bluuebunny/crossref_metadata_2025 huggingface dataset:
Collision nodal metastasis of bladder cancer and melanoma: The first reported case and literature review
Authors: Sanguedolce Francesca , Troiano Francesco , Musci Giovanni , Zanelii Magda , Zizzo Maurizio , Ascani Stefano , Carrieri Giuseppe , Cormio Luigi
Published: January 2022

Collision metastasis is a rare phenomenon of concomitant localization of 2 or more different tumors in the same lymph node. In most cases, primary malignancies are synchronous carcinomas arising in the same organ or area of the body. A 82-year-old man presented with hematuria and acute renal failure; he had undergone dermatological consultation ten months ago because of a large deep brown skin lesion in his dorso-lumbar region, which was not excised upon patient’s request. He underwent radical cystectomy with extended pelvic lymphadenectomy due to nonpapillary high-grade urothelial carcinoma, with focal squamous features, infiltrating the bladder wall and prostate gland. In one left iliac lymph node, small foci of metastatic urothelial carcinoma (positive for P63 and CK34betaE12) were close to melanoma cells (positive for HMB45). The patient refused further treatment and died of metastatic disease 12 months after cystectomy. There is no specific clinical feature for nodal collision metastasis. A polymorphic histologic appearance poses the suspect, but immunohistochemical stains are needed to define the primary tumors. Collision metastases are thought to carry a poor prognosis. Their clinical relevance is linked to the fact that the patient faces 2 different metastatic tumors that may require specific multidisciplinary approach once diagnosed as metastatic. We present, to the best of our knowledge, the first case of collision nodal metastasis from bladder cancer and melanoma, and describe its clinical and histopathological characteristics to raise awareness on this rare occurrence, which portends a poorer prognosis than each single tumor.
Retrieval and Characterization of a Plutonium-beryllium Source at the University of Utah
Authors: Olson Codey , Bates William , Cazalas Edward
Published: January 2022

A shielded neutron irradiation facility has been constructed to contain a 74 GBq plutonium-beryllium neutron source at the University of Utah. Due to lack of information and recent use, the GEANT4 Monte Carlo Toolkit was used to perform dose assessments and validation of the designed shield and beam port for storage and operational geometries where the source was to be placed. Borated polyethylene was used as the primary shielding material with a lead-lined beam port to collimate neutrons and reduce gamma rays within the active beam profile. The lead lining was found to reduce the gamma-to-neutron ratio within the profile to 0.259 ± 0.001 and maintain an average neutron flux of 4,633.7 ± 10.2 n cm−2 s−1. The measured dose rate of the source at 30 cm from its constructed storage configuration was found to be 22.3 ± 1.1 μSv h−1 and in good agreement with simulated values. This was also close to the target rate of 20 μSv h−1, the public limit for whole-body dose accumulation, imposed on the design. Measurements of the source during its retrieval and placement into the shield show good agreement with the simulated results and provide a strong validation for the future use of the source in experiments at the University of Utah.
Rotavirus Infection in Children <5 Years of Age in Suzhou, China, 2013–2019
Authors: Shen Si , Ren Shaolong , Chen Liling , Xue Jian , Shao Xuejun , Zhang Tao , Zhao Genming
Published: January 2022

Background:

This study aimed to determine the disease burden and strain distribution of rotavirus in children with diarrhea <5 years old in Suzhou, China.

Methods:

The study was conducted among children with diarrhea <5 years old at Suzhou University Affiliated Children’s Hospital from 2013 to 2019. Rotavirus antigen was detected in clinical laboratory and then sent to Suzhou Centers for Disease Control and Prevention for further molecular analysis. Group A rotavirus (RVA) was detected through enzyme-linked immunosorbent assays, and G-genotype and P-genotype of RVA were tested using reverse transcription-polymerase chain reaction.

Results:

Of a total of 198,130 children with diarrhea, 70,813 (35.7%) were positive for RVA; RVA-related diarrhea was detected in 7798 (20.7%, n = 7798/37,710) inpatients and 63,015 (39.3%, n = 63,015/160,420) outpatients. Most children (92.0%, n = 65,171/70,813) positive for RVA were found as children <3 years old. Children 12-35 months old were reported as the highest prevalence among all age groups. The seasonal peak of RVA was in the autumn and winter. Among all 673 RVA strains genotyped, the G9P[8] strain was reported to be persistently predominant in the pediatric population from 2013 to 2019.

Conclusions:

The burden of diarrhea disease due to rotavirus infection remains high in Suzhou.
Intracameral dexamethasone 9% vs prednisolone acetate 1% in controlling postoperative pain and inflammation in patients undergoing cataract surgery
Authors: Hovanesian John A. , Donnenfeld Eric D.
Published: January 2022

Purpose:

To compare patient preferences of postoperative cataract surgery topical medication use between a 1-drop and a 3-drop regimen.

Setting:

Two private cataract surgery centers.

Design:

Open-label randomized self-controlled prospective study.

Methods:

This study included 30 patients (60 eyes) undergoing routine cataract surgery in both eyes. In this contralateral eye study, 1 eye of each patient was randomized to the 1-drop regimen of intracameral delivery of moxifloxacin and dexamethasone suspension and topical bromfenac for 30 days. The other eye, randomized to the 3-drop regimen, received topical moxifloxacin 0.5% 4 times a day for 7 days and bromfenac 0.07% daily for 30 days postoperatively, along with prednisolone acetate 1% 4 times a day for 30 days. Patients reported their preferred regimen 2 weeks after the second surgery with a validated questionnaire. Secondary outcomes included subjective ocular pain, inflammation score, and out-of-pocket cost. Intraocular pressure (IOP) and macular thickness were also measured.

