bluuebunny/crossref_metadata_2025 huggingface dataset:
CytoSorb Rescue for COVID-19 Patients With Vasoplegic Shock and Multiple Organ Failure: A Prospective, Open-Label, Randomized Controlled Pilot Study*
Authors: Stockmann Helena , Thelen Philipp , Stroben Fabian , Pigorsch Mareen , Keller Theresa , Krannich Alexander , Spies Claudia , Treskatsch Sascha , Ocken Michele , Kunz Julius Valentin , Krüger Anne , Khadzhynov Dmytro , Kron Susanne , Budde Klemens , Eckardt Kai-Uwe , Enghard Philipp , Lehner Lukas Johannes
Published: February 2022

OBJECTIVES:

To investigate the effect of extracorporeal cytokine reduction by CytoSorb (CytoSorbents, Monmouth Junction, NJ) on COVID-19–associated vasoplegic shock.

DESIGN:

Prospective, randomized controlled pilot study.

SETTING:

Eight ICUs at three sites of the tertiary-care university hospital Charité—Universitätsmedizin Berlin.

PATIENTS:

COVID-19 patients with vasoplegic shock requiring norepinephrine greater than 0.2 µg/kg/min, C-reactive protein greater than 100 mg/L, and indication for hemodialysis.

INTERVENTIONS:

Randomization of 1:1 to receive CytoSorb for 3–7 days or standard therapy. To account for inadvertent removal of antibiotics, patients in the treatment group received an additional dose at each adsorber change.

MEASUREMENTS AND MAIN RESULTS:

The primary endpoint was time until resolution of vasoplegic shock, estimated by Cox-regression. Secondary endpoints included mortality, interleukin-6 concentrations, and catecholamine requirements. The study was registered in the German Registry of Clinical Trials (DRKS00021447). From November 2020 to March 2021, 50 patients were enrolled. Twenty-three patients were randomized to receive CytoSorb and 26 patients to receive standard of care. One patient randomized to cytokine adsorption was excluded due to withdrawal of informed consent. Resolution of vasoplegic shock was observed in 13 of 23 patients (56.5%) in the CytoSorb and 12 of 26 patients (46.2%) in the control group after a median of 5 days (interquartile range [IQR], 4–5 d) and 4 days (IQR, 3–5 d). The hazard ratio (HR) for the primary endpoint, adjusted for the predefined variables age, gender, extracorporeal membrane oxygenation-therapy, or time from shock onset to study inclusion was HR, 1.23 (95% CI, 0.54–2.79); p = 0.63. The mortality rate was 78% in the CytoSorb and 73% in the control group (unadjusted HR, 1.17 [95% CI, 0.61–2.23]; p = 0.64). The effects on inflammatory markers, catecholamine requirements, and the type and rates of adverse events were similar between the groups.

CONCLUSIONS:

In severely ill COVID-19 patients, CytoSorb did not improve resolution of vasoplegic shock or predefined secondary endpoints.
Knee Reconstruction following Sarcoma Resection Utilizing Pedicled Anterolateral Thigh Propeller Flap: A Case Series
Authors: Benedict Katherine C. , Wegener Brown Kathryn , Barr Jennifer S. , McIntyre Benjamin C.
Published: February 2022

Coverage of knee wounds with exposure or violation of the joint capsule has long been a challenge to plastic surgeons. Wide resection and radiation treatment for soft-tissue sarcomas further this difficulty due to resultant diminished vascularity and soft tissue fibrosis. Traditional muscle flaps such as the gastrocnemius may be within the radiated field, limiting their arc of rotation to the knee. We present a series of exposed knee joint reconstructions using pedicled propeller flaps after sarcoma resection. Three patients diagnosed with soft tissue sarcomas underwent neoadjuvant radiation followed by wide local resection by orthopedic oncology. All patients had underlying knee joint exposure and underwent successful soft tissue reconstruction utilizing pedicled anterolateral thigh (ALT) propeller flaps. The ALT flap is widely used in plastic surgery for reconstruction of soft tissue defects due to its reliable vascularity, long pedicle, versatility, low donor-site morbidity, and large size. As a propeller flap, we demonstrate this is a viable alternative for reconstruction when the vascular plexus around the knee is unreliable after neoadjuvant radiation. Extending the ALT propeller flap with a large proximal skin paddle provides a nonmicrosurgical alternative to traditional muscle flaps at this location. The ALT propeller flap is an excellent option for reconstruction of large defects of the knee, especially in the setting of a radiated wound bed with unpredictable vascularity. In our case series, all three patients underwent successful reconstruction of exposed knee joints after resection of soft tissue sarcoma utilizing ALT propeller flaps.
A Structured Review of Commercially Available Cardiac Rehabilitation mHealth Applications Using the Mobile Application Rating Scale
Authors: Meddar John M. , Ponnapalli Aditya , Azhar Rimsha , Turchioe Meghan Reading , Duran Andrea Tiana , Creber Ruth Masterson
Published: February 2022

Purpose:

This study systematically evaluated the quality and functionalities of patient-facing, commercially available mobile health (mHealth) apps for cardiac rehabilitation (CR).

Methods:

We performed our search in two of the most widely used commercial mobile app stores: Apple iTunes Appstore and Google Play Store (Android apps). Six search terms were used to query relevant CR apps: “cardiac rehabilitation,” “heart disease and remote therapy,” “heart failure exercise,” “heart therapy and cardiac recovery,” “cardiac recovery,” and “heart therapy.” App quality was evaluated using the Mobile Application Rating Scale (MARS). App functionality was evaluated using the IQVIA functionality scale, and app content was evaluated against the American Heart Association guidelines for CR. Apps meeting our inclusion criteria were downloaded and evaluated by two to three reviewers, and interclass correlations between reviewers were calculated.

