bluuebunny/crossref_metadata_2025 huggingface dataset:
Minimally invasive approach to a deep-seated motor eloquent brain tumour: a technical note
Authors: Lavrador Jose Pedro , Oviedova Anna , Pereira Noemia , Patel Sabina , Rajwani Kapil Mohan , Sekhon Priya , Gullan Richard , Ashkan Keyoumars , Vergani Francesco , Bhangoo Ranjeev
Published: December 2021

Deep-seated brain tumours represent a unique neurosurgical challenge as they are often surrounded by eloquent structures. We describe a minimally invasive technique using tubular retractors and intraoperative neurophysiology monitoring for open biopsy of a deep-seated lesion surrounded by the corticospinal tract. We used preoperative functional mapping with diffusion tensor imaging tractography and navigated transcranial magnetic stimulation to identify a safe surgical corridor. We also used 5-Aminolevulinic Acid induced fluorescence to identify the lesion intraoperatively and optimize tissue samples obtained for histopathological diagnosis. We found the use of these tools improved the safety of surgery and reduced the risk of surgical morbidity.
Spindle cell sarcoma: a case report of diagnostic and therapeutic quandary in a low resource setting
Authors: Panthi Sagar , Poudel Sajana , Khanal Nimesh , Bhandari Siddhartha , Adhikari Seema , Khatiwada Pradeep , Bhattarai Bharosha , Sharma Susmit , Khanal Sandeep , Shah Suresh P
Published: December 2021

Sarcomas can present differently in different parts of the body and showcase varied histopathological features and tend to recur locally and metastasize to distant sites. We discuss a case of a 37-year-old male with local recurrence of spindle cell sarcoma of the paraspinal muscles of size 20 × 20 cm2 with overlying ulceration and discharge with possible pulmonary metastasis. The mass was evaluated using magnetic resonance imaging/computed tomography and the histology was confirmed by biopsy. Wide surgical resection of the mass was done and the patient was referred to another center for radiotherapy and further treatment. The large size of the sarcoma and the possible pulmonary metastasis poses a risk of significant morbidity and mortality in this patient. This case showcases the scenario of many patients in developing countries where the patients are lost to follow-up due to various reasons and present later with grave consequences.
Collective Equality: Theoretical Foundations for the Law of Peace
Authors: Yehuda Limor
Published: December 2021

Significant tensions exist between constitutional strategies central to contemporary peacemaking in ‘deeply divided places’ and human rights law (HRL). These tensions are generally framed as a peace versus justice dilemma. Such framing is built on a narrow, individualistic conception of justice that fails to account for the meaning and requirements of justice in such places, and is consequently blind to the possible ‘justness’ of peacemaking strategies. In response, this article offers the concept of Collective Equality as a new theoretical basis for the law of peace. Collective Equality endorses national groups as legitimate actors and sets proper relations among them based on equality and non-domination. Collective Equality builds on emerging trends in self-determination law and provides a normative yardstick for political arrangements in deeply divided places. Collective Equality aims to decrease tensions between HRL and peacemaking practice, and to support HRL to better serve justice in such places.
Caught between Cultures: Unintended Consequences of Improving Opportunity for Immigrant Girls
Authors: Dahl Gordon B , Felfe Christina , Frijters Paul , Rainer Helmut
Published: December 2021

What happens when immigrant girls are given increased opportunities to integrate into the workplace and society, but their parents value more traditional cultural outcomes? We answer this question in the context of a reform which granted automatic birthright citizenship to eligible immigrant children born in Germany after 1 January 2000. Using survey data, we collected from students in 57 schools and comparing those born in the months before vs. after the reform, we find the introduction of birthright citizenship lowers measures of life satisfaction and self-esteem for immigrant girls by 0.32 and 0.25 standard deviations, respectively. This is especially true for Muslims, where parents are likely to prefer more traditional cultural outcomes than their daughters. Moreover, we find that Muslim girls granted birthright citizenship are less integrated into German society: they are both more socially isolated and less likely to self-identify as German. Exploring mechanisms for these unintended drops in well-being and assimilation, we find that immigrant Muslim parents invest less in their daughters’ schooling and that these daughters receive worse grades in school if they are born after the reform. Parents are also less likely to speak German with these daughters. Consistent with a rise in intra-family conflict, birthright citizenship results in disillusionment where immigrant Muslim girls believe their chances of achieving their educational goals are lower and the perceived odds of having to forgo a career for a family rise. In contrast, immigrant boys experience, if anything, an improvement in well-being, integration, and schooling outcomes. Taken together, the findings point towards immigrant girls being pushed by parents to conform to a role within traditional culture, whereas boys are allowed to take advantage of the opportunities that come with citizenship. To explain these findings, we construct a simple game-theoretic model which builds on Akerlof and Kranton (2000), where identity-concerned parents constrain their daughter’s choices, and hence lower their daughter’s well-being, when faced with the threat of integration. Alternative models can explain some of the findings in isolation.
High school students constructing knowledge about convergence and limits
Authors: Elias Dafna , Dreyfus Tommy
Published: December 2021

