bluuebunny/crossref_metadata_2025 huggingface dataset:
How Collaborative Position Paper on the Management of Thrombocytopenia in Pregnancy
Authors: Eslick R. , Cutts B. , Merriman E. , McLintock C. , McDonnell N. , Shand A. , Clarke L. , Ng S. , Kando I. , Curnow J.
Published: March 2022

(Aust N Z J Obstet Gynaecol. 2021;61:195–204)

Up to one in 10 pregnant women develop thrombocytopenia (TCP) defined as a platelet (PLT) count of <150×109/L. More severe TCP with PLT <100×109/L, affect 1-2% of pregnant patients, and may increase risk of postpartum hemorrhage (PPH). There are no randomized trials studying this issue and clinicians must use retrospective reviews and guidelines for decision making. This paper by members of the Haematology in Obstetrics and Women’s Health (HOW) Collaborative provides evidence-based guidelines for the management of TCP in Australia and New Zealand. Following independent literature review, all authors reached consensus on the final version. The recommendations are National Health and Medical Research Council grade C as there is a lack of high-quality evidence.
The Risk of Complications in Second Pregnancy by Maternal BMI: The Role of First-pregnancy Complications, Pregestational Diabetes and Chronic Hypertension
Authors: Sormunen-Harju H. , Koivusalo S. , Gissler M. , Metsälä J.
Published: March 2022

(Acta Obstet Gynecol Scand. 2021;100:489–496. doi: 10.1111/aogs.14028. Epub November 2, 2020)

Obesity, increased pregnancy body mass index (BMI), and past pregnancy complications are associated with future pregnancy complications and adverse short- and long-term maternal and neonatal outcomes. Gestational diabetes (GDM), gestational hypertension (GH), and preeclampsia (PE) are common pregnancy-associated complications. Recurrence of these complications increases when pregestational DM and/or chronic hypertension (cHTN) are present, though little research has been done on how adiposity and prior-pregnancy complications impact the risk of second-pregnancy complications. This study analyzes how complications in the first pregnancy and chronic conditions impact subsequent pregnancy complications and the role of maternal BMI.
Randomized Trial of Fetal Surgery for Moderate Left Diaphragmatic Hernia
Authors: Deprest J.A. , Benachi A. , Gratacos E. , Nicolaides K. , Berg C. , Persico N. , Belfort M. , Gardener G.J. , Ville Y. , Johnson A. , Morini F. , Wielgoś M. , Van Calster B. , DeKoninck P.L.J.
Published: March 2022

(N Engl J Med. 2021;385:119–129)

Congenital diaphragmatic hernia (CDH) can lead to pulmonary hypoplasia and is associated with serious neonatal complications and death. In infants with severe left diaphragmatic hernia, fetoscopic endoluminal tracheal occlusion (FETO) has been associated with greater survival rates but also higher rates of premature birth. This study aimed to determine the effects of FETO on pregnancies affected by moderate CDH compared with expectant prenatal care.
Difficulty in Advancing Flexible Epidural Catheters When Establishing Labor Analgesia: An Observational Open-label Randomized Trial
Authors: Pancaro C. , Purtell J. , LaBuda D. , Saager L. , Klumpner T.T. , Dubovoy T. , Rajala B. , Singh S. , Cassidy R. , Vahabzadeh C. , Maxwell S. , Manica V. , Eckmann D.M. , Mhyre J.M. , Engoren M.C.
Published: March 2022

(Anesth Analg. 2021;133:151–159. doi: 10.1213/ANE.0000000000005526)

Flexible epidural catheters have a lower incidence of both paresthesias and intravascular catheter placement. This study aimed to compare and analyze the efficacy of 2 commercially available epidural kits: kit “A” (single-end hole wire-reinforced polyurethane epidural catheter; n=135) and kit “B” (multi-orifice wire-reinforced polyamide nylon blend epidural catheter; n=122).
Temporal Trends in the Incidence of Postdural Puncture Headache Following Labor Neuraxial Analgesia in the United States, 2006-2015
Authors: Guglielminotti J. , Landau R. , Ing C. , Li G.
Published: March 2022

(Int J Obstet Anesth. 2021;45:90–98)

Postdural puncture headache (PDPH) following neuraxial analgesia for labor is associated with several adverse postpartum outcomes including delayed discharge, persistent backache and neurological complications. Thankfully, over the past 2 decades, anesthesia care has improved and anesthesia-related complications have declined. This study examined the temporal trends in the incidence of PDPH following neuraxial analgesia procedures in the United States from 2006 to 2015.
Epidural Analgesia, Intrapartum Hyperthermia, and Neonatal Brain Injury: A Systematic Review and Meta-Analysis
Authors: Morton S. , Kua J. , Mullington C.J.
Published: March 2022

(Br J Anaesth. 2021;126:500–515)

Neonatal brain injury, a spectrum of diseases including neonatal encephalopathy and cerebral palsy, is caused by a number of factors. Intrapartum hypoxia and chorioamnionitis have both been associated with cerebral palsy. Evidence also suggests that epidural analgesia (EA) is associated with an increased risk of intrapartum hyperthermia. However, previous systematic reviews have shown that EA does not increase the risk of intrapartum infection, suggesting that epidural analgesia is a distinct condition. Growing evidence linking intrapartum hyperthermia and neonatal brain injury and recognizing epidural analgesia as a distinct condition has raised questions of whether EA is an independent risk factor of neonatal brain injury. This systematic review and meta-analysis was conducted to determine (1) if epidural analgesia is a cause of intrapartum hyperthermia, (2) if intrapartum hyperthermia is associated with neonatal brain injury and (3) if epidural analgesia is associated with neonatal brain injury.
Effect of Preoperative Oral Carbohydrate Loading on Body Temperature During Combined Spinal-epidural Anesthesia for Elective Cesarean Delivery
Authors: Yang C. , Cheng Y. , Liu S. , Huang S. , Yu X.
Published: March 2022

