bluuebunny/crossref_metadata_2025 huggingface dataset:
Ischemic Preconditioning Is Present in Patients With Non–ST Elevation Myocardial Infarction Screened With Electrocardiogram-Derived Moderate Obstructive Sleep Apnea
Authors: Borczynski Elizabeth , Suba Sukardi , Mackin Lynda A. , Mortara David W. , Badilini Fabio , Rodway George W. , Pelter Michele M.
Published: June 2022

Background

Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular events, including acute coronary syndrome (ACS). There is conflicting evidence that suggests OSA has a cardioprotective effect (ie, lower troponin), via ischemic preconditioning, in patients with ACS.

Purpose

This study had 2 aims: (1) compare peak troponin between non–ST elevation (NSTE) ACS patients with and without moderate OSA identified using a Holter-derived respiratory disturbance index (HDRDI) and (2) determine the frequency of transient myocardial ischemia (TMI) between NSTE-ACS patients with and without moderate HDRDI.

Method

This was a secondary analysis. Obstructive sleep apnea events were identified from 12-lead electrocardiogram Holter recordings using QRSs, R-R intervals, and the myogram. Moderate OSA was defined as an HDRDI of greater than or equal to 15 events per hour. Transient myocardial ischemia was defined as greater than or equal to 1 mm of ST-segment ↑ or ↓, in 1 or more electrocardiogram lead, lasting at least 1 minute.

Results

In 110 patients with NSTE-ACS, 39% (n = 43) had moderate HDRDI. Peak troponin was lower in patients with moderate HDRDI (6.8 ng/mL yes vs 10.2 ng/mL no; P = .037). There was a trend for fewer TMI events, but there were no differences (16% yes vs 30% no; P = .081).

Conclusions

Non–ST elevation ACS patients with moderate HDRDI have less cardiac injury than those without moderate HDRDI measured using a novel electrocardiogram-derived method. These findings corroborate previous studies suggesting a possible cardioprotective effect of OSA in patients with ACS via ischemic precondition. There was a trend for fewer TMI events in patients with moderate HDRDI, but there was no statistical difference. Future research should explore the underlying physiologic mechanisms of this finding.
Coexposure to Solvents and Noise as a Risk Factor for Hearing Loss in Agricultural Workers
Authors: Farfalla Alexandra A. , Beseler Cheryl , Achutan Chandran , Rautiainen Risto
Published: June 2022

Objective

This study addressed the relationship of hearing loss and coexposure to solvents and noise among farmers and ranchers in central United States.

Methods

The surveillance study included surveys to stratified random samples of operations in 2018 and 2020 (n = 34,146), requesting information on injuries, illnesses, exposures, and preventive measures. Responses (n = 7495) were analyzed using hierarchical multinomial logistic regression, adjusting for personal and work characteristics.

Results

Nearly 60% of respondents exposed to both solvents and noise reported hearing loss. The exposures increased the adjusted odds of moderate/severe hearing loss as follows: solvents alone, (odds ratio [OR], 1.49; 95% confidence interval [CI], 0.93–2.38), noise alone (OR, 4.42; 95% CI, 3.39–5.76), and coexposure to both noise and solvents (OR, 6.03; 95% CI, 4.67–7.78).

Conclusions

Solvent exposure, along with noise, should be considered in hearing conservation programs among farmers and ranchers.
Rates and Predictors of Long-term Clinical Outcomes in Patients With Perianal Crohn’s Disease on Biologic Therapy
Authors: Gubatan John , Frost Spencer , Levitte Steven , Keyashian Kian
Published: June 2022

Background and Goals:

Perianal Crohn’s disease (pCD) represents an aggressive phenotype with limited studies on long-term outcomes. We evaluated 5-year outcomes of these patients on biologic therapies.

Methods:

We performed a retrospective analysis of patients with pCD at a tertiary medical center. We used Kaplan-Meier curves to estimate rates and multivariate logistic regression to identify predictors of long-term outcomes.

Results:

We included 311 patients with pCD of which 168 patients were started on biologics [138 anti–tumor necrosis factor (TNF) α, 14 vedolizumab, 16 ustekinumab] at the time of diagnosis. Anti-TNF use at the time of diagnosis was associated with decreased rates of perianal abscess recurrence [hazard ratio (HR)=0.48, 95% confidence interval (CI): 0.32-0.74], whereas ustekinumab use was associated with increased rates of perianal fistula closure (HR=3.58, 95% CI: 1.04-12.35) and decreased rates of perianal abscess recurrence (HR=0.20, 95% CI: 0.07-0.56) at follow-up. Among patients who failed their first anti-TNF, switching to another anti-TNF was associated with decreased rates of colectomy (HR=0.20, 95% CI: 0.04-0.90) and permanent diversion (HR=0.16, 95% CI: 0.03-0.94) compared with ustekinumab, whereas vedolizumab use was associated with decreased perianal fistula closure (HR=0.22, 95% CI: 0.05-0.96) compared with ustekinumab. Predictors of colectomy included colonic disease (odds ratio=2.71, 95% CI: 1.36-5.38) and anal stenosis (odds ratio=4.44, 95% CI: 1.59-12.43).

Conclusion:

Type of biologic use at the time of pCD diagnosis or after first anti-TNF failure may be associated with long-term outcomes in patients with pCD.
Phosphate balance during dialysis and after kidney transplantation in patients with chronic kidney disease
Authors: Duque Eduardo J. , Elias Rosilene M. , Moysés Rosa M.A.
Published: June 2022

Purpose of review

In patients with chronic kidney disease (CKD), hyperphosphatemia is associated with several adverse outcomes, including bone fragility and progression of kidney and cardiovascular disease. However, there is a knowledge gap regarding phosphate balance in CKD. This review explores its current state, depending on the stage of CKD, dialysis modalities, and the influence of kidney transplantation.

