bluuebunny/crossref_metadata_2025 huggingface dataset:
P268 Anomalies of pulmonary arteries in Tetralogy of Fallot in developing countries: study of 100 cases in indian population
Authors: Tiwari A , Barwad PARAG , Dabi U M A
Published: January 2020

Introduction

Right ventricular outflow tract (RVOT) obstruction in some or other form is one of the major components of Tetralogy of Fallot. It can occur at any level, isolated or in combination, from Infundibulum (most common), Pulmonary valve, Main pulmonary artery, Right and Left pulmonary arteries and up to their segmental branches. Incidence of pulmonary artery anomalies are reported between 15-20%, though some reported as high as 40%. 

Purpose

 The objective of this retrospective  observational study is to determine the presence and degree of pulmonary artery  abnormalities and associated cardiac defects in patients with Tetralogy of Fallot and to  define the pulmonary arterial anatomy to guide the further surgical management.

Method

A total of 100 newly diagnosed or follow up cases of TOF irrespective of age (range 5 days- 32 years) and gender (32 female, 68 male) who were planned for surgical management and referred for evaluation of pulmonary artery anatomy. All patient underwent non-ECG gated CT pulmonary Angiography in Toshiba 64 slice CT scanner.  CT data was analyzed retrospectively to look for cardiac and pulmonary artery anatomy by one independent observer having experience in cardiac radiology.

Results

92 patient had infundibular and valvular stenosis and 8 patients has atretic pulmonary valve with additional supravalvar pulmonary stenosis in 17% patient. Out of total 100 patients, 35% had pulmonary artery abnormalities. This included 19 patient (19%) with isolated main pulmonary artery (MPA) abnormality, 6 % had isolated left pulmonary artery (LPA) abnormality, 2 had isolated right pulmonary artery abnormality, 4% had  combined MPA and LPA  abnormality, 2% had combined MPA and RPA abnormalities and 1% patient had all 3 (MPA,LPA,RPA) involvement in form of stenosis or hypoplasia. As TOF is commonly associated with other cardiac structural anomalies, we encountered following associations in our study – aortopulmonary collaterals (37%), Patent ductus arteriosus (29%), right sided aortic arch (19%), bilateral superior vena cava (10%), bovine arch (3%), double aortic arch (2%), d malposition of great vessels (2%), l malposition of great vessels (1%), situs inversus (1%), dextrocardia (1%), annuloaortic ectasia (1%) aortopulmonary window (1%) and cardiac totally anomalous pulmonary venous connection (1%).

Conclusions

Anomalies of pulmonary arteries are important determinant of surgical outcome of TOF patients. CT angiography is now established modality to delineate pulmonary artery and other anatomical details in TOF patient. Pulmonary artery anomaly can range from isolated branch pulmonary stenosis to diffuse hypoplasia of pulmonary vasculature, based on which management can differ from complete correction to palliative or medical management only. Our study emphasize the importance of pulmonary artery evaluation and its variation among patients of TOF.

Abstract P268 Figure.
P269 Mid-term clinical outcomes of biodegradable polymer everolimus-eluting stents compared with durable polymer everolimus-eluting stents: a propensity-matched study
Authors: Matsuda H , Kagase A , Tokuda T , Ochiumi Y , Takeya M , Sato K , Murata A , Suzuki Y , Ito T
Published: January 2020

Background

Introduction: Several studies have reported that durable polymer drug-eluting stents could cause delayed healing and late catch-up. Although biodegradable polymer everolimus-eluting stents (BP-EES) might solve these problems, there is few data about mid-term clinical outcomes of BP-EES compared with durable polymer everolimus-eluting stents (DP-EES).

Purpose

This study aimed to compare mid-term clinical outcomes between BP-EES and DP-EES.

Methods

Between January to December 2016, 206 consecutive patients were treated with BP-EES and 177 consecutive patients were treated with DP-EES in our Heart Center. The primary endpoint was 3-year cumulative incidence of target lesion failure (TLF) defined as cardiac death, target vessel-related myocardial infarction and clinical-driven target lesion revascularization. Moreover, clinical-driven target vessel revascularization (TVR) and definite stent thrombosis (ST) were also evaluated. 

Results

After propensity score matching, 160 patients were selected in each group. At 3 years, the cumulative incidences of TLF were 4.1% in BP-EES group vs. 7.9% in DP-EES (p = 0.12). Similarly, those of clinical-driven TVR were not different between the 2 groups (10.9% vs. 8.0%, p = 0.39). The incidence of definite ST in BP-EES tended to be higher than in that of DP-EES (BP-EES vs. DP-EES; 0% vs. 1.8%, p = 0.06).

Conclusions

There were no significant differences of TLF between BP-EES and DP-EES within 3 years. In this study, BP-EES seems to prevent definite ST and be safer than DP-EES in mid-term.

Abstract P269 Figure.
P272 The need for vasodilators use prior to transradial cardiac catheterization in high volume cardiac center
Authors: Asiri T , Almutairi M , Alkhushail A , Al-Asiri N , Meraya A M , Khan A S , Alotaiby M , Mubarak Mahmoud M , Almoghairi A , Al-Amri H
Published: January 2020

Funding Acknowledgements

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors

Background

Radial artery spasm (RAS) is one of the most common complication encountered by operators while performing trans-radial artery cardiac catheterization. Due to the technological advances in recent years and the increase number of experts in high volume centers, the prophylactic use of vasodilators may be unnecessary. To date, there are no clear recommendations for using these vasodilators and when to be used in day to day practice. Basically, It depends on operators discretion and hospital protocol. Therefore, further research in this area is warranted due to the conflicting findings of the prior studies.

purpose

To evaluate the need of using prophylactic vasodilators prior to trans-radial approach in high volume cardiac center and to identify factors associated with the development of RAS.