(Anesth Analg. 2021;133:731–738. doi: 10.1213/ANE.0000000000005447)

Hypothermia is common after neuraxial blockade during cesarean delivery (36% to 85%). Preoperative oral carbohydrate loading has been shown to mitigate this complication. This objective of this study was to assess the impact of preoperative oral carbohydrate loading on body temperature during elective cesarean delivery under combined spinal-epidural anesthesia (CSEA).
The Effect of COVID-19 Disease on General Anaesthesia Rates for Caesarean Section
Authors: Russell R. , Lucas D.N.
Published: March 2022

(Anaesthesia. 2021. PMID: 33300126)
Maternal and Fetal Anaesthesia for Fetal Surgery
Authors: Dick J.R. , Wimalasundera R. , Nandi R.
Published: March 2022

(Anaesthesia. 2021;76(suppl 4):63–68)

Over the past 3 decades, great advances have been made in fetal surgery. While many procedures require only local anesthesia, additional maternal and/or fetal anesthesia can be needed. Multidisciplinary planning is needed to ensure success in these procedures. This article reviews three fetal surgical procedures and the anesthetic considerations for each.
Whole-Person Development of Undergraduate Nursing Students: A Multi-University Study
Authors: Cruz Jonas Preposi , Alquwez Nahed , Alshammari Farhan , Alabdulaziz Hawa , Alsharari Abdalkarem F. , Alqahtani Friyal Mubarak , Tork Hanan M. M. , Almazan Joseph U.
Published: March 2022

AIM

This study examines how nursing students in Saudi Arabia view their holistic development during university study and the association between their perceptions and academic performance.

BACKGROUND

Holistic nursing education fosters broad development and emphasizes students’ cognitive, emotional, social, physical, and spiritual potentials.

METHOD

This descriptive and correlational study utilizes the Whole Person Development Inventory to collect data from 998 student nurses enrolled in six governmental universities in Saudi Arabia.

RESULTS

The professional dimension recorded the highest mean, followed by the intellectual, spiritual, physical, and psychological dimensions. The social dimension received the lowest overall mean. Intellectual, psychological, social, and spiritual development has an association with high academic performance.

CONCLUSION

This study encourages policymakers and various stakeholders concerned with nursing education in the country and worldwide to be intentional and systematic in adapting the whole-person development approach in nursing education.
Early Outcomes of a New NIH Program to Support Research in Residency
Authors: Price Rapoza Maria , McElvaine Allison , Conroy Molly B. , Okuyemi Kolawole , Rouphael Nadine , Teach Stephen J. , Widlansky Michael , Williams Chris , Permar Sallie R. ,   for the National R38 Consortium investigators
Published: March 2022

The work of physician–investigators has historically led to key discoveries and developments in modern medicine, but recent decades have seen significant declines in the number of U.S. physician–investigators. One of the barriers to physicians participating in research is the lack of mentored research opportunities during clinical training, especially during residency training. In response to this identified barrier and to expand the physician–investigator workforce, the National Institutes of Health initiated the R38 program, known as Stimulating Access to Research in Residency, to support mentored research opportunities for residents. This article reports on the early outcomes of the recipients of the initial round of R38 awards, granted in 2018. Early positive outcomes include increases in the reported likelihood of resident–investigators pursuing physician–investigator careers, greater reported clarity in resident–investigators’ research directions, the commitment of additional institutional resources to support the R38-awarded programs, and the approval of resident–investigators as having met training requirements for certification by multiple medical boards.
The Affordable Care Act and its Effects on Trauma Care Access, Short- and Long-term Outcomes and Financial Impact
Authors: Newsome Kevin , Autrey Cody , Sen-Crowe Brendon , Ang Darwin , Elkbuli Adel
Published: March 2022

Objective:

The purpose of this study is to evaluate the current evidence regarding the impact of the ACA on trauma outcomes and the financial impact on trauma patients and trauma systems.

Background:

Traumatic injuries are the leading cause of death and disability between the ages of 1 to 47 years. Uninsured status has been associated with worse outcomes and higher financial strain. The Affordable Care Act (ACA) was signed into law with the aim of increasing health insurance coverage. Despite improvements in insured status, it is unclear how the ACA has affected trauma.

Methods:

We conducted a literature search using PubMed and Google Scholar for peer-reviewed studies investigating the impact of the ACA on trauma published between January 2017 and April 2021.

Results:

Our search identified 20 studies that evaluated the impact of ACA implementation on trauma. The evidence suggests ACA implementation has been associated with increased postacute care access but not significant changes in trauma mortality. ACA implementation has been associated with a decreased likelihood of catastrophic health expenditures for trauma patients. ACA was also associated with an increase in overall reimbursement and amount billed for trauma visits, but a decrease in Medicaid reimbursement.

