.

Results:

Overall 5017 pN0, 530 pN1, and 253 pN2 patients were identified, of whom 9%, 35%, and 64% received PORT, respectively. Within the pN1 cohort, PORT was associated with improved survival versus observation (adjusted hazard ratio, 0.66; 95% confidence interval, 0.46-0.97; P=0.03). Among observed patients, the prognosis of pN1 was equivalent to pN2 and inferior to pN0; in contrast, among patients treated with PORT, the prognosis of pN1 was equivalent to pN0 and superior to pN2. Without PORT, pN1 remained an adverse risk factor relative to pN0 regardless of the depth of invasion, lymph node size, lymph node location, and extent of lymph node dissection.

Conclusions:

PORT was associated with a survival benefit compared with observation. Notably, pN1 was an adverse risk factor relative to pN0 if, and only if, patients did not receive PORT, suggesting pN1 by itself may be an indication for PORT.
Proliferating Pilar Tumors: Can Immunohistochemistry Differentiate Benign and Malignant Forms?
Authors: Yildiz Pelin , Aydin Ulgen Ovgu , Yol Cansu , Demirkesen Cuyan
Published: January 2021

Background:

Proliferating pilar tumor (PPT) is an adnexal tumor of purported differentiation toward the follicular outer root sheath. Immunohistochemistry has been suggested to differentiate between benign and malignant forms.

Methods:

Eleven benign (PPT) and 9 malignant PPT lesions were reviewed; Ki67, p27, and p53 were applied. The staining intensity (strong, moderate, weak, and negative), positive cell numbers, and marker indexes (%) were scored using image-analysis software (ViraSoft).

Results:

Overall, there was no significant correlation between Ki67 and p53 and histopathological features. However, malignant PPTs had significantly lower numbers of p27-positive cells (P = 0.030).

Conclusions:

Our study includes the largest group of patients in whom image analysis of p53, Ki67, and p27 has been used to try to separate benign from malignant lesions. Although there were no significant differences regarding Ki67 and p53, malignant lesions have a statistically lower expression of p27. Further studies may be needed to determine the clinical usefulness of image analysis in this differential diagnosis.
A Prospective Ultrasound Study of Plasma Polychlorinated Biphenyl Concentrations and Incidence of Uterine Leiomyomata
Authors: Wesselink Amelia K. , Claus Henn Birgit , Fruh Victoria , Orta Olivia R. , Weuve Jennifer , Hauser Russ , Williams Paige L. , McClean Michael D. , Sjodin Andreas , Bethea Traci N. , Brasky Theodore M. , Baird Donna D. , Wise Lauren A.
Published: January 2021

Background:

Uterine leiomyomata, or fibroids, are hormone-dependent neoplasms of the myometrium that can cause severe gynecologic morbidity. In previous studies, incidence of these lesions has been positively associated with exposure to polychlorinated biphenyls (PCBs), a class of persistent endocrine-disrupting chemicals. However, previous studies have been retrospective in design and none has used ultrasound to reduce disease misclassification.

Methods:

The Study of Environment, Lifestyle, and Fibroids is a prospective cohort of 1,693 reproductive-aged Black women residing in Detroit, Michigan (enrolled during 2010–2012). At baseline and every 20 months for 5 years, women completed questionnaires, provided blood samples, and underwent transvaginal ultrasound to detect incident fibroids. We analyzed 754 baseline plasma samples for concentrations of 24 PCB congeners using a case–cohort study design. We used multivariable Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals for the association between plasma PCB concentrations and ultrasound-detected fibroid incidence over a 5-year period.

Results:

We observed little association between PCB congener concentrations and fibroid incidence. The HR for a one-standard deviation increase in log-transformed total PCBs was 0.94 (95% CI = 0.78, 1.1). The PCB congener with the largest effect estimate was PCB 187 (HR for a one-standard deviation increase in log-transformed exposure = 0.88, 95% CI = 0.73, 1.1). Associations did not seem to vary strongly across PCB groupings based on hormonal activity.