Recent findings

Adequate phosphate control is one of the goals of treatment for CKD-mineral and bone disorder. However, ongoing studies are challenging the benefits of phosphate-lowering treatment. Nevertheless, the current therapy is based on dietary restriction, phosphate binders, and optimal removal by dialysis. In the face of limited adherence, due to the high pill burden, adjuvant options are under investigation. The recent discovery that intestinal absorption of phosphate is mostly paracellular when the intraluminal concentration is adequate might help explain why phosphate is still well absorbed in CKD, despite the lower levels of calcitriol.

Future studies could confirm the benefits of phosphate control. Greater understanding of the complex distribution of phosphate among the body compartments will help us define a better therapeutic strategy in patients with CKD.
The promise of artificial intelligence for kidney pathophysiology
Authors: Jiang Joy , Chan Lili , Nadkarni Girish N.
Published: June 2022

Purpose of review

We seek to determine recent advances in kidney pathophysiology that have been enabled or enhanced by artificial intelligence. We describe some of the challenges in the field as well as future directions.

Recent findings

We first provide an overview of artificial intelligence terminologies and methodologies. We then describe the use of artificial intelligence in kidney diseases to discover risk factors from clinical data for disease progression, annotate whole slide imaging and decipher multiomics data. We delineate key examples of risk stratification and prognostication in acute kidney injury (AKI) and chronic kidney disease (CKD). We contextualize these applications in kidney disease oncology, one of the subfields to benefit demonstrably from artificial intelligence using all if these approaches. We conclude by elucidating technical challenges and ethical considerations and briefly considering future directions.

The integration of clinical data, patient derived data, histology and proteomics and genomics can enhance the work of clinicians in providing more accurate diagnoses and elevating understanding of disease progression. Implementation research needs to be performed to translate these algorithms to the clinical setting.
Functional outcomes more than 5 years following acetabulum fracture
Authors: Heimke Isabella M. , Pothireddy Sahini , Krebs J. Collin , Breslin Mary A. , Vallier Heather A.
Published: June 2022

Objectives:

The purposes of this project were to evaluate functional outcomes more than 5 years after acetabulum fracture and to determine factors related to function.

Methods:

This retrospective study consisted of 205 adult patients treated for acetabulum fracture who completed the Musculoskeletal Function Assessment (MFA) a minimum of 5 years following injury. The MFA includes survey of daily activities, gross and fine mobility, social and work function, sleeping, and mood. Higher scores indicate worse function.

Results:

Two hundred five patients with 210 fractures, 69.3% of whom were male, with mean age of 45.7 and mean body mass index 30.1 were included after mean 128 months follow-up. Fracture patterns included OTA/AO 62A (37.1%), 62B (40.5%), or 62C (22.4%), and 80.0% were treated surgically. Late complications were noted in 35.2%, including posttraumatic arthrosis (PTA: 19.5%), osteonecrosis and/or heterotopic ossification. Mean MFA of all patients was 31.4, indicating substantial residual dysfunction. Worse MFA scores were associated with morbid obesity (body mass index >40: 42.3, P>.09), and current tobacco smoking history vs former smoker vs nonsmoker (45.2 vs 36.1 vs 23.0, P < .002). Patients with late complications had worse mean MFA scores (38.7 vs 27.7, P = .001); PTA was the most common late complication, occurring in 19.5%.

Conclusions:

More than 5 years following acetabulum fracture, substantial residual dysfunction was noted, as demonstrated by mean MFA. Worse outcomes were associated with late complications and tobacco smoking. While fracture pattern was not associated with outcome, those patients who had late complications, mostly PTA, had worse outcomes.
First-Year Enrollment and Utilization of New York State Paid Family Leave: 2018
Authors: Dennison Barbara A. , Ncube Butho , Nguyen Trang
Published: June 2022

Context:

The New York Paid Family Leave (NYPFL) law was passed in April 2016 and took effect January 1, 2018. Expanding paid family leave (PFL) coverage has been proposed as a public health strategy to improve population health and reduce disparities.

Objective:

To describe first-year enrollment in NYPFL and to evaluate utilization of NYPFL benefits.

Design:

Observational study.

Setting:

New York State.

Participants:

Employees enrolled in the NYPFL program (N = 8 528 580).

Methods:

We merged NYPFL enrollment and claim data sets for 2018. Descriptive analysis and multiple logistic regression models were used to assess utilization by demographic variables and business size.

Main Outcome Measure(s):

Utilization and duration of NYPFL to bond with a newborn or care for a family member differed by employees' age, sex, race and ethnicity, residence, income, and business size.

Results:

Approximately 90% of working New Yorkers (N = 8 528 580) were enrolled in NYPFL. First-year utilization of PFL for newborn bonding and family care (9.4 and 4.0 per 1000 employees, respectively) was higher than comparable state PFL programs in California, New Jersey, or Rhode Island. An estimated 38.5% of employed women in New York utilized PFL for newborn bonding. Employees who worked at small businesses (1-49 employees) had lower utilization of PFL. Employees with lower incomes were more likely to claim PFL and employees of color or with lower incomes were more likely to take the maximum 8 weeks of PFL.