Conclusions:

Some improvements on the financial impact of ACA implementation on trauma patients and trauma systems have been shown, but studies are limited by methods of calculating costs and by inconsistent pre-/post-ACA timeframes. Further studies on cost-effectiveness and cost-benefit analysis will need to be conducted to definitively determine the impact of ACA on trauma.
Treatment of Critical-Sized Bone Defects Involving the Ankle Joints: Staged Tibiotalocalcaneal Arthrodesis With Induced Membrane Technique and Intramedullary Nail
Authors: Choi Wonseok , Park Kyeong-Hyeon , Oh Chang-Wug , Kim Joon-Woo , Son Whee Sung , Cho Jae-Woo , Abdel-Baki Sharkawy Wagih , Oh Jong-Keon
Published: March 2022

Objectives:

To report the outcomes of staged tibiotalocalcaneal (TTC) arthrodesis for critical-sized bone defects involving the ankle joints.

Design:

Retrospective review of case series.

Setting:

Two academic Level 1 trauma centers.

Patients/Participants:

The study included 20 patients with critical-sized (≥2 cm) segmental bone defects around the ankle joints.

Intervention:

Staged TTC arthrodesis was performed with induced membrane technique and retrograde intramedullary nail.

Main Outcome Measurements:

We investigated the radiological evaluation, including modified radiographic union scale for tibia fractures score, time to union, and leg length discrepancy, and functional outcomes using foot and ankle outcome score and American Orthopaedic Foot and Ankle Society ankle–hindfoot score.

Results:

The average bone defect was 6.4 cm (range: 2.4–12.3). Two of the 20 (10%) patients developed recurrence of infection. Fifteen patients (75%) achieved primary healing. Three patients (15%) were treated with repeated bone grafting and additional plating. The average time to union and leg length discrepancy were 10 months (range: 5–21) and 9 mm (range: 0–31), respectively. The mean foot and ankle outcome score and American Orthopaedic Foot and Ankle Society ankle–hindfoot score were 63 (range: 52–71) and 74 (range: 64–81), respectively.

Conclusions:

Staged TTC arthrodesis with induced membrane technique and intramedullary nail can be an effective treatment method for critical-sized bone defects involving the ankle joints.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Knee Disarticulation Versus Transfemoral Amputation: The Prosthetist's Perspective
Authors: Parry Joshua A. , Neufeld Eric
Published: March 2022

Objectives:

The objective of this study was to survey a broad group of prosthetists on their experience with amputees with knee disarticulation (KD) and transfemoral amputation (TFA) to determine their preference of amputation level, opinions on patient preference, and common problematic issues to guide decision-making for patients and surgeons faced with the decision of a high-level lower extremity amputation.

Design:

This is a survey-based study.

Intervention:

A blinded electronic mail survey was completed by 102 prosthetists.

Main Outcome Measurements:

Each prosthetist was asked (1) what amputation level (KD or TFA) do they prefer and why and (2) which amputation level do they believe patients prefer and why

Results:

There was no consensus among prosthetists regarding amputation level preference. Fifty-four (53%) prosthetists preferred KD and 48 (47%) preferred TFA. Fifty-five (54%) prosthetists believed patients preferred TFA and 47 (46%) believed patients preferred KD. Amputation level preference often depended on age, functional goals, and concerns with cosmesis. The most common benefits given for KD over TFA included distal-end weight-bearing (n = 53), a lower subischial socket (n = 43), and better function (n = 30). The most common disadvantages given for KD over TFA included component limitations due to space available below amputation (n = 56), poor cosmesis (n = 49), an asymmetrical knee axis (n = 42), and difficulties with sitting/standing (n = 13).

Conclusion:

No consensus exists between prosthetists regarding preference for KD versus TFA. The advantages and disadvantages of KD reported in this study, along with the associated decision tree, can be used for future counseling of patient's faced with high-level lower extremity amputations.
Preoperative and Intraoperative Considerations Using Intramedullary Nails for the Treatment of Tibial Shaft Fractures Below Total Knee Arthroplasty
Authors: Stevens Nicole M. , Tyler Andrew F. , Mitchell Phillip M. , Stinner Daniel J.
Published: March 2022

Periprosthetic tibial shaft fractures below total knee arthroplasty (TKA) are relatively rare, with an incidence of approximately 1%. However, as the rates of arthroplasty increase, orthopaedic surgeons are likely to see a corresponding increase in these types of fractures. Native tibial shaft fractures are routinely treated with either nails or plates, and the success of intramedullary nailing of tibial shaft fractures has been well described in the literature. In this article, we seek to describe a case series of tibial shaft fractures in patients with ipsilateral TKA treated with infrapatellar intramedullary nailing. We will focus on preoperative considerations including templating and measurement of the anterior cortical implant distance on the lateral radiograph to ensure space for safe nail passage. We will also discuss intraoperative technical tricks, including Kirschner wire insertion for sounding the start point, utilization of the curved awl, use of hand reamers, and rotation of the nail to bypass the implant. Using meticulous preoperative planning and technical intraoperative tricks, patients with tibial shaft fractures below TKA may be successfully treated with intramedullary nailing.
The Third Wave: Comparing Seasonal Trends in COVID-19 Patient Data at a Large Hospital System in New York City
Authors: Tandon Pranai , Leibner Evan S. , Hackett Anna , Maguire Katherine , Mashriqi Nazia , Kohli-Seth Roopa
Published: March 2022

IMPORTANCE:

The third wave of COVID-19 is unique in that vaccines have been widely available; however, the highly transmissible Delta variant has been the predominant strain. Temporal changes of hospitalized patient characteristics should continue to be analyzed as COVID-19 progresses.