Methods

It is a prospective, randomized, double blind and placebo-controlled trial conducted in a single high volume cardiac center in Saudi Arabia from July to November 2017. Patients who met the inclusion criteria were randomized to either a cocktail vasodilators (nitroglycerin and verapamil) or matching placebo (normal saline) in 1:1 ratio. Subjective definition of RAS was utilized, consistent with previous studies. The primary outcome is the development of RAS in both groups. The secondary outcome is identifying the factors associated with the development of RAS. The calculated sample size is 315 patients. Data analysis was performed using SPSS 20 and STATA 15 softwares. Multiple stepwise logistic regression was used to examine the association between the study variables and incidence of RAS.

Results

A total of 490 patients were randomized (244 in placebo and 246 in treatment groups). There were no differences in the baseline demographic and clinical characteristics between both groups. Significantly, higher proportion of patients on the placebo group had RAS compared to those on the treatment group (23% vs 11%; p = 0.001). After controlling for the other factors, patients on the treatment were less likely to develop RAS than those on the placebo (OR= 0.32; p <0.001). The independent risk factors associated with the occurrence of RAS are: female gender (OR= 6.18; p <0.001), multiple puncture attempts (OR= 2.83; p = 0.003), current smoking (OR= 3.02; p =0.03) and using dihydropyridine calcium channel blockers (OR= 4.60; p <0.001). We did not find a significant relationship between operators’ level of experience and the occurrence of RAS.

Conclusion

The use of cocktail vasodilators reduces the incidence of RAS regardless to the hospital volume and operators experience. Further studies on factors associated with RAS is warranted.
P274 Three-hour ambulatory blood pressure monitoring: a new surrogate for ambulatory blood pressure assessment in the pakistani population
Authors: Shahab H , Khan H , Tufail M , Almas A , Khan A H
Published: January 2020

Funding Acknowledgements

Aga Khan University Faculty of Health Sciences Research Committee (#80096)

On Behalf

PC BP (Post Clinic Blood Pressure) Study Group

Background

The gold standard Ambulatory Blood Pressure Monitoring (ABPM) eliminates white coat effect. However, it is expensive and 24 hours long, making it cumbersome. Prior studies in other populations have investigated the utility of shorter intervals in which ABPM can be used to get the same results as 24-hour ABPM.

Purpose

Our objective was to determine if 3-hour ABPM correlates with 24-hour ABPM in the Pakistani population.

Methods

A cross-sectional study, involving 150 participants as part of the PC ABP (post clinic ambulatory blood pressure) study, was conducted in the cardiology clinics, starting 2015. Participants ≥18years of age and were either hypertensive or referred for assessment of hypertension were included. Pregnant females were excluded. Blood pressure (BP) readings were taken with an ambulatory BP monitor over a 24 hour period, every half hour during daytime and every hour during nighttime. After excluding the first hour called the white-coat window, the mean of the first 6 systolic readings taken every half hour during the daytime was calculated and was called systolic 3-hour ABPM. Pearson correlation coefficients were calculated and Bland Altman plots were constructed to determine the correlation and limits of agreement between mean systolic 3-hour ABPM and mean daytime ABPM.

Results

Of 150 participants, 49% were male.  Of all participants, 76% were hypertensive. Mean age of the participants was 60.3 ± 11.9 years. Mean systolic 3-hour ABPM was 135.0 ± 16mmHg. Mean systolic daytime ABPM was 134.7 ± 15mmHg respectively. Pearson correlation coefficient between mean systolic 3-hour ABPM and mean systolic daytime ABPM was 0.85 (p-value of <0.001). The difference between systolic 3-hour ABPM and systolic daytime ABPM was 0.3mmHg (95% Confidence Interval -1.1 to 1.7mmHg). The limits of agreement were 18mmHg to -17mmHg for systolic 3-hour ABPM and systolic daytime ABPM.

Conclusion

Three-hour ABPM correlates well with 24-hour gold standard ABPM in the Pakistani population. We suggest using this shortened study for the assessment of hypertension where a full ABPM cannot be conducted due to expense or logistic reasons, thus saving time and upfront cost.
P279 Standard dose of rivaroxaban in Asian patients with atrial fibrillation: 20ms vs.15mg? Off label dose reduction of rivaroxaban should be avoided
Authors: Jeong H K , Won J M , Lee K H , Yoon N S , Park H W , Cho J G
Published: January 2020

Background

Rivaroxaban emerged as potential alternatives to warfarin for the prevention of thromboembolisim in patients with atrial fibrillation (AF). Because of the concern for the risk of major bleeding with rivaroxaban in Asian patients, off label rivaroxaban dose reduction to15mg is common in Asian real-world practice. We aimed to set standard rivaroxaban dose in Asian patients with AF by comparison between on-label rivaroxaban 20mg and off-label reduced rivaroxaban dose 15mg.

