bluuebunny/crossref_metadata_2025 huggingface dataset:
Toe Keloids Treated with Core Excision, Postoperative Radiotherapy, and Steroid Plaster
Authors: Kaku Chiemi , Matsunaga Noriko , Kuribayashi Shigehiko , Ogawa Rei
Published: February 2021

Although keloids are common on the joints, precordial areas, and abdomen, toe keloids are rare. The limited literature to date also suggests that they can be difficult to treat. We experienced the case of a 21-year-old woman with toe keloids on the first, second, and third toes that arose after ingrown-nail operations at another hospital. The second toe keloid was resected but recurred. Since subsequent conservative treatments were ineffective, the patient was referred to our hospital. The first visit revealed three large keloids: in particular, the keloid on the second toe had engulfed the entire circumference of the toe. Surgery with the core-excision method and postoperative radiotherapy were performed. After the sutures were removed, the scars were treated for 24 hours/day with steroid plaster until the induration disappeared. One and a half years after the operation, recurrence was not observed and the appearance of the toes had improved greatly. Thus, combination therapy composed of core excision, radiotherapy, and steroid plaster therapy is highly effective for toe keloids.
Mastectomy Incision Design to Optimize Aesthetic Outcomes in Breast Reconstruction
Authors: Lotan Adi Maisel , Tongson Krystina C. , Police Alice M. , Dec Wojciech
Published: February 2021

Background:

Choosing the optimal mastectomy incision must account for oncologic, reconstructive, and aesthetic considerations, including nipple preservation, mastectomy skin margins and potential for skin involvement, mastectomy skin perfusion and viability, mastectomy skin excess, previous breast scars, the reconstructive plan, and inconspicuous new scar placement. In the present study, we aimed to assess breast reconstruction aesthetics, as they are influenced by mastectomy incision design.

Methods:

Nine commonly utilized mastectomy incision patterns were grouped into 3 categories: hidden scar, vertical scar, and transverse scar. Twenty plastic surgeons were asked to blindly grade before and after photographs of reconstructed breasts with regard to scar visibility and position and according to their influence on breast aesthetics.

Results:

Statistically significant differences were observed between the study groups. Mastectomies and reconstructions performed through hidden incisions yield the most aesthetic results. Vertical scars are favorable to transverse scars. In the case of bilateral reconstructions, symmetric scar placement is paramount to optimizing aesthetic outcomes.

Conclusions:

The mastectomy incision pattern significantly affects the aesthetic outcomes in breast reconstruction. Patterns borrowed from cosmetic breast surgery consistently yield highly aesthetic outcomes. Surgeons must consider oncologic factors and patient characteristics in choosing an ideal incision for each patient.
Extended Transverse-oblique Back Flap for Myelomeningocele Defect Closure: A Case Series of 10 Patients
Authors: Kattan Abdullah E. , Alsufayan Faris A. , Alammar Alwaleed K. , Alhazmi Bushra , Ahmed Albanderi , Gelidan Adnan G. , Almishal Obaid M.
Published: February 2021

Background:

Myelomeningocele is the most common phenotype of congenital neural tube defects. Various reconstructive techniques have been described for soft tissue coverage following myelomeningocele repair, one of which is the use of dorsal intercostal artery perforator based flaps. The aim of this study was to describe our experience with the use of a transverse-oblique back flap that can be reliably extended to the anterior axillary line for closure of myelomeningocele defect. This pedicle transposition flap is based on thoracic or lumbar paraspinal perforators that originate from the dorsal intercostal arteries.

Methods:

This is a retrospective two center case-series where all patients who underwent myelomeningocele defect closure with extended transverse-oblique flap over three years period were included. Patients’ clinical data, surgical variables, and outcomes were documented and analyzed using descriptive measures. Flap harvest technique is also delineated in the present study.

Result:

Ten newborns (7 baby girls and 3 baby boys) who underwent a surgical closure of the myelomeningocele defect with an extended transverse-oblique back flap during the first week of life were included in the analysis. The defect was most commonly located in the lumbosacral area (50%) followed by the lumbar area (40%), with an overall average surface area of 22 ± 8.32 cm2. Common encountered complications include venous congestion to the distal part of the flap and minor wound dehiscence of less than 0.5 cm, all were managed conservatively. There were no incidences of flap loss or full necrosis. Primary closure of the donor site was possible in all cases.

Conclusions:

In the current series, the extended transverse-oblique back flap provided a safe and reliable coverage for myelomeningocele defect. Such a flap does not jeopardize other regional fasciocutanous or musclocutaneous flaps that might be needed for soft tissue coverage later in life for this population. It also obviates the placement of skin suture line over the repaired neural tube, thus yielding a durable coverage with no major complications or functional disability.
A Systematic Review of Cutaneous Dog Ear Deformity: A Management Algorithm
Authors: Kang Ajaipal S. , Kang Kevin S.
Published: February 2021

Background:

Dog ear, a characteristic bunching up of excess tissue formed during wound closure, is a common unsightly problem in cutaneous surgery. It may present as a cosmetic concern or a source of physical discomfort. Several management techniques have been reported, but it is unclear which approach is the most effective or whether outcomes vary with surgical situations. This report assesses the best practices for dog ear management.