Results:

Of the 29 patients, 28 (96.6%) significantly more preferred the eye treated with a 1-drop regimen. Self-reported pain, activity interference, and out-of-pocket cost were significantly less in the 1-drop group. Inflammation and 1-day uncorrected distance visual acuity were also significantly better in the 1-drop group. Macular thickness and mean IOP were similar between groups.

Conclusions:

Intracameral delivery of steroid and antibiotics was preferred by most of the patients undergoing cataract surgery. These eyes had significantly less pain, inflammation, activity interference, and out-of-pocket cost and significantly better uncorrected distance visual acuity at 1 day postoperatively. IOP and macular thickness were similar between groups.
Treatment History Characteristics Associated With Use of Isocarboxazid
Authors: Holm Magnus , Larsen Jens Knud , Ishtiak-Ahmed Kazi , Speed Maria , Gasse Christiane , Østergaard Søren Dinesen
Published: January 2022

Purpose/Background

The monoamine oxidase inhibitor isocarboxazid (Marplan) is occasionally used in the treatment of depression, but there is only little knowledge on the nature of the use of isocarboxazid in clinical practice. We aimed to identify treatment history characteristics associated with this use.

Methods/Procedures

Via the nationwide Danish registers, we identified all adult incident users of isocarboxazid in the period from 2001 to 2018, as well as up to 5 matched controls using another antidepressant (matched on date of redeemed prescription, age, sex, and region of residence). The 5-year treatment history of the isocarboxazid users and the controls was assessed via the Danish registers. The association between treatment history characteristics and isocarboxazid use was examined by multivariate conditional logistic regression.

Findings/Results

We identified 1455 isocarboxazid users and 7045 controls using another antidepressant. The following characteristics were associated with statistically significant increased likelihood of receiving isocarboxazid treatment: Prior treatment with a selective serotonin reuptake inhibitor (odds ratio [OR], 1.80 with 95% confidence interval [CI], 1.46–2.23), a serotonin-norepinephrine reuptake inhibitor (OR, 4.90; 95% CI, 4.08–5.89), a noradrenergic and specific serotonergic antidepressant (OR, 1.56; 95% CI, 1.30–1.88), a tricyclic antidepressant (OR, 5.05; 95% CI, 4.19–6.08), other antidepressants (OR, 4.74; 95% CI, 3.74–6.01), lithium (OR, 6.70; 95% CI, 5.08–8.83), an antipsychotic (OR, 1.43; 95% CI, 1.19–1.73), and each diagnosis of depression received in relation to psychiatric hospital treatment (OR, 1.31; 95% CI, 1.23–1.39). Forty percent of those initiating isocarboxazid had received treatment with drugs from 5 or more different psychopharmacological classes in the 5 preceding years.

Implications/Conclusions

These findings suggest that isocarboxazid is typically used for treatment-resistant depression, consistent with guideline recommendations.
Examination of Similarities and Quantitative Analysis of Trends Between Admissions Variables and Academic Outcomes
Authors: Keough Kory
Published: January 2022

Purpose:

The purpose of this study was to analyze similarities and trends between admissions variables and academic outcomes of physician assistant (PA) graduate programs to better understand the correlations between them.

Methods:

First, multiple admissions variables were examined individually to determine whether and, if so, why they were similar to each of the following 3 academic outcomes: students' first-time Physician Assistant National Certifying Exam scores and overall and first-term graduate school grade point averages (GPAs). Afterward, trends between those individual academic outcome variables and the independent variables associated with any admissions criteria found to share similarities with individual academic outcomes were analyzed using simultaneous multiple linear regression models. Each model used at least 562 students from a sample set of 566 across 3 different PA graduate school programs.

Results:

Undergraduate GPAs and Graduate Record Examination (GRE) Verbal Reasoning and Quantitative Reasoning scores shared similarities with each academic outcome, and those similarities were included in each regression model. In each model, the undergraduate GPA beta coefficient was greater than the value of the GRE beta coefficients.

Conclusions:

Based on the beta coefficient values, the undergraduate GPA variable appeared to be the nonbinary and non-age-independent variable that trended upward the strongest alongside increases in each academic outcome when other variables were controlled for.
Comparison of Semicustom and Custom UCBL on Lower-Limb Kinematics in Flexible Flatfoot
Authors: Atefe Lesani , Ghomshe Tabatabai , Mahmood Bahramizadeh
Published: January 2022

Introduction

Orthotic devices can be successfully used to treat lower-limb injuries. However, their high cost is a major obstacle. Some orthotic companies have offered the semicustom alternatives at reasonable prices. The purpose of this study was to examine whether semicustom UCBL orthoses can provide similar rearfoot control as custom UCBL orthoses in individuals with flexible flatfoot.

Material and Methods

Eighteen subjects walked through the motion analysis laboratory under three conditions: no orthosis, custom UCBL orthosis, and semicustom UCBL orthosis. The rearfoot kinematics were assessed for each device.