Conclusions:

These findings suggest that state PFL programs increase equity in employment benefits. Wider adoption of state/federal PFL programs could help reduce health disparities and improve maternal and infant health outcomes.
Association of Peripheral Serum MicroRNAs With Persistent Phantom Limb Pain in Individuals With Amputation
Authors: Bhomia Manish , Balakathiresan Nagaraja , Zhai Min , Alphonso-Morrison Aimee , Tung Monica , Finn Sacha , Perry Briana , Hill Wendy , O’Connell Colleen , Hanling Steven , Hunt Morgan , Pasquina Paul , Tsao Jack , Knollmann-Ritschel Barbara
Published: June 2022

Objective

Individuals with major limb amputation(s) frequently experience phantom limb sensations, which are described as vivid impressions of either parts or entire missing limb(s). Despite the high incidence and prevalence of phantom limb pain, the underlying pathophysiology of phantom limb pain remains poorly understood. The objective of this study was to evaluate a possible role of microRNAs in the pathophysiology of phantom limb pain.

Design

Adults with acquired limb amputation and varying degrees of phantom limb pain consented to provide clinical data and blood samples. One hundred forty participants with single or multiple limb amputation(s) were enrolled. The Visual analog scale and neuropathic pain symptom inventory were administered to evaluate the pain. Serum samples were analyzed for microRNA expression and bioinformatic analysis was performed.

Results

Sixty-seven participants did not experience phantom limb pain, whereas 73 participants experienced varying severities of phantom limb pain measured on a pain scale. Linear regression analysis suggested that the time since amputation is inversely related to severity of the pain. A significantly increased expression of 16 microRNAs was observed in participants experiencing phantom limb pain. Bioinformatic analysis shows a possible role of these microRNAs in regulating genes expressed in peripheral neuropathy.

Conclusions

This study provides the first evidence of association of microRNA in phantom limb pain.
Novel testing system to determine shoe mechanical properties
Authors: Anderson Kirsten M. , Martens Ellyson , Powers Olivia , Wilken Jason M.
Published: June 2022

Background:

Shoes play an important role in ankle foot orthosis (AFO) function and alignment. Despite this, shoe mechanical testing systems are rarely colocated with gait analysis systems, limiting their availability and use during AFO-related studies.

Objective:

The purpose of this study was to evaluate a novel mechanical testing system used to measure shoe heel stiffness and change in height with loading using equipment available in most gait analysis laboratories. The novel testing system will allow for shoe assessment during AFO studies at little additional cost.

Study design:

Shoes were tested to determine initial stiffness, terminal stiffness, and total stiffness, and whether these measures changed with repeated compressions (early vs. late).

Technique:

The novel testing system consists of a baseplate for counterweights, uprights that support a low-friction hinge, and a lever arm with a heel-shaped indenter to apply force to the shoe. Minimal detectable change values were calculated using the standard error of measurement. Intraclass correlation coefficients were calculated in SPSS using a (2, k) model.

Results:

No significant differences in mean values, or interactions, were observed between rounds of testing and early and late compressions (P > .05). Intraclass correlation coefficient values were greater than 0.98, and minimal detectable change values were less than 20% of the average for each measure.

Conclusions:

The novel mechanical testing system, combined with pre-existing gait analysis equipment, can be used to reliably assess shoe stiffness and change in height.
Profile of the Portfolio of NIH-Funded HIV Implementation Research Projects to Inform Ending the HIV Epidemic Strategies
Authors: Queiroz Artur , Mongrella Melissa , Keiser Brennan , Li Dennis H. , Benbow Nanette , Mustanski Brian
Published: June 2022

Background:

The US government created an initiative to end the HIV epidemic in the United States by the year 2030 (EHE). This multiagency initiative was structured around four pillars: Prevent, Diagnose, Treat, and Respond to improve HIV programs, resources, and service delivery infrastructure. In support of its research mission, the National Institutes of Health (NIH) has funded implementation research (IR) projects by addressing the four pillars and encouraging investigators to collaborate with local partners and Health and Human Services (HHS) grantees in 57 priority jurisdictions.

Methods:

This paper analyzed data from the NIH funded CFAR/ARC supplement projects from 2019 to 2021. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework was used to characterize projects by stage of implementation.

Results:

The Prevent pillar was most frequently studied, with Pre-Exposure Prophylaxis (PrEP) being the most studied intervention. The most common partners were health departments, community-based organizations (CBOs), and Federally Qualified Health Centers (FQHCs). The Consolidated Framework for Implementation Research (CFIR) framework was the most utilized to investigate implementation determinants, followed by the RE-AIM framework and Proctor model to assess implementation outcomes.

Conclusion:

Monitoring the projects resulting from NIH investments is fundamental to understanding the response to EHE, and achieving these results requires systematic and continuous effort that can support the generalizable implementation knowledge emerging from individual studies. There are some remaining gaps in the project portfolio, including geographical coverage, range of implementation outcomes being measured, and interventions still requiring further research to ensure equitable scale-up of evidence based interventions and achieve EHE goals.
Tailored Motivational Interviewing in Adolescent HIV Clinics: Primary Outcome Analysis of a Stepped Wedge Implementation Trial
Authors: Naar Sylvie , MacDonell Karen , Chapman Jason , Todd Lisa , Wang Yuxia , Sheffler Julia , Fernandez Maria Isabel
Published: June 2022

Background:

Youth continue to have the poorest outcomes along the HIV prevention and care continua. Motivational Interviewing (MI) may promote behavior change and reduce perceived stigma, but providers often demonstrate inadequate MI competence. This study tested Tailored Motivational Interviewing (TMI), a set of implementation strategies designed to improve MI competence in youth HIV providers.