Methods:

A systematic literature search was performed. All relevant articles written in English and involving human subjects were included.

Results:

There were 2028 potentially relevant articles, but only 36 articles met the inclusion criteria. These articles were published in multispecialty journals. They included 23 techniques or case report articles, 6 retrospective and prospective studies, but no clinical trial or randomized control trial. Ten major techniques were identified in the literature. No single technique was proved to be superior in the literature. There was no recommended algorithm in the literature.

Conclusions:

Despite there being no single recommended technique to manage dog ear deformities, there is ample evidence to suggest surgeons avoid a pre-planned elliptical design, use a proper skin-conserving design for excision, and carry out a meticulous suture closure as the first steps to prevent dog ears. We discuss the indications for each of the ten techniques and propose an algorithm for dog ear management. Until further research is performed, multispecialty cutaneous surgeons should familiarize themselves with the discussed techniques to provide patients with the best functional and aesthetic results.
Safe and Efficient Implant-based Breast Reconstruction
Authors: Chao Albert H.
Published: February 2021

Implant-based breast reconstruction is a safe and effective option associated with high patient satisfaction. Techniques have evolved significantly over the past several decades, characterized mostly by a reduction in the number of stages and time required to complete reconstruction, with maximal preservation of native breast elements. Nevertheless, both old and new techniques of implant-based breast reconstruction have a role depending on the specific clinical scenario, and thus plastic surgeons should be well versed in the full spectrum of options. This article reviews the key considerations underlying decision-making in implant-based breast reconstruction and the most effective techniques, with a focus on optimizing safety and efficiency.
Reconstruction of the Necrotic Scrotum with Hydrosurgery System and Pedicle DIEP Flap: A Case Report of Fournier Gangrene
Authors: Makino Yuma , Matsumine Hajime , Fujimaki Hiroshi , Takagi Mika , Takeuchi Masaki
Published: February 2021

Despite medical advances, the mortality rate associated with Fournier gangrene has remained largely unchanged and extremely high. In addition, conventional surgical treatment of Fournier gangrene of the scrotum requires excision of the testicles in some cases, which can result in loss of fertility. We report herein the favorable results of reconstruction of the scrotum following Fournier gangrene, using the hydrosurgery system and pedicled deep inferior epigastric perforator flap. A 60-year-old male patient was urgently transported to our hospital for fever, lower abdominal pain, and scrotal pain for several days. He was diagnosed with Fournier gangrene and underwent an emergency debridement procedure on the same day. Later, we performed a 2-phase reconstruction with a hydrosurgery system and pedicled deep inferior epigastric perforator flap under general anesthesia for the postoperative tissue defect. At 6 months postoperatively, there was no ulceration or scar contracture, and the results were aesthetically pleasing. There are no reported cases of reconstruction of the scrotum following Fournier gangrene using this procedure, and it might be an effective treatment option.
Free Nipple Grafting and Nipple Sharing in Autologous Breast Reconstruction after Mastectomy
Authors: Egozi Dana , Allwies Tanir M. , Fishel Ron , Jacobi Eliran , Lemberger Moran
Published: February 2021

Nipple sparing mastectomy is gaining popularity in recent years, as it provides superior aesthetic results and has a positive impact on the psychological well-being of patients. However, patients with macromastia and high grade ptosis are not good candidates for nipple sparing mastectomy due to a high risk for nipple necrosis; for these patients, the free nipple grafting (FNG) is an excellent option following autologous reconstruction. We herein present our experience with FNG for women with large and ptotic breasts undergoing mastectomy and autologous reconstruction. We also present the option of splitting a single nipple-areolar complex to provide 2 grafts for bilateral nipple reconstruction. This retrospective study is based on data collected between 2014 and 2019 at a single institution. We report on 7 patients (13 grafts): 5 patients underwent FNG (4 bilateral, 1 unilateral) and 2 patients had a single nipple split into 2 parts to create 2 nipple-areolar complexes. Of the 13 grafts, 9 had complete take, 3 had almost complete take, and only 1 graft was lost. Overall patient satisfaction from the procedure was high. The use of FNG is an excellent reconstructive option, as it preserves the patient’s own nipple in terms of color, shape, and texture. The procedure can be executed as part of a direct single-staged reconstruction for patients who are at a high risk for nipple necrosis.
Navigating Women’s BIA-ALCL Information Needs: Group Seminars May Offer an Opportunity to Empower the Patient–Surgeon Team
Authors: Park Jade O. , Webb Carmen E. , Temple-Oberle Claire F.
Published: February 2021

Background:

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a T-cell non-Hodgkin’s lymphoma that has been linked to textured breast implants, and is an emerging concern within the plastic and reconstructive surgery community. Many surgeons are struggling with how best to inform their patients and manage BIA-ALCL care without overwhelming their standard clinical practice.

Methods:

Five educational group seminars were held for 53 patients. A thematic analysis of the field notes taken at each seminar was conducted to identify recurring patient and surgeon behaviors.