Results:

We reviewed 3121 apps and nine apps met our inclusion criteria. On average, the apps scored a 3.0 on the MARS (5-point Likert scale) for overall quality. The two top-ranking mHealth apps for CR for all three quality, functionality, and consistency with evidence-based guidelines were My Cardiac Coach and Love My Heart for Women, both of which scored ≥4.0 for behavior change.

Conclusion:

Overall, the quality and functionality of free apps for mobile CR was high, with two apps performing the best across all three quality categories. High-quality CR apps are available that can expand access to CR for patients with cardiovascular disease.
Percentage of Age-Predicted Cardiorespiratory Fitness and Risk of Incident Hypertension
Authors: Laukkanen Jari A. , Kunutsor Setor K.
Published: February 2022

Purpose:

There are inverse and independent associations between cardiorespiratory fitness (CRF) and several adverse cardiometabolic outcomes including hypertension (HTN). The prospective relationship between percentage of age-predicted CRF and risk of HTN has not been previously investigated. We aimed to assess the association of percentage of age-predicted CRF with incident HTN in a long-term prospective cohort study.

Methods:

Cardiorespiratory fitness, as measured by peak oxygen uptake, was assessed using the gold standard respiratory gas exchange analyzer in 1602 men who underwent cardiopulmonary exercise testing. The age-predicted CRF estimated from a regression equation for age was converted to percentage of age-predicted CRF ([achieved CRF/age-predicted CRF] × 100). The HR with 95% CI were estimated for HTN.

Results:

During a median follow-up of 26.8 yr, 308 HTN cases were recorded. There was a linear relationship between age-predicted CRF and incident HTN (P value for nonlinearity = .68). A 1-SD increase in percentage of age-predicted CRF was associated with a decreased risk of HTN in analysis adjusted for established risk factors (HR = 0.79: 95% CI, 0.69-0.90), which remained consistent on further adjustment for several other potential confounders including alcohol consumption, physical activity, socioeconomic status, and inflammation (HR = 0.83: 95% CI, 0.72-0.95). The corresponding adjusted HRs were 0.55 (95% CI, 0.38-0.80) and 0.63 (95% CI, 0.43-0.91), respectively, when comparing extreme quartiles of percentage of age-predicted CRF levels.

Conclusions:

Percentage of age-predicted CRF is linearly, inversely, and independently associated with risk of incident HTN, and it is comparable to absolute CRF as a risk indicator for HTN in a general population of middle-aged men.
Validation of the PROMIS-29v2 Health-Related Quality-of-Life Questionnaire in Patients With Coronary Heart Disease Participating in Remote Cardiac Rehabilitation
Authors: Candelaria Dion , Ladak Laila Akbar , Randall Sue , Kirkness Ann , Roach Kellie , Fethney Judith , Gallagher Robyn
Published: February 2022

Purpose:

The aim of this study was to validate the 29-item Patient-Reported Outcomes Measurement Information System version 2.0 (PROMIS-29v2) health-related quality-of-life (HRQL) questionnaire for use in patients with coronary heart disease (CHD) participating in remotely delivered cardiac rehabilitation (CR).

Methods:

Patients commencing remote CR across four sites in New South Wales, Australia, answered the PROMIS-29v2 and 12-item Short Form Health Survey version 2.0 (SF-12v2) questionnaires at CR entry and completion (6 wk). The data were analyzed for validity, reliability, and responsiveness to change.

Results:

Patients (N = 89) had a mean age of 66.9 ± 9.3 yr; 83% were male and were referred to CR for elective percutaneous coronary intervention (PCI) (42%), myocardial infarction (36%), and coronary artery bypass grafting (22%). Internal consistency reliability was adequate, with the Cronbach α ranging from 0.78-0.98. Convergent validity between the PROMIS-29v2 and SF-12v2 summary scores showed significantly strong correlations for physical (r = 0.62) and moderate for mental (r = 0.36) health. Discriminant validity was confirmed for sex (women reported lower physical and mental health) and referral diagnosis (patients who had elective PCI reported better physical health). Effect size (ES) comparisons confirmed responsiveness to change from CR entry to completion in physical health (ES = 0.51) and demonstrated evidence of more responsiveness than SF-12v2 for mental health (ES = 0.70).

Conclusion:

The PROMIS-29v2 is reliable, valid, and responsive to changes in patients with CHD attending remotely delivered CR and allows for baseline HRQL assessment, between-diagnosis comparisons, and evaluation of changes over time.
How psychological safety and feeling heard relate to burnout and adaptation amid uncertainty
Authors: Kerrissey Michaela J. , Hayirli Tuna C. , Bhanja Aditi , Stark Nicholas , Hardy James , Peabody Christopher R.
Published: February 2022

Background

Psychological safety—the belief that it is safe to speak up—is vital amid uncertainty, but its relationship to feeling heard is not well understood.

Purpose

The aims of this study were (a) to measure feeling heard and (b) to assess how psychological safety and feeling heard relate to one another as well as to burnout, worsening burnout, and adaptation during uncertainty.

Methodology

We conducted a cross-sectional survey of emergency department staff and clinicians (response rate = 52%; analytic N = 241) in July 2020. The survey measured psychological safety, feeling heard, overall burnout, worsening burnout, and perceived process adaptation during the COVID-19 crisis. We assessed descriptive statistics and construct measurement properties, and we assessed relationships among the variables using generalized structural equation modeling.