Results

Both devices effectively reduced eversion excursion. Compared with the no orthotic condition, the custom and semicustom UCBL orthoses significantly decreased eversion excursion (P < .05), whereas peak eversion angle and velocity were not affected by any type of orthoses (P > .05).

Conclusion

Regarding the ability of semicustom UCBL orthoses to control rearfoot motion, they can be considered as a feasible alternative to custom UCBL orthoses for individuals with flexible flatfoot.

Clinical Relevance

This study provides evidence that semicustom UCBL orthoses are as effective as custom UCBL orthoses in controlling the rearfoot motion in flexible flatfoot. Therefore, owing to less fabrication time and lower price, semicustom UCBL orthoses are reasonable alternatives to custom UCBL orthoses.
Learning on the Go: Assessing Knowledge Gained From Medical Podcasts Created for Vulvovaginal Disease Education
Authors: Dmytryshyn Julia , Selk Amanda
Published: January 2022

Objective

The aim of the study was to evaluate the effectiveness of “The Vulva Diaries” podcast as a novel learning tool for vulvovaginal disease education.

Materials and Methods

Medical students and residents were invited to participate in the study using social media advertisements. Online pretests and posttests, one based on a podcast episode regarding genital herpes and the other on lichen sclerosus, were used to assess changes in knowledge level pre– and post–podcast listening in medical students and residents respectively. A second posttest was sent out 2 weeks after the first to assess knowledge retention. Results were analyzed using paired t tests comparing mean scores before and after podcast.

Results

In medical students, the average test score increased by 20% (n = 56, p < .001). Similarly, in residents the average test score increased by 23.1% (n = 22, p < .001). Medical students and residents rated their average preference for using podcasts as compared with other resources at 3.6 and 3.7/5, respectively. Furthermore, in both groups, there was no significant difference between average scores for posttest 1 versus posttest 2 written 2 weeks later suggested excellent knowledge retention.

Conclusions

“The Vulva Diaries” podcast increases knowledge on vulvovaginal disease and is an effective learning tool for health care trainees in women's health. This study emphasizes the role of podcasts as a valuable educational resource within gynecology. The success of such initiatives will hopefully bolster the effort to correct the lack of provider knowledge in treating vulvovaginal diseases.
The Disconnect Between Extracorporeal Circulation and the Microcirculation: A Review
Authors: Govender Krianthan , Jani Vinay P. , Cabrales Pedro
Published: January 2022

Extracorporeal circulation (ECC) procedures, such as cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), take over the function of one or more organs, providing clinicians time to treat underlying pathophysiological conditions. ECMO and CPB carry significant mortality rates for patients, despite prior decades of research focused on the resulting failure of critical organs. Since the focus of these procedures is to support blood flow and provide oxygen-rich blood to tissues, a shift in research toward the effects of ECMO and CPB on the microcirculation is warranted. Along with provoking systemic responses, both procedures disrupt the integrity of red blood cells, causing release of hemoglobin (Hb) from excessive foreign surface contact and mechanical stresses. The effects of hemolysis are especially pronounced in the microcirculation, where plasma Hb leads to nitric oxide scavenging, oxidization, formation of reactive oxygen species, and inflammatory responses. A limited number of studies have investigated the implications of ECMO in the microcirculation, but more work is needed to minimize ECMO-induced reduction of microcirculatory perfusion and consequently oxygenation. The following review presents existing information on the implications of ECMO and CPB on microvascular function and proposes future studies to understand and leverage key mechanisms to improve patient outcomes.
A Scoping Review of Biological Pathways of Integrative Interventions Used to Manage Chemotherapy-Induced Nausea and Vomiting in Children With Cancer
Authors: Kamkhoad Donruedee , Cho Youngmin , Santacroce Sheila Judge
Published: January 2022

Background

As with pharmacological management approaches, characteristics of complementary and alternative medicine (CAM) interventions for managing chemotherapy-induced nausea and vomiting (CINV) in children with cancer should be considered when developing and testing these interventions and reporting the outcomes.

Objectives

This systematic scoping review aimed to identify gaps and weaknesses in CAM and integrative interventions studies to prevent and manage CINV in children being treated for cancer, according to the CINV biological pathways.

Methods

This systematic scoping review was conducted under the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guideline. Included studies were published in English before May 2020 and examined the effects of integrative interventions on CINV in children being treated for cancer. Two authors performed computerized searches and manual reviews; these authors also extracted data about study characteristics, intervention characteristics, and CINV outcomes from the studies included in the review.

Results

Twenty-six studies of 29 CAM interventions met eligibility criteria. Most of these studies used randomized controlled trial designs and measured CINV outcomes at least once prior to and then after the intervention. Some studies did not explicate the interval between exposure to the intervention and outcome measurements. The CAM interventions studied included 15 cognitive–behavioral interventions, 8 acupoint stimulation interventions, 5 herb/supplementation interventions, and 1 educational intervention. One study tested two CAMs and clarified the underlying biological pathways, whereas 25 studies (27 CAMs) did not illustrate pathways; the pathways were deduced from information provided in the articles.

