bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of obesity and cardiovascular disease and progress in pharmacotherapy: what is next for obesity?
Authors: Mallah Manthar Ali , Soomro Tahmina , Noreen Sobia , Ali Mukhtiar , Kafle Akriti , Khatoon Nafeesa , Naveed Muhammad
Published: February 2023

Obesity has recently emerged as one of the most severe health concerns. Obesity is a key autonomous risk factor for heart failure and contributes to cardiovascular disease (CVD) risk factors such as hypertension, type 2 diabetes, and metabolic abnormalities. Obesity is caused by a metabolic imbalance, which occurs when calories burnt are fewer than the number of calories consumed. There are several pathways accountable for the adverse impacts of obesity on the cardiovascular system. Inflammatory cell infiltration develops in the adipose tissue, the pancreas, and other issues similar to the progression of obesity. Inflammation is triggered by immune cells that invade dysfunctional adipose tissue. The atherosclerotic inflammation phase, related to obesity, induces coronary calcification. Obesity is linked to elevated levels of leptin and high blood pressure. Leptin causes systemic vasoconstriction, sodium retention, and increased blood pressure by influencing the synthesis of nitric oxide and activating the sympathetic nervous system. Obesity is a well-known risk factor for CVD and is one of the leading causes of the greater risk of diseases, including dyslipidemia, hypertension, depression, metabolic syndrome, atrial fibrillation, and heart failure in adults and children. When used with dietary improvements, antiobesity drugs improve the probability of experiencing clinically healthy (5%) weight loss. This review aimed to address the consequences of obesity on cardiac structure and function, risk factors, the impact of the obesity paradox, pharmacological treatment strategies for managing and recommended exercise and diet.
Promotion of Student Engagement Through the Application of Good Practices in Nursing Online Education
Authors: Hampton Debra , Hardin-Fanning Fran , Culp-Roche Amanda , Hensley Angie , Wilson Jessica L.
Published: February 2023

The purpose of this article is to review Chickering and Gamson's principles of good practice in teaching and to illustrate their applicability to nursing online education delivery. An additional purpose is to present examples of teaching methods used by faculty to promote engagement in online education courses during the pandemic. The original 7 best practices in education, including (a) encourages contact between students and faculty, (b) develops reciprocity and cooperation among students, (c) uses active learning techniques, (d) gives prompt feedback, (e) emphasizes time on task, (f) communicates high expectations, and (g) respects diverse talents and ways of learning, remain evidence-based guidelines today. The authors recommend the addition of 2 new best practices: (a) incorporating assignment flexibility to meet student learning preferences; and (b) applying learning to real-life situations. Having evidence-based guidelines for supporting the role of a teacher in the online learning setting is of paramount importance.
Living as a Survivor: Sleep Disturbance, Fatigue, Depressive Mood, and Cognitive Dysfunction After Breast Cancer Treatment
Authors: Wu Horng-Shiuann , Gao Feng , Given Charles
Published: February 2023

Background

Many cancer survivors endure multiple symptoms while striving to return to a normal life. Those symptoms often co-occur and exacerbate one another; however, their interplay is not fully understood.

Objective

This study aimed to examine the occurrence and concurrence of sleep disturbance, fatigue, depressive mood, and cognitive dysfunction in posttreatment breast cancer survivors.

Methods

The data for this descriptive analysis were collected as part of the screening for a clinical trial. The occurrences of sleep disturbance, depressive mood, and cognitive dysfunction were each determined by the cutoff scores of the Pittsburgh Sleep Quality Index, Center for Epidemiological Studies Depression Scale, and Montreal Cognitive Assessment, respectively; fatigue was determined by meeting the International Classification of Diseases cancer-related fatigue criteria.

Results

A convenience sample of 81 women completed chemotherapy or/and radiation for stage I-III breast cancer an average of 23.1 (±SD = 9.0) months ago. Sleep disturbance (85%) was most prevalent, followed by fatigue (67%), depressive mood (46%), and cognitive dysfunction (29%). Of the survivors, 80% reported 2 or more co-occurring symptoms. Worsened subjective sleep quality, sleep disturbance, and daytime dysfunction significantly increased the risk of fatigue by 5.3, 4.3, and 4.3 times (all P < .001) and depression by 2.0, 2.7, and 3.0 times (all P < .05), respectively.

Conclusion

Sleep disturbance significantly increased the risk of survivors’ fatigue and/or depressive mood after cancer treatment completion.

Implication for Practice

Effectively managing sleep disturbance and improving the individual’s sleep perception may subsequently reduce fatigue and/or depressive mood among breast cancer survivors. Nonpharmacological strategies for managing multiple posttreatment symptoms are needed.
The Relationship Between Social Support and Suicide Resilience in Chinese Cancer Patients: A Serial Multiple Mediation Model Through Self-care Self-efficacy and Meaning in Life
Authors: Zhang Yinying , Ding Xiaoping , Liu Yilan , Han Yanhong , Wang Gang , Cai Meijie , Zhang Yan , Hu De-Ying
Published: February 2023

Background

A growing body of literature has shown a higher risk of suicide in cancer patients compared with the general population. Early detection of factors related to suicide resilience in cancer patients could prevent loss of life.

Objective

The study aimed to investigate the serial-multiple mediation of self-care self-efficacy and meaning in life in the relationship between social support and suicide resilience among Chinese cancer patients.