We investigated how two didactical tools assist high school students in constructing knowledge about convergence and limits. The first tool is manual plotting of the terms of selected sequences, and the second, a technological applet. Student pairs worked in an interview setting on an activity designed for the purpose of this research. The interviews were transcribed and analysed using the RBC model of abstraction in context. The analysis of the interviews revealed that manual plotting supported students’ development of intuition about convergence and the technological tool supported students in constructing a notion of ‘as close as one pleases’, thus making a step in the direction of the formal definition of limit. As a result, a structure of the elements of knowledge of the concept of convergence of sequences has been developed, the support of the tools has been evaluated and possible obstacles of the process have been identified.
An Examination of the Predictive Validity of Subjective Age and Core Self-evaluations on Performance-Related Outcomes
Authors: Laguerre Rick A , Barnes-Farrell Janet L , Hughes James M
Published: December 2021

The widely used single-item operationalization of subjective age “how old do you feel?” is unstable; yet, it is frequently used in longitudinal research. Based upon calls to investigate the psychometric properties of the multi-item (“Ages of Me”) operationalization of subjective age, we conducted a series of tests that evaluated the stability and incremental predictive validity of this construct. Using a 3-wave longitudinal design with a sample of working adults (T1 N = 1,182, T2 N = 975, T3 N = 875), we identified that the multi-item composite measure of subjective age (feel-age, do-age, interest-age, and look-age) has stable psychometric properties over time. Regression analyses revealed that the multi-item subjective age operationalization had stronger associations with job performance, the achievement of personal workplace goals, and work-related flow than the single-item version; however, when controlling for prior levels of outcomes the majority of effects dissipated. Moreover, core self-evaluations had incremental predictive validity over subjective age and prior levels of outcomes. Relative weights analysis confirmed that the core self-evaluations construct is a more important predictor than either subjective age operationalization. Results are discussed in the context of debates surrounding the utility of subjective age and core self-evaluations for aging research. We offer theoretical and practical considerations for future studies on subjective age and core self-evaluations at work.
Occupational inhalant allergy in food handling occupations
Authors: Jeebhay Mohamed F. , Baatjies Roslynn
Published: December 2021

Purpose of review

Review article on recent developments on inhalant food allergens associated with occupational respiratory allergy and asthma.

Recent findings

This review has found that occupational inhalant allergy in food handling occupations is a common and recognisable clinical entity (class 3 food allergy) in high-risk food occupations such as bakeries and seafood processing. Aerosolised food proteins from plant or animal food sources, additives and biological food contaminants cause occupational sensitization, rhinitis and asthma. The risk of allergy may be enhanced across the food value chain as a result of food processing techniques including the introduction of new food allergens in the food matrix. Occupational food allergy and asthma can be prevented by improved health-based exposure standards, workplace control measures, education and training activities, and early diagnosis accompanied with exposure reduction.

Future studies need to focus on exposure-response studies to establish improved exposure limits especially for flour dust, the relevance of cooked vs raw foods in influencing risk, identifying and characterising major inhalant food allergens accompanied with component resolved diagnostic approaches, and evaluating the effectiveness of interventions for common high-risk food sensitizers causing occupational rhinitis and asthma.
From Expressing Human Milk to Breastfeeding—An Essential Element in the Journey to Motherhood of Mothers of Prematurely Born Infants
Authors: Brødsgaard Anne , Andersen Bente Lund , Skaaning Diana , Petersen Mette
Published: December 2021

Background:

Lactation and breastfeeding present an extraordinary challenge for mothers of prematurely born infants.

Purpose:

To explore the significance of and the circumstances that affect lactation for mothers of premature infants.

Methods:

A qualitative exploratory study based on single, in-depth, semistructured interviews with 16 purposefully sampled mothers of premature infants admitted to the neonatal intensive care unit (NICU). Data were analyzed using content analysis. The study was reported according to Standards for Reporting Qualitative Research.

Findings:

The overall theme was “From expressing human milk to breastfeeding—an essential element in the journey to motherhood.” The theme emerged from 3 categories: the birth preparation time has been interrupted; expressing human milk is essential for lactation; and the motherhood journey encompasses breastfeeding. The analysis also revealed that the categories were impacted by initiating, performing, and maintaining lactation and further influenced by inhibitors and promoters.

Implications for Practice:

The promoters for performing milk expression and breastfeeding should be stimulated and the inhibitors should be eliminated. The achievement of “zero separation” and mother–infant couplet care in the NICU would be beneficial. In order for mothers to maintain successful lactation, it is essential that they receive supportive around-the-clock access to health professionals with expertise in lactation and breastfeeding until exclusive breastfeeding is well established.