Methods

A total of 2,208 consecutive non-valvular AF patients were enrolled between 2011 and 2017. After propensity score matching, both warfarin (n = 804) and rivaroxaban group (n = 804) had comparable baseline characteristics. Rivaroxaban group was further divided into on-label rivaroxaban 20mg group (n = 390) and off-label reduced rivaroxaban 15mg group (n = 333). Efficacy outcome was stroke/systemic embolism. Safety outcome was major bleeding. Primary net clinical benefit (NCB) was defined as the composite of stroke, systemic embolism, major bleeding and all-cause mortality. Secondary NCB was defined as the composite of stroke, systemic embolism and major bleeding. Patients were followed upto one-year or until the first occurrence of any study outcomes.

Results

Both Rivaroxaban groups had comparable efficacy compared to warfarin. However, both on-label rivaroxaban 20mg (hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.18-0.90, p = 0.026) and off-label reduced rivaroxaban 15mg (HR 0.37, 95% CI 0.16-0.88, p = 0.025) significantly reduced major bleeding. There were no differences in efficacy and safety outcomes between on-label rivaroxaban 20mg and off-label reduced rivaroxaban 15mg group. On-label rivaroxaban 20mg significantly reduced primary (HR 0.44, 95% CI 0.25-0.79, p = 0.006) and secondary (HR 0.51, 95% CI 0.27-0.96, p = 0.038) NCBs compared to warfarin. However, off-label reduced rivaroxaban 15mg did not reduce both primary and secondary NCBs.

Conclusion

Off-label rivaroxaban dose reduction to 15mg had no benefit compared to on-label rivaroxaban 20mg. Compared to warfarin, on-label rivaroxaban 20mg significantly improved primary and secondary NCBs, whereas off-label reduced rivaroxaban 15mg did not. Therefore, rivaroxaban 20mg is favorable as standard dose in Asian patients.
Friendships in Old Age: Daily Encounters and Emotional Well-Being
Authors: Ng Yee To , Huo Meng , Gleason Marci E , Neff Lisa A , Charles Susan T , Fingerman Karen L
Published: January 2020

Objectives

Having friends in old age is linked to higher levels of happiness and life satisfaction. Yet, we know little about older adults’ emotional experiences when they encounter friends throughout the day. This study examined whether older adults reported (a) more pleasantness, (b) fewer conversations about stressful experiences, and (c) better mood when they had contact with friends compared to when they had contact with other social partners or were alone throughout the day. We also examined whether these experiences varied by the friendship closeness.

Method

Adults aged 65+ (n = 313) from the Daily Experiences and Well-being Study provided background information and listed and described their close social partners. Participants then completed ecological momentary assessment (EMA) surveys every 3 hr for 5 to 6 days where they reported their encounters with social partners, rated the pleasantness and indicated whether they discussed stressful issues during these encounters, and rated positive and negative mood.

Results

Multilevel models revealed that encounters with friends were more pleasant and were associated with fewer discussions about stressful experiences compared to encounters with romantic partners or family members throughout the day. Encounters with friends were also associated with better mood, though this link only held for encounters with friends who were not considered close.

Discussion

Findings are discussed in terms of functionalist theory, socioemotional selectivity theory, relationship ambivalence, and the benefits of less close ties. This work facilitates the understanding of how daily contact with friends can promote older adults’ emotional well-being.
Evaluating the Saliva of Burn ICU Patients for Resistant Infections Harbor Metallo-β-Lactamase Genes
Authors: Emami Amir , Pirbonyeh Neda , Keshavarzi Abdolkhalegh , Bazargani Abdollah , Hassanpour Somayeh , Javanmardi Fatemeh
Published: January 2020

Pseudomonas aeruginosa and Acinetobacter baumannii are the bacteria which increasingly account for nosocomial infections. Due to high virulence, the rate of Multi-Drug Resistance (MDR) and limited availability of new agents, these infections create significant clinical burdens, making it important to identify the possible sources of their occurrence. The aim of this study was to assess non-lactose fermenting bacteria and their metallo-β-lactamase (MBLs) genes expression in the Burn Intensive Care Unit (BICU) patients’ saliva samples. This cross-sectional study was conducted from 2017 to 2018 on 124 saliva samples of BICU patients. Identified isolates were evaluated for drug susceptibility by disc diffusion method. MBLs production isolates were detected by Modified Hodge test and Imipenem-EDTA Combined disk. MBLs related genes were evaluated by polymerase chain reaction (PCR). A total of 86 Gram negative non-lactose fermenting bacteria (38; A. baumannii) and (48; P. aeruginosa), were detected. All of the A. baumannii isolates were resistant to Carbapenems, while more than 90% of them were sensitive to Colistin. However, the highest sensitivity in P. aeruginosa isolates was related to Carbapenems and Colistin. More than 95% of A. baumannii and 32% of P. aeruginosa were detected MDR. MBLs production was confirmed in 9 (33.33%) P. aeruginosa and 18 (66.67%) A. baumannii isolates. The blaVIM was the most prevalent gene, while this gene was detected in all of MBLs positive strains. This study confirmed the prevalence of carbapenemase producer Gram-negative bacilli in the saliva of BICU patients. The results of the present study provide a new data set about saliva infection source that could lead to the proper antibiotic regimen and better control of drug resistance.
A Political Economy of Global Security Approach to Migration and Border Control
Authors: Lori Noora , Schilde Kaija
Published: January 2020