Methods

A cross-sectional investigation of 287 cancer patients using a battery of self-reported questionnaires was performed. For preliminary analyses, descriptive, univariate, and Pearson correlation analyses were performed. Mediation analyses were tested using a serial-multiple mediation model (PROCESS model 6).

Results

Mediation analysis indicated the indirect effects of social support on suicide resilience mediated solely by either self-care self-efficacy (point estimate = 0.20; 95% confidence interval [CI], 0.12–0.30), or by meaning in life (point estimate = 0.06; 95% CI, 0.01–0.12), or by the multiple mediation of self-care self-efficacy to meaning in life (point estimate = 0.03; 95% CI, 0.01–0.06).

Conclusions

The findings demonstrated the crucial direct or indirect effects of social support, self-care self-efficacy, and meaning in life on facilitating cancer patients’ suicide resilience.

Implications for Practice

Oncology nurses, as 24-hour care providers for cancer patients, may interact with and be important sources for the psychosocial care of cancer patients at risk of suicide. Prevention and intervention efforts must be directed at assisting cancer patients, improving self-care self-efficacy, and finding meaning in life after a cancer diagnosis.
The Association Between Engagement in Activities of Daily Living and Care Interactions for Residents Living With Dementia
Authors: McPherson Rachel , Resnick Barbara , Galik Elizabeth , Gruber-Baldini Ann L. , Holmes Sarah , Kusmaul Nancy
Published: February 2023

Background:

Care interactions are essential to residents with dementia.

Purpose:

The purpose of the study was to describe the characteristics and quality of staff-resident care interactions among nursing home residents living with dementia and to test whether the quality of staff-resident care interactions varied by resident level of engagement in the interaction. Specifically, it was hypothesized that controlling for age, gender, comorbidities, cognition, and function, actively engaged residents would have more positive care interactions with staff compared with passively engaged residents.

Methods:

This was a secondary data analysis using baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia intervention study.

Results:

A total of 532 residents were included. Actively engaged residents had significantly more positive interactions compared to passively engaged residents.

Conclusions:

Passively engaged residents may be at risk to receive poor quality care interactions. Strategies and interventions to optimize care interactions for these individuals are needed.
The Johns Hopkins Activity and Mobility Promotion Program
Authors: McLaughlin Kevin H. , Friedman Michael , Hoyer Erik H. , Kudchadkar Sapna , Flanagan Eleni , Klein Lisa , Daley Kelly , Lavezza Annette , Schechter Nicole , Young Daniel
Published: February 2023

Background:

Greater mobility and activity among hospitalized patients has been linked to key outcomes, including decreased length of stay, increased odds of home discharge, and fewer hospital-acquired morbidities. Systematic approaches to increasing patient mobility and activity are needed to improve patient outcomes during and following hospitalization.

Problem:

While studies have found the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program improves patient mobility and associated outcomes, program details and implementation methods are not published.

Approach:

JH-AMP is a systematic approach that includes 8 steps, described in this article: (1) organizational prioritization; (2) systematic measurement and daily mobility goal; (3) barrier mitigation; (4) local interdisciplinary roles; (5) sustainable education and training; (6) workflow integration; (7) data feedback; and (8) promotion and awareness.

Conclusions:

Hospitals and health care systems can use this information to guide implementation of JH-AMP at their institutions.
Implementation of Evidence-Based Practice in Peripheral Intravenous Catheter Care
Authors: Hontoria-Alcoceba Rocío , López-López Candelas , Hontoria-Alcoceba Virginia , Sánchez-Morgado Ana Irene
Published: February 2023

Background:

Inserting a peripheral intravenous (PIV) catheter is a common health care procedure; however, risks include phlebitis, extravasation, and accidental dislodgement. Using evidence-based practices (EBPs) can reduce these risks.

Purpose:

The purpose of this study was to implement an evidence-based PIV catheter care bundle and a decision-making algorithm.

Methods:

A quasi-experimental study design was used. A care bundle and an evidence-based decision-making algorithm were implemented on a medical unit. Outcomes included length of PIV catheter dwell time, phlebitis and other complications, and health professionals' adherence to the interventions.

Results:

A total of 364 PIV catheters were assessed. PIV catheter dwell time decreased from 3.6 to 2.9 days (P < .001), and phlebitis rates decreased from 14.8% to 4.9% (P < .05). Health professionals' adherence increased from 84.3% to 91.8%.

Conclusions:

Implementing EBPs can improve care provided to patients with PIV catheters.
Innovative Education With Super User Model for Complex Nursing Practice Change
Authors: Olson Courtney , Wittwer Wendy , Webber Megan
Published: February 2023

The purpose of this article was to describe the unique education method and super user model utilized to prepare for, support, and facilitate ongoing optimization of infusion pump/electronic health record integration at one integrated healthcare system in the Midwest. Although we are describing how this model was used for a specific technology project, it should be considered as an alternative for any implementation that traditionally calls for classroom education.
Stroke Counseling Intervention for Young Adult African Americans
Authors: Aycock Dawn M. , Clark Patricia C. , Hayat Matthew J. , Salazar Laura F. , Eriksen Michael P.
Published: February 2023

Background

African Americans have a higher incidence of early-onset stroke and poorer stroke-related outcomes than other race/ethnic groups.

Objectives

Our two-arm, randomized controlled trial was implemented to assess efficacy of the nurse-led Stroke Counseling for Risk Reduction (SCORRE) intervention in reducing stroke risk in young African American adults by improving accuracy of perceived stroke risk and lifestyle behaviors (i.e., diet, physical activity, and smoking cessation). Stroke knowledge, behavior change readiness, and perceived competence to live a healthy lifestyle were also explored as secondary outcomes.