OBJECTIVES:

Compare the demographics and outcomes of hospitalized patients during New York City’s third wave of COVID-19 to the first two waves.

DESIGN, SETTING, AND PARTICIPANTS:

Retrospective cohort study across five hospitals within Mount Sinai Health System, a quaternary academic medical system in New York City. Participants were adult inpatients admitted with COVID-19 identified by positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction at admission or clinical documentation of infection during the three waves of COVID-19.

MAIN OUTCOMES AND MEASURES:

Patient demographics, comorbidities, vaccination status, and outcomes of COVID-19 patients hospitalized at Mount Sinai Health System were examined. Patients admitted during the third wave were notably younger than the first two, were mostly unvaccinated against COVID-19, and there was a higher rate of patients who self-report as Black or African American as compared with the first two waves. The rate of patients requiring ICU level of care remained consistent throughout all three periods; however, the rate of patients requiring invasive mechanical ventilation decreased and inhospital mortality has trended down. Unvaccinated patients in the third wave are significantly younger with lower comorbidity burden than fully vaccinated patients.

RESULTS:

A total of 13,036 patients were included between the 3 waves. In the 3rd wave patients were notably younger, with a lower intubation rate and lower inhospital death rate. In the 3rd wave, 400 (62.9%) were unvaccinated, 236 (37.1%) were fully vaccinated, and 34 (4.8%) were partially vaccinated. Unvaccinated patients had similar rates of intubation and invasive mechanical ventilation compared with vaccinated patients, though inhospital mortality was lower in unvaccinated patients compared with vaccinated patients which may be expected given their lower age and burden of comorbidities.

CONCLUSIONS AND RELEVANCE:

We continue to see improved outcomes in hospitalized COVID-19 patients. Patients that are unvaccinated against COVID-19 are younger and have less reported comorbidities.
Hepatitis D: advances and challenges
Authors: Miao Zhijiang , Xie Zhenrong , Ren Li , Pan Qiuwei
Published: March 2022

Hepatitis D virus (HDV) infection causes the most severe form of viral hepatitis with rapid progression to cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Although discovered > 40 years ago, little attention has been paid to this pathogen from both scientific and public communities. However, effectively combating hepatitis D requires advanced scientific knowledge and joint efforts from multi-stakeholders. In this review, we emphasized the recent advances in HDV virology, epidemiology, clinical feature, treatment, and prevention. We not only highlighted the remaining challenges but also the opportunities that can move the field forward.
Complete androgen blockade vs. medical castration alone as adjuvant androgen deprivation therapy for prostate cancer patients following radical prostatectomy: a retrospective cohort study
Authors: Jin Di , Jin Kun , Chen Bo , Zhou Xianghong , Yuan Qiming , Zhang Zilong , Wei Qiang , Qiu Shi
Published: March 2022

Background:

Till date, the optimal treatment strategy for delivering adjuvant androgen deprivation therapy (ADT) in localized and locally advanced prostate cancer (PCa), as a lower stage in PCa progression compared with metastatic PCa, is still unclear. This study compares the efficacy of castration alone with complete androgen blockade (CAB) as adjuvant ADT in patients with localized and locally advanced PCa undergoing radical prostatectomy (RP).

Methods:

Patients diagnosed with PCa, without lymph node or distant metastasis, who received RP in West China Hospital between January 2009 and April 2019, were enrolled in this study. We performed survival, multivariable Cox proportional hazard regression, and subgroup analyses.

Results:

A total of 262 patients were enrolled, including 107 patients who received castration alone and 155 patients who received CAB. The survival analysis revealed that there was no significant difference between the two groups (hazard ratios [HR] = 1.07, 95% confidence intervals [95% CI] = 0.60–1.90, P = 0.8195). Moreover, the multivariable Cox model provided similarly negative results before and after adjustment for potential covariant. Similarly, there was no significant difference in the clinical recurrence between the two groups in both non-adjusted and adjusted models. Furthermore, our subgroup analysis showed that CAB achieved better biochemical recurrence (BCR) outcomes than medical castration alone as adjuvant ADT for locally advanced PCa (P for interaction = 0.0247, HR = 0.37, 95% CI = 0.14–1.00, P = 0.0497).

Conclusion:

Combined androgen blockade achieved better BCR outcomes compared with medical castration alone as adjuvant ADT for locally advanced PCa without lymph node metastasis.
CD5+ Gamma Delta T-Cell Lymphoproliferative Disorder/Lymphoma Without Cytotoxic Granules in the Skin
Authors: Ju Jennifer Y. , Sorensen Eric P. , Walsh John S. , Shinohara Michi M. , Naresh Kikkeri N.
Published: March 2022

We report a case of an unusual and aggressive gamma delta T-cell lymphoproliferative disorder/lymphoma presenting in the skin that lacked the expected cytotoxic markers and had increased expression of CD5, CD20, CD79a, CD30, and PD-1 without CD56. Monoclonal TCR-γ gene rearrangement was identified. A computed tomography scan of the chest, abdomen, and pelvis revealed a 7.7-cm soft-tissue inguinal mass and prominent retroperitoneal and pelvic lymphadenopathy, without hepatosplenomegaly. Flow cytometry finding on peripheral blood was normal. The clinical, morphologic, and immunophenotypic features of this case defy the current World Health Organization and European Organization for Research and Treatment of Cancer classifications, and a similar case has not been reported previously.
Effects of Supervised Exercise Training on Atrial Fibrillation
Authors: Oesterle Adam , Giancaterino Shaun , Van Noord Megan G. , Pellegrini Cara N. , Fan Dali , Srivatsa Uma N. , Amsterdam Ezra A.
Published: March 2022

Purpose:

Atrial fibrillation (AF) is associated with the comorbidities of a sedentary lifestyle. Endurance athletes also show an increased incidence of AF. The role of exercise in the treatment of AF is unknown so this study aimed to examine the effects of supervised exercise on AF.