Setting:

Ten HIV clinics in the Adolescent Trials Network for HIV/AIDS Interventions.

Methods:

In a stepped wedge design, 10 clinics (N = 151 providers) were randomized in 5 clusters every 3 months to receive TMI for a 12-month implementation period. Sites were rerandomized within each cluster to receive communities of practice guidance with or without internal facilitator support in the sustainment period. Standard patient assessments were coded every 3 months for 36 months.

Results:

Nesting was addressed using mixed-effects regression models, with random effects for providers and sites. TMI resulted in significantly improved MI competence over baseline. Despite small reductions in competence in the sustainment window, competence was still significantly improved over baseline, with no difference between the 2 sustainment conditions.

Conclusions:

TMI may be an important tool to capacitate the HIV HealthForce to end the HIV epidemic in young people.
Safe Spaces 4 Sexual Health: A Status-Neutral, Mobile Van, HIV/STI Testing Intervention Using Online Outreach to Reach MSM at High Risk for HIV Acquisition or Transmission
Authors: Fields Errol L. , Thornton Nicole , Huettner Steven , Schumacher Christina , Barrow Genevieve , Greenbaum Adena , Jennings Jacky M.
Published: June 2022

Background:

Black men who have sex with men (MSM) carry the greatest burden of new HIV diagnoses in the United States. Ending the HIV epidemic requires strategic, culturally specific approaches to target factors contributing to persistent HIV disparities.

Setting:

Safe Spaces 4 Sexual Health (SS4SH), a community-informed HIV/sexually transmitted infection (STI) testing strategy combining mobile van testing with online outreach, was implemented over a 14-month period from 2018 to 2019 in Baltimore, MD.

Methods:

We evaluated the reach of MSM at high risk with high acquisition or transmission risk by SS4SH mobile van combined with online outreach as compared with the Baltimore City Health Department's venue-based mobile van (with no online outreach) operating during the same period based on the following HIV/STI testing outcome measures: (1) number of MSM HIV or STI tested, (2) new HIV diagnosis rate, (3) percent with new syphilis diagnosis, (4) percent at high risk for HIV acquisition, and (5) percent people living with HIV at high risk for transmission.

Results:

Over a 14-month period, SS4SH HIV/STI tested 151 MSM. Of these, 74% were Black and the mean age was 34 (SD = 10, range = 19–68). Seven percent (10/148) were new HIV diagnoses, and 10% (13/130) were diagnosed with syphilis. The Baltimore City Health Department's venue-based mobile van strategy yielded 53% (231) more MSM (71% Black, mean age 38, SD = 14, range = 15–74), but the HIV/syphilis positivity rate was significantly lower: 0.5% new HIV diagnosis rate (P < 0.001) and 0.5% with syphilis diagnosis (P < 0.001).

Conclusions:

Our findings suggest SS4SH combing online outreach with mobile van testing may be more effective at reaching high-risk Black MSM than venue-based mobile testing.
Explorations of the Role of Digital Technology in HIV-Related Implementation Research: Case Comparisons of Five Ending the HIV Epidemic Supplement Awards
Authors: Jones Jeb , Knox Justin , Meanley Steven , Yang Cui , Lounsbury David W. , Huang Terry T. , Bauermeister Jose , Gonzalez-Hernandez Graciela , Frye Victoria , Grov Christian , Patel Viraj , Baral Stefan D. , Sullivan Patrick S. , Schwartz Sheree R.
Published: June 2022

Introduction:

The use of digital technology in HIV-related interventions and implementation strategies is increasing. Whether the use of technology is to directly improve patient outcomes (ie, part of the intervention) or as part of the strategy to implement interventions has important implications. In this article, we present 5 case studies of projects that feature the use of technology in HIV-related implementation research to identify and describe challenges specific to technology-based implementation research about study design, outcome measurement, implementing in an evolving technology landscape, and equity.

Methods:

For each case study, we identified the technological components, classified the components as intervention or implementation strategy, and identified implications for measuring performance and ensuring equity. The Exploration, Preparation, Implementation, and Sustainment framework was used to identify the research stage of each project.

Results:

Technology is being leveraged across a diverse array of implementation strategies to promote Ending the HIV Epidemic in the United States. The case studies were primarily in the exploration and preparation phases of implementation, yet technology played a different role in each project— developing educational materials, mass media to recruit participants or distribute evidence-based campaigns, providing training, guiding tailoring, and implementing novel methods to democratize intervention development.

Discussion:

Technology can play multiple roles in HIV-related implementation research projects, including serving as the intervention, being leveraged within implementation strategies, or both. We identified multiple considerations across projects that should be taken into account when measuring success and planning for equitable and sustained impact.
Reconstruction of the Fourth Metacarpal Using a Chimeric Medial Femoral Condyle Vascularized Osteochondral Cutaneous Graft
Authors: S. R. G. Jorge Ana Cristina , Estler Arne , Wahler Theodora , Grözinger Gerd , Stahl Stéphane
Published: June 2022

Background

The medial femoral condyle has become a matter of great interest, thanks to the possibility of harvesting versatile chimeric flaps for reconstruction of metacarpal defects with minimal donor site morbidity. This case stands out because of the complete reconstruction of the metacarpal head, harvesting with a skin paddle for tension-free closure and monitoring, and the use of external fixation for better predictability of the reconstruction and early postoperative mobilization.