Results:

The thematic analysis identified 5 key themes: seeking, amplifying, framing, trusting, and empowering. Seeking describes the knowledge sought by patients and their varying engagement in their care. Amplifying underlines how the emotionally charged topic of BIA-ALCL impacted patient and surgeon behaviors. Framing presents surgeon efforts to help patients understand the risk level of BIA-ALCL. Trusting addresses the ways BIA-ALCL has impacted patient trust in the medical community and the mechanisms to rebuild this trust. Empowering outlines surgeon efforts to engage patients in shared decision-making.

Conclusions:

Herein is presented a possible framework for efficient BIA-ALCL patient education that can be adapted to different surgical practices. Lessons learned are: (1) patients want information on BIA-ALCL’s clinical features and prophylactic implant removal; (2) BIA-ALCL discussions are emotionally charged and surgeons must remain cognizant of group dynamics and that the physician–patient power differential may impact patient decision-making; (3) patient trust has been strained but can be restored; and (4) patient responses to BIA-ALCL are variable and subjective; thus, surgeons should emphasize patient-centered care.
Reconstruction of Lower Limb Necrotizing Fasciitis by Hydrosurgical Debridement and Multiperforator Anterolateral Thigh Flap
Authors: Matsumine Hajime , Fujimaki Hiroshi , Takagi Mika , Shimizu Mari , Takeuchi Masaki
Published: February 2021

The authors describe a surgical treatment that optimally combined the use of the hydrosurgical system and a free multiperforator anterolateral thigh flap to prevent lower limb amputation in a severe case of necrotizing fasciitis. A 43-year-old woman was diagnosed with necrotizing fasciitis, and amputation was performed at the level of the metatarsal shafts with an emergency debridement using the hydrosurgical system. In the second reconstructive surgery, a free anterolateral thigh flap measuring 28 × 8 cm2 was harvested using the left thigh as the donor site and the vascular pedicle was made up of a total of 3 vessels, 2 perforating arteries from the descending branch of the lateral circumflex femoral artery, and 1 oblique branch from the lateral circumflex femoral artery. To thin the flap, we first resected as much subcutaneous fat as possible in the distal part of the flap (which would eventually cover the ankle joint) and ensured adequate residual volume of the proximal part of the flap (which would cover the metatarsal stumps). We then sutured the flap to the tissue defect on the left foot and then end-to-side anastomosing the lateral femoral circumflex artery and posterior tibial artery while the 2 veins were anastomosed to the posterior tibial veins under a microscope. Six months after the surgery, adequate flap volume was maintained over the metatarsal stumps with no postoperative complications such as infection or ulcer formation, and there were no other complications such as motor dysfunction at the donor site on the left thigh.
Strategy for Correction of the Whistling Deformity in Secondary Cleft Lip Reconstruction
Authors: Jian Xinchun , Jian Yu , Wu Xiaoshan , Li Hongyi
Published: February 2021

Background:

Following primary repair of a cleft lip, patients present with many facial deformities. One of the commonly observed sequelae of cleft lip repair is a whistling deformity. This retrospective study was carried out to evaluate the outcomes following correction of whistling deformities in secondary cleft lip reconstruction.

Methods:

We retrospectively reviewed the hospital records of patients with various whistling deformities who underwent repair from April 1989 to March 2018; 2 surgeons performed the repair using either the double movable mucomuscular complex flaps technique, modified Abbe flap technique, or Abbe flap technique. The postoperative anatomical structure and aesthetic effects of the surgery were evaluated.

Results:

In total, 136 patients were included in this study. Among these patients, 60 (44.2%) had a grade I whistling deformity and 47 (34.5%) had a grade II deformity and repair was performed using the double movable mucomuscular complex flaps technique and modified Abbe flap transfer technique, respectively, whereas the Abbe flap transfer technique was used in 16 patients (11.8%) and 13 patients (9.5%) with a grade III and grade IV whistling deformity, respectively. All patients were found to have normal postoperative anatomical structures and aesthetic effects of the upper lip, with all patients experiencing mild to moderate postoperative edema of the upper lip, and 29 cases (21.3%) developed an inconspicuous scar.

Conclusion:

The repair technique should be chosen based on the type of whistling deformity.
A Safe and Effective Lip Augmentation Method: The Step-by-Step Φ (Phi) Technique
Authors: Keramidas Evangelos , Rodopoulou Stavroula , Gavala Maria-Ioanna
Published: February 2021

Background:

The shape and fullness of the lips are essential in facial aesthetics. We describe a safe injection technique of hyaluronic acid (HA), based on the well-known golden number Φ (phi), for lip augmentation.

Methods:

The name given to that procedure is “the step-by-step Φ technique.” Firstly, “step-by-step” because we never inject more than 1–1.5 ml of HA in 1 session, and “phi” because we apply the golden ratio 1.618—broadly known as Φ—to identify the proper points for injection. Using a specific caliper, we identified 3–4 points in each upper half of the lip. We injected 0.01–0.05 ml of lower concentration (25 mg/g) HA in these particular areas of the upper lip, from the vermillion border into the vermillion. We took into consideration the existing lip volume to decide the proper amount of HA to be injected in every single site, as lips are often asymmetric. On the lower lip, we use the same caliper to identify again the proper injection points. If necessary, the next 2 sessions are performed at an interval of 15–30 days.