Methods

African Americans aged 20–35 years, recruited from an urban university and surrounding community, were randomized to SCORRE or an attention placebo control group receiving safe sex education. Data were collected pre-intervention, immediate post-intervention, and at 8 weeks. Multilevel models were used for primary outcome analyses.

Results

Participants (n = 106) were mostly in their mid-20s, female, college students, and averaged about three modifiable stroke risk factors. Compared to the control group, participants in the intervention group had, on average, a significant increase in accuracy of perceived stroke risk post-intervention, a greater change in perceived competence to live healthy, and a greater increase in dietary components at 8 weeks. Significant changes were not found in physical activity and other outcomes.

Discussion

These findings suggest that SCORRE is a promising intervention to reduce stroke risk among young African American adults. Results will inform a more robust, randomized controlled trial of SCORRE to have an age, culture, and gender-focused intervention that effectively reduces stroke risk among African Americans early in life.
Validation of Self-Reported Attachment Classification Among Racially and Ethnically Diverse Parents of Young Children
Authors: Cain Cary M. , Mandell Dorothy J. , Padhye Nikhil S. , Rozmus Cathy L.
Published: February 2023

Background

The Attachment Style Questionnaire (ASQ) was developed to measure individual differences in insecure adult attachment and was suitable for populations that may have minimal or no experience in romantic relationships. The measure was previously validated on homogenous populations.

Objectives

The purpose of this study was to verify construct validity and internal consistency of the ASQ among an ethnically and racially diverse sample of caregivers of young children ages birth to 3 years.

Methods

Using a cross-sectional design, we examined the psychometric properties of the ASQ. A racially and ethnically diverse sample of caregivers of young children (birth to 3 years old) completed the 40-item measure. Factor analyses and internal consistency analyses were conducted.

Results

Confirmatory factor analyses showed that the previously published factor structures were not a good fit for this diverse sample. Exploratory factor analysis with promax rotation revealed a four-factor solution among 16 items, including relationship anxiety, relationships as secondary, discomfort with closeness, and relationship distrust. Adequate internal consistency was noted for the factors, and structural invariance was confirmed across Hispanic and non-Hispanic ethnicities.

Discussion

Nurse scientists and practitioners should take caution when using or developing indices based on previous research. There should be consideration of structural stability and replication across the intended population.
CGRP, Migraine, and Brain MRI in CADASIL
Authors: Goldstein Eric D. , Gopal Neethu , Badi Mohammed K. , Hodge David O. , de Havenon Adam , Glover Patrick , Durham Paul L. , Huang Josephine F. , Lin Michelle P. , Baradaran Hediyeh , Majersik Jennifer J. , Meschia James F.
Published: February 2023

Background:

Migraine is associated with neuroimaging differences in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). However, it is unknown if migraine-related disability (MRD) or if calcitonin gene-related peptide (CGRP), a vasoactive peptide important in migraine pathology, have radiographic implications. The aims of this study were to identify whether MRD or interictal serum CGRP levels impacted neuroimaging findings for those with CADASIL.

Materials and Methods:

A cross-sectional analysis was performed. The primary outcomes were neuroimaging differences associated with MRD among those with migraine or interictal serum CGRP levels of those with and without migraine. MRD was defined by 2 migraine disability scales (Migraine Disability Assessment, Headache Impact Test-6). Retrospective brain magnetic resonance imaging was reviewed (average 1.7 ± 2.0 y before enrollment). Rank-sum and χ2 tests were used.

Results:

Those with migraine (n=25, vs. n=14 without) were younger [median 49 (25 to 82) y vs. 60 (31 to 82) y, P<0.007], had fewer cerebral microbleeds (0 to 31 vs. 0 to 50, P=0.02) and less frequently had anterior temporal lobe T2 hyperintensities [68% (17/25) vs 100% (14/14), P=0.02]. MRD scale outcomes had no significant radiographic associations. Interictal serum CGRP did not differ (migraine: n=18, 27.0±9.6 pg/mL vs. no migraine: n=10, 26.8±15.7 pg/mL, P=0.965).

Conclusions:

Migraine may forestall microangiopathy in CADASIL, though possibly independent of severity as measured by MRD. Interictal serum CGRP did not differ in our cohort suggesting CGRP may not be vital to migraine pathophysiology in CADASIL. Larger studies are needed to account for age differences.
Does Dry Eye Disease Severity Impact Efficacy of Varenicline Solution Nasal Spray on Sign and Symptom Treatment Outcomes?
Authors: Sheppard John D. , O’Dell Leslie E. , Karpecki Paul M. , Raizman Michael B. , Whitley Walter O. , Blemker Gretchen , Hemphill Mandy , Hendrix Laura H. , Gibson Andrea , Macsai Marian
Published: February 2023

Significance

There is a clinical necessity for dry eye disease treatments that perform across a broad range of presenting patient severities. Varenicline solution nasal spray (VNS), a unique cholinergic agonist ocular surface-sparing nasal spray therapy, demonstrated significant improvement in both signs and symptoms of dry eye disease in subjects with mild, moderate and severe symptoms as the clinical studies enrolled a more real-world patient population.

Purpose

This study evaluated efficacy outcomes for VNS in patients with mild-moderate and severe dry eye disease.