Implications for Research:

The study highlights the need to investigate mother–infant as one entity rather than separately as mother and infant.
Early Advanced Weight-Bearing After Periarticular Fractures: A Randomized Trial Comparing Antigravity Treadmill Therapy Versus Standard of Care
Authors: Stinner Daniel J. , Rivera Jessica C. , Smith Christopher S. , Weiss David B. , Hymes Robert A. , Matuszewski Paul E. , Gary Joshua L. , Morshed Saam , Schmidt Andrew H. , Wilken Jason M. , Archer Kristin R. , Bailey Lane , Kleihege Jacquelyn , McLaughlin Kevin H. , Thompson Richard E. , Chung Suna , Remenapp Craig , MacKenzie Ellen J. , Reider Lisa ,   on behalf of METRC
Published: December 2021

In current clinical practice, weight-bearing is typically restricted for up to 12 weeks after definitive fixation of lower extremity periarticular fractures. However, muscle atrophy resulting from restricting weight-bearing has a deleterious effect on bone healing and overall limb function. Antigravity treadmill therapy may improve recovery by allowing patients to safely load the limb during therapy, thereby reducing the negative consequences of prolonged non–weight-bearing while avoiding complications associated with premature return to full weight-bearing. This article describes a multicenter randomized controlled trial comparing outcomes after a 10-week antigravity treadmill therapy program versus standard of care in adult patients with periarticular fractures of the knee and distal tibia. The primary hypothesis is that, compared with patients receiving standard of care, patients receiving antigravity treadmill therapy will report better function 6 months after definitive treatment.
Long-Term Consequences of Major Extremity Trauma: A Pilot Study
Authors: Castillo Renan C. , Carlini Anthony R. , Chaffee Trisha , Bosse Michael J. , O'Toole Robert V. , Kleweno Conor P. , McKinley Todd O. , Agel Julie , Higgins Thomas F. , Morshed Saam , Staguhn Elena D. , Aaron Rachel V. , Reider Lisa , Wu Albert W. , MacKenzie Ellen J. ,   on behalf of METRC
Published: December 2021

Limited data are available on the longer-term physical and psychosocial consequences after major extremity trauma apart from literature on the consequences after major limb amputation. The existing literature suggests that although variations in outcome exist, a significant proportion of service members and civilians sustaining major limb trauma will have less than optimal outcomes or health and rehabilitation needs over their life course. The proposed pilot study will address this gap in current research by locating and consenting METRC participants with the period of 5–7 years postinjury, identifying potential participation barriers and appropriate use of incentives, and conducting the follow-up examination at several data collection sites. The resulting data will inform the primary objective of refining and developing specific hypotheses to determine the design, scope, and feasibility of the main long-term consequences of major extremity trauma. Three METRC enrollment centers will contact past participants to achieve the goal of completing an interview, select patient-reported outcomes, perform a medical record review, and conduct an in-person clinic visit that will consist of a physical examination, blood draw, and x-ray of the study injury area. If successful, it will be possible to design studies to further examine these effects and develop future therapeutic interventions.
Amlodipine Improves Spinal Cord Injury Repair by Inhibiting Motoneuronal Apoptosis Through Autophagy Upregulation
Authors: Huang Yang , Ren Hao , Gao Xiang , Cai Danyang , Shan Huajian , Bai Jinyu , Sheng Lei , Jin Yong , Zhou Xiaozhong
Published: December 2021

Study Design.

The effect of amlodipine (AM) on spinal cord injury (SCI) and autophagy was researched by establishing ventral spinal cord cells (VSC4.1) oxygen and glucose deprivation model and SCI mice model.

Objective.

To determine the neuroprotective effects of AM by upregulating autophagy during SCI repair.

Summary of Background Data.

AM, an antihypertensive medication, has been shown in several studies to inhibit neuronal apoptosis and exert neuroprotective effects in various central nervous system diseases. However, its effects on SCI are unexplored. Autophagy could inhibit cell apoptosis, which has been shown to promote SCI repair. However, the role of AM in autophagy remains unclear.

Methods.

We examined the relationship between AM, apoptosis, and autophagy in ventral spinal cord cells and the injured spinal cords of C57BL/6 female mice respectively, following histological, behavioral, microscopic, immunofluorescence, and western blotting analyses.

Results.

We found that AM could inhibit motor neuronal apoptosis in vitro. Furthermore, AM promoted locomotor recovery by upregulating autophagy and alleviating apoptosis, neuronal loss, and spinal cord damage after SCI.

Conclusion.

AM inhibited motoneuronal apoptosis by upregulating autophagy to improve SCI recovery.
No Benefit with Preservation of Midline Structures in Decompression for Lumbar Spinal Stenosis
Authors: Elmqvist Erik , Lindhagen Lars , Försth Peter
Published: December 2021

Study Design.

Observational cohort study.

Objective.

The aim of this study was to investigate whether preservation of the midline structures is associated with a better clinical outcome compared to classic central decompression for lumbar spinal stenosis (LSS).

Summary of Background Data.

The classic surgical procedure for LSS is a central, facet joint sparing decompressive laminectomy (LE). Alternative approaches have been developed to preserve the midline structures. The effect of the alternative techniques compared to LE remains unclear.

Methods.

All patients >50 years of age who underwent decompression surgery for LSS without concomitant fusion in the National Swedish Spine Registry (Swespine) from December 31, 2015 until October 6, 2017 were included in this study based on surgeon-reported data and patient questionnaires before and 2 years postoperatively. Propensity score matching was used to compare decompression with preservation of midline structures with patients who underwent LE. The primary outcome was the Oswestry Disability Index (ODI) and secondary outcomes were the Numeric Rating Scale (NRS) for leg and back pain, EuroQol-5 Dimensions (EQ-5D), Global Assessment (GA), patient satisfaction and rate of subsequent surgery.

Results.