Results

Psychological safety and feeling heard demonstrated acceptable measurement properties and were correlated at r = .54. Levels of feeling heard were lower on average than psychological safety. Psychological safety and feeling heard were both statistically significantly associated with lower burnout and greater process adaptation. Only psychological safety exhibited a statistically significant relationship with less worsening burnout during crisis. We found evidence that feeling heard mediates psychological safety’s relationship to burnout and process adaptation.

Conclusion

Psychological safety is important but not sufficient for feeling heard. Feeling heard may help mitigate burnout and enable adaptation during uncertainty.

Practice Implications

For health care leaders, expanding beyond psychological safety to also establish a feeling of being heard may further reduce burnout and improve care processes.
Improved Hematologic Outcomes in HIV1-Exposed Infants Receiving Nevirapine Compared With Zidovudine for Postnatal Prophylaxis in a High Resource Setting
Authors: Dollfus Catherine , Le Chenadec Jérome , Mandelbrot Laurent , Tubiana Roland , Faye Albert , Brossard Maud , Frange Pierre , Blanche Stéphane , Warszawski Josiane ,   for the ANRS CO1/CO11 study group
Published: February 2022

In the ANRS French Perinatal Cohort, we compared outcomes in 830 HIV1-exposed infants who received either nevirapine (NVP) or zidovudine postnatal prophylaxis. At 1 month, anemia grade ≥2 was less frequent on NVP than zidovudine (2.9% vs. 8.0%; P = 0.01), favoring the use of NVP as a first choice prophylaxis in infants at low risk of HIV acquisition.
Outcomes of cataract surgery complicated by posterior capsule rupture in the European Registry of Quality Outcomes for Cataract and Refractive Surgery
Authors: Segers Maartje H.M. , Behndig Anders , van den Biggelaar Frank J.H.M. , Brocato Lucia , Henry Ype P. , Nuijts Rudy M.M.A. , Rosen Paul , Tassignon Marie-José , Young David , Stenevi Ulf , Lundström Mats , Dickman Mor M.
Published: February 2022

Purpose:

To analyze the outcomes of cataract surgery complicated by posterior capsule rupture (PCR).

Setting:

European clinics affiliated to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO).

Design:

Retrospective cross-sectional register-based study.

Methods:

Data were retrieved from the EUREQUO between January 1, 2008, and December 31, 2018. The database consists of data on demographics, intraoperative complications such as PCR, type of intraocular lens (IOL) material, postoperative refraction, corrected distance visual acuity (CDVA), and postoperative complications.

Results:

1 371 743 cataract extractions with complete postoperative data were reported in the EUREQUO. In 12 196 cases (0.9%), PCR was reported. After PCR, patients were more likely to receive a poly(methyl methacrylate) IOL (5.2% vs 0.4%, respectively) or no IOL (1.1% vs 0.02%, respectively) compared with patients without PCR. The refractive and visual outcomes in patients with PCR were significantly worse than in those without PCR (mean CDVA 0.13 ± 0.21 vs 0.05 ± 0.16 logMAR, P < .001; mean absolute biometry prediction error 1.15 ± 1.60 diopters [D] vs 0.41 ± 0.45 D, P < .001). A multivariate linear regression analysis, adjusting for potential explanatory variables, confirmed a statistically significant difference (0.04 logMAR, P < .001, and .70 D, P < .001, respectively). Patients with PCR had significantly more postoperative complications (corneal edema 0.88% vs 0.17%, adjusted odds ratio [aOR], 2.80 95% CI, 2.27-3.45, endophthalmitis 0.11% vs 0.02%, aOR, 4.40 95% CI, 2.48-7.81, uncontrolled intraocular pressure 0.55% vs 0.03%, aOR, 14.58 95% CI, 11.16-19.06, P < .001).

Conclusions:

Patients with PCR had significantly worse visual and refractive outcomes and more postoperative complications than patients without PCR. However, most of these patients achieved better postoperative visual acuity than that preoperatively.
Toric intraocular lenses for astigmatism correction after keratoplasty in phakic and pseudophakic eyes
Authors: Wan Kelvin H. , Chang John S.M. , Jhanji Vishal
Published: February 2022

Residual astigmatism and anisometropia significantly affect patients' vision and quality of life even in clear grafts after corneal transplant. This study reviewed and summarized the role of toric intraocular lenses (IOLs) in phakic and pseudophakic eyes after penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty in correcting residual astigmatism. 342 eyes from 20 studies with iris-clipped toric IOL, ciliary sulcus toric implantable collamer lens, piggyback sulcus toric IOL, or posterior chamber toric IOL implantations for phakic, pseudophakic, or eyes undergoing cataract surgery after keratoplasty were included. Visual, refractive, and predictability outcomes were encouraging. Secondary realignment rate and complications were low. Endothelial cell loss secondary to phakic toric IOLs might be a concern over the long-term, particularly in iris-clipped IOLs in PKP eyes. Toric IOLs represent a viable option in the treatment of residual astigmatism in postkeratoplasty eyes, resulting in improved visual acuity and reduced anisometropia.
Costs of shoulder disorders in Denmark: a nationwide cost-of-illness study investigating 617,334 patients and matched controls
Authors: Sørensen Lotte , van Tulder Maurits , Johannsen Hans Viggo , Ovesen Janne , Enemark Ulrika , Blæhr Emely Ek , Oestergaard Lisa Gregersen
Published: February 2022