Conclusions:

In this cohort of reproductive-aged Black women, plasma PCB concentrations typical of the contemporary general population were not appreciably associated with higher risk of fibroids.
Pharmacologic Prevention of Myocardial Ischemia–Reperfusion Injury in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
Authors: Kakavand Hessam , Aghakouchakzadeh Maryam , Coons James C. , Talasaz Azita H.
Published: January 2021

Establishing efficient perfusion into the myocardium is the main purpose in patients with acute coronary syndrome, but the process of reperfusion is not without risk and can damage the myocardium paradoxically. Unfortunately, there is no effective treatment for reperfusion injury, and efforts to find an efficient preventive approach are still ongoing. In the past 3 decades, there have been many successful animal studies on how to prevent reperfusion injury; nonetheless, translation to the clinical setting has almost always proven disappointing. In this article, we review clinical studies on the prevention of reperfusion injury in patients with acute coronary syndrome undergoing primary percutaneous coronary intervention in a pharmacologic-based approach. We categorize all the agents that are evaluated for the prevention of myocardial reperfusion injury based on their mechanisms of action into 5 groups: drugs that can reduce oxidative stress, drugs that can affect cellular metabolism, rheological agents that target microvascular obstruction, anti-inflammatory agents, and agents with mixed mechanisms of action. Then, review all the clinical studies of these agents in the setting of primary percutaneous coronary intervention. Finally, we will discuss the possible reasons for the failure in translation of studies into practice and propose potential solutions to overcome this problem.
Ethically Justified, Practical Guidance for the Professionally Responsible Investigation of Maternal-Fetal Intervention for Fetal or Neonatal Benefit
Authors: Chervenak Frank A. , McCullough Laurence B.
Published: January 2021

This paper provides ethical guidance for the professionally responsible clinical investigation of maternal-fetal investigation for fetal or neonatal benefit and its transition into clinical practice. We present an ethical framework based on the ethical principles of beneficence, respect for autonomy, and justice, the professional virtue of integrity, and the ethical concept of the fetus as a patient. We identify the implications of this ethical framework for the qualifications that centers for maternal-fetal intervention should satisfy. These centers have the ethical obligation to provide prospective review and oversight of both innovation (an experiment undertaken to benefit an individual patient) and research (an experiment undertaken to create generalizable knowledge). We describe ethically justified criteria for innovation and early-phase research, for randomized clinical trials, and for the responsible transition into clinical practice. We also identify the elements of the informed consent process, including measures to prevent therapeutic misconception by pregnant patients during the informed consent process. The scientific, clinical, and ethical requirements of maternal-fetal investigation are demanding. However, the commitment to safety and quality requires that they be met. Fulfilling this commitment will result in well-documented professionally responsible investigation of maternal-fetal intervention for fetal and neonatal benefit.
QR678 & QR678 Neo Hair Growth Formulations: A Cellular Toxicity & Animal Efficacy Study
Authors: Kapoor Rinky , Shome Debraj , Vadera Sapna , Kumar Vaibhav , Ram Male Shiva
Published: January 2021

Background:

Current treatment modalities are limited in their approach and success for hair loss. QR 678 & QR 678 Neo are new formulations, consisting of a combination of growth factors and peptides. This study demonstrates safety analysis of QR 678 & QR 678 Neo formulation, using in vitro cytotoxicity assay and in vivo animal efficacy.

Methods:

Factors including vascular endothelial growth factor, basic fibroblast growth factor, insulin-like growth factor-1, keratinocyte growth factor, and copper tripeptide 1 (QR 678) or their biomimetic peptides (QR678 Neo) were suspended in a sterile injectable vehicle. The 3-2,5-diphenyl tetrazolium bromide assay was used to explore the cytotoxic effects of each factor used in the compositions in human keratinocyte cell and human fibroblast cell assays. An in vivo analysis, wherein study animals were given intradermal QR 678 & QR 678 Neo injections, was conducted to assess whether the formulations produce hair growth. Also, hair follicle viability was checked by intradermal injection of the pharmaceutical compositions in secondary alopecia.