Methods:

A meta-analysis of randomized controlled trials (RCTs) examining supervised exercise training in participants with AF was performed. The primary outcome was AF recurrence and burden. Secondary outcomes included AF symptoms, quality of life, and cardiorespiratory fitness (CRF).

Results:

Thirteen RCTs, involving 1155 participants, were included. Paroxysmal AF was present in 34% and persistent AF in 64%. The types of exercise were diverse and included cardiac rehabilitation (64%), aerobic training (7%), Qi Gong (4%), interval training (11%), and yoga (15%). Exercise training reduced AF recurrence (relative risk = 0.77: 95% CI, 0.60–0.99), improved quality of life in 5 of the 10 components of the Short Form 36 survey, and improved CRF (standardized mean difference [SMD] = 0.56: 95% CI, 0.27–0.85). The AF burden was reduced only in studies that included continuous ambulatory monitoring (SMD =−0.49: 95% CI, −0.96 to −0.01) but not when all studies were included (SMD =−0.12: 95% CI, −0.61 to 0.38). There was no difference in adverse events between exercise and control.

Conclusions:

Supervised exercise training is safe, reduces AF recurrence, and improves quality of life and CRF in participants with AF. Further large RCTs with ambulatory monitoring and robust exercise regimens are needed to assess the effects of exercise training on AF burden and AF symptoms.
Very Low Risk for In-hospital Adverse Outcome Such as ST-elevation or Non-ST-elevation Myocardial Infarction in Patients Undergoing Knee Surgery
Authors: Talle Armin , Hashemzadeh Mehrtash , Movahed Mohammad Reza
Published: March 2022

Background:

Knee surgery is a very common surgery. The risk of cardiac events is thought to be low. The goal of this study was to evaluate inpatients adverse outcomes such as ST-elevation myocardial infarction (STEMI) or Non-ST-elevation myocardial infarction in patients undergoing knee surgery.

Method:

Using the nation inpatient sample database, we evaluated the occurrence of STEMI and Non-STEMI in a very large population.

Results:

Using 2 random samples from 2005 to 2014, 10 years apart involving 7444 knee surgeries, the occurrence of STEMI and Non-STEMI were very low. In 2005, only 1 STEMI (0.0%) and 4 non-STEMI (0.1%) events occurred in inpatient knee-surgery patients. In the 2014 group, 0 STEMI (0.0%) and 5 non-STEMI (0.16%) events occurred in inpatient knee-surgery patients. Overall, STEMI or non-STEMI events occurred in 0.13% of inpatient knee-surgery procedures.

Conclusions:

Inpatients’ adverse outcome of patients undergoing knee surgery is very low suggesting that extensive cardiac workup for knee surgery may not be warranted.
CLINICAL FEATURES OF RETINAL METASTASES
Authors: Gascon Pierre , Matet Alexandre , Gualino Vincent , Denis Danièle , Nguyen Anh-Minh , Papegaey Maxence , Levy Natanael , Arnould Thomas , Kodjikian Laurent , Mathis Thibaud
Published: March 2022

Purpose:

To report a cohort of patients diagnosed with retinal metastases (RM), and to integrate these new cases in a systematic review of the literature, analyzing the clinical features and prognosis factors of patients with RM.

Methods:

We conducted a retrospective multicenter study including patients with RM. We also performed a full literature review of all published cases with a diagnosis of RM.

Results:

A total of six new cases were described on multimodal imaging. By combining the data from the literature and from our patients, we report the characteristics of a total of 69 patients. The most frequent primary tumor sites were cutaneous melanoma (36%), lung (23%), gastrointestinal tract (17%), and breast (12%). Multimodal imaging highlighted specific characteristics of RM. Fluorescein and indocyanine green angiography revealed early hypofluorescence followed by progressive filling of intrinsic dilated vessels. Optical coherence tomography demonstrated a hyperreflective intraretinal mass in all cases with or without subretinal fluid, hyperreflective intraretinal dots, or intraretinal fluid. Ultrasonography revealed a medium-high reflective dome-shaped tumor. Fifty-nine percent of the patients died during the follow-up with a mean survival time of 8.8 ± 8.7 months.

Conclusion:

We described here the clinical spectrum of RM and highlighted specific features of the disease.
Development and Validity Testing of an Assessment Tool for Oncofertility Barriers in Multidisciplinary Healthcare Providers on the Breast Cancer Team
Authors: HUANG Sheng-Miauh , LAI Jerry Cheng-Yen , LI Chin-Ching , CHEN Ping-Ho , LIEN Pei-Ju , LIEN Ching-Ting
Published: March 2022

Background

Multidisciplinary healthcare providers, especially clinical nurses, lack a valid tool to assess the comprehensive barriers affecting oncofertility care in breast cancer treatment.

Purpose

The aims of the research were to develop a self-assessment scale on oncofertility barriers and test its validity and reliability.