Some 3339 patients completed a 2-year follow-up. Of these, 2974 (89%) had decompression with LE and 365 underwent midline preserving surgery. Baseline scores were comparable between the groups. Mean ODI improvement at follow-up was 16.6 (SD = 20.0) in the LE group and 16.9 (SD = 20.2) in the midline preserving surgery group. In the propensity score-matched analysis the difference in improved ODI was 0.53 (95% confidence interval, CI −1.71 to 2.76; P = 0.64). The proportion of patients who showed a decreased ODI score of at least our defined minimal clinically important difference (=8) was 68.3% after LE and 67.0% after preserving the midline structures (P = 0.73). No significant differences were found in the improvement of NRS for leg and back pain, EQ-5D, GA or patient satisfaction. The rate of subsequent surgery was 5.5% after LE and 4.9% after midline preserving surgery without a significant difference in the propensity score-matched analysis (hazard ratio, HR 0.87; 95% CI 0.49–1.54; P = 0.64).

Conclusion.

In this study on decompression techniques for LSS, there was no benefit in preserving the midline structures compared to LE 2 years after decompression. The conclusion is that the surgeon is free to choose the surgical method that is thought most suitable for the patient and the condition with which the patient presents.

Level of Evidence: 3
Increased Cervical Spinal Instability is Associated With the Development of Proximal-type Cervical Spondylotic Amyotrophy
Authors: Ishiwata Sho , Lizuka Yoichi , Takasawa Eiji , Mieda Tokue , Kakuta Yohei , Tomomatsu Yusuke , Honda Akira , Ito Shunsuke , Inomata Kazuhiro , Chikuda Hirotaka
Published: December 2021

Study Design.

Retrospective cohort study.

Objectives.

We aimed to clarify the clinical relationship between the etiology of proximal-type cervical spondylotic amyotrophy (CSA) and cervical sagittal alignment and instability.

Summary of Background Data.

Although several researchers have discussed hypotheses regarding the etiology of CSA, the trigger and mechanism underlying the onset remain unclear.

Methods.

We retrospectively analyzed 52 proximal-type CSA patients (CSA group) and 60 control patients (Control group). The following data were collected: age; sex; cervical lordosis (CL); T1 slope (TS); TS-CL; C2-7 sagittal vertical axis (SVA) on x-ray in the neutral position; flexion angle; extension angle and range of motion (ROM) of C3/4, C4/5 and C5/6; and C3/4, C4/5 and C5/6 instability (translation of >3 mm for adjacent segmental segments) on dynamic x-ray.

Results.

Compared with the Control group, the CSA group was associated with an older age (mean age, 67.6 vs. 61.1 years’ old, P= 0.029) and male sex (78.8% vs. 50.0%, P= 0.002). In the CSA group, the radiographic parameters showed smaller C4/5 and C5/6 extension angles and C5/6 ROM values and a greater C3/4 flexion angle than the Control group. Furthermore, compared with the Control group, the CSA group was associated with C3/4 instability (13.5% vs. 3.3%, P=0.049) and C4/5 (21.2% vs. 3.3%, P = 0.003). A logistic regression analysis, with adjusting for the age and sex, showed that the C3/4 flexion angle (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.08– 1.40, P=0.002), C3/4 instability (OR, 7.3; 95% CI 1.25–42.96, P=0.027) and C4/5 instability (OR, 8.1; 95% CI, 1.56–42.19, P= 0.012) were independent risk factors of CSA.

Conclusion.

This study suggested that a wide C3/4 flexion angle and high C3/4 or C4/5 spinal instability were closely associated with the etiology of proximal-type CSA.
Does the Distal Level Really Matter in the Setting of Health-Related Quality of Life? Assessment of a Series of Adolescent Idiopathic Scoliosis Patients at More Than 7 Years Following Surgery
Authors: Marie-Hardy Laura , Besse Micaela , Chatelain Léonard , Pannier Stéphanie , Glorion Christophe , Ferrero Emmanuelle
Published: December 2021

Study Design.

Retrospective longitudinal study

Objective.

The main goal of this study was to measure the disability after AIS correction, according to the LIV.

Summary of Background Data.

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that may require surgical correction. If the upper and lower instrumented levels (UIV and LIV) of these fusions are defined by the characteristics of the curve, the long-term consequences of the LIV choices are still partially unknown.

Methods.

This retrospective longitudinal study collected demographic, radiologic (Lenke classification, Cobb angle), and surgical data (approach, LIV, UIV) on 116 patients operated for AIS fusion on a specialized pediatric spine center were collected. All participants answered SRS30, SF12, lumbar and leg pain Visual Analogue Scales (VAS) at last follow-up. Statistical analysis between LIV (T12L1, L2, L3 or L4L5) and clinical data at last follow-up was realized.

Results.

The mean follow-up was 87months. The mean increase of back pain VAS per UIV level was 9 mm. No statistically significant difference between the different LIV was found, for SRS30 or SF12 MCS (mental component scale). There was a statistically significant difference between L3 UIV and L4L5 UIV for SF-12 PCS (physical component scale); (P = 0.03).

Conclusion.