Case Presentation

We report the case of a 20-year-old male patient who presented with an aneurysmal bone cyst involving the fourth metacarpal bone. The patient underwent resection en bloc of the metaphysis and distal epiphysis of the fourth metacarpal bone, and the bone defect was reconstructed using a 3.4-cm vascularized osteochondral cutaneous graft from the medial femoral condyle.

Results

At 1-year follow-up, the patient showed no impairment in hand range of motion and had a Disabilities of Arm, Shoulder and Hand score inferior to that of the male healthy population. Almost 5 years after the procedure, the radiographic examination did not reveal signs of arthrosis. This case report shows that the medial femoral condyle is an excellent and versatile source of vascularized osteochondral grafts for reconstruction of metacarpal defects.
Outcomes of Flexor Tendon Repair in Patients With Concurrent Neurovascular Injuries of Multiple Digits in Zone 1
Authors: Cha Soo Min , Shin Hyun Dae , Lee Seung Hoo , Shin Jae Woo
Published: June 2022

Purpose

We treated several patients with multiple flexor (flexor digitorum profundus; FDP) injuries accompanied by injuries to the digital nerve or vessels around the distal interphalangeal crease (zone 1). Here, we retrospectively report the outcomes and review the literature.

Materials and Methods

Between January 2010 and December 2018, 16 patients who met the study inclusion criteria were investigated. Tendons were repaired using the cross-locked cruciate (Adelaide) technique (6-strand) or modified Becker method (4-strand). The neurovascular structures were repaired under a microscope.

Results

Sixteen patients (47 digits) were treated. According to the criteria of Moiemen and Elliot, the lacerated areas were in zones IA and IB in 7 and 40 digits, respectively. The mean ranges of motion were 149.27 ± 7.78 and 66.43 ± 2.04 degrees according to the Strickland and modified Strickland assessments, respectively. The mean 2-point discrimination was 5.00 ± 0.63 mm. Four patients (group 1) presented with injuries to 2 digits, and 9 (group 2) and 3 (group 3) patients had 3 and 4 injured digits, respectively. The outcomes were satisfactory in terms of the mean range of motion; 2-point discrimination; cold tolerance; visual analog scale pain score; Disabilities of the Arm, Shoulder, and Hand score; and grip strength. There were no differences among the groups.

Conclusions

Open multiple-finger injuries involving flexor digitorum profundus rupture with concurrent neurovascular injuries on one or both sides occasionally occur in industrial environments. Fortunately, each digit exhibits a consistent injury type in a particular anatomical location; appropriate repair yields satisfactory outcomes despite the presence of multiple injuries.
Perforators of the Anteromedial Thigh Skin and Possible Design of the Anteromedial Thigh Flap
Authors: El-Shennawy Habiba Ahmed Tawfik Mahmoud , Elzawawy Ehab Mostafa , Atta-Allah Elsayed Soliman , Omar Sally Mahmoud Mohamed Hussein
Published: June 2022

Background

Specific perforator-based flaps are a new era in plastic reconstruction. They have replaced many of the traditional paradigms in plastic surgery. The anteromedial thigh flap is a versatile flap that can be used as a primary choice for many reconstructive purposes or as a secondary choice for the anterolateral thigh flap. Mapping the vascular territory of anteromedial thigh is essential for the proper design of the flap.

Aim of the Work

The aim of this work was to study the cutaneous perforators of the anteromedial thigh and explain their significance in flap design.

Material and Methods

The material of this study included 30 fresh cadaveric lower limbs. The external iliac artery was injected with colored latex. Superficial and deep dissections were undertaken under a magnifying lens to locate the perforators and identify their type. The length and diameter of the perforators were measured.

Results

Anteromedial thigh skin was divided into 6 squares. Squares 1 and 4 are the upper squares and comprise the skin over the upper medial thigh. It is primarily based on the superficial external pudendal artery, deep external pudendal artery, and superficial circumflex femoral artery. Squares 2 and 5 are the middle squares and were mainly supplied by perforators of the superficial femoral artery. Squares 3 and 6 are the lower squares and were mainly supplied by the saphenous artery and superficial femoral artery. The possible flap designs are then discussed.

Conclusion

The anteromedial thigh skin is richly supplied by a mixture of perforators from multiple sources. The segmental nature of the perforators arising from the superficial external pudendal artery, deep external pudendal artery, superficial femoral artery, and saphenous artery together with the long course and large diameter of perforators grant the anteromedial thigh flap its versatility.
Outcomes of Free Flap Reconstruction for Chronic Venous Ulceration in the Lower Limb
Authors: Song Marie S. H. , Baldwin Alexander J. , Wormald Justin C. R. , Coleman Claire , Chan James K. K.
Published: June 2022

Background

The mainstay of treatment for venous ulceration is conservative wound management and lifelong compression therapy. For patients with recalcitrant ulcers, free flap reconstruction has been proposed as a treatment option to reconstruct the diseased soft tissues as well as the underlying insufficient venous system. This review systematically evaluates the outcomes of free flap reconstruction for chronic venous ulcers in the lower limb.

Method

A protocol was developed a priori and registered on the PROSPERO database. A systematic search of literature was performed in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), clinical trials registries, and OpenGrey from inception to April 2020 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies of patients undergoing free tissue transfer reconstruction for chronic venous ulcers in the lower limb were included.