Population movements have causes and consequences for both global security and the economic and security considerations of states. Migration itself is inexorably intertwined with global security outcomes, in the form of instability, state fragility, transnational terrorism and crime, and the radicalization (or perceived radicalization) of migrants and host societies. While modern states may have monopolized the authority over legitimate movement, they have never fully captured the management and enforcement of migration flows. Instead, market actors play key roles in determining migration outcomes—including the scale, direction, and violence associated with migration flows. Migration outcomes are, thus, critically constituted by two key forces—the security priorities of states and the complementary and competing forces of privatization and profit-making. While market forces undermine state control over migration, states have buffered and further consolidated their power over mobility by harnessing private actors and markets toward migration management and border control. We situate migration management and border control as a political economy of security issue, arguing that migration outcomes cannot be explained without examining the interaction between state security imperatives, private actors, and market forces.
A rare case of a closed loop obstruction due to epiploic appendage of the sigmoid colon
Authors: Gosavi Rathin , Ban Ee
Published: January 2020

An internal hernia is a protrusion of viscera through a congenital or acquired defect in the mesentery of peritoneum. They account for <0.9% of all small bowel obstructions [1] and ~4% of obstructions due to hernias [2]. We present a rare case of closed loop obstruction secondary to a band adhesion traversing the lower abdomen from a sigmoid colon appendage epiploicae to the right pelvic wall. A 82-year-old woman presented to the emergency department with nausea, vomiting and worsening right sided abdominal pain for 24 h, on the background of previous pelvic radiation and hysterectomy for uterine cancer. She was subsequently found to have a closed loop obstruction with 30 cm of ischemic bowel strangulated by a band adhesion from a sigmoid colon appendage epiploicae to the right abdominal wall. The patient underwent a successful small bowel resection with primary anastomosis and made an uneventful recovery.
Evolution of the extracytoplasmic function σ factor protein family
Authors: Pinto Daniela , da Fonseca Rute R
Published: January 2020

Understanding transcription has been a central goal of the scientific community for decades. However, much is still unknown, especially concerning how it is regulated. In bacteria, a single DNA-directed RNA-polymerase performs the whole of transcription. It contains multiple subunits, among which the σ factor that confers promoter specificity. Besides the housekeeping σ factor, bacteria encode several alternative σ factors. The most abundant and diverse family of alternative σ factors, the extracytoplasmic function (ECF) family, regulates transcription of genes associated with stressful scenarios, making them key elements of adaptation to specific environmental changes. Despite this, the evolutionary history of ECF σ factors has never been investigated. Here, we report on our analysis of thousands of members of this family. We show that single events are in the origin of alternative modes of regulation of ECF σ factor activity that require partner proteins, but that multiple events resulted in acquisition of regulatory extensions. Moreover, in Bacteroidetes there is a recent duplication of an ecologically relevant gene cluster that includes an ECF σ factor, whereas in Planctomycetes duplication generates distinct C-terminal extensions after fortuitous insertion of the duplicated σ factor. At last, we also demonstrate horizontal transfer of ECF σ factors between soil bacteria.
Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain
Authors: Whedon James M , Toler Andrew W J , Kazal Louis A , Bezdjian Serena , Goehl Justin M , Greenstein Jay
Published: January 2020

Objective

Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.

Design and Setting

We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012–2017.

Subjects

We included adults aged 18–84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain. We identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care.

Methods

We performed adjusted time-to-event analyses to compare recipients and nonrecipients with regard to the risk of filling an opioid prescription. We stratified the recipient populations as: acute (first chiropractic encounter within 30 days of diagnosis) and nonacute (all other patients).

Results

The total number of subjects was 101,221. Overall, between 1.55 and 2.03 times more nonrecipients filled an opioid prescription, as compared with recipients (in Connecticut: hazard ratio [HR] = 1.55, 95% confidence interval [CI] = 1.11–2.17, P = 0.010; in New Hampshire: HR = 2.03, 95% CI = 1.92–2.14, P < 0.0001). Similar differences were observed for the acute groups.

Conclusions

Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase.
Associations between migraine attacks and nightly sleep characteristics among adults with episodic migraine: a prospective cohort study
Authors: Vgontzas Angeliki , Li Wenyuan , Mostofsky Elizabeth , Rueschman Michael , Mittleman Murray A , Bertisch Suzanne M
Published: January 2020

Study Objectives

Given the unknown immediate impact of migraine on nighttime sleep, we prospectively examined whether migraine headaches were associated with subsequent shorter sleep duration, higher fragmentation, and poorer quality in a cohort of 98 adults with episodic migraine.

Methods

Participants completed twice-daily electronic diaries and wore actigraphs continuously for 6 weeks. We examined whether days with headaches were associated with changes in that night’s sleep characteristics compared with headache-free days, using adjusted multivariable linear mixed models with subject-specific intercepts.

Results

Participants were 35 ± 12 years old, 88% women, with an average of five migraine headaches per month. Over 4,406 days, we observed 1,077 headache days, representing 823 discrete headaches. Average nightly objective sleep duration was 7.3 ± 1.2 hr, efficiency 89.5 ± 3.3%, and wake after sleep onset (WASO) 44.8 ± 17.0 min. Objective sleep duration was 7.3 min (95% CI: 1.5, 13.0) longer on nights following a headache day compared with nights on a headache-free day. Objective sleep efficiency, WASO, and reported sleep quality were not significantly different on headache days compared with headache-free days (sleep efficiency: −0.06 min, 95% CI: −0.3, 0.2; WASO 1.5 min, 95% CI: 0.0, 3.0; sleep quality: 1.0, 95% CI: 0.8, 1.3).