The long-term consequences of LIV choice mostly affect levels distal to L3. If the LIV is mostly defined by the characteristics of the curve, one level caudally corresponds to +9 mm of back pain VAS at 7 years of follow-up. Surgeons may be aware of the long-term consequence of LIV choice and patients be informed.
Single Incision Modified Tension Slide Technique in Distal Biceps Repair: Improved Load to Failure While Reducing Surgical Pitfalls
Authors: Fitzgerald Michael J. , Mullen James R. , Starecki Mikael J. , Greenberg Andrew , Tuckman David V.
Published: December 2021

Historically, distal biceps tendon repair through the tension slide technique (TST) using a cortical button has yielded the strongest published repair measured by observed gap formation in both cyclic and maximal load to failure. The modified tension slide technique (MTST) was developed in order to provide the surgeon with a technically simpler and biomechanically more effective way to reduce gap formation and consistently seat/bottom-out the tendon within the bone tunnel through a more direct line of pull. In order to compare the biomechanics of the MTST to the TST, we used 24 matched bovine extensor tendons, and conducted maximal load to failure and cyclical load to failure testing using an Instron 5566 machine. The mean maximal load to failure for the MTST was 444 N versus 229 N for the TST (P<0.004) while no gap formation was observed in either group after cyclic load testing. These findings indicate that the MTST has a statistically significant increased load to gap formation of ∼2-fold in comparison to TST. In the MTST both limbs of suture are passed back through the tendon, before button implantation, eliminating the “operating in a hole” effect required in the TST, and making for a simpler surgical procedure.
Arthroscopic Excision of Hamate Osteoid Osteoma
Authors: AR Altamimi Anas , Al-Naser Saeed , Alhanbali Misbah
Published: December 2021

Osteoid osteoma is considered the most common benign bone forming tumor accounting for 12% of all benign bone tumors. The carpus is a rare site for this tumor but quite a few cases were reported before. The lesion can be subperiosteal, cortical or medullary. Computed tomography scan is the gold standard diagnostic study, whereas magnetic resonance imaging can result in delaying the diagnosis as reported in the literature. Open excision with or without grafting was the technique of choice in most reviewed cases in the literature. In this paper we will illustrate a minimally invasive technique using wrist arthroscopy for an osteoid osteoma of hamate proximal pole. This minimally invasive arthroscopic technique provides a rapid recovery for patients with lesions that are accessible to wrist arthroscopy.
Immunomodulation for hepatocellular carcinoma therapy: current challenges
Authors: Macek Jilkova Zuzana , Ghelfi Julien , Decaens Thomas
Published: December 2021

Purpose of review

The emergence of novel immunotherapies, such as immune-checkpoint inhibitors has changed the landscape of systemic cancer treatment. In hepatocellular carcinoma (HCC) patients, despite initial enthusiasm, the proportion of responders to immune-checkpoint inhibitors remains low. We provide a brief update of this rapidly evolving field, with specific focus on the development in the field of predictive factors and the immunomodulation induced by locoregional therapies.

Recent findings

Even if the immune contexture of HCC before the treatment remains the most promising predictive marker for response to immunotherapies, recent findings show that the cause of HCC may have also a key role. Specific inflammatory mechanisms induced by NASH may result in limited efficacy of immunotherapy compared with viral HCC. Other recent findings showed that percutaneous ablations are responsible for intratumoral immune changes and systemic immune system activation that may help to prevent recurrence when combined with immunotherapies. In case of multifocal HCC, transarterial therapies (TACE and SIRT) may help to turn a cold tumor type to a hot tumor type and could be associated with immune-checkpoint inhibitors to improve outcomes.

The future HCC management will focus on patient stratification for specific immunotherapies depending on the signature and cause of HCC and the best combined approaches in which locoregional therapies may play a pivotal role.
Purple urine bag syndrome: An unusual manifestation of urinary tract infection, our experience at a tertiary care center
Authors: Neniwal Vishal Kumar , Swain Samir , Rulaniya Suresh Kumar , Hota Datteswar , Agarwal Piyush , Yadav Praveen Kumar
Published: December 2021

Background

Purple urine bag syndrome (PUBS) is an unusual condition in which a purple discoloration of urine and bag occurs in people with urinary catheters. People with purple urine usually do not complain of any symptoms. The purple discoloration of the urine bag is often the only finding, frequently noted by caregivers.

Materials and methods

This prospective observational study was conducted at our tertiary care institute from June 2018 to May 2020. A total of 46 patients with PUBS were included in this study. The objective of our study was to record the prevalence of each predisposing factor and to correlate the pathological mechanism through which the PUBS is manifested.

Results

The mean age of PUBS patients was 67.4years and 67.4% were males. Most patients of PUBS (60.9%) had a urethral catheter, while there was percutaneous nephrostomy in 26.1% patients and 13% patients had a percutaneous suprapubic cystostomy catheter. Among the patients, 69.65% were bedridden or in an institutionalized situation, 73.9% were suffering from chronic constipation, 21.7% were associated with dementia, and 47.8% were cerebrovascular accidents with hemiparesis patients. In addition, 93.5% of patients presented with alkaline urine and 3 patients with acidic urine. The most common bacteria isolated in urine culture were E coli and Pseudomonas.