Shoulder disorders are very common musculoskeletal conditions. Few studies have focused on the costs associated with shoulder disorders, and the economic burden has never been established in a nationwide cost-of-illness study. We aimed to evaluate the healthcare costs and costs of productivity loss (sick leave) and to evaluate if costs were higher for specific subgroups. Using national Danish registers, we identified individuals with shoulder disorders (subacromial pain, stiffness, fracture, or dislocation) diagnosed between 2005 and 2017 and controls matched on age and gender without shoulder disorders. Health care usage, sick leave, and related costs were estimated. During the 13-year inclusion period, 617,334 unique individuals were identified and the incidence rate was 1215 per 100,000 person-years in 2017. The expected additional societal costs were €1.21 billion annually. The mean additional total costs for the 6-year period were €11,334 (11,014-11,654) for individuals aged ≥65 years and €25,771 (25,531-26,012) for individuals aged <65 years. For individuals in the working age, the costs of sick leave accounted for approximately 70% of the total costs. Individuals aged ≥65 years had healthcare costs that were twice as high as individuals aged <65 years. Additionally, the 20% of cases accruing the highest costs accounted for 66% of the total costs. In conclusion, incidence rates of shoulder disorders were high and costs of sick leave accounted for a large proportion of total costs associated with illness in working age people. Furthermore, a minority of patients accounted for a substantial share of the total costs.
Anoctamin 1/TMEM16A in pruritoceptors is essential for Mas-related G protein receptor–dependent itch
Authors: Kim Hyesu , Kim Hyungsup , Cho Hawon , Lee Byeongjun , Lu Huan-Jun , Kim Kyungmin , Chung Sooyoung , Shim Won-Sik , Shin Young Kee , Dong Xinzhong , Wood John N. , Oh Uhtaek
Published: February 2022

Itch is an unpleasant sensation that evokes a desire to scratch. Pathologic conditions such as allergy or atopic dermatitis produce severe itching sensation. Mas-related G protein receptors (Mrgprs) are receptors for many endogenous pruritogens. However, signaling pathways downstream to these receptors in dorsal root ganglion (DRG) neurons are not yet understood. We found that anoctamin 1 (ANO1), a Ca2+-activated chloride channel, is a transduction channel mediating Mrgpr-dependent itch signals. Genetic ablation of Ano1 in DRG neurons displayed a significant reduction in scratching behaviors in response to acute and chronic Mrgpr-dependent itch models and the epidermal hyperplasia induced by dry skin. In vivo Ca2+ imaging and electrophysiological recording revealed that chloroquine and other agonists of Mrgprs excited DRG neurons via ANO1. More importantly, the overexpression of Ano1 in DRG neurons of Ano1-deficient mice rescued the impaired itching observed in Ano1-deficient mice. These results demonstrate that ANO1 mediates the Mrgpr-dependent itch signaling in pruriceptors and provides clues to treating pathologic itch syndromes.
Right Ventricular Dysfunction is Associated with Increased Mortality in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019
Authors: Maharaj Valmiki , Alexy Tamas , Agdamag Arianne C. , Kalra Rajat , Nzemenoh Bellony N. , Charpentier Victoria , Bartos Jason A. , Brunsvold Melissa E. , Yannopoulos Demetris
Published: February 2022

Respiratory failure caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is associated with mortality. Patients unresponsive to conventional therapy may benefit from temporary venovenous extracorporeal membrane oxygenation (VV-ECMO). We investigated clinical and echocardiographic characteristics, particularly, right ventricular dysfunction, with survival in patients with respiratory failure caused by SARS-CoV-2. We performed a single-center retrospective cohort study of patients requiring VV-ECMO for respiratory failure from COVID-19 infection between January 2020 and December 2020. Demographics, comorbidities, laboratory parameters, and echocardiographic features of left and right ventricular (LV/RV) function were compared between patients who survived and those who could not be weaned from VV-ECMO. In addition, we evaluated outcomes in a separate population managed with venoarterial extracorporeal membrane oxygenation (VA-ECMO). In total, 10/17 patients failed to wean from VV-ECMO and died in the hospital on average 41.5 ± 10.9 days post admission. Seven were decannulated (41%) and survived to hospital discharge. There were no significant differences in demographics, comorbidities, and laboratory parameters between groups. Moderate to severe RV dysfunction was significantly more in those who died (8/10, 80%) compared to survivors (0/7, 0%) (p = 0.002). Patients supported with VA-ECMO had superior survival with 5/9 patients (56%) decannulated and discharged. Moderate to severe RV dysfunction is associated with increased mortality in patients with respiratory failure requiring VV-ECMO for COVID-19.
The Impact of Preceptor Education, Experience, and Preparation on the Role
Authors: Warren Joan Insalaco , Harper Mary G. , MacDonald Ryan , Ulrich Beth , Whiteside Dawn
Published: February 2022

Findings from the 2020 Association for Nursing Professional Development National Preceptor Practice Analysis study validated the Ulrich precepting model. This secondary data analysis examines the influence of preceptor training, experience, and education on perceptions of the importance of the preceptor roles, domains (knowledge and practice), and required competencies. Preceptor training compared with education and experience best predict nurses’ perceived importance of precepting and its seven roles.
Pandemic Impact on the Preceptor/New Nurse Dyad
Authors: Bohnarczyk Nancy , Cadmus Edna
Published: February 2022

This qualitative study examined the impact of the pandemic on the preceptor role in out-of-hospital settings, including the preceptor/new nurse working relationship prepandemic and the challenges encountered during the pandemic. On the basis of the study findings, suggestions for adapting preceptor education to address this working relationship in the “new normal” including more preparation for “letting go” of the preceptor/new nurse relationship and the increased use of technology for just-in-time learning for the preceptor are highlighted.
Botulinum Toxin Type A Immunogenicity across Multiple Indications: An Overview Systematic Review
Authors: Rahman Eqram , Banerjee Pooja S. , Asghar Andleeb , Gupta Niraj Kumar , Mosahebi Afsin
Published: February 2022

Background:

Botulinum toxin type A has been used to treat a wide array of neurologic, medical, and aesthetic indications. Several factors contribute to the formation of neutralizing antibodies, such as shorter intervals of treatment, higher dosage, amounts of antigenic proteins, serotypes, and storage of formulations.