Conclusions

Sleep periods immediately following migraine headaches are not associated with shorter duration, higher disruption, or poorer sleep quality in patients with episodic migraine. These results suggest that clinical evaluation of sleep disturbance in patients with episodic migraine should be approached independently of their migraine status.
Endodormancy release in Norway spruce grafts representing trees of different ages
Authors: Partanen Jouni , Häkkinen Risto , Sutinen Sirkka , Viherä-Aarnio Anneli , Zhang Rui , Hänninen Heikki
Published: January 2020

Studies addressing endodormancy release in adult trees are usually carried out using twigs detached from the trees in the experiments. Potential problems caused by cutting the root–shoot connection when detaching the twigs can be avoided by using grafts as the experimental material. We studied the effects of chilling on the endodormancy release in Norway spruce (Picea abies (L.) Karst.) grafts where twigs of 16-, 32- and 80-year-old trees were used as the scions. The grafts were first exposed to chilling in natural conditions and then samples of them were transferred at intervals to a regrowth test in forcing conditions in a greenhouse. The bud burst percentage, BB%, in the forcing conditions generally increased from zero to near 100% with increasing previous chilling accumulation from mid-October until mid-November, indicating that endodormancy was released in almost all of the grafts by mid-November. The days to bud burst, DBB, decreased in the forcing conditions with successively later transfers until the next spring. Neither BB% nor DBB was dependent on the age of the scion. However, in the early phase of ecodormancy release, the microscopic internal development of the buds was more advanced in the grafts representing the 16-year-old than in those representing the 32- or 80-year-old trees. In conclusion, our findings suggest that no major change in the environmental regulation of endodormancy release in Norway spruce takes place when the trees get older. Taken together with earlier findings with Norway spruce seedlings, our results suggest that regardless of the seedling or tree age, the chilling requirement of endodormancy release is met in late autumn. The implications of our findings for Norway spruce phenology under climatic warming and the limitations of our novel method of using grafts as a proxy of trees of different ages are discussed.
Intravenous Ibuprofen Reduces Opioid Consumption During the Initial 48 Hours After Injury in Orthopedic Trauma Patients
Authors: Weisz Russell D. , Fokin Alexander A. , Lerner Vivian , Flynt Amy , Macias-Perez Ines , Pavliv Leo , Crawford Maggie , Puente Ivan
Published: January 2020

Objectives:

To evaluate the efficacy of intravenous (IV) ibuprofen (Caldolor) administration in the management of acute pain in orthopedic trauma patients and to minimize opioid use.

Design:

Randomized controlled trial, double-blind, parallel, placebo-controlled.

Setting:

Level 1 Trauma Center.

Patients:

A total of 99 consecutive orthopedic trauma patients with fractures of the ribs, face, extremities, and/or pelvis were randomized to receive either 800 mg IV ibuprofen (53 patients) or placebo (44 patients) administered every 6 hours for a total of 8 doses within 48 hours of admission and the same PRN medications along with 20-mg IV/PO Pepcid twice a day. To establish pain reduction efficacy, the analysis was consequently performed in the modified intent-to-treat group that included 74 randomized subjects with a baseline pain score greater than 2. The primary outcomes were reduction in opioid consumption and decrease in pain intensity (PI).

Intervention:

Administration of study medications.

Outcome Measurements:

PI measured by Numerical Rating Scale, opioid consumption adjusted to morphine equivalent dose, and time to first narcotic administration.

Results:

The 2 groups had comparable baseline characteristics: age, sex distribution, mechanism of injury, type of injury, injury severity score, and PI. IV ibuprofen statistically significantly reduced opioid consumption compared with placebo during the initial 48-hour period (P = 0.017). PI calculated as PI differences was statistically different only at 8-hour interval after Caldolor administration. Time to first narcotic medication was significantly longer in the Caldolor group (hazard ratio: 1.640; 95% confidence interval, 1.009–2.665; P = 0.046).

Conclusions:

IV ibuprofen provided adequate analgesia, prolonged time to first narcotic administration, and was opioid-sparing for the treatment of pain in orthopedic trauma patients, which makes Caldolor a recommended candidate for managing acute pain in the diverse orthopaedic trauma population.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Human immunodeficiency virus prevention strategies in China
Authors: Wu Zun-You , Scott Sarah Robbins
Published: January 2020

This paper reviews the current epidemics of human immunodeficiency virus (HIV) infection in China, particularly the globally available prevention strategies developed and implemented. This review focuses on HIV prevention measures in general, such as education, testing, and counseling and in specific responses to transmission modes, such as blood safety, harm reduction for people who inject drugs, and condom promotion to reduce sexual transmission. We also assess newly developed prevention measures, such as prevention treatment, pre-exposure prophylaxis, post-exposure prophylaxis, male circumcision, and promising potential future preventions, including microbicides and vaccines. Based on this assessment, we provide recommendations for their implementation in China. We conclude that there is no magic bullet for HIV prevention, particularly sexual transmission of the disease, but only a combination of these prevention strategies can control the HIV epidemic.
Intrascleral hydration for 23-Gauge Pars Plana Vitrectomy Sclerotomy Closure
Authors: Rizzo Stanislao , Pacini Bianca , De Angelis Lorenzo , Barca Francesco , Savastano Alfonso , Giansanti Fabrizio , Caporossi Tomaso
Published: January 2020

Purpose:

To describe and evaluate the effectiveness of a new technique to close 23-gauge sclerotomies in transconjunctival pars plana vitrectomy.