Discussion

Considering the biological pathways underlying CINV while developing integrative interventions, including the CAM component, could improve intervention efficacy. Measurement of biomarkers of activity in these pathways would provide a means to test whether changes in underlying pathways mediate change in CINV. Better reporting of intervention details and study processes is needed to support replication of CAM interventions and inform translation into clinical practice.
Characterization of Serum Samples With Discordant Results in 2 Herpes Simplex Virus Type 2 IgG Assays
Authors: Prince Harry E. , Batterman Hollis J. , Marlowe Elizabeth M.
Published: January 2022

Background

Our laboratory system tests sera for herpes simplex virus type 2 (HSV-2) IgG using the DiaSorin Liaison chemiluminescent immunoassay (CIA), with the option to confirm positive samples by a laboratory-developed HerpeSelect inhibition assay. As part of the confirmation process, the HerpeSelect HSV-2 IgG enzyme immunoassay (EIA) is performed. This study investigated the relationship between DiaSorin HSV-2 IgG CIA-positive indices and HerpeSelect HSV-2 IgG EIA results.

Methods

HerpeSelect HSV-2 IgG EIA results were compiled for a cohort of consecutive DiaSorin HSV-2 IgG CIA-positive (index ≥1.10) samples. To further characterize DiaSorin CIA-positive samples that were positive (concordant) or negative (discordant) by the HerpeSelect EIA, a separate composite reference study panel was constructed and also tested using the Biokit HSV-2 IgG assay and an HSV-2 IgG inhibition assay developed for the DiaSorin instrument. Samples were classified as DiaSorin HSV-2 IgG true positive or false positive based on a composite reference using HerpeSelect EIA, Biokit, and DiaSorin inhibition results.

Results

Of 2305 consecutive DiaSorin HSV-2 IgG CIA-positive samples, 411 (17.8%) were HerpeSelect HSV-2 IgG EIA negative; 343 of 411 (83%) had DiaSorin indices of 1.10 to 3.00. For the composite reference study panel (N = 120), 59 of 60 discordant samples were classified as DiaSorin HSV-2 IgG false positive based on the composite reference, whereas 58 of 60 concordant samples were classified as true positive.

Conclusions

Nearly all DiaSorin HSV-2 IgG CIA-positive but HerpeSelect HSV-2 IgG EIA-negative sera are falsely positive in the DiaSorin CIA. Furthermore, most DiaSorin false-positive samples exhibit low-positive indices, suggesting that guidelines for confirmatory testing should include low-positive samples by CIA and EIA.
Anatomic Characteristics of the Adolescent Cricothyroid Membrane on Computed Tomography Scans
Authors: Kelly Geoffrey S. , Tekes-Brady Aylin , Woltman Nathan Michael
Published: January 2022

Background

The cricothyroid membrane (CTM) is the most important anatomic structure when performing emergency front-of-neck access (FONA) procedures. Adolescence is a period of rapid morphologic change in laryngeal structures, including the CTM. We hypothesized that the adolescent CTM would be sufficiently different from pediatric or adult anatomy to merit special consideration in FONA.

Objective

The aim of the study was to define the procedurally relevant CTM anatomy in an adolescent population.

Methods

This was a retrospective, multicenter cohort study composed of patients who underwent a diagnostic computed tomography scan during routine clinical care. Inclusion criteria were ages 16 to 19 years and a computed tomography of the neck with or without contrast. The primary outcome was CTM height measured in the midsagittal plane using electronic calipers.

Results

One hundred thirty-four imaging studies met inclusion criteria. The average CTM height was strongly associated with age and ranged between 5.4 and 6.2 mm in male adolescents and 4.6 and 5.8 mm in female adolescents. We predicted that standard cuffed endotracheal and tracheostomy tubes recommended for FONA procedures (5.0- and 6.0-mm devices) could potentially fail for most patients in our cohort.

Conclusions

The adolescent CTM is smaller than previously recognized. We recommend having a variety of equipment sizes readily available at any site where airway management in adolescents may occur.
Severity of Illness Scoring for Pediatric Interfacility Transport
Authors: Mansoor Maha , Hansen Gregory , Bigham Michael , Holt Tanya
Published: January 2022

Objective

Severity of illness scoring during pediatric critical care transport may provide objective data to determine illness trajectory and disposition and contribute to quality assurance data for pediatric transport programs. The objective of this study was to ascertain the breadth of severity of illness scoring tool application among North American pediatric critical care transport teams.

Methods

A cross-sectional quantitative survey using REDCap was distributed to 137 North American pediatric transport programs. Baseline team characteristics were established along with questions related to severity of illness tool application.

Descriptive statistics were used for analysis.

Results

There were 55 responses (40%), and of those, 13 (24%) use a severity of illness scoring tool within their practice. A variety of tools were used including: Transport Risk Index of Physiologic Stability, Children's Hospital Medical Center Cincinnati, Canadian Triage and Acuity Score, Transport Risk Assessment in Pediatrics, Pediatric Early Warning Scores, Levels of Acuity, Transport Pediatric Early Warning Scores, and an unspecified tool. The timing of scoring, team personnel who applied the score, and the frequency of analysis varied between transport programs.

Conclusions

Severity of illness scoring is not consistently performed by pediatric interfacility transport programs in North America. Among the programs that use a scoring tool, there is variability in its application. There is no universally accepted or performed severity of illness scoring tool for pediatric interfacility transport.