Results:

Our technique was performed in 833 patients. Mean age was 30.2 years (range: 18–72 years), and most patients were very satisfied. With this technique, we avoid severe complications such as arterial embolism or venous occlusion and unnatural results. The most common side effects were swelling, redness, and mild pain.

Conclusion:

The step-by-step Φ technique is safe, easy to learn and perform, and can provide natural results in lip augmentation.
A Workhorse Flap for Covering Moderate-sized Defects after Breast-conserving Surgery: Supercharged Lateral Thoracodorsal Flap
Authors: Kim Do Gon , Choi Dong Hun , Lee Joon Seok , Lee Jeong Woo , Lee Jeeyeon , Park Ho Yong , Yang Jung Dug
Published: February 2021

Background:

The lateral thoracodorsal (LTD) flap technique is a type of oncoplastic breast surgery that involves transposition of tissue from the lateral aspect of a partial mastectomy defect. It is a relatively simple procedure and shows lower donor morbidity and good aesthetic outcomes. Complications, such as fat necrosis and wound dehiscence due to poor circulation, may occur at the distal part of the flap. We used a supercharged LTD flap to reduce this problem. In this study, the outcomes of the LTD flap over 13 years were reviewed.

Methods:

We performed a retrospective study of 86 patients who underwent an LTD flap procedure between 2007 and 2019. We analyzed patient information using medical chart review and classified patients into groups according to lateral thoracic artery perforator supercharging. The incidence of complications, such as fat necrosis and wound dehiscence, was also analyzed.

Results:

The mean tumor weight was 83.67 g, and defects had a moderate size, as they represented 25.02% of the total breast volume. Fat necrosis was noted in 19.4% of cases in the group without lateral thoracic artery perforator supercharging and 4% of cases in the group with supercharging, with a significantly lower rate in the supercharged group.

Conclusions:

Our findings show that the LTD flap could be used to cover moderate-sized defects after breast-conserving surgery. Careful dissection to preserve the lateral thoracic artery perforator resulted in the reduction of complications, such as fat necrosis, and excellent aesthetic results.
Association of long-term SBP with clinical outcomes and quality of life in heart failure with preserved ejection fraction: an analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial
Authors: Huang Peisen , Yu Yuan , Wei Fangfei , Zhu Wengen , Xue Ruicong , Dong Yugang , Liu Chen
Published: February 2021

Aims:

To determine the associations of long-term SBP (LT-SBP) levels with clinical outcomes and health-related quality of life in heart failure with preserved ejection fraction (HFpEF).

Methods and results:

We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study with available different SBP measurements from different follow-ups (n = 3310). LT-SBP was the mean SBP value from 4-week measurement to the last one. The outcome measures are all-cause mortality and a composite of heart failure readmission or all-cause mortality and the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score. To determine the associations of LT-SBP and outcomes, we used adjusted Cox proportional hazards models and restricted cubic spline models. After multivariable adjustment, LT-SBP of 120–129 and 130–139 mmHg were associated with a lower risk of mortality (hazard ratio 0.66, 95% CI 0.51–0.87, P = 0.003; hazard ratio 0.68, 95% CI 0.51–0.90, P = 0.007, respectively); LT-SBP of 100–119 mmHg had similar risk of mortality (hazard ratio 0.96, 95% CI 0.72–1.28, P = 0.778) compared with LT-SBP of at least 140 mmHg. There was U-shaped relationship between LT-SBP and all-cause mortality (P < 0.001) with nadir risk occurring around 123 mmHg. Similar relationships were observed between LT-SBP and composite end point of heart failure readmission or all-cause mortality. The adjusted mean improvement in KCCQ score was significantly higher in the 120–129 mmHg group than in the at least 140 mmHg group beginning from the 12-month follow-up visit without significant differences in other groups.

Conclusion:

Among patients with HFpEF, long-term control of SBP level at 120–129 mmHg is independently associated with the highest risk reduction of all-cause mortality and improvement of KCCQ score. Future randomized clinical trials need to specifically evaluate optimal SBP treatment goals in patients with HFpEF.
“They Know Me and My Situation—Patients' and Spouses' Perceptions of Person-Centered Care in Hospital-at-Home Care”
Authors: Vaartio-Rajalin Heli , Fagerström Lisbeth , Santamäki-Fischer Regina
Published: February 2021

Realization of person-centered care (PCC) is contextual. How is it perceived at hospital-at-home? Pairwise telephone interviews of patients (n = 27) and their spouses (n = 18) emerged in 4 themes. Care was found to be person-centered when both the principles and activities that underpin the concept PCC were realized.
The Effect of Lavender Aromatherapy on Heart Rate, Blood Pressure, and Perceived Stress Among Cardiac Rehabilitation Patients
Authors: Sebastian Lonnie Aquaro , Kear Tamara
Published: February 2021

