bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac amyloidosis: diagnostic challenges and recent advancement in the treatment of transthyretin amyloidosis (ATTR)
Authors: Rahman Tanvir , Moghadam Reihaneh C , Agarwal Vikram V , Reiss Craig K
Published: August 2021

ATTR-CA is an under-reported cause of congestive heart failure (CHF) and cardiac arrhythmias. Heightened clinical suspicion along with a multimodal investigative approach is often required in diagnosing this potentially fatal condition. Tafamidis and inotersen have shown promising results in terms of progression-free survival by ameliorating CHF symptoms and peripheral neuropathies in clinical trials.

In this case series of five patients, we present three wild-type cardiac amyloidosis (ATTRwt-CA), one familial cardiac amyloidosis (ATTRm-CA) and one primary cardiac (AL-CA). The diagnostic modality was different for each patient. ATTRwt-CA, ATTRm-CA and AL-CA patients received tafamidis, inotersen and chemotherapy with bone marrow stem-cell transplantation, respectively.
Fibroblastic meningioma mimicking an intracerebral hemorrhage: case report
Authors: Devia Diego Armando , Devia David Andrés Armando , Meek Eugenio , Rivera Diego , Feo-Lee Oscar
Published: August 2021

A 50-year-old woman presented to the emergency room complaining of severe headache. A non-contrasted head CT was obtained, which demonstrated a hyperdense image compatible with an intracerebral hemorrhage in the posterior region of the left temporal lobe. The patient displayed no neurological deficit during the consultation and a subsequent MRI showed a temporoinsular bleeding lesion that was suggestive of an atypic meningioma or a metastatic lesion. Afterwards, neck, chest and abdomen CT scans were performed, and the imaging ruled out a secondary neoplasm. The patient underwent surgical resection of the lesion, and a solid tumor was found with no bleeding associated. The pathology reported a WHO I fibroblastic meningioma.
I drank too much and now I can’t walk: a case of alcohol-induced dysautonomia
Authors: Assaker Richard , El Hasbani Georges , Antezana Arturo Alvarez , Gamarra Jose Vargas , Amaya-Suarez Jose , Bertely Christopher , Suleman Natasha
Published: August 2021

Dysautonomia is a dysfunction of the autonomic nervous system, which mediates both sympathetic and parasympathetic functions of the human body. Alcohol has been established to affect the autonomic function through liver injury and accumulation of vasodilators. Alcohol can induce peripheral neurological diseases as well. This case report describes a patient who had a chronic history of alcoholism and uncontrolled diabetes mellitus presenting for orthostatic hypotension and peripheral neuropathy without underlying liver disease or other endocrinopathies. Although diabetes mellitus was controlled pharmacologically and risk factors for orthostatic hypotension were managed conservatively, his symptoms did not improve which indicated an alcohol-related autonomic dysfunction, shedding light on one of long-term complications of alcoholism.
Sudden unexpected death caused by infantile acute lymphoblastic leukaemia
Authors: Morota Kei , Shimizu Mariko , Sugitate Ryo , Ide Munenori , Yamato Genki , Tomizawa Daisuke , Muramatsu Kazuhiro , Matsui Atsushi
Published: August 2021

A 7-week-old girl with a normal birth history suddenly developed respiratory distress while feeding. Cardiopulmonary resuscitation was initiated at home after she had a cardiac arrest and was continued in the emergency room but all efforts at resuscitation proved unsuccessful and she died 2 h after presentation. Investigations performed in the emergency room revealed that she had a significantly high white blood cell count and severe anaemia. The cause of death was identified as KMT2A-rearranged infantile acute lymphoblastic leukaemia based on cytogenetic tests. She had no abnormalities at the 4-week check-up; however, she developed a skin nodule on her abdomen thereafter, and the family did not consult a doctor for fear of contracting COVID-19. Early detection and diagnosis could have changed the prognosis of the patient. The present case highlights the negative impact of the reduction of outpatient consultations during the COVID-19 pandemic.
HIV-associated intussusception
Authors: Mewaldt Christian , Mehta Raaj
Published: August 2021

A 39-year-old man with untreated HIV presented with watery, non-bloody diarrhea and associated 25-lb weight loss. His workup was notable for a CT abdomen/pelvis which showed an entero-enteric intussusception of 3.4 cm without an underlying pathologic mass. The patient's intussusception resolved without intervention, as is typical of telescoping <3.5 cm. HIV is associated with an increased risk of developing intussusception because of an increased incidence of infectious and neoplastic conditions of the bowel.
Services provided for axial spondyloarthritis patients by rheumatologists in India: a survey
Authors: Pathak Himanshu , Ajmani Sajal , Kumar Ashok , Misra Ramnath
Published: August 2021

Objective

We sought to evaluate the current knowledge and attitudes of Indian rheumatologists concerning axial spondyloarthritis (axSpA) with respect to recent terminology for diagnosis, management strategies and additional services.

Methods

The survey was designed for spondyloarthritis care given by rheumatologists in the Indian health-care context. The structured survey consisted of a combination of multiple-choice and open-ended questions. An anonymous Web-based questionnaire was sent to 710 members of the Indian Rheumatology Association, and descriptive analysis of responses was done.