Methods

This was a methodological study. The initial 36 items of the developed Oncofertility Barrier Scale (OBS) were generated through qualitative study and a review of the literature. This scale was further refined using expert validity (n = 10), face validity (n = 10), and item analysis (n = 184). Exploratory factor analysis with principal axis factoring and direct oblimin rotation was used to determine the construct validity. The reliability of the OBS was evaluated using internal consistency and test–retest analyses.

Results

The mean item-level and scale-level content validity indices of the initial OBS were higher than .96. The data were shown to be feasible for the factor analysis, and a six-factor solution was chosen that accounted for approximately 57.6% of the total variance. These factors included (a) lack of information and education, (b) rigid thinking toward oncofertility care, (c) cancer patient stereotypes, (d) fertility risk, (e) insufficient support, and (f) interrupted oncofertility care. The Cronbach’s alpha of the 27-item OBS was .91, and the test–retest reliability coefficient was .55.

Conclusions/Implications for Practice

The final version of the developed OBS has acceptable reliability, content validity, and construct validity. This scale is appropriate for use in research and clinical practice settings to identify the barriers to fertility cancer care that should be resolved by the breast cancer care team.
Health-Related Quality of Life Trajectories Among Older Adults With Diabetes Mellitus: A Group-Based Modeling Approach
Authors: PARK Sunhee , PARK Chang Gi , LEE Taewha
Published: March 2022

Background

Health-related quality of life (HR-QoL) is an important issue among older adults with diabetes mellitus. However, information on longitudinal changes in HR-QoL over time using the illness trajectory model is limited.

Purpose

The purpose of this study was to identify patterns of temporal change in HR-QoL and their predictors using longitudinal data and a group-based modeling approach.

Methods

European Quality of Life–5 Dimensions data for 440 older adults with diabetes mellitus were drawn from the nationwide Korea Health Panel Survey conducted from 2009 to 2013. Latent class growth analysis and multinomial logistic regression models were used to identify the predictors of HR-QoL trajectories.

Results

Four distinct classes of HR-QoL trajectory were identified: high decrease (n = 46, 10.5%), high stable (n = 232, 52.7%), medium stable (n = 157, 35.7%), and low increase (n = 5, 1.1%). Participants in ``high decrease” and ``high-stable” classes tended to be men who were highly educated, physically active, and adherent to their medication regimen. High economic status, few chronic diseases, independence in activities of daily living, and high self-rated health status were also identified as indicators of being in the ``high-decrease” and ``high-stable” class group.

Conclusions/Implications for Practice

A salient finding of this study is that HR-QoL trajectories in older adults with diabetes mellitus are not homogeneous but instead diverge into four distinct classes. Most participants showed no major changes in HR-QoL across the 5-year period, regardless of HR-QoL level. To prevent patients with diabetes from experiencing chronically low levels of HR-QoL, comprehensive assessment and individualized care based on HR-QoL are necessary.
Evaluation of an Intensive Care Outreach Nurse Program in 4 UAE Hospitals
Authors: Williams Ged , Du Plessis Jean , Rotering Loralee , Samuel Asha , Abdel Khaleq Maher Husni , Sweeny Amy
Published: March 2022

Background:

Intensive care outreach nurses (ICONs) can reduce deterioration and death of patients in hospitals.

Purpose:

Evaluate outcomes associated with implementation of the ICON role across 4 UAE hospitals.

Methods:

Trend analyses and χ2 tests were used to measure changes before ICON program, during ICON year 1, ICON year 2, when the service coverage extended 24/7, and until the end of 2019.

Results:

From year 1 to year 2, failures to escalate decreased from a rate of 14.8 to 5.6 episodes per 1000 admissions for all sites combined (P < .001). The cardiac arrest rate went from 4.04 to 1.42 per 1000 admissions in year 2 and continued downward to 0.72 per 1000 (P < .001). Transfer from ward or readmission to intensive care unit/high dependency unit varied by site, although there was a statistically significant trend for all hospitals combined.

Conclusion:

The ICON role contributed to fewer failure to escalate incidents and lower cardiac arrest rates.
Variation in Prehospital Protocols for Pediatric Respiratory Distress Management in the United States
Authors: McCans Kerry , Varma Selina , Ramgopal Sriram , Martin-Gill Christian , Owusu-Ansah Sylvia
Published: March 2022

Objective

This study aimed to compare statewide emergency medical services protocols for the management of pediatric respiratory distress.

Methods

We performed a descriptive study of emergency medical services protocols for the management of pediatric respiratory distress in the United States, excluding those without model or mandatory protocols. We compared medication recommendations for specific disease processes, including asthma, croup, epiglottitis, anaphylaxis, generalized respiratory distress, intubation, and drug assisted intubation.

Results

Thirty-four state protocols were included. All had protocols to address the management of pediatric respiratory distress. There was high agreement in albuterol use for bronchospasm and epinephrine use in anaphylaxis. Epinephrine was recommended in all anaphylaxis protocols, 27 croup protocols (79%), and 3 epiglottitis protocols (9%). Six states (18%) called for albuterol in patients with generalized respiratory distress. Steroid recommendations and indications had variance among states; 26 states (76%) allowed steroid use in patients with asthma, 19 states (56%) recommended steroid use in anaphylaxis, and 11 (32%) recommended steroid use in croup protocols. The route for steroid administration also varied among protocols. Five states (15%) allowed continuous positive airway pressure application in pediatric patients, whereas endotracheal intubation and rapid sequence intubations had varying requirements as well as recommendations for use. Twelve (35%) listed impending or current respiratory failure as an indication, whereas other states had specific markers, such as Glasgow Coma Scale or oxygen saturation, as indications.