Results

A total of 5 noncomparative cohort studies featuring 56 patients with 62 recalcitrant venous ulcers treated with 64 free flaps who had a mean age of 50 years (range, 17–76 years) were included, and a narrative analysis undertaken. Mean defect size following ulcer debridement was 153.3 cm2 (range, 24–600 cm2). Defects were reconstructed with muscle (n = 39 [60.9%]), fasciocutaneous (n = 23 [35.9%]), and visceral (n = 2 [3.1%]) free flaps, with latissimus dorsi (n = 16, 25%) and rectus abdominis flaps (n = 16, 25%) being the most frequently used. Mean follow-up ranged from 24 to 125 months. Pooled flap survival rate was 95%. No recurrence within the territory of the flap was reported, but there were 20 instances (35.7%) of new ulcers outside of the flap boundaries.

Conclusion

There is currently an absence of evidence to support the use of free flap reconstruction for recalcitrant venous ulcers compared with conventional management. Although evidence suggests that it is technically feasible, there is no evidence to suggest it prevents ulceration outside the reconstructed region. Further studies are necessary to evaluate its effectiveness for venous ulcers in the lower limb.
Tubularized and Effaced Gastric Cardia Mimicking Barrett Esophagus Following Sleeve Gastrectomy
Authors: Johari Yazmin , Budiman Kenny , Catchlove William , Laurie Cheryl , Hebbard Geoffrey , Norden Sam , Brown Wendy A. , Burton Paul
Published: June 2022

Objective:

To describe expected endoscopic and histological changes at gastro-esophageal junction (GEJ) and define diagnostic paradigms for Barrett esophagus (BE) postsleeve gastrectomy (SG).

Summary Background Data:

De novo incidence of BE post SG was reported as high as 18.8%. A confounding factor is the lack of standardized definition of BE post SG, which may differ from the general population due to procedure-induced alterations of GEJ.

Methods:

Part 1 involved evaluating endoscopic changes of GEJ post SG (N = 567) compared to pre SG (N = 320), utilizing protocolized preoperative screening, postoperative surveillance and synoptic reporting. Part 2 involved dedicated studies examining causes of altered anatomical and mucosal GEJ appearance using histopathology (N = 55) and high-resolution manometry (HRM) (N = 15).

Results:

Part 1 – A characteristic tubularized cardia segment projecting supra-diaphragmatically was identified and almost exclusive to post SG (0.6% vs.26.6%, P < 0.001). True BE prevalence was low (4.1%pre SG vs. 3.8%post SG, P = 0.756), esophagitis was comparable (32.1% vs. 25.9%, P = 0.056). Part 2 - Histologically-confirmed BE was found in 12/55 patients, but 70.8% had glandular-type gastric mucosa implying tubularized cardia herniation. HRM of tubularized cardia demonstrated concordance of supra-diaphragmatic cardia herniation between endoscopy and HRM (3 cm vs. 3.2 cm, P = 0.168), with frequent elevated isobaric intraluminal pressurizations in supra-and infra-diaphragmatic cardia compartments.

Conclusion:

A novel appearance of tubularized cardia telescoping supra-diaphragmatically with flattening of gastric folds is common post SG, likely associated with isobaric hyper-pressurization of proximal stomach. incidence of true BE post SG is low in short-intermediate term. These provided a clear framework for approaching endoscopic screening and surveillance, with correct anatomical and mucosal identifications, and clarified key issues of SG and BE.
Opioid Consumption After Urogynecologic Surgery: A Prospective Multicenter Observational Study Using a Text-Messaging Survey Tool
Authors: Dahl Molly E. , McDonald Katherine C. , Brown Oluwateniola , Halder Gabriela , Crouss Tess , Pan Christine , Eckhardt Sarah , Hoover Mallorie , Dancz Christina E.
Published: June 2022

Importance

Understanding postoperative opioid consumption is key to reducing opioid misuse.

Objective

The aim of the study was to quantify the amount of outpatient opioids consumed after urogynecologic surgery.

Study Design

This is a prospective multicenter cohort study sponsored by the American Urogynecologic Society Fellow’s Pelvic Research Network. Women undergoing pelvic organ prolapse or urinary incontinence surgery between May 2019 and January 2021 were included. Patients used text messaging to report daily opioid consumption, pain levels, and nonopioid analgesic consumption 2 weeks postoperatively. Demographic and perioperative factors associated with high opioid use (>75th percentile) were identified.

Results

Two hundred sixty-one patients were included from 9 academic centers. The median (interquartile range) morphine milligram equivalents (MME) consumed were 28 (0–65) and prescribed were 75 (50–113). The median ibuprofen and acetaminophen tablets consumed were 19 (10–34) and 12 (4–26). The median pain level was 2.7 of 10 (1.7–4.4). Factors associated with high MME use (>65 MME) included body mass index greater than 30 (P < 0.01), chronic pain (P < 0.01), elevated baseline pain score (P < 0.01), elevated blood loss (P < 0.01), longer operating time (P < 0.01), and southern region (P < 0.01). High MME consumers more frequently underwent perineorrhaphy (P = 0.03), although this was not significant on multivariate analysis.

Conclusions

Urogynecology patients consume a median of 28 MME (3–4 oxycodone 5-mg tablets) after surgery, and surgeons prescribe 3 times this amount (75 MME, 10 oxycodone tablets). In addition, there are several factors that can be used to identify patients who will require greater numbers of opioids. These data may be used to enhance existing prescribing guidelines.
One-Year Changes in Optic Nerve Head Parameters in Recovered COVID-19 Patients
Authors: Burgos-Blasco Barbara , Güemes-Villahoz Noemi , Vidal-Villegas Beatriz , Martinez-de-la-Casa Jose M. , Garcia-Feijoo Julian , Donate-Lopez Juan , Martin-Sanchez Francisco J. , Gonzalez-Armengol Juan J. , Mendez-Hernandez Carmen D.
Published: June 2022

Background:

The main purpose was to evaluate the changes in peripapillary retinal nerve fiber layer (RNFL) thickness and vessel density (VD) in post–COVID-19 patients during 12-month follow-up.