Method:

This overview followed the Cochrane guideline for overview reviews. The AMSTAR-2 (revised version of A Measurement Tool to Assess Systematic Reviews) tool was used for the critical appraisal of the selected systematic reviews.

Results:

Five systematic reviews consisting of 203 studies (17,815 patients) were included, and their AMSTAR-2 scores were low to critically poor. There was high heterogeneity between the studies. Across the clinical indications, neutralizing antibody prevalence was significantly higher in dystonia, spasticity, and urologic conditions, and nil to insignificant in hyperhidrosis and aesthetic indications. The overall rate for the neutralizing antibody formation across three different formulations, abobotulinumtoxinA, incobotulinumtoxinA, and onabotulinumtoxinA, was 1 to 2.1 percent, with no significant difference between them.

Results:

Although there is debate on the prevalence rate across the different botulinum toxin type A formulations in individual systematic reviews, the overall frequency of the development of neutralizing antibodies and the immunogenicity of abobotulinumtoxinA, incobotulinumtoxinA, and onabotulinumtoxinA remain low to insignificant.

Conclusions:

Properly designed comparative trials are required to explore the difference in the prevalence of neutralizing antibodies across the commercially available botulinum toxin type A products. Such studies should also examine the relevance of neutralizing antibody titer to clinical responsiveness and nonresponse.
Size and Perception of Facial Features with Selfie Photographs, and Their Implication in Rhinoplasty and Facial Plastic Surgery
Authors: Pressler Mark P. , Kislevitz Mikaela L. , Davis Justin J. , Amirlak Bardia
Published: February 2022

Background:

Patients increasingly use photographs taken with a front-facing smartphone camera—“selfies”—to discuss their goals with a plastic surgeon. The purpose of this study was to quantify changes in size and perception of facial features when taking a selfie compared to the gold standard of clinical photography.

Methods:

Thirty volunteers took three series of photographs. A 12-inch and 18-inch series were taken with a front-facing smartphone camera, and the 5-foot clinical photography series was taken with a digital single-lens reflex camera. Afterward, subjects filled out the FACE-Q inventory, once when viewing their 12-inch selfies and once when viewing their clinical photographs. Measurements were taken of the nose, lip, chin, and facial width.

Results:

Nasal length was, on average, 6.4 percent longer in 12-inch selfies compared to clinical photography, and 4.3 percent longer in 18-inch selfies compared to clinical photography. The alar base width did not change significantly in either set of selfies compared to clinical photography. The alar base to facial width ratio represents the size of the nose in relation to the face. This ratio decreased 10.8 percent when comparing 12-inch selfies to clinical photography (p < 0.0001) and decreased 7.8 percent when comparing 18-inch selfies to clinical photography (p < 0.0001).

Conclusions:

This study quantifies the change in facial feature size/perception seen in previous camera-to-subject distance studies. With the increasing popularity of front-facing smartphone photographs, these data allow for a more precise conversation between the surgeon and the patient. In addition, the authors’ findings provide data for manufacturers to improve the societal impact of smartphone cameras.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, III.
Controlling Nasal Tip Projection and Rotation with New Composite Septocolumellar Flap Approaches
Authors: Öztürk Güncel
Published: February 2022

Background:

Rhinoplasty is one of the most common and challenging surgeries in the field of aesthetic surgery. For obtaining an aesthetically pleasing nose, it is extremely important to control nasal tip projection and rotation as much as possible. Since the last decade, septocolumellar suture techniques have been most frequently used for modifying and controlling nasal tip rotation and projection and for obtaining a better columellar–labial angle during rhinoplasty. In the present study, the author has described 10 different approaches using composite septocolumellar flaps with the aim of obtaining better outcomes, such as the control of nasal tip projection and rotation, in addition to obtaining better tip refinement.

Methods:

The records of 68 patients were included in the present study based on the inclusion and exclusion criteria. Ten composite septocolumellar flap approaches were followed by the same surgeon.

Results:

The initial median Rhinoplasty Outcome Evaluation score was 60.5 points; the score increased to 92.5 points at 12 months after the surgery (p < 0.001). Satisfaction was excellent in 87.5 percent of the patients. The patients were also evaluated in terms of functionality. Their patency scores increased from 6.0 to 9.0 (out of 10) after a 12-month follow-up (p = 0.001).