Conclusions

All included states had specific recommendations for the management of pediatric respiratory distress. There was consistency in recommendations for albuterol use for wheezing and epinephrine use for anaphylaxis. However, there was wide variability in other uses for epinephrine, steroid administration, continuous positive airway pressure use, and specific treatments for croup and epiglottitis. The findings of this study provide a base for important future evidence-based protocol developments and changes in prehospital pediatric respiratory distress treatment.
Assault-Related Concussion in a Pediatric Population
Authors: Means Margaret J. , Myers Rachel K. , Master Christina L. , Arbogast Kristy B. , Fein Joel A. , Corwin Daniel J.
Published: March 2022

Objectives

The aim of this study was to compare demographic characteristics, medical care, and outcomes among patients with assault-related concussion (ARC) versus sports and recreation–related concussion (SRC).

Methods

We conducted a retrospective chart review of 124 patients (62 ARC, 62 SRC) aged 8 to 17 years presenting to the care network of a large tertiary care pediatric hospital between July 1, 2012, and June 30, 2014 with a concussion diagnosis at time of presentation. We abstracted patient demographics, initial medical care visit characteristics, and outcome data, and compared proportions using χ2testing and Fisher exact test and medians using Wilcoxon rank sum test.

Results

Patients with ARC were more likely to be Black, publicly insured, and present first for care to the emergency department. Significantly fewer patients with ARC received visio-vestibular testing at initial visit (27% vs 74%,P< 0.001). During recovery, the total number of reported physical, cognitive, emotional, and sleep symptoms did not differ between groups; however, more than twice as many patients with ARC reported decline in grades postinjury compared with patients with SRC (47% vs 20%,P= 0.012). There were trends toward prolonged symptom recovery and time to physician clearance for full return to activities among patients with ARC compared with SRC.

Conclusions

This study highlights potential disparities in the initial evaluation and outcomes of pediatric concussion patients based on mechanism of injury. Patients with ARC were less likely to receive a concussion-specific diagnostic evaluation and reported a greater impact on educational outcomes, suggesting differences in concussion diagnosis and management among assault-injured patients. Further examination in larger populations with prospective studies is needed to address potential inequities in concussion care and outcomes among patients with ARC.
Accumulation of 99mTc-DTPA in Lumbar Tuberculosis
Authors: Yin Hongyan , Yu Haojun , Shi Dai , Lv Jing , Shi Hongcheng
Published: March 2022

A 70-year-old woman with lumbar and renal tuberculosis underwent 99mTc-DTPA renal scintigraphy to evaluate renal function before lumbar lesion resection and nephrectomy. The images incidentally identified a focus of abnormal DTPA activity in the midline of the abdomen, which corresponded to lumbar tuberculosis revealed by CT images. Subsequent pathology after the resection of the lesions was consistent with lumbar and renal tuberculosis.
Dimethyl malonate slows succinate accumulation and preserves cardiac function in a swine model of hemorrhagic shock
Authors: Taghavi Sharven , Abdullah Sarah , Toraih Eman , Packer Jacob , Drury Robert H. , Aras Oguz A.Z. , Kosowski Emma M. , Cotton-Betteridge Aaron , Karim Mardeen , Bitonti Nicholas , Shaheen Farhana , Duchesne Juan , Jackson-Weaver Olan
Published: March 2022

BACKGROUND

Succinate (SI) is a citric acid cycle metabolite that accumulates in tissues during hemorrhagic shock (HS) due to electron transport chain uncoupling. Dimethyl malonate (DMM) is a competitive inhibitor of SI dehydrogenase, which has been shown to reduce SI accumulation and protect against reperfusion injury. Whether DMM can be therapeutic after severe HS is unknown. We hypothesized that DMM would prevent SI buildup during resuscitation (RES) in a swine model of HS, leading to better physiological recovery after RES.

METHODS

The carotid arteries of Yorkshire pigs were cannulated with a 5-Fr catheter. After placement of a Swan-Ganz catheter and femoral arterial line, the carotid catheters were opened and the animals were exsanguinated to a mean arterial pressure (MAP) of 45 mm. After 30 minutes in the shock state, the animals were resuscitated to a MAP of 60 mm using lactated ringers. A MAP above 60 mm was maintained throughout RES. One group received 10 mg/kg of DMM (n = 6), while the control received sham injections (n = 6). The primary end-point was SI levels. Secondary end-points included cardiac function and lactate.

RESULTS

Succinate levels increased from baseline to the 20-minute RES point in control, while the DMM cohort remained unchanged. The DMM group required less intravenous fluid to maintain a MAP above 60 (450.0 vs. 229.0 mL; p = 0.01). The DMM group had higher pulmonary capillary wedge pressure at the 20-minute and 40-minute RES points. The DMM group had better recovery of cardiac output and index during RES, while the control had no improvement. While lactate levels were similar, DMM may lead to increased ionized calcium levels.