Materials and Methods:

A prospective, consecutive, interventional study of 90 eyes of 90 patients who underwent 23-gauge pars plana vitrectomy with the introduction of the new sealing technique was conducted. The 23-gauge sclerotomies were hydrated with a 30-gauge needle inserted in the scleral stroma near the scleral opening.

Results:

A total of 90 eyes of 90 patients were recruited in the study. The number of the eyes requiring suture for sclerotomy closure was 3.3% (3 of 90), and the sclerotomies requiring suture were 1.4% (4 of 270). Three eyes had hypotony on Day 1. No statistically significant difference was registered between preoperative intraocular pressure and postoperative intraocular pressure on Days 15 and 30. No leaking of endotamponade bubble filling was noticed on Day 1. No postoperative complications were registered during the follow-up period.

Conclusion:

The intrascleral stroma hydration is a simple and fast technique that does not require extra surgical materials.
Long-Term Incidence of Infectious-Related Hospitalizations of Offspring Born to Mothers With Intrauterine Device
Authors: Tamari Itamar , Wainstock Tamar , Sheiner Eyal , Pariente Gali
Published: January 2020

Background:

Pregnancy with an Intrauterine device (IUD) is a risk factor for adverse pregnancy outcomes. The purpose of this study was to examine a possible association between presence of IUD during pregnancy and long-term incidence of infectious-related hospitalizations of the offspring.

Methods:

A population-based cohort analysis was performed including all singleton deliveries between 1991 and 2014 at a single tertiary hospital. Primary exposure was defined as delivery of an infant to a mother who conceived with an IUD, that was either removed or retained during pregnancy. Offspring of mothers who conceived without an IUD comprised the comparison group. The main outcome evaluated was infectious-related hospitalizations of the offspring up to the age of 18 years.

Results:

The number of deliveries that met the inclusion criteria was 227,431, of which 209 were to mothers who conceived with an IUD that was removed and 52 were to mothers who retained their device. Long-term incidence of infections-related hospitalizations was compared between the groups (12.5% in the retained IUD, 12.9% in the removed IUD and 11.2% in the No-IUD group, P = 0.638). A Kaplan-Meier survival curve did not demonstrate a significantly higher cumulative incidence of infectious-related hospitalizations in offspring of women who conceived with an IUD (log-rank P = 0.340). In a Cox regression model, while controlling for confounders such as maternal age and preterm birth, conceiving with an IUD was not found to be independently associated with long-term incidence of infectious-related hospitalizations of the offspring.

Conclusion:

Offspring of women conceiving with an IUD are not at increased risk for long-term incidence of infectious-related hospitalizations.
Haploinsufficiency of AKT3 gene causing microcephaly and psychomotor delay in a patient with 1q43q44 microdeletion
Authors: Pelle Alessandra , Modena Piergiorgio , Cavallini Anna , Selicorni Angelo
Published: January 2020

Deletion of the 1q43q44 chromosomal region has been related to a clinical syndrome characterized by neurodevelopmental delay, intellectual disability, microcephaly, congenital abnormality of the corpus callosum, and epilepsy and dysmorphic features. A wide variability of the clinical features have been linked to the contiguous deleted genes and incomplete penetrance has been observed too. Here, we report a 4-years-old boy with microcephaly, neurodevelopmental delay, and cardiac atrial septal defect, who had a de-novo 117 Kb 1q43-q44 microdeletion. The deleted chromosomal region encompassed the two genes SDCCAG8 and AKT3. The characteristics of the deletion and the clinical condition of the patient suggest a pathogenic role of the 1q43-q44 deletion, supporting a pivotal role of AKT3 gene in the expression of the clinical phenotype.
The Efficacy of Intensive Short-Term Dynamic Psychotherapy for Social Anxiety Disorder
Authors: Rahmani Fateh , Abbass Allan , Hemmati Azad , Mirghaed Sahar Rezaei , Ghaffari Niloofar
Published: January 2020

This research examined the efficacy of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of social anxiety disorder (SAD) and compared the therapeutic outcomes of ISTDP when feeling focus or defense work is emphasized. A three-group randomized design with 6-month follow-up was used. Forty-one subjects were selected among volunteer college students diagnosed with SAD. They were assigned randomly into three groups; 14 cases to feeling-focused ISTDP (FF-ISTDP) group, 14 cases to defense-focused ISTDP (DF-ISTDP) group, and 13 cases to a control group. All subjects were evaluated at pretest, posttest, and six-month follow-up through clinical interviewing using DSM-5 criteria for SAD along with the Liebowitz Social Anxiety Scale. Each experimental group had a course of 8 to 10 sessions of ISTDP treatment. Analysis of variance showed that ISTDP is an effective treatment for SAD compared with a control group. No outcome differences were found between FF-ISTDP and DF-ISTDP in treating SAD.
Effectiveness of Emergency Department Treatment of Pediatric Headache and Relation to Rebound Headache
Authors: Sheridan David C. , Dhatt Saroop , Narayan Kamil , Lin Amber , Fu Rongwei , Meckler Garth D.
Published: January 2020

Objective

This study aimed to assess the association between the degree of headache relief obtained in the pediatric emergency department (PED) with abortive treatment and unscheduled return visits to the PED for a recurrent or persistent headache within 72 hours.