Methods

Analysis of integrated data from two randomized clinical trials: ONSET-1 (NCT03636061) and ONSET-2 (NCT04036292) (vehicle control [VC], n = 294; VNS 0.03 mg, n = 308). Adults ≥22 years with dry eye disease, Ocular Surface Disease Index score ≥ 23, corneal fluorescein staining score ≥ 2 in ≥1 regions/≥4 all regions, and Schirmer Test Score (STS) ≤10 mm (no restrictions on eye dryness score [EDS]). Efficacy was evaluated using analysis of covariance among prespecified subgroups of mild-moderate and severe baseline disease severity defined by STS (≤5 versus >5) and EDS (<60 versus ≥60). Consistency of effect was evaluated by interaction tests.

Results

No treatment-subgroup interactions were observed for all end points (P > 0.05). Odds of achieving a ≥ 10 mm improvement in STS for VNS versus VC for patients with baseline STS ≤5 and > 5 were 3.4(95%CI, 2.0–5.6) and 2.3(1.3–4.0); for EDS <60 and ≥ 60 were 3.4(1.9–6.1) and 2.5(1.5–4.0). Least squares mean treatment/VC differences in change from baseline in EDS for patients with baseline STS ≤5 or > 5 were − 7.4(95% confidence interval, −12.5 to −2.4) and − 2.8(−8.7 to 3.1); EDS <60 and ≥ 60 were − 2.9(−8.3 to 2.5) and − 8.1(−13.6 to −2.6).

Conclusions

Compared with VC, VNS improved tear production and patient-reported symptoms in patients with dry eye disease, demonstrating consistency of effect regardless of initial presenting severity.
Casein Protein Block to Optimize Immunohistochemistry Detection of Surface Immunoglobulin Heavy Chain Expression in Lymphoid Cells
Authors: Lossos Chen , Nadji M. , Lossos Izidore S. , Chapman Jennifer R.
Published: February 2023

We describe our recent experience of studying expression of immunoglobulin (Ig) heavy chain (IgG, IgM, and IgA) in lymphoid cells comprising a research set of formalin-fixed, paraffin-embedded human diffuse large B-cell lymphoma samples. We found that using typical clinical automated immunohistochemistry protocols and usual buffers as blocking agents, the extent of undesirable staining was extreme and impaired our ability to interpret heavy chain Ig expression by individual lymphoid cells. We were not able to optimize this with serial dilutions in antibody concentration or time of primary antibody exposure. We therefore developed an added step of casein protein block, which solved the problem. We are not aware of other such reports in clinical or human research tissue sets and believe this solution may be useful when clinical pathologists or researchers encounter similar technical issues.
Aberrant MUC Immunohistochemical Expressions in Inflammatory Bowel Diseases
Authors: Hamamoto Yuichiro , Kawamura Michihiro , Uchida Hiroki , Takagahara Kojiro , Katori Chiaki , Asai Hinako , Harada Hiroshi , Shimizu Shigeki , Morii Eiichi , Yoshida Kyotaro
Published: February 2023

Ulcerative colitis (UC) and Crohn disease (CD) are cryptogenic inflammatory bowel diseases that are suggestive of aberrant mucin (MUC) expression; however, their relationship remains unclear. Here, we examined aberrant MUC expression in intestinal samples from UC and CD patients in comparison to samples from patients with ischemic colitis and control groups. To study the expression of MUC1, MUC5AC, and MUC6 in different patient groups, we reviewed the slides stained with hematoxylin and eosin and performed immunohistochemistry. The results revealed that MUC1 was expressed more in the UC group and MUC6 in the CD group. No significant changes were observed in MUC expression in the ischemic colitis group. Overall, we demonstrated changes in MUC expression in UC and CD, which can help in the diagnosis and early clinical management of UC and CD.
Learning effect for large joint diagnostic aspirations with fluoroscopy and ultrasound
Authors: Foley Justin , Roesly Heather , Provo Justin , Henrie A. Michael , Teramoto Masaru , Cushman Daniel M.
Published: February 2023

Objective

The first objective was to identify if increased experience, gauged by number of procedures performed post-training, is correlated with greater likelihood of obtaining joint fluid in diagnostic aspirations. The second objective was to identify whether trainee involvement at the time of procedure affected the success rate of the procedure (which in this case was obtaining fluid on aspiration).

Design

This was a retrospective analysis of fluoroscopic- and ultrasound-guided large joint aspirations. Logarithmic fit was performed to identify the presence of a learning curve to the successful attainment of fluid with experience. Logistic regression analysis was used to identify if trainee presence for a procedure affected fluid attainment.

Results

Ultrasound did not demonstrate a significant fit to the logarithmic curve (p = 0.447), while fluoroscopy did (p < 0.001), indicative of a learning curve for fluoroscopy. After adjusting for covariates, joint fluid was successfully attained at a similar rate if trainees were present or not. Significant independent factors related to successful joint fluid attainment were: image guidance technique (p = 0.001), BMI (p = 0.032), and joint aspirated (overall p < 0.001).

Conclusion

There was a statistically significant learning curve for fluoroscopic-guided joint aspirations, but not with ultrasound guidance. Trainee involvement did not affect the success rate of joint aspirations.
Incidence and disease course of COVID-19 infection amongst unvaccinated patients who received local corticosteroid injections
Authors: Okçu Mehmet , Azizov Shahin , Gündüz Osman Hakan , Şencan Savaş
Published: February 2023

Objective

There are concerns that local corticosteroid injections may increase the risk of COVID-19 infection due to the immunosuppressive effect of corticosteroids. This study aimed to examine the relationship between local corticosteroid injections and the risk of COVID-19 infection.