DISCUSSION

Dimethyl malonate slows SI accumulation during HS and helps preserve cardiac filling pressures and function during RES. In addition, DMM may protect against depletion of ionized calcium. Dimethyl malonate may have therapeutic potential during HS.
Social ageing: exploring the drivers of late-life changes in social behaviour in mammals
Authors: Siracusa Erin R. , Higham James P. , Snyder-Mackler Noah , Brent Lauren J. N.
Published: March 2022

Social interactions help group-living organisms cope with socio-environmental challenges and are central to survival and reproductive success. Recent research has shown that social behaviour and relationships can change across the lifespan, a phenomenon referred to as ‘social ageing’. Given the importance of social integration for health and well-being, age-dependent changes in social behaviour can modulate how fitness changes with age and may be an important source of unexplained variation in individual patterns of senescence. However, integrating social behaviour into ageing research requires a deeper understanding of the causes and consequences of age-based changes in social behaviour. Here, we provide an overview of the drivers of late-life changes in sociality. We suggest that explanations for social ageing can be categorized into three groups: changes in sociality that (a) occur as a result of senescence; (b) result from adaptations to ameliorate the negative effects of senescence; and/or (c) result from positive effects of age and demographic changes. Quantifying the relative contribution of these processes to late-life changes in sociality will allow us to move towards a more holistic understanding of how and why these patterns emerge and will provide important insights into the potential for social ageing to delay or accelerate other patterns of senescence.
Quentin Bone. 17 August 1931—6 July 2021
Authors: Mackie George
Published: March 2022

Quentin Bone came from a family of well-known artists but, although he shared their talents, he chose to become a scientist because of his interest in natural history. After graduating in zoology from Oxford, he joined the scientific staff of the Marine Biological Association Laboratory at Plymouth, working there until retirement in 1991 and continuing thereafter as an emeritus research fellow. He was interested in all aspects of how fish swim, the structure and innervation of their swimming muscles, their metabolism, flotation and hydrodynamics. He showed that fishes have two distinct, independently innervated locomotory systems, red muscle for cruising and white muscle for rapid swimming bursts, and that the white muscle works on the basis of glycolytic metabolism, the red on oxidative. Later he showed that squids have convergently evolved two sorts of muscle fibre roughly equivalent to those of fishes. Bone took a comparative and evolutionary approach in all his work, looking for changes in design from simple to more complex systems and going right back to amphioxus, a putative ancestor of fishes. He also worked extensively on pelagic marine invertebrates that swim by jet propulsion—such as salps, doliolids and siphonophores—using optical and electron microscopy combined with electrophysiology to establish the neuromuscular basis of locomotion. In one such study he showed how salp chains, though lacking nervous connections between individual zooids, can swim in a coordinated manner using excitable epithelia. In another, using intracellular recordings and whole cell voltage clamp techniques, he was able to link changes in a siphonophore's swimming directly to changes in ion channel kinetics. While Bone's early studies on fish swimming established him as a leader in one important field, his later work on the behavioural physiology of a wide variety of pelagic marine invertebrates adds up to an equally outstanding body of work.
A feedback control principle common to several biological and engineered systems
Authors: Suen Jonathan Y. , Navlakha Saket
Published: March 2022

Feedback control is used by many distributed systems to optimize behaviour. Traditional feedback control algorithms spend significant resources to constantly sense and stabilize a continuous control variable of interest, such as vehicle speed for implementing cruise control, or body temperature for maintaining homeostasis. By contrast, discrete-event feedback (e.g. a server acknowledging when data are successfully transmitted, or a brief antennal interaction when an ant returns to the nest after successful foraging) can reduce costs associated with monitoring a continuous variable; however, optimizing behaviour in this setting requires alternative strategies. Here, we studied parallels between discrete-event feedback control strategies in biological and engineered systems. We found that two common engineering rules—additive-increase, upon positive feedback, and multiplicative-decrease, upon negative feedback, and multiplicative-increase multiplicative-decrease—are used by diverse biological systems, including for regulating foraging by harvester ant colonies, for maintaining cell-size homeostasis, and for synaptic learning and adaptation in neural circuits. These rules support several goals of these systems, including optimizing efficiency (i.e. using all available resources); splitting resources fairly among cooperating agents, or conversely, acquiring resources quickly among competing agents; and minimizing the latency of responses, especially when conditions change. We hypothesize that theoretical frameworks from distributed computing may offer new ways to analyse adaptation behaviour of biology systems, and in return, biological strategies may inspire new algorithms for discrete-event feedback control in engineering.
Temporal exponential random graph models of longitudinal brain networks after stroke
Authors: Obando Catalina , Rosso Charlotte , Siegel Joshua , Corbetta Maurizio , De Vico Fallani Fabrizio
Published: March 2022

Plasticity after stroke is a complex phenomenon. Functional reorganization occurs not only in the perilesional tissue but throughout the brain. However, the local connection mechanisms generating such global network changes remain largely unknown. To address this question, time must be considered as a formal variable of the problem rather than a simple repeated observation. Here, we hypothesized that the presence of temporal connection motifs, such as the formation of temporal triangles (T) and edges (E) over time, would explain large-scale brain reorganization after stroke. To test our hypothesis, we adopted a statistical framework based on temporal exponential random graph models (tERGMs), where the aforementioned temporal motifs were implemented as parameters and adapted to capture global network changes after stroke. We first validated the performance on synthetic time-varying networks as compared to standard static approaches. Then, using real functional brain networks, we showed that estimates of tERGM parameters were sufficient to reproduce brain network changes from 2 weeks to 1 year after stroke. These temporal connection signatures, reflecting within-hemisphere segregation (T) and between hemisphere integration (E), were associated with patients' future behaviour. In particular, interhemispheric temporal edges significantly correlated with the chronic language and visual outcome in subcortical and cortical stroke, respectively. Our results indicate the importance of time-varying connection properties when modelling dynamic complex systems and provide fresh insights into modelling of brain network mechanisms after stroke.