Results

The survey respondents were from government and private health-care facilities and gave a response rate of 19% (133 of 710). About 49% of respondents were using the terminology axSpA for a new diagnosis of spondyloarthritis (SpA). BASDAI was used routinely as the main disease monitoring tool by most respondents (76.2%). Same-day MRI was available to 42.9% (51 of 119) respondents. Selective cyclooxygenase-2 inhibitors were the preferred first NSAID for 50% of respondents, and SSZ was the most preferred DMARD for peripheral arthritis. Financial constraints were the most common factor that affected the initiation of biologics and also the most common reason for stopping biological therapies. Nearly 65% (80 of 122) of respondents did not have a multidisciplinary team available in clinical practice, and only 15% of respondents had access to patient support groups.

Conclusion

For a new diagnosis, the terminology of axSpA is not fully accepted by Indian rheumatologists. The axSpA management given by Indian rheumatologists is in agreement with recent guidelines, however, there is a significant lack of accessibility to multidisciplinary care and patient support groups in India.
Winning by Default: Why is There So Little Competition in Government Procurement?
Authors: Kang Karam , Miller Robert A
Published: August 2021

Government procurement contracts rarely have many bids, often only one. Motivated by the institutional features of federal procurement, this article develops a principal-agent model where a buyer seeks sellers at a cost and negotiates contract terms with them. The model is identified and estimated with data on IT and telecommunications contracts. We find the benefits of drawing additional sellers are significantly reduced because the procurement agency can extract informational rents from sellers. Another factor explaining the small number of bids is that sellers are relatively homogeneous, conditional on observed project attributes. Administrative hurdles and corruption appear to play very limited roles.
Measuring the Incentive to Collude: The Vitamin Cartels, 1990–99
Authors: Igami Mitsuru , Sugaya Takuo
Published: August 2021

Do mergers help or hinder collusion? This article studies the stability of the vitamin cartels in the 1990s and presents a repeated-games approach to quantify “coordinated effects” of a merger. We use data and direct evidence from American courts and European agencies to show the collusive incentive of the short-lived vitamin C cartel was likely to be negative when it actually collapsed in 1995, whereas the incentives of the long-lived cartels (vitamins A and E, and beta carotene) were unambiguously positive until the prosecution in 1999. Simulations suggest some mergers could have prolonged the vitamin C cartel, but others could have further destabilized it, because both the direction and magnitude of coordinated effects depend not only on the number of firms but also on their cost asymmetry.
Priority Design in Centralized Matching Markets
Authors: Çelebi Oğuzhan , Flynn Joel P
Published: August 2021

In many centralized matching markets, agents’ property rights over objects are derived from a coarse transformation of an underlying score. Prominent examples include the distance-based system employed by Boston Public Schools, where students who lived within a certain radius of each school were prioritized over all others, and the income-based system used in New York public housing allocation, where eligibility is determined by a sharp income cutoff. Motivated by this, we study how to optimally coarsen an underlying score. Our main result is that, for any continuous objective function and under stable matching mechanisms, the optimal design can be attained by splitting agents into at most three indifference classes for each object. We provide insights into this design problem in three applications: distance-based scores in Boston Public Schools, test-based scores for Chicago exam schools, and income-based scores in New York public housing allocation.
A pilot examination of the inter-rater reliability of the 18-item Household Food Security Module between cohabiting mothers and fathers
Authors: Foster Jaime S , Adamsons Kari , Schwartz Marlene B , Taylor Emily A , Mobley Amy R
Published: August 2021

Food insecurity, defined as the inability to access sufficient food for an active, healthy life, affects 11.1% of the US population and is primarily assessed using the United States Department of Agriculture’s (USDA) 18-item Household Food Security Survey Module (HFSSM). The HFSSM is a self-report measure presumed to represent all household members, but it is unknown if cohabiting parents report food security differently. This pilot study aimed to determine (i) the inter-rater reliability of the HFSSM; (ii) the direction of any difference between responses to the HFSSM; and (iii) the item-level response similarities and differences among mothers and fathers of young children. Twenty-five pairs of low-income, food-insecure cohabiting parents of 2.5- to 10-year-old children participated in cognitive interviews assessing their level of food security using the USDA’s HFSSM and completed related questionnaires. Intraclass correlations were computed to compare the responses of each dyad on the HFSSM overall and by item. Results revealed that overall report of food security was significantly but weakly correlated (r = .40, p = .02) within dyads. The majority of fathers (60%) reported higher food security scores on the HFSSM than their respective female partners. Furthermore, item-level intraclass correlations revealed that some HFSSM questions had poor reliability between cohabiting parents. This research identifies that a potential shortcoming of the HFSSM is the under-reporting of food insecurity by fathers compared with mothers within the household. These findings have implications for the utility of this measure used in national monitoring of the nation’s food security.
Should Facebook advertisements promoting a physical activity smartphone app be image or video-based, and should they promote benefits of being active or the app attributes?
Authors: Northcott Celine , Curtis Rachel , Bogomolova Svetlana , Olds Timothy , Vandelanotte Corneel , Plotnikoff Ronald , Maher Carol
Published: August 2021