Design

The date and type of procedure, the dose and type of corticosteroids used in patients who underwent local corticosteroid injections within one year after the first COVID-19 case in the country were examined retrospectively and recorded. Patients who did not receive corticosteroids were included in the control group. COVID-19 infection histories of all patients were recorded.

Results

There was no significant difference between the patients who received local corticosteroids and the control group in terms of the incidence of COVID-19 infections, and the number of patients who needed hospitalization or intensive care treatment. In addition, it was found that the administration of two injections, the type of procedure performed, and the dose and type of steroids were not associated with the incidence or severity of COVID-19 infections.

Conclusion

It has been shown that local corticosteroid injections are not associated with the incidence of COVID-19 infections and the number of patients who need hospitalization or intensive care treatment due to COVID-19.
Interventional Spine Course: Improving Fluoroscopic Safety and Procedural Efficacy Among PM&R Residents Using a Lecture and Model-based Curriculum
Authors: Appeadu Michael , Rosales Richard , Sherman Andrew L , Irwin Robert , Tiozzo Eduard , Price Chanë
Published: February 2023

Therapeutic interventional techniques using fluoroscopy are often utilized in the management of spinal pain. Currently, there are no standardized means of instruction and assessment of fluoroscopic interventional spinal procedures for physiatry trainees. The aim of our study was to evaluate the utility of an interventional spine training course for PM&R residents in improving safety and efficacy when performing these procedures. We performed a prospective multiple cohort study analyzing interventional spine knowledge and procedural ability among PM&R residents after implementing a training course that utilized lectures, hands-on training, and video-recorded OSCE self-assessments. Out of the total of 28 PM&R residents over the two-year study period, each class saw a statistically significant improvement in mean OSCE scores from pre to post-examination (p < 0.05). Written examination scores also had a statistically significant pre to post improvement in the PGY2 and PGY3 classes. Our study supports the use of an interventional spine course for PM&R residents, and by following the existing cohorts and adding more cohorts in the future we will continue to demonstrate valuable and comprehensive results.
A Comparison of Patients Discharged to Skilled Nursing and Inpatient Rehabilitation Facilities Following Hospitalization for COVID-19: A Retrospective Study
Authors: Valbuena Valecillos Adriana D. , Gober Joslyn , Palermo Annie , Johnson-Greene Doug , Shapiro Lauren T.
Published: February 2023

Objectives

To identify differences in demographics, severity of disease, and rates of hospital readmission among adults discharged to skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) following hospitalization for coronavirus-2019 (COVID-19).

Design

Retrospective cohort study of adults hospitalized with COVID-19 infection at academic medical centers participating in the Vizient® Clinical Data Base (CDB) between April 1, 2020 and June 30, 2021 who were discharged to SNFs or IRFs (n = 39,882). Data from the CDB is used with permission of Vizient, Inc. All rights reserved.

Results

Among adults hospitalized with COVID-19 infection, those discharged to SNFs were 1.4 times more likely to require hospital readmission than those discharged to IRFs. They were, on average, older (73 versus 61 years, p < .001) and had shorter hospital lengths of stay (15 versus 26 days, p < .0001) than the patients discharged to IRFs. Persons discharged to IRFs were more likely to have received intensive care and mechanical ventilation while hospitalized (p < .001).

Conclusion

Individuals discharged to IRFs following hospitalization for COVID-19 differ from those discharged to SNFs on a number of key variables, including age, hospital length of stay, having received intensive care, and odds of hospital readmission.
Clinical interpretability of quadriceps strength and gait speed performance in total knee arthroplasty: A longitudinal study
Authors: Pua Yong-Hao , Poon Cheryl Lian-Li , Seah Felicia Jie-Ting , Tan John Wei-Ming , Woon Ee-Lin , Chong Hwei-Chi , Thumboo Julian , Clark Ross Allan , Yeo Seng-Jin
Published: February 2023

Objective

Following a total knee arthroplasty (TKA), physical assessments of quadriceps strength and gait speed performance are often undertaken during rehabilitation. Our study aimed to improve their clinical interpretability by examining trajectory curves across levels of self-reported walking and stair climbing function.

Design

A sample of 2,624 patients with primary TKA participated in this retrospective longitudinal study. Monthly, for 4 months post-surgery, quadriceps strength and gait speed were quantified. At the Month-6 timepoint, self-reported walking and stair climbing function was measured.

Results

All physical measures improved nonlinearly over time. In mixed-effects models, greater quadriceps strength and gait speed over time were associated with higher Month-6 self-reported walking and stair climbing function (P-values<0.001). Steeper gains in quadriceps strength and gait speed were associated with higher levels of walking and stair-climbing function (interaction P-values<0.001). Amongst female patients who had great difficulty with stair ascent and ambulation, quadriceps strength trajectory curves plateaued after 8 weeks post TKA.

Conclusions

By stratifying trajectory curves across clinically interpretable functional levels, our findings potentially provide patients and clinicians a means to better interpret the continuous-scaled quadriceps strength and gait speed values. This information may be valuable when engaging patients in shared decision making and expectation setting.
Quantifying Surgical Complications for Reduction Mammaplasty in Adolescents
Authors: Morrison Kerry A. , Vernon Rebecca , Choi Mihye , Karp Nolan S.
Published: February 2023

Background:

Reduction mammaplasty is a safe, effective procedure to alleviate symptoms of adolescent macromastia. However, there remains limited data on surgical complications associated with reduction mammaplasty in adolescents, which may not be concordant with those cited for adults seeking reduction mammaplasty.