Methods:

In this prospective study, patients with COVID-19 who were attended in the Hospital Clinico San Carlos (Madrid, Spain) were included. All patients underwent a complete ophthalmological examination, optic nerve head optical coherence tomography (OCT), and OCT angiography (OCTA) using the Cirrus HD-OCT 5,000 with AngioPlex OCTA 1, 3, and 12 months after laboratory-confirmed diagnosis. Sociodemographic data, medical history, disease severity, and laboratory workup were registered.

Results:

A total of 180 eyes of 90 patients with SARS-CoV-2 infection were included; the mean age was 55.5 ± 8.9 years, and 46 patients (51%) were females. The mean visual acuity was 0.76 ± 0.16, and no abnormalities attributable to SARS-CoV-2 were detected in the ocular or fundus examination. No differences in the OCT and OCTA data were found between severity groups in each visit (all P > 0.05). Overall, there was a decrease in RNFL global thickness (P < 0.001) from the first to the last visit, and an increase in VD and flux index was noted in some sectors at the 12-month examination. A significant correlation was detected at 12 months between vascularization parameters and RNFL thickness.

Conclusions:

One year after SARS-CoV-2 infection, changes in peripapillary RNFL thickness and vascularization occur, possibly indicating a recovery in such parameters.
Ocular Motor Nerve Palsy After Traumatic Brain Injury: A Claims Database Study
Authors: Heo Hwan , Lambert Scott R.
Published: June 2022

Background:

Traumatic brain injury (TBI) is one of the common causes of ocular motor nerve (oculomotor nerve [CN3], trochlear nerve [CN4], and abducens nerve [CN6]) palsies, but there has been no large study of ocular motor nerve palsy caused by TBI. This study aimed to investigate the characteristics of and differences in ocular motor nerve palsy after TBI, according to patient age and severity of TBI.

Methods:

This was a population-based retrospective cohort study that included patients who had ocular motor nerve palsy after TBI with ≥6 months of continuous enrollment using claims data from the IBM MarketScan Research Databases (2007–2016). We assessed sex, age at the first diagnosis of TBI, the severity of TBI, and the rates of strabismus procedures according to the age and severity of TBI. The rates of muscle transposition surgery and chemodenervation in CN3, CN4, and CN6 palsy were investigated.

Results:

A total of 2,606,600 patients with TBI met the inclusion criteria. Among them, 1,851 patients (0.071%) had ocular motor nerve palsy after TBI. The median age of the patients was 39 (Q1–Q3: 19–54) years, and 42.4% of the patients were female. The median continuous enrollment period after the first diagnosis of TBI was 22 (Q1–Q3: 12–38) months. Of the 1,350,843 children with TBI, 454 (0.026%) had ocular motor nerve palsy. Of the 1,255,757 adults with TBI, 1,397 (0.111%) had ocular motor nerve palsy. Among these 1,851 patients, CN4 palsy (697, 37.7%) occurred most frequently, and strabismus procedures were performed in 237 patients (12.8%). CN6 palsy developed most frequently in children. More children (16.5%) underwent strabismus surgeries than adults (11.6%) (P = 0.006). The proportion of CN4 palsy (52.3%) was higher while the proportion of CN3 palsy (15.5%) was lower in patients with mild TBI than in patients with moderate-to-severe TBI (P < 0.001).

Conclusions:

CN4 palsy developed most frequently among patients of all ages, and only approximately 13% of the patients underwent strabismus procedures for ocular motor nerve palsy after TBI. The rate of development of ocular motor nerve palsy was approximately 4.3 times lower in children than adults, and children most frequently had CN6 palsy after TBI.
Intra-amniotic Injection of Poly(lactic-co-glycolic Acid) Microparticles Loaded with Growth Factor: Effect on Tissue Coverage and Cellular Apoptosis in the Rat Model of Myelomeningocele
Authors: Maassel Nathan L , Wu Douglas H , Yung Nicholas K , Bauer-Pisani Tory , Elizabeth Guerra Mary , Ullrich Sarah J , Mark Saltzman W , Stitelman David H
Published: June 2022

BACKGROUND:

Myelomeningocele (MMC) is a devastating congenital neurologic disorder that can lead to lifelong morbidity and has limited treatment options. This study investigates the use of poly(lactic-co-glycolic acid) (PLGA) microparticles (MPs) loaded with fibroblast growth factor (FGF) as a platform for in utero treatment of MMC.

STUDY DESIGN:

Intra-amniotic injections of PLGA MPs were performed on gestational day 17 (E17) in all-trans retinoic acid-induced MMC rat dams. MPs loaded with fluorescent dye (DiO) were evaluated 3 hours after injection to determine incidence of binding to the MMC defect. Fetuses were then treated with PBS or PLGA particles loaded with DiO, bovine serum albumin, or FGF and evaluated at term (E21). Fetuses with MMC defects were evaluated for gross and histologic evidence of soft tissue coverage. The effect of PLGA-FGF treatment on spinal cord cell death was evaluated using an in situ cell death kit.

RESULTS:

PLGA-DiO MPs had a binding incidence of 86% and 94% 3 hours after injection at E17 for doses of 0.1 mg and 1.2 mg, respectively. Incidence of soft tissue coverage at term was 19% (4 of 21), 22% (2 of 9), and 83% (5 of 6) for PLGA-DiO, PLGA-BSA, and PLGA-FGF, respectively. At E21, the percentage of spinal cord cells positive for in situ cell death was significantly higher in MMC controls compared with wild-type controls or MMC pups treated with PLGA-FGF.