Future research to validate and standardize a pediatric transport severity of illness scoring tool for North America is necessary.
Expression of Potential Biomarker Targets by Immunohistochemistry in Cervical Carcinomas
Authors: Sun Lulu , Schroeder Molly C. , Hagemann Ian S. , Pfeifer John D. , Schwarz Julie K. , Grigsby Perry W. , Markovina Stephanie , Lin Alexander J.
Published: January 2022

There have been few clinically useful targetable biomarkers in uterine cervical carcinomas. Estrogen receptor (ER), HER2, and fibroblast activation protein (FAP) are potential therapeutic or theranostic targets in other gynecologic and genitourinary carcinoma types. We determined the immunohistochemical expression patterns of these markers in treatment-naive cervical carcinoma, and whether expression correlated with clinical outcomes after definitive chemoradiation therapy. Tissue microarrays were created from 71 patient samples taken before therapy (57 squamous cell carcinomas and 14 nonsquamous cell carcinomas) and stained for ER, HER2, and FAP. ER was positive in 25/70 cases (36%). Of 66 tumors with evaluable HER2 staining, only 1 had positive (3+) staining (3%, positive for HER2 amplification by fluorescence in situ hybridization), and 1 had equivocal (2+) staining (negative for amplification by fluorescence in situ hybridization). The remainder were negative for HER2 overexpression. FAP expression was widely variably in the tumor stroma. ER positivity and FAP expression did not correlate with cervical recurrence, pelvic recurrence, distant recurrence, or cancer death. In conclusion, HER2 amplification is very rare in nonmetastatic treatment-naive cervical carcinomas, but if present, could represent a target for antibody therapy. ER and FAP were expressed in a subset of tumors, but expression did not correlate with clinical outcomes. These immunohistochemical markers do not demonstrate prognostic significance in treatment-naive cervical cancer, but they may have utility in targeted therapy or imaging.
The Korea National Patient Safety Incidents Inquiry Survey: Feasibility of Medical Record Review for Detecting Adverse Events in Regional Public Hospitals
Authors: Kim Min Ji , Seo Hee Jung , Koo Hong Mo , Ock Minsu , Hwang Jee-In , Lee Sang-Il
Published: January 2022

Objectives

We aimed to examine the Korea National Patient Safety Incidents Inquiry conducted in the Republic of Korea; specifically, we assessed the validity of screening criteria, interreviewer reliability, quality of medical records, and the time required for reviewing medical records.

Methods

A 3-stage retrospective medical record review was performed. The sensitivity and positive predictive value of the screening criteria for the adverse events were calculated, and interreviewer reliability was verified using the overall agreement rate and κ value. In addition, the results of medical record quality assessment and time required for review were analyzed.

Results

There were a total of 4159 patients (55.5%) with at least 1 of the 41 screening criteria. In stage 1, the overall percent of agreement was 81.9% when all negatives from the 2 reviewers were included, and the κ value was 0.64 (95% confidence interval [CI], 0.61–0.66). In stage 2, 84.6% of cases were a perfect match, and 87.4% were a partial match. The κ values were 0.159 (95% CI, 0.12–0.20) and 0.389 (95% CI, 0.35–0.43), respectively. The mean quality assessment scores were 3.18 of 4 points in stage 1 and 3.05 of 4 points in stage 2. In stage 1, it took an average of 13.02 minutes to asses each patient file; in stage 2, it took an average of 5.06 minutes.

Conclusions

To increase the feasibility of medical record review for detecting adverse events, it is important not only to improve the reliability between reviewers but also to monitor the quality of medical records and the time required for review.
Spinal Cord Stimulators: An Analysis of the Adverse Events Reported to the Australian Therapeutic Goods Administration
Authors: Jones Caitlin M. P. , Shaheed Christina Abdel , Ferreira Giovanni , Mannix Liam , Harris Ian A. , Buchbinder Rachelle , Maher Chris G.
Published: January 2022

Background

Spinal cord stimulators are used to treat intractable pain. Placebo-controlled trials of spinal cord stimulators typically involve short-term treatment and follow-up, so long-term safety and efficacy are unclear.

Aim

The aim of the study was to describe the adverse events relating to spinal cord stimulators reported to the Therapeutic Goods Administration of Australia between July 2012 and January 2019.

Methods

Adverse events were coded by seriousness, severity, body system affected, type of event, action taken, and attribution of fault. Data on the number of stimulators implanted and removed were sourced from the Admitted Patient Care Minimum Data Set.

Results

Five hundred twenty adverse events were reported for spinal cord stimulators. Most events were rated as severe (79%) or life-threatening (13%). Device malfunction was the most common event (56.5%). The most common action taken in response to an adverse event was surgical intervention with or without antibiotics (80%). The ratio of removals to implants was 4 per every 10 implanted.

Conclusions

Spinal cords stimulators have the potential for serious harm, and each year in Australia, many are removed. In view of the low certainty evidence of their long-term safety and effectiveness, our results raise questions about their role in providing long-term management of intractable pain.
Current international and national guidelines for managing skin and soft tissue infections
Authors: Bouza Emilio , Burillo Almudena
Published: January 2022

Purpose of review

Skin and soft tissue infections account for a significant percentage of both community and nosocomial infections. Several nosological entities are included in this concept. However, there is a very scarce body of doctrine for their treatment based on randomised trials. Therefore, we considered it necessary to review current treatment guidelines to bring new recommendations and improvements to our colleagues. In this review of recent literature, we identified updated guidelines in this area by searching the databases PubMed, evidence-based medicine online, York University reviewers group, Cochrane, MBE-Trip and Sumsearch using the terms: soft tissue infection, therapy, guideline.