Conclusions

Urinary catheter associated urinary tract infection and PUBS is most commonly documented in females, but our study showed that it is more common in males. The appearance of a purple bag does not depend on the material and type of the catheter or the catheterization method. In addition, no correlation was found between the microorganisms isolated from the environment and patients’ urine.
Trichloroacetic Acid Paint for Boxcar and Polymorphic Acne Scars
Authors: Sun Cong , Lim Davin
Published: December 2021

BACKGROUND

Scarring is a common complication of acne vulgaris with a significant impact on the psychological well-being of patients. Focal application of high concentration trichloroacetic acid (TCA) has been proven efficacious in treating ice-pick scars, but the utility in other scar types is understudied.

OBJECTIVE

The aim of this study is to evaluate the efficacy and safety of 90% TCA in boxcar and polymorphic acne scars using a novel brush applicator.

MATERIALS AND METHODS

Forty-one patients with acne scars were recruited for treatment of boxcar and polymorphic scar with 90% TCA applied with a cosmetic brush. Each patient received 3 treatment sessions spaced between 7 and 9 weeks apart.

RESULTS

All participants had good to excellent outcomes as per Jacob and colleagues grading. Patients with skin Type 3 to 6 had more excellent outcomes (13 patient, 59%) than patients of skin type 1 to 2 (9 patients, 41%). Two participants (5%) had postprocedural complications. Five participants (14%) were on concomitant isotretinoin with no appreciable increase in reepithelialization time or rate of complications.

CONCLUSION

Focal 90% TCA with a cosmetic brush applicator is safe and effective in treating boxcar and polymorphic scars. The clinical outcome is good to excellent with low rates of complication.
The Efficacy of Pulsed Dye Laser Treatment for Acne Vulgaris: A Systemic Review and Meta-Analysis
Authors: Yang Ting-Hua , Li Chien-Nien , Huang Yu-Chen
Published: December 2021

BACKGROUND

Previous reports have shown that pulsed dye laser (PDL) is promising for the treatment of acne; however, results provide conflicting evidence.

OBJECTIVE

To determine the efficacy of PDL in treating acne vulgaris.

METHODS

A systematic review and meta-analysis of studies published before March 31, 2020 was conducted. Randomized controlled trials and case series were analyzed. The meta-analysis estimated the standardized mean difference (SMD) in acne severity score changes in patients treated by PDL versus control and also the SMD of the acne severity scores and comedone counts changes before and after PDL treatment.

RESULTS

Eleven studies were included in this systematic review. Six studies were included in the meta-analysis. Pulsed dye laser treatment was not found to be superior to the control group in treating acne vulgaris (SMD: −0.285; 95% confidence interval [CI], −0.886 to 0.317). However, single-arm studies revealed a significantly improved acne severity score after PDL therapy (SMD, −1.321; 95% CI, −2.057 to −0.586), especially when a multiple-session treatment and a longer pulse duration were employed. The comedone counts were significantly decreased after PDL therapy (SMD, −0.596; 95% CI, −1.137 to −0.054).

CONCLUSION

When treatment consisted of 4 or more sessions or longer pulse duration, PDL could significantly decrease the acne severity score.
Three-Dimensional Computed Tomographic Study of the Supratrochlear Artery and Supraorbital Artery to Determine Arterial Variations and Their Relationship
Authors: Liao Zhi-Feng , Cong Li-Yao , Hong Wei-Jin , Luo Cheng-En , Luo Sheng-Kang
Published: December 2021

BACKGROUND

The forehead has high risks associated with filler injection considering its highly complex vascular system. This study aims to thoroughly describe the anatomical variations and relationships between the supratrochlear artery (STA) and supraorbital artery (SOA).

MATERIALS AND METHODS

We studied 56 cadaveric heads by computed tomography after contrast-agent injection.

RESULTS

The deep branch of the STA originated in the deep superior orbital arcade and the ophthalmic artery (OA), whereas that of the SOA originated at 3 locations: the deep superior orbital arcade, deep superior orbital artery, and OA. The superficial branch of the STA also had 3 origins: the superficial superior orbital arcade, OA, and angular artery, whereas the superficial branch of the SOA had 2 origins: the superficial superior orbital arcade and OA. Based on the relationship between the STA and SOA, 2 main arterial distribution patterns were observed in both superficial and deep layer arteries: STA/SOA connected pattern and STA/SOA disconnected pattern, of which the latter pattern has 3 subtypes.

CONCLUSION

The forehead arteries have complex origins. The relationship of the supratrochlear and supraorbital arteries could be categorized into 2 main patterns. The study elucidated the complexity of the forehead vasculature.
Risk Factors That Are Associated With Outliers in Mohs Micrographic Surgery in the National Medicare Population, 2018
Authors: Aggarwal Pushkar , Neltner Scott A. , Fleischer Alan B.
Published: December 2021

BACKGROUND

Physician variation exists in the mean number of stages performed per Mohs micrographic surgery (MMS) case. Physicians who are outliers in medical practice may be leading to a higher health care cost burden.

OBJECTIVE

To identify factors that influence being a high outlier in the mean stages per MMS case.

MATERIALS AND METHODS

The study comprised a retrospective analysis of 2018 data from physicians who billed Medicare Part B for Current Procedural Terminology (CPT) 17311 and 17312 (MMS of the head, neck, hands, feet, or genitalia) and/or CPT 17313 and 17314 (MMS of the trunk, arms, or legs).