Social media provides a convenient platform for health campaigns. However, practitioners designing such campaigns are faced with a number of decisions regarding advertising formats and appeals. This study set out to compare the effectiveness of two advertising formats (image vs. video) and two advertising appeals (benefits of being active vs. app attributes and features) for promoting a physical-activity smartphone app. The advertising experiment was conducted on Facebook and employed a 2 × 2 full-factorial experimental design, examining two advertising formats: image versus video and two advertising appeals: benefit versus attribute. Outcome measures were advertisement cost (number of viewers reached according to the amount spent) and consumer engagement (rates of advertisement click-through and app downloads). Chi-Square analysis revealed that advertisement cost was found to differ according to the type of advertising format used, with image advertisements achieving a greater audience reach than video advertisements (χ 2(1) = 905.292, p < .001). Consumer engagement also differed according to advertising format and appeal: images achieved high rates of advertisement click-through (2.7% vs. 1.9%; χ 2(1) = 196.9, p < .001) and app downloads (0.6% vs. 0.5%; χ 2(1) = 4.0, p = .044) compared with videos. Furthermore, benefit appeal advertisements were more effective than attribute appeals, yielding a greater rate of advertisement click-through (2.8% vs. 1.8%; χ 2(1) = 282.2, p < .001) and app downloads (0.7% vs. 0.4%; χ 2(1) =106.0, p < .001). Overall, image advertisements were seen to be the most cost-effective and engaging. Advertisements employing a benefit appeal achieved greater consumer engagement than and attribute appeal advertisements.
User-centered development of a smartphone application (Fit2Thrive) to promote physical activity in breast cancer survivors
Authors: Welch Whitney A , Solk Payton , Auster-Gussman Lisa , Gavin Kara L , Whitaker Madelyn , Cullather Erin , Izenman Emily , Courneya Kerry S , Ackermann Ronald , Spring Bonnie , Cella David , Penedo Frank , Phillips Siobhan M
Published: August 2021

Increased moderate and vigorous physical activity (MVPA) is associated with better health outcomes in breast cancer survivors; yet, most are insufficiently active. Smartphone applications (apps) to promote MVPA have high scalability potential, but few evidence-based apps exist. The purpose is to describe the testing and usability of Fit2Thrive, a MVPA promotion app for breast cancer survivors. A user-centered, iterative design process was utilized on three independent groups of participants. Two groups of breast cancer survivors (group 1 n = 8; group 2: n = 14) performed app usability field testing by interacting with the app for ≥3 days in a free-living environment. App refinements occurred following each field test. The Post-Study System Usability Questionnaire (PSSUQ) and the User Version Mobile Application Rating Scale (uMARS) assessed app usability and quality on a 7- and 5-point scale, respectively, and women provided qualitative written feedback. A third group (n = 15) rated potential app notification content. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using a directed content analysis. The PSSUQ app usability score (M1= 3.8; SD = 1.4 vs. M2= 3.2; SD = 1.1; lower scores are better) and uMARS app quality score (M1 = 3.4; SD = 1.3 vs. M2= 3.4; SD = 0.6; higher scores are better) appeared to improve in Field Test 2. Group 1 participants identified app “clunkiness,” whereas group 2 participants identified issues with error messaging/functionality. Group 3 “liked” 53% of the self-monitoring, 71% of the entry reminder, 60% of the motivational, and 70% of the goal accomplishment notifications. Breast cancer survivors indicated that the Fit2Thrive app was acceptable and participants were able to use the app. Future work will test the efficacy of this app to increase MVPA.
Defeating meningitis by 2030 – an ambitious target
Authors: Greenwood Brian , Sow Samba , Preziosi Marie-Pierre
Published: August 2021

Acute bacterial meningitis remains a major cause of mortality and morbidity, especially in lower-income countries. Thus, in 2017, a group of people concerned with this continuing problem came together to plan a way forward. A task force was established, a baseline situation analysis undertaken and a road map for a new initiative ‘Defeating Meningitis by 2030’ prepared. This road map will be launched officially in September 2021. Additional finances for meningitis control will be needed, together with the support of many different institutions and people with different skills, if the ‘Defeating Meningitis by 2030’ initiative is to achieve its ambitious goals.
Consumption Subaggregates Should Not Be Used to Measure Poverty
Authors: Christiaensen Luc , Ligon Ethan , Sohnesen Thomas Pave
Published: August 2021

Frequent measurement of poverty is challenging because measurement often relies on complex and expensive expenditure surveys that try to measure expenditures on a comprehensive consumption aggregate. This paper investigates the use of consumption “subaggregates” instead. The use of consumption subaggregates is theoretically justified if and only if all Engel curves are linear for any realization of prices. This is very stringent. However, it may be possible to empirically identify certain goods that happen to have linear Engel curves given prevailing prices, and when the effect of price changes is small, such a subaggregate might work in practice. The paper constructs such linear subaggregates using data from Rwanda, Tanzania, and Uganda. The findings show that using subaggregates is ill advised in practice as well as in theory. This also raises questions about the consistency of the poverty tracking efforts currently applied across countries, since obtaining exhaustive consumption measures remains an unmet challenge.
Molecular Diagnostic Yield of Exome Sequencing in Patients With Cerebral Palsy
Authors: Moreno-De-Luca Andrés , Millan Francisca , Pesacreta Denis R. , Elloumi Houda Z. , Oetjens Matthew T. , Teigen Claire , Wain Karen E. , Scuffins Julie , Myers Scott M. , Torene Rebecca I. , Gainullin Vladimir G. , Arvai Kevin , Kirchner H. Lester , Ledbetter David H. , Retterer Kyle , Martin Christa L.
Published: August 2021