Methods

This was a retrospective observational study with 369 patients, all younger than 18 years, who presented to the PED with a primary complaint of either a headache or migraine. Patient and visit details were collected from the medical chart, along with presenting and discharge pain score. Percent pain reduction at discharge was determined through the following calculation: (Presenting Pain Score − Discharge Pain Score)/Presenting Pain Score. Associations were assessed using multivariable logistic regression.

Results

No significant association was found between the percent pain reduction and return to the PED (P = 0.49). Mean presenting pain score at the index visit was statistically higher for those who ended up returning to the PED versus those who did not (8.1 vs 7.4; P = 0.02). A trend toward increase in return visits was seen among patients who had a headache duration greater than 3 days (odds ratio, 1.99) and patients who experienced less than 50% pain reduction in the PED (odds ratio, 1.77).

Conclusions

Complete resolution in the PED may not be necessary, given the lack of association between the degree of pain relief and revisit rates. Perhaps, the goal should be to achieve at least 50% pain reduction before discharge.
What Is That? Innumerable Mysterious Densities Identified on Abdominal Imaging
Authors: Kaiser Nicole , Blackford Martha G.
Published: January 2020

Radiopaque densities can be observed on imaging after the ingestion of either foreign bodies or some medications. Our case report discusses an 11-year-old boy with autism spectrum disorder and attention deficient disorder who presented to the emergency department because of concerns for constipation and dehydration. Incidentally, an abdominal x-ray showed numerous radiopaque densities throughout his intestines in addition to his constipation. He was admitted, and his home regimen was reviewed to attempt to identify a potential source for these radiopaque densities. This case presented an interesting teaching opportunity in the identification of the radiopaque densities and review of pharmacokinetics.
Pioneers in Modern Craniofacial Surgery: Assessing the Academic Impact of Drs. Joseph Gruss and Paul Manson
Authors: Chandawarkar Akash , Birgfeld Craig B. , Yaremchuk Michael J. , Tufaro Anthony P. , Hopper Richard A. , Susarla Srinivas M.
Published: January 2020

Background:

The authors conducted this study to assess the impact that Drs. Joseph Gruss and Paul Manson have had on craniofacial surgery through their individual contributions and through their trainees.

Methods:

This was a retrospective analysis of fellows trained by either Dr. Gruss or Dr. Manson. Demographic and bibliometric measures were recorded for each fellow. Demographic factors included years since completion of fellowship training, current practice of craniomaxillofacial surgery, academic practice, and academic leadership roles. Bibliometric measures included number of publications, number of citations, and h-index. To adjust for scholarly activity before fellowship training, only contributions published after fellowship training were included.

Results:

Over a 39-year period, a total of 86 surgeons completed fellowship training with either of the two principal surgeons. The mean time since completion of training was 18.7 ± 11.4 years. Seventy-nine percent of surgeons had active practices in craniomaxillofacial surgery; 54 percent had academic practices. The mean number of publications was 26.4 ± 69.3, the mean number of citations was 582 ± 2406, and the average h-index was 6.7 ± 10.6. Among academic surgeons, the average h-index was 10.7 ± 13.1, 89 percent practiced in North America, 89 percent had active practices in craniomaxillofacial surgery, and nearly 50 percent had achieved a leadership role.

Conclusions:

Modern craniofacial reconstruction has evolved from principles used in trauma and correction of congenital differences. The extensive impact that Drs. Paul Manson and Joseph Gruss have had on the field, and plastic surgery at large, is evident through their primary contributions and the immense impact their trainees have had on the field.
Mechanical Irritation in Vascularized Composite Tissue Allotransplantation Triggers Localized Skin Rejection
Authors: Messner Franka , Fischer Anna-Christina , Runggaldier Elias , Sprung Susanne , Müller Jule , Eiter Sebastian , Gantschnigg Antonia , Zelger Bettina , Zelger Bernhard , Wolfram Dolores , Öfner Dietmar , Hautz Theresa , Schneeberger Stefan
Published: January 2020

Background.

Mechanical and thermal stress has been observed to trigger skin rejection in hand-transplanted patients. This study aims to investigate this phenomenon.

Methods.

Syngeneic and allogeneic orthotopic hindlimb transplantations were performed using male rats (Brown Norway to Lewis). Using a specially designed device, standardized mechanical skin irritation at a force of 5 N was applied to the planta pedis of the transplanted limb for 10 days, 4 times daily for 10 minutes. Biopsies, taken on day 10 and after a 5-day observational period, were assessed for macroscopic alterations using a standardized scale, by histopathology and immunohistochemistry, and for inflammatory protein expression using Luminex technology.

Results.

