bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Accuracy of Diaphragm Ultrasound in Detecting and Characterizing Patient–Ventilator Asynchronies during Noninvasive Ventilation
Authors: Vivier Emmanuel , Haudebourg Anne Fleur , Le Corvoisier Philippe , Mekontso Dessap Armand , Carteaux Guillaume 
Published: March 2020

Abstract

Background
Management of acute respiratory failure by noninvasive ventilation is often associated with asynchronies, like autotriggering or delayed cycling, incurred by leaks from the interface. These events are likely to impair patient’s tolerance and to compromise noninvasive ventilation. The development of methods for easy detection and monitoring of asynchronies is therefore necessary. The authors describe two new methods to detect patient–ventilator asynchronies, based on ultrasound analysis of diaphragm excursion or thickening combined with airway pressure. The authors tested these methods in a diagnostic accuracy study.

Methods
Fifteen healthy subjects were placed under noninvasive ventilation and subjected to artificially induced leaks in order to generate the main asynchronies (autotriggering or delayed cycling) at event-appropriate times of the respiratory cycle. Asynchronies were identified and characterized by conjoint assessment of ultrasound records and airway pressure waveforms; both were visualized on the ultrasound screen. The performance and accuracy of diaphragm excursion and thickening to detect each asynchrony were compared with a “control method” of flow/pressure tracings alone, and a “working standard method” combining flow, airway pressure, and diaphragm electromyography signals analyses.

Results
Ultrasound recordings were performed for the 15 volunteers, unlike electromyography recordings which could be collected in only 9 of 15 patients (60%). Autotriggering was correctly identified by continuous recording of electromyography, excursion, thickening, and flow/pressure tracings with sensitivity of 93% (95% CI, 89–97%), 94% (95% CI, 91–98%), 91% (95% CI, 87–96%), and 79% (95% CI, 75–84%), respectively. Delayed cycling was detected by electromyography, excursion, thickening, and flow/pressure tracings with sensitivity of 84% (95% CI, 77–90%), 86% (95% CI, 80–93%), 89% (95% CI, 83–94%), and 67% (95% CI, 61–73%), respectively.

Conclusions
Ultrasound is a simple, bedside adjustable, clinical tool to detect the majority of patient–ventilator asynchronies associated with noninvasive ventilation leaks, provided that it is possible to visualize the airway pressure curve on the ultrasound machine screen. Ultrasound detection of autotriggering and delayed cycling is more accurate than isolated observation of pressure and flow tracings, and more feasible than electromyogram.

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Considerations in spinopelvic parameters and acetabular component orientation in patients with lumbar spinal fusion following total hip arthroplasty: A retrospective study
Authors: Huerfano Elina , Alzate Ricardo , Muñoz Juan M. , Riveros Emilio A. , Márquez Diego , Páez Rodolfo , Nossa Juan M. 
Published: March 2020

Background:
Although several authors have tried to describe the ideal acetabular component position, the influence of the spine on the orientation of the pelvis is not always considered. The aim of this study was to describe the spinopelvic behavior through body postural changes and its influence on acetabular component orientation in patients with previous spinal lumbar fusion who underwent total hip arthroplasty (THA).

Methods:
This is a retrospective case control study of 10 patients with previous lumbar spine fusion who underwent THA (study group) compared with 17 patients without lumbar spine pathology who underwent THA (control group). Spinopelvic parameters and acetabular component orientation were measured in each group on spinopelvic radiographs in standing and sitting positions, and dislocations were recorded.

Results:
From standing to sitting position, the pelvic tilt (PT) increased posteriorly, and the sacral slope (SS) decreased in both groups. However, the mean degree of change of PT was higher in the control than in the study group (−23.64 degrees vs. −12.8 degrees, P=0.017). Regarding acetabular component orientation, from standing to sitting position, the mean degree of change of the ante-inclination angle (AIA) was highest in patients in the control group as compared to the study group (−23.94 degrees vs. −13.9 degrees, P=0.017). Two study group patients and no control group patients experienced hip dislocation.

Conclusions:
The presence of concomitant spine disease should be considered in preoperative planning of THA because procedures such as lumbar spine fusion influence adaptability of spinopelvic parameters and acetabular component orientation in functional body position changes.