(Abstracted from JAMA 2021;325:467–475)

Cerebral palsy (CP) is a nonprogressive neurodevelopmental disorder that affects early motor development and typically impairs movement and posture. The adult population with CP is increasing as the life expectancy increases with changes in medical and social care.
The NRP 8th Edition: Innovation in Education
Authors: Zaichkin Jeanette , Kamath-Rayne Beena D. , Weiner Gary
Published: August 2021

Background:

Approximately 10% of newborns need assistance at birth, and an evidence-based, timely, and coordinated response is critical to optimal outcome. The Neonatal Resuscitation Program® (NRP®) is the training and education standard in the United States for healthcare professionals who manage newborns in the hospital. This article summarizes the development of evidence-based resuscitation science, changes in the NRP 8th edition educational methodologies, and several significant practice changes made for educational efficiency and patient safety.

Evidence Acquisition:

The NRP 8th edition is informed by multiple systematic reviews of emerging science conducted by the International Liaison Committee on Resuscitation (ILCOR), which culminates in consensus documents on resuscitation science. The American Academy of Pediatrics (AAP) and the American Heart Association (AHA) used these recommendations to develop the most recent neonatal resuscitation guidelines for North America. These guidelines inform the NRP 8th edition practice recommendations.

Results:

The most recent CoSTR (Consensus on Science with Treatment Recommendations) summary and AAP/AHA guidelines for neonatal resuscitation yielded no major changes in practice. However, scientific research over the past 5 years resulted in new and higher grades of evidence to support previous recommendations. The NRP Steering Committee revised several practices in the interest of patient safety and educational efficiency.

Implications for Practice:

The NRP 8th edition materials were released in June 2021 and must be in use by January 1, 2022. In the new ILCOR evidence review format, CoSTR scientific reviews and statements are published continuously instead of every 5 years; however, future editions of NRP will be released every 5 years unless there is compelling evidence that mandates an earlier change.
The First Aortic Endoaneurysmorrhaphy
Authors: Lozano-Sanchez Francisco S. , García-Cenador M. Begoña
Published: August 2021

In 1888, Rudolph Matas described and performed a procedure (endoaneurysmorrhaphy) that revolutionized the treatment of aneurysms, which for centuries had been untreatable or simply involved treatment by ligation and other marginal techniques. In 1940, during the annual meeting of the American Surgical Association, Matas presented the excellent results he had obtained with 98 endoaneurysmorrhaphies, although none of these cases involved an aortic aneurysm. On November 4, 1904, a Spanish surgeon called Ricardo Lozano Monzón was the first person in the world to perform an endoaneurysmorrhaphy on a patient suffering from an abdominal aortic aneurysm. The case was reported in a local journal called La Clínica Moderna in 1905. Despite the journal’s limited circulation, Matas and others acknowledged that Lozano was the practitioner of the first, although admittedly unsuccessful, endoaneurysmorrhaphy on an abdominal aorta. Lozano’s attempt was followed by other equally unsuccessful ones until Isaac A. Bigger performed the first successful procedure in 1938. The different kinds of endoaneurysmorrhaphy that Matas used, which proved to be effective in the treatment of peripheral aneurysms, did not perform in the same way in aortic aneurysms. Nonetheless, the procedure paved the way for new ideas and contributions (Creech technique).
Factors Associated With Increased Laboratory Use in the Pediatric Cardiac Intensive Care Unit
Authors: Fisk Anna C. , Gauvreau Kimberlee , Connor Jean A.
Published: August 2021

Background

Laboratory testing is frequently used to guide postoperative management and contributes to hospital resource utilization; however, there is little evidence identifying patient or clinical factors to inform the appropriate frequency of laboratory testing in the pediatric cardiac intensive care unit.

Objectives

To examine the factors associated with increased laboratory utilization following pediatric congenital heart surgery.

Methods

For each patient, the total number of tests and types of laboratory tests were recorded. Patients whose number of tests was greater than the 90th percentile were categorized as increased laboratory use.

Results

A sample of 250 unique patients and 909 nursing shifts were obtained for patient- and shift-level analyses. The top 10% of patients identified as the high laboratory utilization group (>128 laboratory tests). High-use group reported significantly younger patients and longer bypass time (P < .001). Patients in the highest Risk Adjustment for Congenital Heart Surgery 1 risk category were 34.7 times more likely to be in high laboratory utilization group (P = .006), independent of age at time of surgery and time on bypass (receiver operating characteristic curve = 0.855). At the shift level, time on bypass (P = .002), age younger than 30 days at surgery (P < .001), 3 to 5 years' registered nurse experience (P < .001), staff precepting (P = .03), and weekday shift status (P = .03) were all independently associated with high laboratory utilization.

Conclusions

There are multiple factors associated with increased laboratory utilization. Recognition of specific patient and nursing factors can be used to impact patient management.
Pediatric Critical Care Nurses' Practices Related to Sedation and Analgesia
Authors: Hagstrom Sandra , Hall Jaclyn , Sakhitab-Kerestes Alyssa , Tracy Mary Fran
Published: August 2021

Background

Pediatric intensive care unit (PICU) nurses may consider additional factors beyond validated tools when managing pain and sedation of children. However, these other factors and related beliefs, practices, and decision-making for analgesia and sedation have not been well described.