Recent findings

Developments focus on using new antimicrobials and on the prescription of shorter antibiotic treatment courses.

With the development of new drugs and the current evidence of their use, there is a need to refine the appropriate drug's decision-making. Drugs with a long half-life, which allows weekly administration, can reduce hospital admission and length of stay with fewer healthcare resources. Shorter courses of antibiotics are recommended. The role of stewardship programmes will continue to expand. The surgical indication and its value are evident in many patients. Therefore, management should rely on a collaborative group with experience in this disease.
Skin manifestations in patients with coronavirus disease 2019
Authors: Bassetti Matteo , Massone Cesare , Vena Antonio , Dettori Silvia , Conforti Claudio , Giacobbe Daniele Roberto , Zalaudek Iris
Published: January 2022

Purpose of review

Coronavirus disease 2019 (COVID-19) is a well established respiratory tract illness. Recent studies in adults and children have shown an increasing number of patients reporting polymorphic cutaneous manifestations during COVID-19, including different types of rashes, from maculopapular, vascular, vesicular to atypical forms.

Recent findings

Although pathogenesis of skin manifestations is still not fully understood, it has been proposed that cutaneous involvement during COVID-19 may be the results of the activation of the immune response against severe acute respiratory syndrome coronavirus-2, the reactivation or co-infection of herpesviruses or drug hypersensitivity.

According to available literature, skin manifestations in patients with COVID-19 may be categorized on the basis of their clinical presentations as follows: erythematous rashes, lesions of vascular origin, vesicular rash, urticarial rash and acute generalized exanthematous pustulosis (AGEP), erythema multiforme and other polymorphic erythema/atypical reactions. Prompt recognition of these cutaneous manifestations represents a crucial point to facilitate diagnosis and management of COVID-19 patients.
Mycobacterial skin infection
Authors: Gardini Giulia , Gregori Natalia , Matteelli Alberto , Castelli Francesco
Published: January 2022

Purpose of review

The aim of this article is to review the most recent evidences concerning mycobacterial skin infections, limiting the period of literature research to 2020--2021.

Recent findings

Mycobacterial skin infections include a heterogeneous group of cutaneous diseases.

Cutaneous tuberculosis is usually the result of hematogenous dissemination or spread from underlying foci and it must be distinguished from tuberculids, resulting from the immunological reaction to Mycobacterium tuberculosis antigens. Leprosy prevalence was drastically reduced after introduction of multidrug therapy in the 1980 s, but cases are still reported due to underdiagnosis, and animal and environmental reservoirs. Recent advances concentrate in the diagnostic field. Specific guidelines for the treatment of nontuberculous mycobacteria skin infections are missing and surgical procedures may be required. Prognosis is better as compared to nontuberculous mycobacteria lung disease. Rapid laboratory-confirmed diagnosis of Buruli ulcer may be achieved by the IS2404 PCR. Among new drugs, telacebec is promising in terms of potency, shorter duration and tolerability in animal studies. A clinical trial in humans is planned.

Mycobacterial cutaneous lesions are nonpathognomonic and clinical suspicion must be confirmed by culture or molecular detection. Long-course multidrug treatment is required based on susceptibility tests. Surgical intervention may also be required. Rehabilitation and psychosocial support reduce long-term physical and mental consequences mostly in Buruli ulcer and leprosy.
Mentorship in Nuclear Medicine—Why and How?
Authors: Parihar Ashwin Singh , Dadparvar Simin
Published: January 2022

Mentorship is a highly gratifying relationship that requires commitment from all involved parties. Several different mentorship models exist that can be modified to suit the requirements of the mentors and mentees, and be fine-tuned for individuals at different career levels. Our proposed framework can be deployed as a pilot design for the trainees and early-career faculty members in nuclear medicine with the scope of appropriate timely modifications based on user feedback.
Performances of 18F-FDOPA PET/CT in the Preoperative Evaluation of the Peritoneal Cancer Index in Small Intestine Neuroendocrine Tumors
Authors: Morland David , Jallerat Pascaline , Brixi Hedia , Cadiot Guillaume , Papathanassiou Dimitri , Deguelte Sophie
Published: January 2022

Purpose

Peritoneal carcinomatosis (PC) concerns up to 30% of patients with a neuroendocrine tumor (NET), especially of the small intestine. Aggressive management of carcinomatosis seems to be justified, especially with regard to possible mechanical complications. 18F-FDOPA PET/CT is known to be the most sensitive imaging modality for the detection of small bowel NET metastases, yet its performance in the detection of PC is not well studied. The main objective of our study is to evaluate the performances of preoperative 18F-FDOPA PET/CT in the prediction of surgical peritoneal cancer index.

Methods

All patients referred to our center for an 18F-FDOPA PET/CT from October 2017 to January 2021 were retrospectively screened. Images were analyzed by a blinded nuclear medicine physician, and peritoneal abnormalities were reported to comply with the surgical peritoneal cancer index standard. Per patient analysis and per region analysis were then conducted.