Conclusions:

The technique has the following advantages: control of nasal tip projection and rotation, fixation of mild deviations, and shortening of the nose with better aesthetic and functional outcomes. Furthermore, because the septocolumellar region is completely protected and remains solid, a dynamic nasal tip is obtained. Surgeons will be able to choose the most suitable approach when a composite septocolumellar flap is needed.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
The Five-Step Rhinoplasty Dead Space Closure Technique
Authors: Savetsky Ira L. , Avashia Yash J. , Rohrich Rod J.
Published: February 2022

The creation of dead space in rhinoplasty creates a welcoming environment for erratic soft -tissue contraction. If rhinoplasty surgeons can control and reliably predict skin contraction and wound healing, rhinoplasty results will undoubtedly improve. Obliteration of dead space is a key component in rhinoplasty as it minimizes soft-tissue contraction, resulting in a more predictable outcome. In this article, the authors present a systematic five-step dead space closure surgical plan.
Dynamic Liver Magnetic Resonance Imaging During Free Breathing
Authors: Endler Christoph H.-J. , Kukuk Guido M. , Peeters Johannes M. , Beck Gabriele M. , Isaak Alexander , Faron Anton , Mesropyan Narine , Luetkens Julian A. , Attenberger Ulrike I. , Kupczyk Patrick A.
Published: February 2022

Objective

Robust dynamic contrast-enhanced T1-weighted images are crucial for accurate detection and categorization of focal liver lesions in liver/abdominal magnetic resonance imaging (MRI). As optimal dynamic imaging usually requires multiple breath-holds, its inherent susceptibility to motion artifacts frequently results in degraded image quality in incompliant patients. Because free-breathing imaging may overcome this drawback, the intention of this study was to evaluate a dynamic MRI sequence acquired during free breathing using the variable density, elliptical centric golden angle radial stack-of-stars radial sampling scheme, which so far has not been implemented in 4-dimensional applications.

Materials and Methods

In a prospective pilot study, 27 patients received a routine abdominal MRI protocol including the prototype free-breathing sequence (4DFreeBreathing) for dynamic imaging. This enables more convenient and faster reconstruction through variable density, elliptical centric golden angle radial stack-of-stars without the use of additional reconstruction hardware, and even higher motion robustness through soft-gating. A standard breath-hold sequence performed subsequently served as reference standard. Of the continuous dynamic data sets, each dynamic phase was analyzed regarding image quality, motion artifacts and vessel conspicuity using 5-point Likert scales. Furthermore, correct timing of the late arterial phase was compared with the preexaminations.

Results

4DFreeBreathing delivered motion-free dynamic images with high temporal resolution in each subject. Overall image quality scores were rated good or excellent for 4DFreeBreathing and the gold standard without significant differences (P = 0.34). There were significantly less motion artifacts in the 4DFreeBreathing sequence (P < 0.0001), whereas vessel conspicuity in each dynamic phase was comparable for both groups (P = 0.45, P > 0.99, P = 0.22, respectively). Correct timing of the late arterial phase could be achieved in 27 of 27 (100%) examinations using 4DFreeBreathing versus 35 of 53 (66%) preexaminations using gold standard (P < 0.001).

Conclusion

The benefit of convenient and fast image reconstruction combined with the superiority in motion robustness and timing compared with standard breath hold sequences renders 4DFreeBreathing an attractive alternative to existing free-breathing techniques in dynamic liver MRI.
Obstetric Simulation Training and Teamwork
Authors: Greer Joy A. , Lutgendorf Monica A. , Ennen Christopher S. , Van Petten Lauren , Modzik Adrian , Salas Dominick , Fish Jessica , Middlebrooks Reginald , Spalding Carmen N. , Delorey Donald R.
Published: February 2022

Introduction

The Obstetric Simulation Training and Teamwork (OB-STaT) curriculum was an in situ interprofessional program to provide standardized postpartum hemorrhage (PPH) simulation training throughout a health system to decrease PPH morbidity. In this study portion, investigators hypothesized that OB-STaT would increase: (a) team member knowledge in diagnosis and management of PPH, (b) teamwork, (c) adherence to established PPH protocols, and (d) patient satisfaction.

Methods

The OB-STaT was implemented at 8 US Navy hospitals between February 2018 and November 2019. Participant PPH treatment and maternal/neonatal resuscitation pretraining/posttraining knowledge was assessed via an 11-item test, whereas teamwork and standardized patient assessment were rated using validated Likert-type scales: the 15-item Clinical Teamwork Scale and 3-item Patient Perception Score, with item ranges of 0 to 10 and 0 to 5, respectively. Local PPH protocol adherence was assessed using role-specific checklists, with a potential maximum of 14 points (anesthesia/nursing) or 22 points (obstetrics).

Results

Fifty-four interprofessional teams participated. Obstetricians (trainees and attendings) demonstrated significantly improved knowledge test scores (8.33 ± 1.6 vs. 8.66 ± 1.5, P < 0.01). Between the 2 scenarios, overall mean Clinical Teamwork Scale scores improved significantly for all interprofessional teams (5.82 ± 2.0 vs. 7.25 ± 1.9, P < 0.01). Anesthesia, nursing, and obstetric subteams demonstrated significant increases in protocol adherence as measured by critical action scores (12.28 ± 1.7 vs. 13.56 ± 1.0, 12.43 ± 1.6 vs. 13.14 ± 1.3, and 18.14 ± 2.7 vs. 19.56 ± 2.1 respectively, all P < 0.02). Although overall standardized patient satisfaction did not significantly improve, scores for feeling well informed did (3.36 ± 1.0 vs. 3.76 ± 0.8, P < 0.01).

Conclusions

The OB-STaT curriculum modestly improved participants' teamwork, communication, and protocol adherence during simulated PPH scenarios; OB-STaT may decrease PPH morbidity.
Who Can Debriefing Assessment for Simulation in Healthcare? Different Perspectives on Teledebriefing Assessments
Authors: Olvera-Cortés Hugo E. , Hernández-Gutiérrez Laura S. , Scherer-Castanedo Emilio , Ramírez-Arias Jessica D. , Argueta Muñoz Fernando D. , Gutiérrez-Barreto Samuel E.
Published: February 2022

Introduction

Virtual debriefing is a cardinal element to achieve the effectiveness of telesimulation. There are different instruments to assess face-to-face debriefing to determine the degree of effectiveness of debriefing; Debriefing Assessment for Simulation in Healthcare (DASH) instrument is one of them. This study aims to describe and compare the evaluation of raters, instructors, and students during a virtual debriefing using the DASH.