Results:

In both formulations, a positive response was observed with respect to the number of mice exhibiting hair growth at the injection sites. The injections caused retention of hair in a 0.25-cm radius around the injection site. On cytotoxicity study, all the factors were found to be safe in human keratinocyte cell and human fibroblast cell assay. A positive response was demonstrated in animals on treatment with the chemotherapeutic agent.

Conclusions:

Intradermal injections of QR 678 & QR 678 Neo hair growth factor formulations are a safe and efficacious option for alopecia. Results seem encouraging enough to warrant a trial in humans with secondary alopecia, post cancer chemotherapy.
The Use of Radiofrequency in Aesthetic Surgery
Authors: Dayan Erez , Burns A. Jay , Rohrich Rod J. , Theodorou Spero
Published: January 2021

The use of radiofrequency for soft tissue tightening has increased over the past 10 years. Both minimally invasive and noninvasive devices are frequently in use. This article describes the different types of radiofrequency technology and the current evidence behind their safety and efficacy.
Revision and Secondary Facelift: Problems Frequently Encountered
Authors: Skouras George A. , Skouras Athanasios G. , Skoura Elena A.
Published: January 2021

Background:

Revision facelift is a very challenging operation. The goal of our study was to examine the most common problems that the facelift surgeon has to face in a revision case and to suggest ways of solving them.

Methods:

A review of all patients from 2012 to 2017 in whom rhytidectomy was performed by the senior author was conducted.

Results:

During the 5-year study period, the author performed 552 face lifts. After the review to confirm revision procedures, a total of 72 revision facelifts were found. On reviewing the most common problems encountered in our facelifts, we found that in addition to the stigmata of the primary facelift, which are thoroughly analyzed in our article, a new type of stigmata has been added nowadays to the revision facelift—that of the various noninvasive interventions that patients undergo after their first facelift, in their effort to postpone or avoid a second operation. In all the abovementioned cases, the surgeon has to modify his basic surgical plan accordingly, to be able to improve or solve all of those problems during the revision surgery.

Conclusions:

The modern facelift surgeon often has to face much more than the stigmata of the primary facelift or the natural aging process. Thus, he/she should be appropriately trained to solve any problem we might encounter in a revision case.
Anesthetic Considerations in Facial Transplantation: Experience at NYU Langone Health and Systematic Review
Authors: Alfonso Allyson R. , Ramly Elie P. , Kantar Rami S. , Rifkin William J. , Diaz-Siso J. Rodrigo , Gelb Bruce E. , Yeh Joseph S. , Espina Mark F. , Jain Sudheer K. , Piper Greta L. , Rodriguez Eduardo D.
Published: January 2021

Background:

Anesthetic considerations are integral to the success of facial transplantation (FT), yet limited evidence exists to guide quality improvement. This study presents an institutional anesthesia protocol, defines reported anesthetic considerations, and provides a comprehensive update to inform future directions of the field.

Methods:

An institutional “FT Anesthesia Protocol” was developed and applied to 2 face transplants. A systematic review of 3 databases captured FTs in the peer-reviewed literature up to February 2020. Two reviewers independently screened titles and abstracts to include all clinical articles with FT recipient and/or donor-specific preoperative, intraoperative, and relevant postoperative anesthetic variables. Data charting guided a narrative synthesis, and quantitative synthesis reported variables as median (range).

Results:

Our institutional experience emphasizes the importance of on-site rehearsals, anticipation of patient-specific anesthetic and resuscitative requirements, and long-term pain management. Systematic search identified 1092 unique records, and 129 met inclusion criteria. Reports of 37 FTs in the literature informed the following anesthetic axes: donor pre- and intraoperative management during facial allograft procurement, recipient perioperative care, immunotherapy, antimicrobial prophylaxis, and pain management. Quantitative synthesis of 30 articles showed a median operative time of 18 hours (range, 9–28) and fluid replacement with 13 L (5–18) of crystalloids, 13 units (0–66) of packed red blood cells, 10 units (0–63) of fresh frozen plasma, and 1 unit (0–9) of platelets.