Results

Thirty-three patients were included; 6 patients (35 regions) presented a peritoneal carcinosis. Peritoneal Carcinomatosis Index (PCI) estimated on 18F-FDOPA PET/CT was significantly and strongly correlated to surgical PCI (r = 0.96, P < 0.001). Patient-based sensitivity, specificity, negative predictive value, and positive predictive value for 18F-FDOPA PET/CT were 100%, 93%, 100%, and 75%, respectively. The agreement between 18F-FDOPA and surgery regarding PC was excellent (Cohen κ = 0.82 on per patient analysis, 0.74 on per region analysis).

Conclusions

A preoperative estimation of PCI is achievable based on 18F-FDOPA PET/CT for small intestine NET and could allow to optimize surgical procedures and patient selection.
Systematic Review of Patient Safety and Quality Improvement Initiatives in Breast Reconstruction
Authors: Paffile Julia , McGuire Connor , Bezuhly Michael
Published: January 2022

Background

Improving patient care and safety requires high-quality evidence. The objective of this study was to systematically review the existing evidence for patient safety (PS) and quality improvement initiatives in breast reconstruction.

Methods

A systematic review of the published plastic surgery literature was undertaken using a computerized search and following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Publication descriptors, methodological details, and results were extracted. Articles were assessed for methodological quality and clinical heterogeneity. Descriptive statistics were completed, and a meta-analysis was considered.

Results

Forty-six studies were included. Most studies were retrospective (52.2%) and from the third level of evidence (60.9%). Overall, the scientific quality was moderate, with randomized controlled trials generally being higher quality. Studies investigating approaches to reduce seroma (28.3% of included articles) suggested a potential benefit of quilting sutures. Studies focusing on infection (26.1%) demonstrated potential benefits to prophylactic antibiotics and drain use under 21 days. Enhanced recovery after surgery protocols (10.9%) overall did not compromise PS and was beneficial in reducing opioid use and length of stay. Interventions to increase flap survival (10.9%) demonstrated a potential benefit of nitroglycerin on mastectomy skin flaps.

Conclusions

Overall, studies were of moderate quality and investigated several worthwhile interventions. More validated, standardized outcome measures are required, and studies focusing on interventions to reduce thromboembolic events and bleeding risk could further improve PS.
Validation of the Pictorial Fit-Frail Scale in a Thoracic Surgery Clinic
Authors: Cooper Lisa , Deeb Ashley , Dezube Aaron R. , Mazzola Emanuele , Dumontier Clark , Bader Angela M. , Theou Olga , Jaklitsch Michael T. , Frain Laura N.
Published: January 2022

Objective:

Examine feasibility and construct validity of Pictorial Fit-Frail scale (PFFS) for the first time in older surgical patients.

Background:

The PFFS uses visual images to measure health state in 14 domains and has been previously validated in outpatient geriatric clinics.

Methods:

Patients ≥65 year-old who were evaluated in a multidisciplinary thoracic surgery clinic from November 2020 to May 2021 were prospectively included. Patients completed an in-person PFFS and Vulnerable Elders Survey (VES-13) during their visit, and a frailty index was calculated from the PFFS (PFFStrans). A geriatrician performed a comprehensive geriatric assessment (CGA) either in-person or virtually, from which a Frailty Index (FI-CGA) and Frailty Questionnaire (FRAIL) scale were obtained. To assess the validity of the PFFS in this population, the Spearman rank correlations (rspearman) between PFFStrans and VES-13, FI-CGA, FRAIL were calculated.

Results:

All 49 patients invited to participate agreed, of which 46/49 (94%) completed the PFFS so a score could be calculated. The majority of patients (59%) underwent an in-person CGA and the reminder (41%) a virtual CGA. The cohort was mainly female (59.0%), with a median age of 77 (range: 67–90). The median PFFStrans was 0.27 (interquartile range [IQR] 0.12-0.34), PFFS was 11 (IQR 5–14), and 0.24 (IQR 0.13–0.32) for FI-CGA. We observed a strong correlation between the PFFStrans and FI-CGA (rspearman = 0.81, P < 0.001) and a moderate correlation between PFFStrans and VES-13 and FRAIL score (rspearman = 0.68 and 0.64 respectively, P < 0.001).

Conclusions:

PFFS had good feasibility and construct validity among older surgical patients when compared to previously validated frailty measurements.
Imaging analysis of ischemic strokes due to blunt cerebrovascular injury
Authors: Abraham Peter J. , Black Jonathan A. , Griffin Russell L. , Abraham Mackenzie N. , Liptrap Elizabeth J. , Thaci Bart , Holcomb John B. , Kerby Jeffrey D. , Harrigan Mark R. , Jansen Jan O.
Published: January 2022

BACKGROUND

The timing of stroke onset among patients with blunt cerebrovascular injury (BCVI) is not well understood. All blunt trauma patients at our institution undergo a screening computed tomographic angiography (CTA) of the neck. Most patients with CTA evidence of BCVI are treated with aspirin, and all patients with clinical evidence of stroke are treated with aspirin and undergo magnetic resonance imaging (MRI) of the brain. We conducted a retrospective review to determine the incidence of stroke upon admission and following admission.

METHODS

All neck CTAs and head MRIs obtained in blunt trauma patients were reviewed from August 2017 to August 2019. All CTAs that were interpreted as showing BCVI were individually reviewed to confirm the diagnosis of BCVI. Stroke was defined as brain MRI evidence of new ischemic lesions, and each MRI was reviewed to identify the brain territory affected. We extracted the time to aspirin administration and the timing of stroke onset from patients' electronic health records.