RESULTS

For CPT 17311 and 17312, the odds ratio for being an outlier for a physician in a solo practice relative to a multiphysician facility is 2.4 (1.6–3.8), for a physician who is not an American College of Mohs Surgery (ACMS) member relative to a ACMS member is 2.0 (1.2–3.2), and for a practice located in the West, Northeast, and South is 7.7 (2.8–21.6), 6.2 (2.1–18.6), and 1.8 (0.6–5.4), respectively, relative to in the Midwest.

CONCLUSION

Physicians who are practicing solo, practicing in the West or Northeast, and are not ACMS members are more likely to be a high outlier in the mean stages per MMS case.
Pilot Survey of Adoption of Telemedicine in Mohs Surgery During the COVID-19 Pandemic
Authors: Maruthur Mario , Lee Erica , Dusza Stephen , Nehal Kishwer , Rossi Anthony
Published: December 2021

BACKGROUND

The Covid-19 Pandemic prompted the widespread implementation of telemedicine across healthcare.

OBJECTIVE

To analyze telemedicine adoption by Mohs Micrographic surgeons (MMS) during the COVID-19 pandemic; to analyze the attitudes and perceived barriers to its long-term continuation by MMS practices.

METHODS AND MATERIALS

An online multiple-choice survey was distributed to members of the American College of Mohs Surgeons.

RESULTS

86.1% of surveyed Mohs surgeons initiated telemedicine during the pandemic surge. The most common uses for telemedicine amongst respondents were post-surgery management (77.4%), “spot checks” (60.9%), and surgical consultations (59.1%). 73.1% report patients were receptive to telemedicine. 68.6% believe that telemedicine has a place in dermatologic surgery; 49.5% plan to incorporate telemedicine into their surgical practices long-term. Physical exam limitations, fitting telemedicine into practice workflow, and patient reception/patient training were viewed as the most significant barriers to long-term implementation.

CONCLUSIONS

While valuable use cases for telemedicine were identified with most Mohs surgeon respondents feeling that telemedicine has a place in their practices, there is uncertainty in how to implement telemedicine into the dermatologic surgery practice workflow.
Pain Intensity Assessment Scales for Dermatologic Surgery Patients: A Systematic Review
Authors: Govas Panayiota , Ketchum Andrea , Kazi Rashek , Gordon Beth R. , Carroll Bryan T.
Published: December 2021

BACKGROUND

Pain assessment plays an important role in dermatologic surgery. The numeric rating scale (NRS), visual analog scale (VAS), verbal rating scale (VRS), and Faces Pain Scale (FPS) are commonly used scales for pain measurement. Conflicting evidence exists regarding the use of each. Prompt pain recognition and treatment during procedures result in higher patient satisfaction.

OBJECTIVE

Determine the most applicable scale for acute pain measurement in dermatologic surgery.

MATERIALS AND METHODS

This systematic review was performed in accordance with PRISMA–Supplemental Digital Content 4, http://links.lww.com/DSS/A976 (PROSPERO; CRD42018091058). PubMed, Cochrane, EMBASE, Scopus, and Web of Science were searched between April 24, 2018, and May 06, 2018. The search query consisted of pain, pain measurement (NRS, VAS, VRS, and FPS), and assessment/comparison. The inclusion criteria included English language literature with primary/secondary outcome objectives directly comparing ≥2 pain scales in acute pain (age: 13+). Study end points included interscale correlations, patient preferences, provider preferences, study author recommendations, and failure rates.

RESULTS

Eight hundred seven studies were retrieved: A total of 42 studies were included. The visual analog scale (n = 42) was most studied, followed by NRS (n = 29), VRS (n = 27), and FPS (n = 11). 93.1% studies showed a high statistical correlation between VAS and NRS. Patients preferred NRS (n = 8/11), followed by FPS (n = 3/11), VRS (n = 2/11), and VAS (n = 1/11). Study authors recommended NRS/VAS (n = 8/19), VRS (n = 6/19), and FPS (n = 1/19). Providers preferred NRS (n = 2/3) and VRS (n = 1/3). The visual analog scale had the highest failure rate (n = 11/12).

CONCLUSION

The numeric rating scale is most applicable for dermatologic surgery because of reported patient and provider preferences, lowest failure rates, and most frequent study author recommendations.
Emergence agitation in paediatric day case surgery
Authors: Larsen Line Gry , Wegger Marie , Lé Greves Sebastian , Erngaard Liv , Hansen Tom G.
Published: December 2021

BACKGROUND

Postoperative emergence agitation remains a significant challenge in paediatric anaesthesia. Although short-lived, it may cause harm to the patient and negative experiences for all. Differentiating agitation, delirium and pain is difficult. Electroencephalography allows precise titration of anaesthetic depth, and heart rate variability monitoring permits immediate intervention regarding nociception and pain. We examined if one of these measures could be used to reduce postoperative agitation in an unselected paediatric day surgical population.

OBJECTIVE

The primary outcome was postoperative agitation with a Richmond Agitation-Sedation Scale greater than 0. Secondary outcomes were: length of stay, postoperative nausea and vomiting, fentanyl and propofol consumption, pain scores and use of postoperative analgesics.

DESIGN

A randomised, single-blinded study constituting children aged 1 to 6 years, undergoing minor general day surgical procedures.

SETTING

Paediatric day surgical department 29th March 2019 to 12th June 2020.