Conclusions:

Anesthetic considerations in FT span the continuum of care. Future efforts should guide standard reporting to establish evidence-based strategies that promote quality improvement and patient safety.
Perceptions of Quality of Life among Face Transplant Recipients: A Qualitative Content Analysis
Authors: Greenfield Jason A. , Kimberly Laura L. , Berman Zoe P. , Ramly Elie P. , Alfonso Allyson R. , Lee Olive , Diep Gustave K. , Rodriguez Eduardo D.
Published: January 2021

Background:

The aim of facial transplantation (FT) was to enhance quality of life (QoL) for individuals living with severe facial disfigurement. Yet QoL has proved challenging to assess, as the field lacks a unified approach for incorporating FT recipients’ perspectives into meaningful QoL measures. In this study, we review FT recipients’ self-reported QoL through a qualitative analysis of publicly available posttransplant interviews to identify the aspects of QoL they report as meaningful.

Methods:

A conventional qualitative content analysis was conducted through a comprehensive review of publicly available interviews with FT recipients. Data sources included English language audio, video, and online print interviews from 2008 to 2019. Recipient interview data were obtained for both partial and full FT recipients located in North America through Google and YouTube searches. Audio and video interviews were transcribed, and an inductive content analysis was used to develop and apply a coding scheme to all interview transcripts. Codes were subsequently grouped into categories and interpreted into themes.

Results:

In total, 81 interviews representing 12 North American, English-speaking face transplant recipients were collected from internet sources, of which 74 interviews remained after exclusion criteria were applied. Three themes emerged representing the dimensions of QoL emphasized by FT recipients: (1) reconstitution and re-embodiment of physical/corporeal selfhood, (2) integrity of cognitive/emotional selfhood, and (3) social selfhood and the importance of social integration.

Conclusions:

This study provides an insight into North American FT recipients’ experiences, values, and goals and illuminates critical aspects of QoL that are meaningful to this unique patient population, which may not be fully captured by currently available assessment tools. The themes developed in this study link facets of QoL to the overall significance of embodied selfhood among FT recipients and will help inform the future development of FT-specific patient-reported QoL outcome measures.
Physical, Biochemical, and Biologic Properties of Fat Graft Processed via Different Methods
Authors: Fang Carrie , Patel Paarun , Li Hui , Huang Li Ting , Wan Hua , Collins Sean , Connell Talia L. , Xu Hui
Published: January 2021

Background:

Clinical use of autologous fat for correction of soft-tissue defects in cosmetic and reconstructive procedures has grown in popularity. Graft processing is implicated as one of the variable factors affecting quality, viability, and subsequent graft survival. This study analyzed the in vitro physical and biologic characteristics of lipoaspirate processed using different techniques.

Methods:

Fresh lipoaspirates from patients with informed consent were processed by 4 methods: decantation, centrifugation, the REVOLVE System, and PureGraft. Processed fat grafts were analyzed for yield, composition, tissue particle size and morphology, and viability and function of adipocytes and stem cells. Fat tissue harvested from waste containers of REVOLVE and PureGraft and trapped on REVOLVE paddles was also evaluated.

Results:

Grafts produced by the filtration systems contained the highest percentage of fat tissue, whereas those from decantation contained the lowest percentage, although they have the highest volume yield. In addition, grafts from REVOLVE and PureGraft showed more large-sized particles (>1000 μm) than those from decantation or centrifugation. REVOLVE also preserved significantly higher populations of viable and functional adipocytes and stromal vascular fraction cells when compared with other processing methods. Tissue particles in waste containers of REVOLVE and PureGraft were mostly (>85%) <300 μm and demonstrated a minimal number of viable adipocytes and stem cells. Fat tissues trapped on REVOLVE paddles contained a higher percentage of noninjectable and fibrous collagen bundles.