The purpose of this study was to test the efficacy of lavender aromatherapy via inhalation as a stress management modality for patients in cardiac rehabilitation. This was a quasi-experimental design. Aromatherapy was provided via inhalation to participants before a cardiac rehabilitation session over 8 minutes using lavender essential oil. The same protocol was used in the non-aromatherapy session without the essential oil. Blood pressure and radial pulse were measured, and subjective data were also collected including assessment of stress level (1-10 scale) and affect using the Positive and Negative Affect Schedule (PANAS). Analyses were performed using SPSS Statistics version 20. Quantitative measures were analyzed using Mann-Whitney nonparametric equivalent to the t test. Inferential measures were analyzed using the χ2 or Fisher's exact test. In the outpatient cardiac rehabilitation program, 25 patients participated in this study. The average change in negative affect (PANAS−) between pre and post-aromatherapy compared with pre- and post-non-aromatherapy sessions was statistically significant. Results showed a reduction in blood pressure following both aromatherapy and non-aromatherapy sessions with no statistical significance between sessions. Heart rate decreased equally post-aromatherapy and non-aromatherapy sessions. Aromatherapy may be a useful stress management tool for cardiac rehabilitation patients.
A Case of Black Fungal Keratitis Caused by Biatriospora mackinnonii
Authors: Aoki Takanori , Fukuoka Hideki , Inatomi Tsutomu , Horiuchi Noriko , Kamei Katsuhiko , Sotozono Chie
Published: February 2021

Purpose:

To report a novel case of fungal keratitis caused by Biatriospora mackinnonii (Pyrenochaeta mackinnonii), a dematiaceous fungus (black fungus) that rarely causes dermatological infection, in a patient treated for ocular cicatricial pemphigoid.

Methods:

An 81-year-old patient with ocular cicatricial pemphigoid was referred to our hospital because of persistent corneal epithelial defects in his left eye. On examination, a slightly elevated dark lesion in the middle of the erosion and hypopyon was observed in that eye, with smear examination of the obtained specimen revealed a filamentous fungal-like material. Initially, treatment included miconazole and fluconazole ophthalmic solution eye drops, natamycin ophthalmic ointment, and systemic voriconazole, followed surgical scraping of the mass, an anterior chamber lavage, and a subconjunctival injection of miconazole. However, the focus had resistance to the treatment and finally led to corneal perforation; hence, therapeutic penetrating keratoplasty (PKP) was subsequently performed.

Results:

Mycological testing revealed that the lesions were Candida parapsiliosis and black fungus, with the black fungus classified as B. mackinnonii via DNA sequencing of the internal transcribed spacer and the D1/D2 domains of the 28S rRNA gene. Fungal keratitis caused by B. mackinnonii was resistant to the antifungal drugs, yet was ameliorated by PKP, with no recurrence of fungal keratitis for more than 2 years postoperative.

Conclusions:

To the best of our knowledge, this is the first reported case of fungal keratitis caused by B. mackinnonii; however, in this case, PKP surgery resulted in a favorable outcome.
Discontinuation of Transmission Precautions for COVID-19 Patients
Authors: Jiwani Rahim A. , Mao Yuxuan , Pona Adrian , Bradner Evan , Hussain Jaffer , Stalls J. Stephen , Cook Paul , Burch Ashley , Afriyie Felix , Labbe Jonathan , Younes Ahmed , Badr Mai , Lee Elisabeth , Roper Rachel L.
Published: February 2021

Background

The decision of when it is safe to discontinue transmission-based precautions for SARS-CoV-2 coronavirus disease 2019 (COVID-19) hospitalized patients has been controversial. The Centers for Disease Control and Prevention offered reverse transcriptase polymerase chain reaction (PCR) diagnostic test- or symptom-based guidelines.

Methods

A retrospective chart review of Vidant Health system, Eastern North Carolina, was conducted. Length of stay, days in isolation unit, and date appropriate for discharge or isolation discontinuation based on the symptom-based strategy were recorded.

Results

Of 196 COVID hospitalized patients, 34 had repeated COVID PCR tests 3 or more days from their first positive test result. Half of these patients experienced delays in release from transmission-based precautions because of repeated positive PCR test results and use of the test-based approach. This resulted in an additional 166 days of hospitalization, costing an estimated $415,000. Furthermore, 2 subjects had a combined 16-day delay in necessary medical procedures. Most of the COVID PCR platforms yield quantitative results in the form of cycle threshold (Ct) values, the number of cycles needed to detect the genome. These values have also been used to assess whether patients are likely to remain contagious. None of our patients who met the criteria for symptom-based strategy for transmission-based precaution discontinuation had positive PCR test results with Ct values lower than 25, but 4 had Ct values lower than 30.