Objectives

This study describes nurses' beliefs, practices, and decision-making related to sedation and analgesia for mechanically ventilated children on a PICU and a pediatric cardiovascular ICU at a tertiary academic children's medical center in the United States.

Methods

A 35-item web-based survey tool was developed to more fully identify nurses' pain, sedation, comfort, and analgesia beliefs, decisions, planning, and procedures for children who were mechanically ventilated in the ICU. It was distributed to 102 nurses in the PICU, pediatric cardiovascular ICU, and pediatric critical care float pool.

Results

Twenty-six nurses (25%) responded; a majority worked the night shift and had 5 years or less of ICU experience. While participants believed intubated pediatric patients required moderate to deep sedation, approximately only half reported patients were adequately sedated. They reported that they were more likely to manage pain and sedation using specific behaviors and changes in vital signs than scores on a standardized scale. Nurses also reported routinely incorporating nonpharmacologic comfort measures. Premedication was more common for invasive procedures than for routine nursing care.

Discussion

Pediatric ICU nurses in this study considered factors beyond standardized scales when evaluating and managing pain and sedation of ventilated children. Nurses prioritized children's specific behaviors, vital signs, and their own nursing judgment above standardized scales. Research is needed to describe nurses' practices beyond this small study and to define and validate additional assessment parameters to incorporate into decision-making to improve management and care outcomes.
Characterization of 3,4-methylenedioxypyrovalerone discrimination in female Sprague–Dawley rats
Authors: Thomas Angela M. , Cargile Kaley J. , Lunn Jannelle A. , Baker Lisa E.
Published: August 2021

3,4-Methylenedioxypyrovalerone (MDPV), one of several synthetic cathinones, is a popular constituent of illicit ‘bath salts’. In preclinical studies utilizing drug discrimination methods with male rodents, MDPV has been characterized as similar to both cocaine and 3,4-methylenedioxymethamphetamine-hydrochloride (MDMA). Whereas few drug discrimination studies have utilized female rats, the current study evaluated the discriminative stimulus effects of MDPV in 12 adult female Sprague–Dawley rats trained to discriminate 0.5 mg/kg MDPV from saline under a fixed ratio 20 schedule of food reinforcement. Stimulus substitution was assessed with MDPV and its enantiomers, other synthetic cathinones [alpha pyrrolidinopentiophenone-hydrochloride(α-PVP), 4-methylmethcathinone (4-MMC)], other dopamine agonists (cocaine, [+)-methamphetamine] and serotonin agonists [MDMA, lysergic acid diethylamide (LSD)] Stimulus antagonism was assessed with the dopamine D1 receptor antagonist, Sch 23390 and the D2 receptor antagonist, haloperidol. Cocaine and (+)-methamphetamine engendered full stimulus generalization to MDPV with minimal effects on response rate. LSD produced partial substitution, whereas MDMA and 4-MMC produced complete substitution, and all these serotonergic compounds produced dose-dependent response suppression. (S)-MDPV and α-PVP engendered full substitution with similar potency to the racemate, while (R)-MDPV failed to substitute up to 5 mg/kg. Both Sch 23390 and haloperidol attenuated the discrimination of low MDPV doses and essentially shifted the dose-response curve to the right but failed to block discrimination of the training dose. These findings are generally consistent with previous reports based exclusively on male rodents. Moreover, they confirm the contribution of dopaminergic mechanisms but do not rule out the possible contribution of other neurotransmitter actions to the interoceptive stimulus effects of MDPV.
Bladder Bleeding Due to Placenta Percreta: Report of Four Cases and Management Discussion
Authors: Zhao Huidan , Zhao Xianlan , Liu Chuanna , Tao Ya , Zhou Yan
Published: August 2021

Placenta percreta with bladder bleeding can occur during gestation or postpartum, posing a great threat to both mother and fetus. But it is rare and lacks standard management strategies. We reported four cases suffering from bladder bleeding caused by placenta percreta even with hemorrhagic shock admitted between January 1st, 2011 and December 31th, 2020 in The First Affiliated Hospital of Zhengzhou University. Clinical information, including age, gravidity and parity, ultrasound and magnetic resonance imaging manifestations, onset gestational age, bladder bleeding volume, clinical manifestations under bleeding, diagnosis, hemostatic methods, hospital stay, treatment cost, and prognosis, are presented. Two cases had bladder bleeding during the second trimester, respectively on the 22+3 and 23+5  weeks. Pregnancy was terminated timely. The other two cases had bladder bleeding on the 2nd day post near-term cesarean section when activity. All the four cases achieved successful hemostasis following angiography and concomitant embolization for iliac vessels, and one of them received electrocoagulation hemostasis under cystoscopy, but failed. They all had favorable clinical outcomes and had no long-term complications. The neonatal outcome in the two cases that bladder hemorrhage occurred after near-term c-section was good. The newborns did not survive in two cases in which bladder hemorrhage occurred at the second trimester of pregnancy. Timely termination of pregnancy is recommended when such a condition develops during gestation. Diagnosis of bladder bleeding is relatively easy, for it is characterized by fast speed and large volume, with concomitant distension of the lower abdomen, blood discharge from the urethral orifice, or the indwelling catheter. Interventional embolization is an effective means to treat bladder bleeding caused by placenta percreta, while electrocoagulation hemostasis under cystoscopy must be applied with great caution. For the pregnant women with a high risk of placenta percreta, timely and accurate diagnosis should be achieved during the gestational age, and bladder bleeding should be concerned when placenta penetrates through the anterior wall of uterus.
Obliteration and Contouring of Comminuted Anterior Wall Frontal Sinus Fracture Using Pericranial Flaps
Authors: Tallal Raghda E. , Estawrow Mina A.
Published: August 2021