CONCLUSION:

PLGA MPs are an innovative minimally invasive platform for induction of soft tissue coverage in the rat model of MMC and may reduce cellular apoptosis.
Understanding the Effect of Bias on the Experience of Women Surgeons: A Qualitative Study
Authors: Olsen Bridget C , Barron Sivana L , Gutheil Caitlin M , Blazick Elizabeth A , Mayo Sara W , Turner Elizabeth N , Whiting James F
Published: June 2022

BACKGROUND:

Exploring the lived experiences of surgeons is necessary to understand the changing culture of surgery and the unique challenges of being a woman in surgery. Surgeons have significant experiences and observations best discovered through qualitative study. The purpose of this study is to identify the similarities and differences between the experiences of men and women surgeons after initiation of mandatory microaggression training.

STUDY DESIGN:

Qualitative semi-structured interviews with female and male surgeons and residents were done following a year-long series of training sessions on the detrimental effects of microaggression. Participants were selected using a convenience sampling method. MAXQDA coding software (Verbi) was used to evaluate interview transcripts with thematic analysis.

RESULTS:

Nineteen surgeons and surgical residents were interviewed. The participants were of equal gender identification, with the majority being attending surgeons. Multiple themes highlighted similarities and differences between male and female participants. Differences were noted in identification of a sensitive personality, family planning considerations, and experiences of bias. Similarities were related to the personality traits required to be successful in surgery, the sacrifice inherent to a surgical career, and the war rhetoric used to describe the comradery of residency.

CONCLUSION:

The challenges and rewards of surgery are similar for women and men, but women have additional stressors, including gender-based bias, microaggression, and family planning. These stressors take up energy, decreasing the mental space available for additional roles and affecting the work environment. Microaggression education can incite necessary discussions of bias and provide women with an opportunity to reflect on and share their experiences.
Anastomosis Time and Outcomes after Donation after Circulatory Death Kidney Transplantation
Authors: Cron David C , Murakami Naoka , Xiang Lingwei , Markmann James F , Yeh Heidi , Adler Joel T
Published: June 2022

BACKGROUND:

At every stage in the transplantation process for a deceased-donor kidney, time means ischemia. Donation after circulatory death (DCD) kidneys are already subject to warm ischemia in the donor, but another underappreciated component of warm ischemia time is the time required for anastomosis prior to reperfusion. We studied the effect of anastomosis time (AT) on outcomes after DCD kidney transplantation.

STUDY DESIGN:

This is a retrospective study of the Scientific Registry of Transplant Recipients, including all US adult DCD kidney transplantation recipients from 2009 to 2015 (N = 6,397). Our exposure was AT (time out of cold storage until reperfusion, quartiles). Outcomes included delayed graft function (DGF), death-censored graft survival, and overall patient survival. Multivariable logistic and Cox regression quantified the association of AT with outcomes, adjusting for donor and recipient factors (including donor warm ischemia time).

RESULTS:

AT accounted for 67% of total warm ischemia time on average, with a median AT of 38 minutes (median total warm ischemia 56 minutes). Longer AT (fourth [≥48min] vs first quartile [≤30min]) was associated with increased DGF (odds ratio = 1.19, p = 0.024) and increased graft failure (hazard ratio = 1.21, p = 0.043) but was not associated with patient survival. Comparing patients with the longest vs shortest AT, adjusted DGF incidence was 44.0% vs 36.7% (p = 0.024), and 5-year graft survival was 84.8% vs 88.2% (p = 0.004).

CONCLUSION:

Prolonged AT is associated with worse graft outcomes in DCD kidney transplant recipients. Efforts to minimize rewarming during implantation and optimize AT may improve graft outcomes.
Variation in Hospital Cost and 1-Year Episodes of Care after Diaphragmatic Hernia Repair
Authors: Kulshrestha Sujay , Penton Ashley , Luchette Fred A , Baker Marshall S , Abdelsattar Zaid M
Published: June 2022

BACKGROUND:

Diaphragmatic hernia repair is a common operation performed at all types of hospitals. The variation in costs and repeat episodes of care after this operation is not known.

STUDY DESIGN:

The Healthcare Cost and Utilization Project State Inpatient and State Ambulatory Surgery and Services Databases for Florida were queried to identify patients undergoing diaphragmatic hernia repair between 2011 and 2018 and the associated inpatient and outpatient encounters within 12 months postoperatively. Hospitals were ranked by cost and grouped into quintiles. All costs and charges were reliability and case-mix adjusted with the use of hierarchical multivariable regression.

RESULTS:

In total, 8,848 patients underwent diaphragmatic hernia operations at 158 hospitals. The most expensive hospital quintile had lower surgical volume, location in rural settings, and fewer than 100 beds. There was a wide variation in costs after diaphragmatic hernia repair. On unadjusted comparison, index costs were $23,041 more expensive in hospitals in the highest quintile than in the lowest quintile. Cost differences were persistent even after case-mix and reliability adjustment. The variation in adjusted aggregate charges for associated outpatient and inpatient encounters in the first year after the index operation was considerably lower than that of the index hospitalization.

CONCLUSION:

There is nearly a 2-fold variation in the cost of a diaphragmatic hernia repair across hospitals. Most of the variation occurs during the index surgical encounter and not for repeat encounters during the first postoperative year. As bundled payment models mature, hospitals and payers will need to target this variation to ensure cost-efficiency.