Conclusions

Concerns surround immunocompromised patients and those treated with steroids who might be delayed or incapable of stopping viral replication and thus remain contagious. Our results suggest that clinicians use all available data including Ct values to evaluate the safety of discontinuation of transmission precautions.
Heightened pain facilitation rather than impaired pain inhibition distinguishes those with moderate/severe disability in work-related neck pain
Authors: Xie Yanfei , Thomas Lucy , Barbero Marco , Falla Deborah , Johnston Venerina , Coombes Brooke K.
Published: February 2021

To better understand the mechanisms underpinning work-related neck pain, this cross-sectional and single-blinded study compared somatosensory profiles among sonographers with varied neck disability levels. Based on K-mean cluster analysis of scores on the neck disability index (NDI), participants were classified into no (NDI ≤ 8%, n = 31, reference group), mild (NDI = 10%-20%, n = 43), or moderate/severe (NDI ≥ 22%, n = 18) disability groups. Data were collected on bodily pain distribution and severity and psychological measures including depression, anxiety, pain-catastrophizing, and fear-avoidance beliefs using validated scales. Participants attended 1 session of quantitative sensory testing performed according to a standardized protocol, including local and remote thermal and mechanical pain thresholds, temporal summation of pain (TSP), conditioned pain modulation, and an exercise-induced analgesia paradigm. Compared with participants with no and mild disability, those with moderate/severe disability showed more widespread pain, cold and mechanical hyperalgesia at a remote nonpainful site, and significantly higher TSP. Participants with mild disability demonstrated significantly higher TSP than those with no disability. These group differences were attenuated after adjusting for depression or anxiety, indicating these psychological factors may mediate the somatosensory changes associated with neck disability. Group differences were not found for conditioned pain modulation or exercise-induced analgesia. These findings suggest that heightened pain facilitation, rather than impaired pain inhibition may underpin nociplastic pain in participants with moderate/severe disability, and it may be associated with depression and anxiety. Clinicians should be aware that individuals with work-related neck pain presenting with moderate/severe disability display distinct somatosensory features and tailor management strategies accordingly.
Barriers and enablers influencing healthcare professionals' adoption of a biopsychosocial approach to musculoskeletal pain: a systematic review and qualitative evidence synthesis
Authors: Ng Wendy , Slater Helen , Starcevich Cobie , Wright Anthony , Mitchell Tim , Beales Darren
Published: February 2021

A substantial evidence–practice gap exists between healthcare professionals learning about the biopsychosocial model of pain and adopting this model in clinical practice. This review aimed to explore the barriers and enablers that influence the application of a biopsychosocial approach to musculoskeletal pain in practice, from the clinicians' perspective. Qualitative evidence synthesis was used. Four electronic databases (CINAHL, EMBASE, MEDLINE, and PsycINFO) were searched. Primary qualitative studies were included if they investigated the experiences of primary healthcare professionals using a biopsychosocial model of musculoskeletal pain care in outpatient settings or their perceptions towards biopsychosocial-oriented clinical practice guidelines. After screening 6571 abstracts, 77 full-text articles were retrieved. Twenty-five studies met the eligibility criteria, reporting the experiences of 413 healthcare professionals (including general practitioners, physiotherapists, and others) spanning 11 countries. Three metathemes were identified that impact the adoption of the biopsychosocial model across the whole of health: (1) at the microlevel, healthcare professionals' personal factors, knowledge and skills, and their misconceptions of clinical practice guidelines, perception of patients' factors, and time; (2) at the mesolevel, clinical practice guideline formulation, community factors, funding models, health service provision, resourcing issues, and workforce training issues; and (3) at the macrolevel, health policy, organizational, and social factors. Synthesized data revealed multilevel (whole-of-health) barriers and enablers to health professionals adopting a biopsychosocial model of pain into practice. Awareness of these multilevel factors may help inform preimplementation preparedness and support more effective implementation of the biopsychosocial model of musculoskeletal pain into clinical practice.
PA1426
regulates
Pseudomonas aeruginosa
quorum sensing and virulence: an in vitro study
Authors: Tan Fang , She Pengfei , Zhou Linying , Li Shijia , Zeng Xianghai , Xu Lanlan , Liu Yaqian , Hussain Zubair , Wu Yong
Published: February 2021

Objective:

Pseudomonas aeruginosa
(
P. aeruginosa
) contains a hierarchy of quorum sensing (QS) network, consisting of the
las, rhl
and
pqs
systems, which play a key role in coordinating the expression of virulence factors.
PA2146
was found to be associated with
P. aeruginosa
pathogenicity in macrophage and host Immune response. The aim of this study was to investigate the effects of
PA2146
on the virulence of
P. aeruginosa
and explore its mechanism.

Methods:

PA2146
gene knockout strain and complement strain of
P. aeruginosa
PAO1 were constructed. The biomass of biofilm was detected by crystal violet staining; the virulence factors were measured, including pyocyanin, rhamnolipid, LasA elastase, LasB elastase and hemolytic activity; RNA-seq and label-free relative quantitative proteomics analyses were carried out to test the influence of
PA2146
on transcriptomics and proteomics. This study was approved by the Institutional Review Board of the Third Xiangya Hospital, Central South University, China (approval No. 2019-S021).

Results:

PA2146
-deficient strains showed reduced biofilm formation and increased pyocyanin, rhamnolipid, LasA elastase, LasB elastase, and hemolytic activity, as well as increased motility, compared with the wild-type strain. RNA-seq and label-free relative quantitative proteomics analyses revealed that
PA2146
repressed the transcription of several genes that are integral to the
pqs
system and to pyocyanin biosynthesis, and increased the expression of MexEF-OprN efflux pump components at the gene and protein level.