One of the common postoperative complications of comminuted fractures of frontal sinus are contour deformity, hardware extrusion, adherence and/or palpability, and skin thinning. We are presenting our novel technique with pericranial flaps to decrease these complications. The study was performed from January 2019 to January 2020, on 40 cases of comminuted fractures of anterior wall of frontal sinus, 28 men and 12 women, with an average age of 41 years. Injury resulted from motor vehicle crashes (n = 25), motorcycle crashes (n = 11), and falling from heights (n = 4). Our novel technique involves the use of two anteriorly based pericranial flaps; one flap is used for obliteration of the frontal sinus and the other is used to overlay the hardware used to restore forehead contouring and to eliminate the possibility of early extrusion or late plates or mesh palpability. Two patients had postoperative minimal disruption of forehead lacerations healed with secondary intention and minimal scarring. Excellent patient compliance without any complaint of mesh palpability. No adherence occurred and no skin thinning. This technique (two anteriorly based pericranial flaps) may be more reliable to obliterate the frontal sinus also overlaying the hardware used to improve forehead contour and decrease the incidence of mesh palpability and skin adherence than using hardware without flap coverage.
Maintaining Contour with a Three-dimensional Interstitial Tissue Marker in 134 Lumpectomies
Authors: Tsang Ashley T. , Cai Lawrence , Edquilang Joanne , Wapnir Irene L.
Published: August 2021

Background:

Breast-conserving surgery (BCS) is meant to preserve the natural appearance of the breast; however, tissue volume deficits cannot always be compensated by soft tissue mobilization. A three-dimensional (3D) interstitial tissue marker (BioZorb) was designed to delineate the lumpectomy cavity for targeting boost irradiation, but an unexpected secondary benefit may be in guiding wound contraction and restoring contour to the lumpectomy bed. We analyze tissue volume excised at the time of lumpectomy as a function of device size selected.

Methods:

In total, 134 consecutive lumpectomy patients implanted with BioZorb between May 2015 and February 2020 were retrospectively analyzed for tissue volume excised, device size used, location, and re-operation rates, including explantation of the device.

Results:

An estimated 113 patients underwent device implantation at initial lumpectomy, and 21 at margin re-excision. Twenty-seven patients underwent re-excision, while 14 elected mastectomy for positive margins following insertion; 22 had the same device reimplanted. Mean lumpectomy volume was 79.0 cm3 (range 10.3–275.8 cm3) during the first implant procedure. Large-volume lumpectomies, averaging 136.5 cm3, were associated with selection of larger devices, which aided in restoring volume and maintaining breast contour. Three (2.2%) patients requested removal of the device.

Conclusions:

BioZorb implantation can be a safe and useful oncoplastic technique for restoring volume with BCS. Large-volume lumpectomies can be performed without contouring defects using the device. An unexpected secondary benefit of the device may be scaffolding for wound contraction.
Smartphone-assisted Augmented Reality in Craniofacial Surgery
Authors: Alshomer Feras , Alazzam Abdualziz , Alturki Ahmed , Almeshal Obaid , Alhusainan Hanan
Published: August 2021

Background:

Augmented reality (AR), a blending of both the physical and digital worlds, can be a valid tool for surgeons wishing to plan interventions and attain symmetry. The use of technology has enabled physicians to achieve desirable results. In this article, we describe a method that uses smartphone’s simple AR utilities for convenient, cost effective, and time saving perioperative planning.

Methods:

Images of preoperative computed tomography, along with 3D reconstructed scans were uploaded to a smartphone and used in an affordable application (Camera Lucida) to superimpose the loaded pictures over the smartphone camera. In one case, a 3D computed tomography scan of the skull was mirrored to help guide fronto-orbital advancement, and in another case the loaded 3D reconstructed computed tomography scan was used to prioritize areas of scalp coverage in a complicated case of craniosynostosis with major scalp wound dehiscence.

Discussion:

Adaptation of AR to assist in the field of craniofacial surgery has been introduced before in several studies that reported the use of computer-based guidance for cranial reshaping. The majority of these reports used sophisticated modalities, combining advanced image registration and tracking with specialized equipment. The utility of smartphone AR for cranial vault reconstruction provided good accuracy when visualizing fronto-orbital advancement and remodeling, together with in depth prioritization of areas in need of soft tissue reconstruction.