Conclusion:

Different processing methods result in fat grafts with varying physical and biologic properties, which may contribute to fat graft viability and retention in vivo.
Wide Awake Local Anesthesia No Tourniquet Forearm Triple Tendon Transfer in Radial Nerve Palsy
Authors: Abdullah Shalimar , Ahmad Amir Adham , Lalonde Donald
Published: January 2021

Tendon transfer for radial nerve palsy is a common procedure done under general anesthesia. We describe a surgical technique of triple tendon transfer with wide awake local anesthesia no tourniquet (WALANT). We transfer flexor carpi radialis to extensor digitorum communis, palmaris longus to extensor pollicis longus, and pronator teres to extensor carpi radialis brevis. This is commonly known as the Brand transfer. Our anesthetic or WALANT solution consists of up to 200 mL of 1:400,000 epinephrine, 0.25% lidocaine buffered with sodium bicarbonate. This technique overcomes the problem of judging the appropriate amount of transfer tension by observing awake patients actively extend their fingers, thumb, and wrist during the surgery and making adjustments before we close the wound. In our experience, there is no need of brain retraining because a patient is able to immediately use the flexor muscles to perform extension movements. WALANT is a safe and viable option for radial nerve tendon transfers.
Median Nerve Neuropathy following Radial Forearm Free Flap Phalloplasty: A Case Report
Authors: Jolly Divya , Chrisos Haley A. , Kaufman-Goldberg Tal , Ganor Oren , Taghinia Amir H.
Published: January 2021

As the transgender population increases, gender-affirming surgeries are being performed at unprecedented rates. Despite this increase, complications and long-term outcomes of gender-affirming interventions are largely understudied. We present a transgender patient who underwent radial forearm free flap (RFFF) phalloplasty as part of gender affirmation. Immediately following surgery, the patient reported paresthesia in the donor arm in the median nerve distribution followed by a neuropathic pain after 1 week. The patient complained of shooting and burning pain and reported a loss of sensation and function at the donor site. Electromyography and magnetic resonance imaging results indicated median nerve damage several inches above the donor site. The symptoms persisted for several months before spontaneously resolving. The spontaneous resolution and location of injury suggest that nerve damage occurred as a result of pneumatic tourniquet application despite adherence to all clinical guidelines for a safe tourniquet application of the same. This is the first reported case of neuropathic pain following RFFF phalloplasty occurring at the donor site. Given the large donor area and the long time of tourniquet application, surgeons offering RFFF phalloplasty must be aware of and actively counsel patients seeking this procedure about the potential for nerve-related damages before surgery.
Intraoperative 3-dimensional Projection of Blood Vessels on Body Surface Using an Augmented Reality System
Authors: Katayama Misato , Ueda Koichi , Mitsuno Daisuke , Kino Hiromi
Published: January 2021

Summary: Preoperative understanding of the running pattern of blood vessels is an important factor to approach surgical fields safely. In 2 cases where the vascular abnormalities were estimated, we projected the blood vessels onto the surgical field using an augmented reality device HoloLens. A splint was made to allow the patient to be fixed while undergoing computed tomographic angiography. Three-dimensional (3D) data on the blood vessels, skin surfaces, bones, and the 3 chosen points for alignment were segmented and then projected onto the body surfaces as holograms using the HoloLens. Two types of projection for holograms were used: projection type 1—where the body contours were projected as a line, and projection type 2—where the body surface was projected as meshed skin type. By projecting projection type 2 rather than projection type 1, we gained a better understanding of the 3D anatomic findings and deformation characteristics, including the anatomic blood vessel variation and positional relationships between the organs and body surfaces. To some extent, we could make sure that the depth perception can be obtained by recognizing the bone, vessels, or tumor inside the meshed skin surface. Our new method allows the 3D visualization of blood vessels from the body surface, and helps understand the 3D anatomic variation of the blood vessels to be applied as long as the blood vessels can be visualized.