Methods

A cross-sectional study was performed evaluating the virtual debriefing of 30 instructors after a heart failure telesimulation scenario. The evaluation was conducted by 30 instructors, 338 undergraduate students in the seventh semester, and 7 simulation raters. The 3 versions of the DASH instrument in Spanish were applied, respectively.

Results

Two comparisons were made, student versus instructor and rater versus instructor. Cronbach α was 0.97 for each version. The averages of the results on the DASH instrument were: 6.61 (3.34–7.0), 5.95 (4.65–7.0), and 4.84 (2.68–6.02) for student, rater, and instructor versions, respectively. The size effect between student and debriefer perspectives was 0.42. In contrast, the size effect between instructor and rater was 0.72. All differences were significant.

Conclusions

There are different rates between the persons who use the DASH. In this study, from the perspective of the instructor and rater, the difference was 1 point with a wide range, in contrast with the difference between instructor and student, which is relatively minor. It is necessary to consider the perspectives of experts in the subject to achieve a virtual debriefing of high quality and improve a debriefing by using the DASH.
Intravenous lidocaine for the management of traumatic rib fractures: A double-blind randomized controlled trial (INITIATE program of research)
Authors: Patton Petrease , Vogt Kelly , Priestap Fran , Parry Neil , Ball Ian M.
Published: February 2022

BACKGROUND

Traumatic rib fractures (TRFs) are common with a 10% incidence in all trauma patients and are associated with significant morbidity and mortality. Adequate analgesia is paramount for preventing pulmonary complications and death. Evidence exists for intravenous (IV) lidocaine's effectiveness and safety in postoperative thoracic and abdominal surgery, and we hypothesized that it would be effective in patients with TRFs.

METHODS

We conducted a single-center, double-blind, randomized control trial comparing IV lidocaine plus usual analgesics to placebo infusion plus usual analgesics for 72 hours to 96 hours. Participants were adult trauma patients diagnosed with two or more TRFs requiring hospital admission. The primary outcome was mean pain score at rest and with movement, as measured on the visual analog scale. Secondary outcomes included patient satisfaction and opioid requirements (standardized total morphine equivalents). The study was powered to detect a 20% reduction in pain scores, which has been deemed clinically meaningful.

RESULTS

Thirty-six patients were enrolled and randomized to IV lidocaine or placebo. Comparison of the mean visual analog scale pain scores demonstrated significant pain reduction with movement in the lidocaine group compared with placebo (7.05 ± 1.72 vs. 8.22 ± 1.28, p = 0.042). Although pain scores at rest were reduced in the lidocaine group, this difference was not statistically significant (3.37 ± 2.00 vs. 3.82 ± 1.97; p = 0.519). Patient satisfaction was higher in the lidocaine group than the placebo group, although this did not reach statistical significance (8.3; interquartile range [IQR], 7.0–9.6 vs. 6.3; IQR, 5.2–7.1; p = 0.105). Total morphine equivalents were lower in the lidocaine group than the placebo group, but this difference did not reach statistical significance (167; IQR, 60–340 vs. 290; IQR 148–390; p = 0.194).

CONCLUSION

These results demonstrate that lidocaine has a beneficial analgesic effect in patients with TRFs. Future work is needed to evaluate lidocaine's ability to reduce patient important consequences of inadequate analgesia.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level II.
The brain state of motor imagery is reflected in the causal information of functional near-infrared spectroscopy
Authors: Du Qiang , Luo Jingjing , Chu Chenxi , Wang Youhao , Cheng Qiying , Guo Shijie
Published: February 2022

Background

Brain–computer interface (BCI) is a promising neurorehabilitation strategy for ameliorating post-stroke function disorders. Physiological changes in the brain, such as functional near-infrared spectroscopy (fNIRS) dedicated to exploring cerebral circulatory responses during neurological rehabilitation tasks, are essential for gaining insights into neurorehabilitation mechanisms. However, the relationship between the neurovascular responses in different brain regions under rehabilitation tasks remains unknown.

Objective

The present study explores the fNIRS interactions between brain regions under different motor imagery (MI) tasks, emphasizing functional characteristics of brain network patterns and BCI motor task classification.

Methods

Granger causality analysis (GCA) is carried out for oxyhemoglobin data from 29 study participants in left- and right-hand MI tasks.

Results

According to research findings, homozygous and heterozygous states in the two brain connectivity modes reveal one and nine channel pairs, respectively, with significantly different (P < 0.05) GC values under the left- and right-hand MI tasks in the population. With reference to the total 10 channel pairs of causality differences between the two brain working states, a support vector machine is used to classify the two tasks with an overall accuracy of 83% for five-fold cross-validation.

Conclusion

As demonstrated in the present study, fNIRS offers causality patterns in different brain states of MIBCI motor tasks. The research findings show that fNIRS causality can be used to assess different states of the brain, providing theoretical support for its application to neurorehabilitation assessment protocols to ultimately improve patients’ quality of life.