Conclusion:

Smartphone AR adaptation proved to be a very convenient tool assisting in the planning of different craniofacial conditions that are time saving and do not incur any additional fees beyond those of the surgery.
Medico-legal Closed Case Trends in Canadian Plastic Surgery: A Retrospective Descriptive Study
Authors: Zhang Zach , Calder Lisa , Finestone P.J. , Liu Richard , Bucevska Marija , Arneja Jugpal S.
Published: August 2021

Background:

To enhance patient safety and prevent medico-legal complaints, we need to understand current trends and impacts. We aimed to characterize Canadian plastic surgery medico-legal patterns in many dimensions.

Method:

This retrospective descriptive analysis of Canadian Medical Protective Association data between January 1, 2013 and December 31, 2017 included closed regulatory body complaints and civil-legal actions involving plastic surgeons. We excluded class action legal cases and hospital complaints. We collected data on patient allegations, procedure types, healthcare-related patient harms, and peer expert criticisms. The primary outcome of interest was physician medico-legal outcome.

Results:

We found 414 cases that met the inclusion criteria: 253 (61.1%) cases involved cosmetic procedures and 161 (38.9%) noncosmetic procedures. The annual incidence among plastic surgeon members of regulatory body complaints and civil-legal actions was 12.1% and 6.7%, for a combined incidence of 18.8%. The most common allegations were deficient clinical assessment, inadequate informed consent, delayed or misdiagnosis, and inadequate monitoring. Leading contributing factors were physician–patient communication breakdown, deficient clinical judgments, and inadequate documentation. The top procedural complications included cosmetic deformity, poor scarring, upper extremity stiffness or deficit, major structural injury, and mental health disorder. Less than half of cases (198/414, 47.8%) had unfavorable medico-legal outcomes for the surgeon. Patients were compensated in 86/198 (43.4%) of civil-legal cases.

Conclusions:

Plastic surgeons experience more medico-legal complaints for cosmetic versus noncosmetic procedures. To minimize medico-legal risks, plastic surgeons should focus on strong physician–patient communication, patient education/consent, thorough clinical assessment, minimizing potentially preventable complications, and maintaining relevant documentation.
Methods for Minimizing Bleeding in Facelift Surgery: An Evidence-based Review
Authors: Tiourin Ekaterina , Barton Natalie , Janis Jeffrey E.
Published: August 2021

Introduction:

Bleeding and hematoma remain leading causes of postoperative complications and unsatisfactory patient outcomes in facelift surgery. Several methods have been implemented, and continue to be developed, to minimize bleeding in facelift surgery. These methods include perioperative blood pressure management, compression dressings, drains, tissue sealants, wetting solution infiltrate, and tranexamic acid.

Methods:

An evidence-based review of methods used to minimize bleeding in facelift surgery was conducted using the PubMed database according to PRISMA guidelines. Included studies were evaluated for the effects of implemented methods on bleeding outcomes in facelift surgery. Recommendations for each method evaluated were determined based on the amount, level, and heterogeneity of included studies.

Results:

Thirty-six studies were included in the evidence-based review. Effective strategies to reduce the time to hemostasis, postoperative drainage volume, and hematoma rate included perioperative blood pressure management, tissue sealants, and tranexamic acid. While the use of drains or wetting solution infiltrate did not demonstrate to significantly influence bleeding outcome measures, these methods may provide other advantages to facelift surgery. Compression dressings have not demonstrated a significant effect on facelift outcome measures.

Conclusions:

Perioperative medical management of blood pressure, tissue sealants, and tranexamic acid are most effective in facilitating hemostasis and preventing postoperative hematoma in facelift surgery.
Cutaneous Anaplastic Large Cell Lymphoma: A Case Report about Masking Effect of Facial Masks in the COVID-19 Pandemic
Authors: Wu Shannon S. , Kwiecien Grzegorz J. , Coombs Demetrius M. , Foglietti Sofia , Fostyk Alanna , Foglietti Mark A.
Published: August 2021

The COVID-19 global pandemic commenced widespread usage of face masks. Due to covering of the lower face in public settings, limited social interaction, and patient hesitancy for seeking in-person healthcare, dermatologic conditions of the lower face are prone to delayed diagnosis and management. With society recovering from the pandemic and social distancing restrictions being lifted, an increasing number of patients present with malignant skin conditions at advanced stage. The authors describe a 47-year-old female patient who presented with a 4-month-old facial mass that was initially believed to originate from skin irritation caused by mask-wearing. A biopsy revealed primary cutaneous anaplastic large cell lymphoma (PC-ALCL). This case report outlines the management of the rare PC-ALCL lesion and diagnostic challenges related to facial masks and social distancing.
Comparison of Postoperative Symptoms of Alcohol-Assisted Versus Mechanical Epithelial Removal in Photorefractive Keratectomy: A Contralateral Double Blind Clinical Trial
Authors: Mohammadpour Mehrdad , Rezaei Fatemeh , Heirani Mohsen , Khorrami-Nejad Masoud
Published: August 2021

Purpose:

To compare the short-term complaints of postoperative pain, and other ocular discomfort symptoms in patients who underwent photorefractive keratectomy (PRK) with alcohol-assisted epithelial removal in one eye versus mechanical debridement in the other eye.

Method:

A prospective, interventional, contralateral double blind clinical trial was performed on 164 eyes of 82 candidates of PRK surgery. The patients were divided into two groups. The first group was alcohol-assisted PRK group in which the epithelial removal was performed on their right eye. The second group was mechanical PRK group in which epithelial removal was performed on their left eye. A numerical rating scale was given to the patients to describe the severity of postoperative pain on the first day following PRK. Postoperative discomfort symptoms including the complaints of light sensitivity, tearing, blurring, and foreign body sensation was also provided by the survey form.