PATIENTS

Ninety-eight children (ASA 1 or 2) were enrolled, and 93 children were included in the final analysis.

INTERVENTIONS

Children received standard monitoring (n=31), standard monitoring plus either Narcotrend (n=31), or Anaesthesia Nociception Index monitoring (n=31). Sevoflurane or fentanyl was titrated immediately according to monitor thresholds.

RESULTS

Kaplan–Meier analysis yielded a statistically significant difference between the groups (P = 0.016) with the lowest agitation levels in the Anaesthesia Nociception Index group, intermediate levels in the control group and the highest agitation levels in the Narcotrend monitored group. Intergroup pairwise comparison however, showed no difference. The Anaesthesia Nocioception Index group received slightly more fentanyl (P = 0.277). The control group patients had the highest pain scores despite receiving more caudal blocks and the Narcotrend group had more sevoflurane adjustments. Other secondary outcomes were comparable.

CONCLUSION

Children in the Anaesthesia Nociception Index group were the least agitated with the highest fentanyl doses, without increasing the length of stay in the PACU or postoperative nausea and vomiting.

CLINICAL REGISTRATION

The study was registered in REDCap online trial database 1/11/2018 trial registration nr. OP720. https://open.rsyd.dk/OpenProjects/openProject.jsp?openNo=720&lang=da.
Personality in anaesthesiologists, a systematic review of the literature
Authors: van der Wal Raymond A.B. , Wallage Jacqueline , Scheffer GertJan , Prins Judith B. , Bijleveld Erik
Published: December 2021

BACKGROUND

As a central part of their job, anaesthesiologists often have to perform demanding tasks under high-stakes conditions. Yet, some anaesthesiologists seem better able to deal with the demands of the profession than others.

OBJECTIVES

This review aims to answer the following questions. What are the necessary or desirable qualities of an anaesthesiologist? Which personality traits or characteristics have been found in anaesthesiologists? How does personality relate to job performance and work stress among anaesthesiologists?

DESIGN

Systematic review of studies that examined anaesthesiologists’ personality or personality characteristics. We performed our synthesis in terms of the five-factor model of personality.

DATA SOURCES

The search was conducted in the PubMed, EMBASE and Web of Science databases. Literature was included until December 2020.

ELIGIBILITY CRITERIA

We included qualitative and quantitative studies that examined anaesthesiologists’ personality; also, we included studies that focused on anaesthesiologists’ stress, performance or mental health but only if these topics were examined from the perspective of personality.

RESULTS

We included 6 qualitative and 25 quantitative articles. Synthesis of the qualitative articles revealed two classes of desirable technical and nontechnical personality characteristics. Synthesis of the quantitative articles suggested that anaesthesiologists do not essentially differ from other medical specialists. Moreover, our synthesis revealed several personality traits that predict good performance, low stress and good mental health among anaesthesiologists: lower Neuroticism, higher Extraversion, higher Openness and higher Conscientiousness.

CONCLUSION

Those personality traits that predict performance, stress or mental health in anaesthesiologists, also predict performance, stress or mental health in other high demand/high stakes environments (both medical and nonmedical). The ideal anaesthesiologist would be lower on Neuroticism, higher on Extraversion and higher on Conscientiousness.
Antifungal Drugs TDM: Trends and Update
Authors: Kably Benjamin , Launay Manon , Derobertmasure Audrey , Lefeuvre Sandrine , Dannaoui Eric , Billaud Eliane M.
Published: December 2021

Purpose:

The increasing burden of invasive fungal infections results in growing challenges to antifungal (AF) therapeutic drug monitoring (TDM). This review aims to provide an overview of recent advances in AF TDM.

Methods:

We conducted a PubMed search for articles during 2016–2020 using “TDM” or “pharmacokinetics” or “drug-drug-interaction” with “antifungal,” consolidated for each AF. Selection was limited to English language articles with human data on drug exposure.

Results:

More than 1000 articles matched the search terms. We selected 566 publications. The latest findings tend to confirm previous observations in real-life clinical settings. The pharmacokinetic variability related to special populations is not specific but must be considered. AF benefit-to-risk ratio, drug–drug interaction (DDI) profiles, and minimal inhibitory concentrations for pathogens must be known to manage at-risk situations and patients. Itraconazole has replaced ketoconazole in healthy volunteers DDI studies. Physiologically based pharmacokinetic modeling is widely used to assess metabolic azole DDI. AF prophylactic use was studied more for Aspergillus spp. and Mucorales in oncohematology and solid organ transplantation than for Candida (already studied). Emergence of central nervous system infection and severe infections in immunocompetent individuals both merit special attention. TDM is more challenging for azoles than amphotericin B and echinocandins. Fewer TDM requirements exist for fluconazole and isavuconazole (ISZ); however, ISZ is frequently used in clinical situations in which TDM is recommended. Voriconazole remains the most challenging of the AF, with toxicity limiting high-dose treatments. Moreover, alternative treatments (posaconazole tablets, ISZ) are now available.

Conclusions:

TDM seems to be crucial for curative and/or long-term maintenance treatment in highly variable patients. TDM poses fewer cost issues than the drugs themselves or subsequent treatment issues. The integration of clinical pharmacology into multidisciplinary management is now increasingly seen as a part of patient care.