Methods:

A retrospective review was conducted of all consecutively performed reduction mammaplasty cases for symptomatic macromastia in patients aged 20 years old and younger over a seven-year period from 2014 to 2021.

Results:

One hundred sixty total breasts were analyzed in 80 patients. Mean age was 18.3±1.4 years with an age range from 15 to 20 years old. Mean BMI was 27.17±5.49. Mean reduction weight was 584.79±261.19 grams. A medial pedicle was used in 91%, and inferior pedicle in 9%. For skin incision, Wise pattern was used in 60%, and short-scar in 40%. There was a 16.3% rate of any surgical complication, which included wound healing by secondary intention treated with local wound care. There were no significant risk factors for a surgical complication in reduction mammaplasty, and no differences in surgical complications related to skin incision type, pedicle use, or breast reduction weight. Performance of a ROC curve for age at surgery and complication demonstrated that there was no age cut-off where the risk of surgical complication was appreciably increased or decreased.

Conclusion:

Age was not identified as a risk factor for surgical complications in adolescent reduction mammaplasty. Overall, complication rates are very low and minor in nature for adolescent reduction mammaplasty with no significant risk factors identified.
“National Undervaluation of Cleft Surgical Services: Evidence from a Comparative Analysis of 50,450 Cases”
Authors: Rochlin Danielle H. , Chaya Bachar F. , Flores Roberto L.
Published: February 2023

Background:

Relative value units (RVUs) are broadly used for billing and physician compensation, however the accuracy of RVU assignments has not been scientifically evaluated for craniofacial surgery. We hypothesize that unbalanced RVU allocation creates inappropriate disparities in value amongst procedures performed by cleft and craniofacial surgeons.

Methods:

The NSQIP Pediatric database was queried to identify all cleft and craniofacial surgery cases performed by plastic surgeons from 2012-2019 based on Current Procedural Terminology (CPT) code. Microsurgical cases and CPT codes with a case count of fewer than 10 were excluded. Efficiency was defined as total RVUs divided by total operative time (i.e. RVUs/hour). Mean efficiency per CPT code was ranked and compared by quartile using Student’s t-tests.

Results:

The sample consisted of 69 CPT codes with 50,450 cases. In the top quartile, most CPT codes were craniofacial procedures including frontofacial procedures (23.53%) and craniectomies for craniosynostosis or bony lesions (35.29%) (mean 15.65±4.22 RVUs/hour). The lowest quartile was comprised mainly of CPT codes for cleft procedures including surgeries for velopharyngeal insufficiency (17.65%), cleft palate repair (23.53%), and cleft septoplasty (5.88%) (mean 7.39±0.98 RVUs/hour, p<0.001). It was 2.5 times more efficient for a cleft and craniofacial surgeon to perform a local skin flap (15.18 RVUs/hour) than a secondary palatal lengthening for cleft palate (6.09 RVUs/hour).

Conclusions:

The current RVU allocation to cleft and craniofacial procedures creates arbitrary disparities in physician efficiency, with cleft procedures disproportionately negatively affected. RVU assignments should be reevaluated to avoid disincentivizing cleft surgical care.
A Two Center Review of Three Techniques for Posterior Vault Expansion Following Either a Staged or Expectant Approach to the treatment of Crouzon and Apert Craniosynostosis
Authors: Breakey Richard W.F. , Mercan Ezgi , van de Lande Lara S. , Sidpra Jai , Birgfeld Craig , Lee Amy , Schievano Silvia , Dunaway David J. , Jeelani N. Owase , Hopper Richard A.
Published: February 2023

Introduction:

Timing of posterior cranial expansion for the management of intracranial pressure can be ‘staged’ by age and dysmorphology or ‘expectant’ by pressure monitoring. We report shared outcome measures from one center performing posterior vault remodeling (PCVR) or distraction (PVDO) following a ‘staged’ approach and another performing spring assisted expansion (SAPVE) following an ‘expectant’ protocol.

Methods:

Apert or Crouzon syndrome cases who underwent posterior expansion less than two years old were included. Perioperative outcomes and subsequent cranial surgeries were recorded up to last follow-up and intracranial volume changes measured and adjusted using growth curves.

Results:

38 patients were included. Following the ‘expectant’ protocol, Apert cases underwent SAPVE at a younger age (8 months) than Crouzon cases (16 months). The initial surgery time was shorter but total operative time, including device removal, longer for PVDO (3:52) and SAPVE (4:34) than for PCVR (3:24). Growth-adjusted volume increase was significant and comparable. 14% PCVR, 33% PVDO, and 11% SAPVE cases had complications, but without long-term deficits. Following the staged approach, 5% only underwent PVDO, 85% had a staged posterior followed by anterior surgery, and 10% required a third expansion. Following the expectant approach, 42% patients had only posterior expansion at last follow-up, 32% had a secondary cranial surgery, and 26% had a third cranial expansion.

Conclusions:

Two approaches involving posterior vault expansion in young syndromic patients using three techniques resulted in comparable early volume expansion and complication profiles.
Effects of an anti-adhesive agent on capsule formation in implant-based breast reconstruction: A randomized controlled trial
Authors: Hong Ki Yong , Kim Il-Kug , Sakong Yong , Park Bo-Yoon , Jin Ung Sik
Published: February 2023

Background:

Although implant-based breast reconstruction is a common surgical modality, a periprosthetic capsule inevitably forms and worsens in cases of postmastectomy radiation therapy. Previous animal studies have reported that anti-adhesive agents (AAAs) inhibit periprosthetic capsule formation. We prospectively examined the clinical effects of an AAA (Mediclore®) on capsule formation in implant-based breast reconstruction.