Results:

One day following PRK, the mean pain score of the alcohol-assisted PRK group and the mechanical PRK group was 3.4±3.1 and 4.1±3.3, respectively (P=0.019). The highest scores recorded for alcohol-assisted and mechanical treated groups were burning (5.22) and light sensitivity (5.46), respectively. Sixty-eight (82.9%) of all patients experienced postoperative pain, and in 52 (76.5%) of them, the time of pain onset was less than 2 hrs.

Conclusion:

We found less pain and discomfort using alcohol-assisted technique compared with mechanical epithelial removal that was provided by a detailed pain and ocular discomfort symptoms assessment one day following PRK surgery.
Direct Nidal Ethyl Vinyl Alcohol Copolymer Embolization With Flow Reduction Techniques as a Primary Treatment for Intraosseous Mandibular Arteriolovenous Malformations
Authors: Worede Fikadu , Granquist Eric J. , Srinivasan Abhay S. , Vatsky Seth E. , Cahill Anne Marie
Published: August 2021

Intraosseous mandibular arteriovenous malformations are uncommon and can be an important cause of major oral bleeding if undiagnosed, especially in the setting of loose dentition. Catheter angiography and embolization has been reported with good success using several agents. This report describes the use of direct (percutaneous/intraoral) intranidal ethylene-vinyl alcohol copolymer injection with arterial flow reduction to treat 2 intraosseous mandibular arteriolovenous malformations without complication. This treatment in both cases resulted in a stable ethylene-vinyl alcohol copolymer cast, fixed dentition, and remodeling of the mandible to a normal architecture with clinical and imaging stability over a long follow-up period.
Meniscus Repair Techniques
Authors: Mcclain William D. , DeFoor Mikalyn T. , Patzkowski Jeanne C.
Published: August 2021

The menisci play a vital role in maintaining knee function and protecting the chondral surfaces. Acute and chronic tears are common injuries among both young athletes and older patients with early degenerative changes. The progression of physiological derangement and chondral injury after meniscus injury and meniscectomy have prompted interest in expanding meniscus repair techniques. Recent literature encourages an attempt at repair in tear patterns previously declared irreparable if the tissue quality allows. The orthopedic surgeon should understand the multitude of techniques available to them and be prepared to combine techniques to optimize the quality of their repair construct. While biological augmentation may show some promising early results, the quality of the current data precludes strong recommendations in their favor.
Meniscal Ramp Lesions and Root Tears: A Review of the Current Literature
Authors: Zhou MAJ Liang , Haley COL Chad
Published: August 2021

The importance of the menisci in providing joint stability and their role in load transmission within the knee are well understood. A growing body of literature has emerged on 2 distinct injury patterns to these crucial anatomic structures, ramp lesions and root tears. Ramp lesions may be characterized as tears at the posterior meniscocapsular junction, while root tears involve bony or soft tissue avulsion of the meniscal insertions at the anterior or posterior intercondylar regions. In this 2-part review, we present an overview of the current available literature on ramp lesions and meniscal root tears, summarizing the unique anatomic considerations, etiology, biomechanics, management decisions, clinical outcomes pertinent to these very distinct injuries.
Cervical spine alignment and clinical outcomes after multilevel anterior cervical decompression and fusion with or without plate
Authors: Liang Yan , Xu Shuai , Yu Guanjie , Zhu Zhenqi , Liu Haiying
Published: August 2021

It was reported imperative on cervical sagittal alignment reconstruction after anterior multilevel procedures with self-locked stand-alone cage (SSC) or anterior cage-with-plate (ACP) system multilevel while there was little knowledge about the relationship on cervical alignment and clinical outcomes.

To identify the importance of cervical sagittal alignment after 3-level anterior cervical discectomy and fusion on cervical spondylotic myelopathy with SSC and ACP system.

Seventy-seven patients with SSC system (SSC group) and 52 cases with ACP system (ACP group) from February 2007 to September 2013 were enrolled with well-matched demographics. Cervical alignment included C2–7 lordosis (CL), operated-segment cervical lordosis (OPCL), upper and lower adjacent-segment cervical lordosis, range of motion of upper and lower adjacent segment at preoperation, immediate postoperation, and the final follow-up. Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score, visual analogous scale (VAS) of arm and neck and adjacent segment degeneration (ASD). Patients were then divided into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).

There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (P < .05) but upper adjacent-segment cervical lordosis/lower adjacent-segment cervical lordosis and range of motion of upper adjacent segment/range of motion of lower adjacent segment were of no significance. NDI, JOA, and VAS got improvement in both groups at immediate postoperation and the final follow-up while ASD was in no difference between SSC and ACP group. A total of 80 patients (39 vs 41) acquired CL improvement with a larger population in ACP group. There were no differences on the rate of ASD, NDI, JOA, VAS, and their change between IM and NIM subgroup. The changes of CL were not correlated to NDI, JOA, VAS, and their change.

SSC and ACP group both provide improved OPCL and efficacy on 3-level cervical spondylotic myelopathy with little impact on adjacent segment. The change of CL is not correlated to clinical outcomes.