Conclusion:

PA2146
gene was found to inhibit the
pqs
system.
PA2146
may affect quorum sensing by directly inhibiting the
pqs
system or by enhancing the expression of MexEF-OprN efflux pump components, thereby promoting efflux of 2-heptyl-4(1H)-quinolone, a
Pseudomonas
quinolone signal precursor, and thus affecting
P. aeruginosa
virulence.
Risk Factors for Reaching Core Body Temperature Thresholds in Florida Agricultural Workers
Authors: Mac Valerie , Elon Lisa , Mix Jacqueline , Tovar-Aguilar Antonio , Flocks Joan , Economos Eugenia , Hertzberg Vicki , McCauley Linda
Published: February 2021

Background:

There is a compelling need to identify agricultural workers at risk for heat related illness (HRI).

Methods:

Data from Florida agricultural workers (N = 221) were collected over 3 summer workdays (2015 to 2017) to examine risk factors for exceeding NIOSH-recommended core temperature (Tc) thresholds (38 °C [Tc38] and 38.5 °C [Tc38.5]) using generalized linear mixed models.

Results:

On an average workday, 49% of participants exceeded Tc38 and 10% exceeded Tc38.5. On average, participants first exceeded both thresholds early in the day; the Tc38 threshold mid-morning (10:38 AM), and Tc38.5 about a half hour later (11:10 AM). Risk factors associated with exceeding Tc38 included years working in US agriculture, body mass index, time performing moderate-to-vigorous physical activity, increasing heat index, and field crop work.

Conclusions:

The high prevalence of core temperatures exceeding recommended limits emphasizes the serious need for mandated HRI prevention programs for outdoor workers.
Training Occupational and Environmental Medicine (OEM) Residents at the Uniformed Services University
Authors: Krahl Pamela L. , Thomas Richard J. , Gaydos Joel C. , Mallon Timothy M.
Published: February 2021

Objective:

To develop an actionable plan to sustain and improve the quality of the Uniformed Services University of the Health Sciences (USU) Occupational and Environmental Medicine (OEM) Residency Program.

Methods:

Program metrics were collected and analyzed to assess strengths, weaknesses, opportunities, and threats (SWOT analysis).

Results:

Program strengths are stable funding, full-time faculty and large class size. Weaknesses are limited toxicology curriculum, and the lack of complex clinical cases. Opportunities include establishing an OEM referral clinic, collaborating with U.S. Department of Defense (DoD) toxicology programs, aligning OEM research priorities in DoD, and including DoD Civilian physicians in OEM residency training. Threats are Military Health System reorganization, budget, and personnel cuts.

Conclusions:

The USU OEM Residency is strong but must be flexible to adjust to personnel, fiscal, and organizational changes. Aggregating the SWOT analyses for all the OEM residency programs may help identify strategies to sustain OEM training in the United States.
COVID-19 Vaccine Acceptability Among US Firefighters and Emergency Medical Services Workers
Authors: Caban-Martinez Alberto J. , Silvera Carlos A. , Santiago Katerina M. , Louzado-Feliciano Paola , Burgess Jefferey L. , Smith Denise L. , Jahnke Sara , Horn Gavin P. , Graber Judith M.
Published: February 2021

Objectives:

Estimate the point prevalence of COVID-19 vaccine acceptability among US firefighters and Emergency Medical Services (EMS) workers.

Methods:

A cross-sectional study design was used to administer an anonymous online survey to a national non-probabilistic sample of firefighter and EMS workers.

Results:

Among the 3169 respondents, 48.2% expressed high acceptability of the COVID-19 vaccine when it becomes available, while 24.2% were unsure and 27.6% reported low acceptability. Using the “high COVID-19 vaccine acceptability” group as the reference category, the groups with greater odds of reporting low acceptability included those: 30 to 39 years of age (odds ratio = 3.62 [95% confidence interval = 2.00 to 6.55]), Black race (3.60 [1.12 to 11.53]), Hispanic/Latinx ethnicity (2.39 [1.45 to 3.92]), with some college education (2.06 [1.29 to 3.27]), married (1.65 [1.03 to 2.65]), of current rank firefighter/EMS (2.21 [1.60 to 3.08]).

Conclusions:

Over half of US firefighters and EMS workers were uncertain or reported low acceptability of the COVID-19 vaccine when it becomes available.
The Economic Burden of Tenosynovial Giant Cell Tumors Among Employed Workforce in the United States
Authors: Lin Feng , Ionescu-Ittu Raluca , Pivneva Irina , Wynant Willy , Shi Sherry , Wu Eric Q. , Kwong Winghan J. , Abraham John A.
Published: February 2021

Objective:

To assess the economic burden of tenosynovial giant cell tumor (TGCT) among US employed workforce.

Methods:

Patients with TGCT medical claims (N = 1395) and matched controls (1:10) without TGCT claims (N = 13,950) were identified from the OptumHealth Care Solutions, Inc. database (January 1, 1999 to March 31, 2017). Adjusted regression models were used to compare healthcare resource utilization, time lost from work, and associated costs between cohorts.

Results:

In patients with TGCT, the rates of inpatient admissions, emergency room visits, outpatient visits, and work loss days were 2.8, 1.5, 2.2, and 2.6 times those of matched controls, respectively (all P < 0.001). Total annual all-cause healthcare costs and work loss-related costs were $9368 and $2708 higher for TGCT patients than for matched controls, respectively (all P < 0.001).