RESULTS

Of the 6,849 blunt trauma patients, 479 (7.0%) had BCVIs. Twenty-four patients (5.0%) with BCVI had a stroke on admission. Twelve (2.6%) of the remaining 455 patients subsequently had a stroke during their hospitalization. The incidence of stroke among patients with BCVI was 7.5%; 2.6% were potentially preventable. Only 5 of the 12 patients received aspirin before the onset of stroke symptoms. All 36 patients with BCVI and stroke had thromboembolic lesions in the territory supplied by an injured vessel.

CONCLUSION

With universal screening, CTA evidence of BCVI is common among blunt trauma patients. Although acute stroke is also relatively common in this population, two thirds of strokes are already evident on admission. One third of BCVI-related strokes occur after admission and often relatively early, necessitating rapid commencement of preventative treatment. Further studies are required to demonstrate the value of antithrombotic administration in preventing stroke in BCVI patients.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic; Level IV.
Systematic Evaluation of Research Priorities in Critical Care Electroencephalography
Authors: Sheikh Zubeda , Selioutski Olga , Taraschenko Olga , Gilmore Emily J. , Westover M. Brandon , Cohen Adam B.
Published: January 2022

Purpose:

The Critical Care EEG Monitoring Research Consortium (CCEMRC) is an international research group focusing on critical care EEG and epilepsy. As CCEMRC grew to include 50+ institutions over the past decade, members met to establish research priorities.

Methods:

The authors used an analytical hierarchy process–based research prioritization method, adapted from an approach previously applied to a Department of Defense health-related research program. Forty-six CCEMRC members identified and scored a set of eight clinical problems (CPs) and 15 research topic areas (RTAs) at an annual CCEMRC meeting. Members scored CPs on three criteria using a five-point ordinal scale: Incidence, Impact, and Gap Size; and RTAs on four additional criteria: Niche, Feasibility, Scientific Importance, and Medical Importance, each of which was assigned a weight. The first three RTA criteria were scored using a five-point scale, and CPs were mapped to RTAs using a four-point scale. The Medical Importance score was a weighted average of its mapping scores and the CP score. Finally, a Priority score was calculated for each RTA as a product of the four RTA criteria scores.

Results:

The CPs with the highest scores were “Altered mental status” and “Long-term neurologic disability after hospital discharge.” The RTAs with the highest priority scores were “Development of risk prediction tools,” “Multicenter observational studies,” and “Outcome prediction.”

Conclusions:

Research prioritization helped CCEMRC evaluate its current research trajectory, identify high-priority near-term research pursuits, and create a roadmap for future research plans aligned with its mission. This approach may be helpful to other academic consortia and research programs.
Niche breadth and elevational range size: a comparative study on Middle-European Brassicaceae species
Authors: Maccagni Alessio , Willi Yvonne
Published: January 2022

High-elevation species are predicted to have larger elevational ranges compared with species of lower elevations. The reasoning is that temperature variability is greater at higher elevation, selecting for wider niche breadth and more plastic genotypes. We used macroevolutionary comparisons involving 90 Brassicaceae species of the central Alps to test for associations among median elevation of occurrence, elevational range size and thermal variability over space and time on the one hand, and their associations with performance breadth or trait plasticity on the other hand. Performance breadth and trait plasticity were estimated by raising replicate plants per species under three temperature treatments (mild, recurrent frost, recurrent heat). Against prediction, we found that mid-elevation species had the largest elevational ranges, and their ranges were associated with increased spatial thermal variability. Nevertheless, variability in the thermal regime was positively associated neither with niche breadth nor with plasticity. Evidence for adaptive constraints was limited to a trade-off between acclimation-based increases in frost and heat resistance, and phylogenetic niche conservatism for median elevation of occurrence and temporal thermal variability. Results suggest that large elevational range size is associated with divergent adaptation within species, but not with more niche breadth or trait plasticity.

This article is part of the theme issue ‘Species’ ranges in the face of changing environments (part I)’.
Genetic load and extinction in peripheral populations: the roles of migration, drift and demographic stochasticity
Authors: Sachdeva Himani , Olusanya Oluwafunmilola , Barton Nick
Published: January 2022

We analyse how migration from a large mainland influences genetic load and population numbers on an island, in a scenario where fitness-affecting variants are unconditionally deleterious, and where numbers decline with increasing load. Our analysis shows that migration can have qualitatively different effects, depending on the total mutation target and fitness effects of deleterious variants. In particular, we find that populations exhibit a genetic Allee effect across a wide range of parameter combinations, when variants are partially recessive, cycling between low-load (large-population) and high-load (sink) states. Increased migration reduces load in the sink state (by increasing heterozygosity) but further inflates load in the large-population state (by hindering purging). We identify various critical parameter thresholds at which one or other stable state collapses, and discuss how these thresholds are influenced by the genetic versus demographic effects of migration. Our analysis is based on a ‘semi-deterministic’ analysis, which accounts for genetic drift but neglects demographic stochasticity. We also compare against simulations which account for both demographic stochasticity and drift. Our results clarify the importance of gene flow as a key determinant of extinction risk in peripheral populations, even in the absence of ecological gradients.

This article is part of the theme issue ‘Species’ ranges in the face of changing environments (part I)’.