Video Abstract: http://links.lww.com/WNR/A653.
Relative numerical middle in rhesus monkeys
Authors: Rugani Rosa , Platt Michael L. , Chen Zhaoying , Brannon Elizabeth M.
Published: February 2022

Animals show vast numerical competence in tasks that require both ordinal and cardinal numerical representations, but few studies have addressed whether animals can identify the numerical middle in a sequence. Two rhesus monkeys (
Macaca mulatta
) learned to select the middle dot in a horizontal sequence of three dots on a touchscreen. When subsequently presented with longer sequences composed of 5, 7 or 9 items, monkeys transferred the middle rule. Accuracy decreased as the length of the sequence increased. In a second test, we presented monkeys with asymmetrical sequences composed of nine items, where the numerical and spatial middle were distinct and both monkeys selected the numerical middle over the spatial middle. Our results demonstrate that rhesus macaques can extract an abstract numerical rule to bisect a discrete set of items.
Trehalose provisioning inDaphniaresting stages reflects local adaptation to the harshness of diapause conditions
Authors: Santos Joana L. , Ebert Dieter
Published: February 2022

Environmental fluctuations often select for adaptations such as diapause states, allowing species to outlive harsh conditions. The natural sugar trehalose which provides both cryo- and desiccation-protection, has been found in diapause stages of diverse taxa. Here, we hypothesize that trehalose deposition in resting stages is a locally adapted trait, with higher concentrations produced in harsher habitats. We used resting stages, produced under standardized conditions, by 37 genotypes ofDaphnia magnacollected from Western Palaearctic habitats varying in their propensity to dry in summer and freeze in winter. Resting eggs produced byD. magnafrom populations from summer-dry habitats showed significantly higher trehalose than those from summer-wet habitats, suggesting that trehalose has a protective function during desiccation. By contrast, winter-freezing did not explain variation in trehalose content. Adaptations to droughts are important, as summer dryness of water bodies is foreseen to increase with ongoing climate change.
Refutation of traumatic insemination in the
Drosophila bipectinata
species complex
Authors: Polak Michal , McEvey Shane F.
Published: February 2022

Traumatic insemination (TI) is a rare reproductive behaviour characterized by the transfer of sperm to the female via puncture wounds inflicted across her body wall. Here, we challenge the claim made by Kamimura (Kamimura 2007
Biol. Lett.
3
, 401–404. (
doi:10.1098/rsbl.2007.0192
)) that males of species of the
Drosophila bipectinata
complex use a pair of claw-like processes (claws) to traumatically inseminate females: the claws are purported to puncture the female body wall and genital tract, and to inject sperm through the wounds into the lumen of her genital tract, bypassing the vaginal opening. This supposed case of TI is widely cited and featured in prominent subject reviews. We examined high-resolution scanning electron micrographs of the claws and failed to discover any obvious ‘groove’ for sperm transport. We demonstrated that sperm occurred in the female reproductive tract as a single-integrated unit, inconsistent with the claim that sperm are injected via paired processes. Laser ablation of the sharp terminal ends of the claws failed to inhibit insemination. We showed that the aedeagus in the complex delivers sperm through the vaginal opening, as in other
Drosophila
. The results refute the claim of TI in the
Drosophila bipectinata
species complex.
Simulating progressive intramural damage leading to aortic dissection using DeepONet: an operator–regression neural network
Authors: Yin Minglang , Ban Ehsan , Rego Bruno V. , Zhang Enrui , Cavinato Cristina , Humphrey Jay D. , Em Karniadakis George
Published: February 2022

Aortic dissection progresses mainly via delamination of the medial layer of the wall. Notwithstanding the complexity of this process, insight has been gleaned by studying
in vitro
and
in silico
the progression of dissection driven by quasi-static pressurization of the intramural space by fluid injection, which demonstrates that the differential propensity of dissection along the aorta can be affected by spatial distributions of structurally significant interlamellar struts that connect adjacent elastic lamellae. In particular, diverse histological microstructures may lead to differential mechanical behaviour during dissection, including the pressure–volume relationship of the injected fluid and the displacement field between adjacent lamellae. In this study, we develop a data-driven surrogate model of the delamination process for differential strut distributions using DeepONet, a new operator–regression neural network. This surrogate model is trained to predict the pressure–volume curve of the injected fluid and the damage progression within the wall given a spatial distribution of struts, with
in silico
data generated using a phase-field finite-element model. The results show that DeepONet can provide accurate predictions for diverse strut distributions, indicating that this composite branch-trunk neural network can effectively extract the underlying functional relationship between distinctive microstructures and their mechanical properties. More broadly, DeepONet can facilitate surrogate model-based analyses to quantify biological variability, improve inverse design and predict mechanical properties based on multi-modality experimental data.
The effect of microbial selection on the occurrence-abundance patterns of microbiomes
Authors: Zapién-Campos Román , Sieber Michael , Traulsen Arne
Published: February 2022

Theoretical models are useful to investigate the drivers of community dynamics. In the simplest case of neutral models, the events of death, birth and immigration of individuals are assumed to only depend on their abundance—thus, all types share the same parameters. The community level expectations arising from these simple models and their agreement to empirical data have been discussed extensively, often suggesting that in nature, rates might indeed be neutral or their differences might not be important. However, how robust are these model predictions to type-specific rates? Also, what are the consequences at the level of types? Here, we address these questions moving from simple neutral communities to heterogeneous communities. For this, we build a model where types are differently adapted to the environment. We compute the equilibrium distribution of the abundances. Then, we look into the occurrence-abundance pattern often reported in microbial communities. We observe that large immigration and biodiversity—common in microbial systems—lead to such patterns, regardless of whether the rates are neutral or non-neutral. We conclude by discussing the implications to interpret and test empirical data.