Allogeneic animals displayed significant aggravated macroscopic skin alterations compared with naive (P < 0.0001) and syngeneic controls (P = 0.0023). Histopathology showed a trend toward higher rejection/inflammation grades in allogeneic animals compared with syngeneic controls. Minor skin alterations in syngeneic limbs recovered quickly; however, in allogeneic limbs, macroscopic skin alterations were significantly more pronounced (P < 0.0001) 5 days after irritation. Interleukin-1b and interferon-γ levels were upregulated in skin of allogeneic limbs.

Conclusions.

Mechanical skin irritation in vascularized composite allotransplantation can trigger localized skin inflammation consistent with rejection.
Mesenchymal Stromal Cells in Solid Organ Transplantation
Authors: Vandermeulen Morgan , Erpicum Pauline , Weekers Laurent , Briquet Alexandra , Lechanteur Chantal , Detry Olivier , Beguin Yves , Jouret François
Published: January 2020

Over the past decade, the clinical application of mesenchymal stromal cells (MSCs) has generated growing enthusiasm as an innovative cell-based approach in solid organ transplantation (SOT). These expectations arise from a significant number of both transplant- and non–transplant-related experimental studies investigating the complex anti-inflammatory, immunomodulatory, and tissue-repair properties of MSCs. Promising preclinical results have prompted clinical trials using MSC-based therapy in SOT. In the present review, the general properties of MSCs are summarized, with a particular emphasis on MSC-mediated impact on the immune system and in the ischemic conditioning strategy. Next, we chronologically detail all clinical trials using MSCs in the field of SOT. Finally, we envision the challenges and perspectives of MSC-based cell therapy in SOT.
Reducing the Risk of Indwelling Catheter–Associated Urinary Tract Infection in Female Patients by Implementing an Alternative Female External Urinary Collection Device
Authors: Eckert Lorena , Mattia Lisa , Patel Shilla , Okumura Rowena , Reynolds Priscilla , Stuiver Ingrid
Published: January 2020

PURPOSE:

The purpose of this quality improvement project was to reduce catheter-associated urinary tract infection (CAUTI) risk for female patients by implementing a female external urinary collection (FEUC) device with suction as an alternative to indwelling catheter (IDC).

PARTICIPANTS AND SETTING:

Participants were female patients admitted to our 386-bed community hospital in Southern California and who required urinary management.

APPROACH:

We implemented a comprehensive CAUTI prevention program in 2014 that was in place for 1.5 years before this project was started. The CAUTI prevention program was based on the US Center for Disease Control and Prevention's CAUTI prevention recommendations. To supplement our CAUTI prevention efforts in our female patients, we implemented the FEUC device in our intensive care, telemetry, medical-surgical, orthopedic, and acute rehabilitations inpatient care units. Indwelling catheter use and CAUTI cases were identified by our Infection Prevention department.

OUTCOMES:

Prior to introduction of the FEUC device, in 2015, the baseline female IDC utilization rate was 31.7% (7181 IDC device-days/22,656 patient-days) and the female CAUTI rate was 1.11 (8 cases/7181 IDC device-days) per 1000 days. Following introduction of the device, both rates declined. In 2016, the IDC utilization rate was 29.7% (P = .000) and the CAUTI rate was 0% (P =.005). We continued to observe a reduction in 2017 IDC utilization rates of 26% (P = .000); the 2017 CAUTI rate of 0.90 was not significantly different to our prior year rate (P = .726).

IMPLICATIONS FOR PRACTICE:

We found that the introduction of the FEUC device reduced the risk for CAUTI. We will continue to prioritize the use of external devices for urinary management to help reduce the risk of our patients developing CAUTI.
A Descriptive Study Using an Intercept Survey
Authors: Pieper Barbara , Sobeck Joanne , Kaljee Linda , Templin Thomas N.
Published: January 2020

PURPOSE:

This project examined knowledge, attitudes, beliefs, and behaviors about systemic antibiotic use for persons who reported a wound within the previous year.

DESIGN:

Secondary data analyses of 505 adults from a cross-sectional, prospective, intercept survey where every fifth adult was randomly approached to participate.

SUBJECTS AND SETTING:

Twenty-six participants (5.15% of the parent sample) stated having a wound within the previous year.

METHODS:

Participants were “interviewed” using the Facilitators and Barriers to Consumer Use of Antibiotics questionnaire that included demographics, health, information sources, antibiotic knowledge, attitudes, beliefs, and behavior questions. Hierarchical agglomerative cluster analysis was used to find clusters of items on the attitude, beliefs, and behavior questions.

RESULTS:

Sample demographics included 15 women and 11 African Americans, and 17 had some college education. Knowledge about antibiotics had a mean correct score of 10 out of 15 (67%) questions. Higher antibiotic knowledge was significantly related to higher education (r
s = 0.69, P < .001). There were 2 attitude and beliefs clusters: most participants (>85%) recognized the need for medical supervision of antibiotic use (cluster 1), and beliefs about the need for antibiotics to prevent illness or treat wounds varied in 27% to 62% of participants (cluster 2). There were 4 behavior clusters: almost all participants 96% (cluster 1) filled and took the antibiotic if prescribed; greater than 71% (cluster 2) disagreed with unapproved methods of obtaining antibiotics; greater than 87% (cluster 3) used prescribed antibiotics correctly; and 36% of participants heard about antibiotic resistance through television or radio or Internet (40%) (cluster 4).

CONCLUSIONS:

Knowledge about antibiotics was low, while attitudes were positive. These findings support the need for research and evidence-based information on the role of antibiotics in wound care.