Methods:

We analyzed patients who underwent immediate two-stage implant-based breast reconstruction following total mastectomy for breast malignancy between November 2018 and March 2019. Each patient was randomly allocated to the control or AAA group. After inserting the breast expander and acellular dermal matrix, AAA was applied around the expander prior to skin closure. The capsule specimen was obtained during the expander-implant change; capsule thickness and immunohistochemistry were investigated.

Results:

A total of 48 patients were enrolled and allocated to the control (n = 22) and AAA (n = 26) groups. There were no significant differences in patient- and operation-related characteristics. Submuscular capsule thickness was significantly reduced in the AAA group than in the control group. The levels of pro-capsular-forming cells (myofibroblasts, fibroblasts, and M1 macrophages) in the capsule were significantly lower in the AAA group than in the control group.

Conclusions:

AAA reduced the thickness of periprosthetic capsules, and changed the profiles of cells involved in capsule formation during the tissue expansion. These findings demonstrate the clinical value of AAA for mitigating capsule formation in implant-based breast reconstruction.
“Efficacy of Platelet-Rich Plasma Plus Basic Fibroblast Growth Factor on the Treatment of Androgenic Alopecia”
Authors: Qu Qian , He Ye , Guo Zhi , Sun Yang , Fan Zhe-xiang , Yi Yan-hua , Zhu De-cong , Hu Zhi-qi , Miao Yong
Published: February 2023

Importance:

Studies have identified platelet-rich plasma (PRP) as a novel adjuvant therapy in AGA. However, the efficacy of PRP still needs to be improved.

Objective:

To assess the efficacy of PRP plus basic fibroblast growth factor (PRPF) for the treatment of AGA.

Design, setting, and participants:

This was a prospective randomized, double-blind, placebo-controlled, half-head study. 80 patients whose AGA staged Norwood-Hamilton III–VII or Ludwig I–III were enrolled in the study from February 2019 to September 2019.

Interventions:

Patients were randomly divided into two groups of 40 patients each and were given the following treatment: (Group1) PRPF was injected in right-half and left-half with placebo; (Group2) PRPF was injected in right-half and left-half with PRP.

Main outcomes and measures:

The treatment was processed 3 times, 1 month apart. Hair growth parameters were evaluated by trichoscope monthly until the sixth month of the study. Patients’ satisfaction, hair pull test and side effects were recorded during follow-up.

Results

Of the 80 patients included in the study, 47 were men and 33 were women with a mean age of 28.96±4.82 (ranged from 21 to 46). Both PRP and PRPF showed positive improvement (p<0.05) on hair count, terminal hair and anagen hair after the treatment. Efficacy of PRPF revealed a significant improvement(p<0.05) in hair count, terminal hair, vellus hair and anagen hair versus PRP. There was no statistical difference among any of the parameters in the placebo group.

Conclusions and Relevance

PRPF can be a safe and valuable form of AGA treatment, and has proven to be more effective than PRP.

Trial registration.

Reviewed and approved by research ethics board at Nanfang Hospital, Southern Medical University NFEC-2019-212
“Surgical Timing and Neurocognitive Development Among Patients with Craniosynostosis: Analysis of Confounding Variables and Selection Bias.”
Authors: Lynn Jeremy V. , Buchman Lauren K. , Breuler Christopher J. , Buchman Steven R.
Published: February 2023

Background:

In 1988, Renier and Marchac asserted that children with craniosynostosis who undergo cranial vault remodeling (CVR) after 12 months of age experience delayed neurocognitive development compared to children who undergo CVR before 12 months of age. The purpose of this study is to identify factors potentially confounding this cause-and-effect relationship. We hypothesize that children with socioeconomic disadvantages or comorbid conditions are more likely to undergo CVR after 12 months and may represent a selection bias toward delayed neurocognitive development.

Methods:

Patients with non-syndromic single-suture craniosynostosis who underwent CVR between 2009 and 2020 at Michigan Medicine were included (n=227). Sociodemographic and clinical variables were documented. The sample was dichotomized to compare patients who underwent CVR before (Early) and after (Late) 12 months of age. Statistical analysis was performed at p<0.05 significance.

Results:

The Early and Late groups contained 157 patients and 70 patients, respectively. Compared to the Early group, the Late group contained a larger proportion of patients who identified as non-white (p=0.03), qualified for need-based financial assistance (p=0.03), were born preterm (p<0.01), or had a comorbid condition (p<0.01). Based on pre-operative testing, the Late group contained a larger proportion of patients with baseline cognitive (p<0.001) and language (p=0.008) delays relative to the Early group.

Conclusion:

This study demonstrates that socioeconomic disadvantages and comorbid conditions are prevalent among patients who undergo delayed CVR and may represent a selection bias toward delayed neurocognitive development. Future studies evaluating the relationship between surgical timing and neurocognitive development must control for these factors.
“Case Control Analysis of Genital Hypoplasia Prior to Gender Affirming Vaginoplasty: Does the Robotic Peritoneal Flap Method Create Equivalent Vaginal Canal Outcomes?”
Authors: Blasdel Gaines , Kloer Carmen , Parker Augustus C. , Shakir Nabeel , Zhao Lee C. , Bluebond-Langner Rachel
Published: February 2023

Background:

Insufficient genital tissue has been reported as a barrier to achieving depth in gender affirming vaginoplasty. We sought to characterize vaginal depth and revision outcomes in patients with genital hypoplasia undergoing robotic peritoneal flap vaginoplasty.