Conclusions:

TGCT was associated with a significant healthcare and work loss burden on US employers.
“I'm Not the Only One With Depression”
Authors: Aubry Christine , Rider Amy , Russell Sasha , Moyer Sara , Kinser Patricia Anne
Published: February 2021

A standard format for depression management has long been the in-person group-based intervention, yet recent calls for scalable interventions have increased interest in individual online formats. However, the perspectives and preferences of women are largely missing in the literature. This secondary qualitative data analysis using a phenomenological method of inquiry explored the lived experiences of pregnant and nonpregnant women with depressive symptoms (N = 44) who participated in 2 studies involving group-based face-to-face mindful physical activity interventions for depressive symptom self-management. Four main themes emerged regarding the group format: shared experiences enhanced the feeling of safety and impact of the group interventions; group instructors played a key role in fostering a safe environment; participants wished for more group interactions; and participants preferred a synchronous group-based intervention over a technology-based or asynchronous alternative for depressive symptom management. The findings from this study suggest that women with depression enjoy synchronous group-based interventions and find them to be beneficial for the shared experiences with other women and the safe environment created by group instructors. Future research should include study designs that consider these factors in the context of hybrid or fully online intervention formats for depression management.
A Comprehensive Conceptual Framework to Guide Clinical Practice and Research About Mental Health During the Perinatal Period
Authors: Moyer Sara Wagner , Kinser Patricia A.
Published: February 2021

Perinatal mood and anxiety disorders (PMADs) affect up to 20% of pregnant and postpartum women and can have negative sequelae for maternal-child health. Nurses with clinical and research roles are on the front line of efforts to assess for and assist with prevention and intervention with PMAD symptoms. Thus, they can play an essential role in enhancing the mental well-being of women in the perinatal period and maternal-child health outcomes. The aim of this article is to assist nurses in this work by outlining the Comprehensive Model of Mental Health during the Perinatal Period, a conceptual framework for considering clinical and research opportunities to enhance perinatal mental health. The framework uses key principles that recognize biopsychoneuroimmunologic mechanisms involved in mental health; the key role that the experience of matrescence (“becoming a mother”) plays in mental health and maternal-child health; and the mother-infant dyad as the functional unit during the perinatal period. Examples are provided of how the key principles of this framework might be used to enhance research and clinical practice about PMADs and, ultimately, enhance maternal-child health outcomes.
Academic dishonesty: What impact does it have and what can faculty do?
Authors: Pittman Oralea A. , Barker Elizabeth
Published: February 2021

Academic dishonesty occurs among nursing students at multiple levels of professional education programs. Studies have shown that students who commit dishonest acts in the educational setting may also commit dishonest acts as students in the clinical setting and as professionals in their practice setting. This lack of professional integrity may result in poor outcomes for patients as well as loss of trust from patients and from colleagues. Although multiple studies done among prelicensure nursing students explored academic dishonesty, there are few studies of academic integrity among nurse practitioner (NP) students. As advanced practice nurses, we need to understand the issues of academic dishonesty among NP students through further research. As faculty, we must act to prevent academic dishonesty and unethical behavior and to provide appropriate consequences when it occurs. It is also important that we consider ways to socialize students into ethical behavior to maintain trust in the profession. It is important that we respond to both students and colleagues who demonstrate a lack of integrity. All NPs must work to create a culture of professional integrity among students and members of the profession at every level.
When to Say When—Reasons to Abort Surgery for Congenital Aural Atresia
Authors: Casazza Geoffrey C. , Kesser Bradley W.
Published: February 2021

Objective:

To determine reasons for premature termination in surgery for congenital aural atresia (CAA).

Study Design:

Retrospective chart review.

Setting:

High-volume tertiary care center.

Patients:

Patients undergoing primary surgical repair of CAA whose surgeries were aborted for various indications.

Intervention:

Patients with CAA who underwent elective aural atresia surgery at the University of Virginia from July 2004 to January 2020 were identified from the medical record and an institutional database of patients with CAA. Patients undergoing revision surgery or surgery not for hearing correction were excluded. All included candidates were noted to be good surgical candidates for atresia repair based on preoperative Jahrsdoerfer score of 6 or greater. Reasons for terminating surgery prematurely were categorized by anatomical constraints (inability to identify middle ear space, position of the facial nerve, or other anatomic abnormality), stapes fixation, and middle ear and/or mastoid inflammatory disease.

Main Outcome Measures:

Reasons for premature termination in CAA surgery.

Results:

Over the interval, 319 patients underwent primary surgery for CAA. Surgery was terminated prematurely without completing the primary objective in 14 patients (4.4%); surgery was terminated in 8 (57%) due to anatomic constraints, 4 (29%) due to stapes fixation, and 2 (14%) due to middle ear space and/or mastoid inflammatory disease.

Conclusions:

Premature termination in surgery for CAA is a rare occurrence with careful study of the preoperative high-resolution computed tomography of the temporal bone. Of the reasons for premature termination, anatomic constraints were the most common. Knowing limitations in surgery—both technical and anatomic—is critical to optimize outcomes and prevent complications.