Methods:

Retrospective case control analysis of patients undergoing robotic peritoneal vaginoplasty between 9/2017 and 8/2020 was utilized. All 43 patients identified as having genital hypoplasia (genital length <7 cm) were included with 49 random controls from the remaining patients with >7 cm genital length. Baseline clinical characteristics and perioperative variables were recorded to identify potential confounders. Outcomes measured included vaginal size reported at last visit and undergoing revision surgery for depth or for vulvar appearance.

Results:

Patients were well matched other than median body mass index at time of surgery, which was greater in the hypoplasia cohort by 3.6 kg/m2 (p <.0001). Patients had a median of one year of follow up, with a minimum follow up of 90 days. No significant differences in outcomes were observed, with a median vaginal depth of 14.5 cm (interquartile range 13.3- 14.5), and median width of dilator used 3.8 cm (3.8- 3.8). No depth revisions were observed, and an 11% (n = 10) rate of external revision occurred.

Conclusions:

Patients with genital hypoplasia had equivalent dilation outcomes in a case control analysis with consistent follow up past 90 days. The robotic peritoneal flap vaginoplasty technique provides vaginal depth of 14cm or greater regardless of genital tissue prior to surgery. Further investigation with patient-reported outcome measures is warranted.
Prognostic factors of Marjolin’s ulcers: A Meta-analysis and Systemic Review Assisted with Machine Learning Techniques
Authors: Cheng Kai-Yuan , Yu Jiaxin , Liu En-Wei , Hu Kai-Chieh , Lee Jian-Jr
Published: February 2023

Background:

Marjolin’s ulcers are malignant tumors arising from previously injured skin, including burn wounds, scars, chronic ulcers, etc. They have a potentially long latent period. We aimed to establish the prognostic factors for recurrence, metastasis, and disease-specific death related to Marjolin’s ulcers.

Methods:

We performed a comprehensive search of PubMed, EMBASE, and the Cochrane Library. After assessing the methodological quality of case series, we performed a meta-analysis and systematic review. Furthermore, we employed machine learning to predict the patients’ survival time.

Results:

Marjolin’s ulcer on the upper limbs, head, and neck had a higher risk of recurrence. Contrastingly, lower-grade lesions, absence of lymph node metastasis, and a tumor diameter of <10 cm were associated with lower recurrence risk. The risks were unrelated to age and latent period. Additionally, patients without lymph node metastasis had a lower risk of developing distant metastasis. Furthermore, the risk of disease-specific death was lower in patients with a lower tumor grade, absent lymph node metastasis, small tumor diameter (<10 cm), and tumors located in regions other than the head and neck. Correlation analysis showed that the age at initial injury was negatively correlated with the latent period of Marjolin’s ulcer.

Conclusions:

We found that tumor grade, tumor site, lymph node status, and tumor size are important predictors of a worse prognosis. To integrate these predictors, we created an equation to predict the survival time for individual patients via machine learning processes. Moreover, we found that Marjolin’s ulcer developed more quickly in older individuals with injuries.
A high-fat diet in the absence of obesity increases lymphangiogenesis by inducing VEGF-C in a murine lymphedema model
Authors: Choi Jaehoon , Kim Jaehoon , kim Junhyung , Jeong Woonhyeok , Jo Taehee , Lee Hyoun Wook , Park Young Sook , Park Sang Woo
Published: February 2023

Background:

Many researchers have attempted to induce lymphangiogenesis for the treatment of lymphedema. However, most previous studies had limited clinical usefulness. A high-fat diet (HFD) increases serum β-hydroxybutyrate (β-OHB) levels, which can stimulate lymphangiogenesis. The authors hypothesized that a HFD will ameliorate lymphedema through enhanced lymphangiogenesis.

Methods:

The effects of β-OHB on the lymphangiogenic process in human dermal lymphatic endothelial cells (HDLECs) were analyzed. A mouse tail lymphedema model was used to evaluate the effects of a HFD on lymphedema. Experimental mice were fed a HFD (45% kcal as fat, 20% as protein and 35% as carbohydrates) for 4 weeks. Tail volume was measured using the truncated cone formula. Biopsies were taken six weeks after surgical induction of lymphedema.

Results:

In HDLECs, treatment with 20 mM β-OHB increased cell viability (p = 0.008), cell migration (p = 0.011), tube formation (p = 0.005), and VEGF-C mRNA and protein expression (p < 0.001) compared with controls. HFD feeding decreased tail volume by 14.3% and fibrosis by 15.8% (p = 0.027), and increased the lymphatic vessel density (p = 0.022) and VEGF-C protein expression (p = 0.005) compared with those of operated, standard chow diet-fed mice.

Conclusion:

Our findings demonstrated that β-OHB promoted lymphatic endothelial cell function and increased VEGF-C mRNA and protein expression. When mice with tail lymphedema were fed a HFD, volume and fibrosis of the tail decreased. Therefore, our findings suggest that a HFD can be a successful novel dietary approach to treating lymphedema.

Clinical Relevance Statement:

Lymphatic regeneration after vascularized lymph node transfer can be augmented when high-fat diet is used in conjunction with vascularized lymph node transfer.