Level of Evidence:
Level III.
Effects of Sterilization Techniques on Bioactivity of Polymethyl Methacrylate Antibiotic Beads Containing Vancomycin and Tobramycin
Authors: Shaw James , Gary Joshua , Baker Andrea , Kaplan Heidi , Kim Yesul , Milhoan Madison , Burgess Andrew , Ambrose Catherine 
Published: March 2020

Objectives:Prefabrication and storage of antibiotic beads may decrease surgical time and allow for use in other settings. This study investigated the effects of sterilization technique and storage time on the bioactivity of antibiotic polymethyl methacrylate (PMMA) beads.Methods:Uniform beads of PMMA containing 1 g each of tobramycin and vancomycin were sterilized using autoclave, ethylene oxide (ETO), or ultraviolet (UV) light. Beads were made in a sterile fashion as a control. Disks containing eluted antibiotics from each of the 4 groups were placed onto agar plates inoculated withStaphylococcus aureus. Zones of inhibition, a measure of bioactivity for antibiotic eluted, were determined for the experimental groups and control. Repeat testing was performed for beads stored for 1 week, 1, 3, and 6 months.Results:Beads sterilized using autoclave, ETO, and UV light showed similar ZOIs after 24 hours of and 1 week of elution compared with the control group. Beads stored for up to 6 months demonstrated similar bioactivity to beads made sterile and tested immediately.Conclusion:PMMA beads containing vancomycin and tobramycin made in a sterile fashion and stored for up to 6 months have the same efficacy as the current standard of beads made sterile and used immediately. The elution and bioactivity of vancomycin–tobramycin antibiotic beads are not negatively impacted by the sterilization methods of autoclaving, ETO gas, or UV light. Furthermore, nonsterile beads can be sterilized and stored up to 6 months with an expected efficacy comparable with beads made in a standard sterile fashion.
Role of metabolic imaging in diagnosis of primary, metastatic, and recurrent prostate cancer
Authors: Hadavand Mohammad Amin , Mayer Dirk , Chen Wengen , Wnorowski Amelia , Siddiqui Mohummad Minhaj 
Published: March 2020

Purpose of review
The present review describes the current role of metabolic imaging techniques such as multiparametric MRI (mpMRI), magnetic resonance spectroscopic imaging (MRSI), hyperpolarized MRSI, and positron emission tomography (PET) in the diagnosis of primary prostate cancer, surveillance of low-grade disease, detection of metastases, and evaluation of biochemical recurrence after therapy.

Recent findings
The natural history of prostate cancer ranges from indolent disease that is optimally monitored by active surveillance, to highly aggressive disease that can be lethal. Current diagnostic methods remain imperfect in noninvasively distinguishing between silent versus aggressive tumors. Hence, there is a high demand for noninvasive imaging techniques that offer insight into biological behavior of prostate cancer cells. Characterization of prostate cancer metabolism is a promising area to provide such insights.

Summary
Metabolic imaging may allow for greater detection and ultimately characterization of tumor based on aggressiveness and spread. Hence, it has the potential to monitor tumor activity, predict prognostic outcomes, and guide individualized therapies.
Establishing a Telemedicine Program for Breast Reconstruction
Authors: Xue Erica Y. , Chu Carrie K. , Winocour Sebastian , Cen Nicholas , Reece Edward 
Published: March 2020

Summary:
Telemedicine is an application of modern technology that allows for the remote delivery of healthcare services to diagnose and treat patients. The potential patient benefits of such a program include added convenience, lowered costs, and improved access. From a practical standpoint, establishing a telemedicine program may seem daunting to the plastic surgeon; success requires not only patient and provider adoption, but also integration of new technology. Despite these challenges, breast reconstruction patients are among those who stand to benefit most from telemedicine technology, as this patient population remains vulnerable to limitations to access following an emotion-provoking breast cancer diagnosis. Geographical limitation, especially in rural areas, represents a major barrier to access. To date, the application of telemedicine in caring for breast reconstruction patients has not been described in the literature. In this article, we describe the protocol developed and implemented by our academic plastic surgery group to care for new breast reconstruction candidates and discuss the role of telemedicine in improved access to breast reconstruction care.
Breast Reconstruction in Obese Patients: The Fat Grafted Latissimus versus Abdominal Free Tissue Transfer
Authors: Novak Matthew D. , Blough Jordan T. , Abraham Jasson T. , Shin Hope D. , Yasuda Tai , Ayala Donna , Altman Andrew M. , Saint-Cyr Michel 
Published: March 2020

Background:
Immediate fat grafting to the pedicled myocutaneous latissimus dorsi (LD) flap has recently gained in popularity as a means to supplement volume for breast reconstruction. The aim of this study is to compare complication rates of the immediately fat-grafted LD to free tissue transfer in the obese population.

Methods:
In this retrospective cohort, 82 patients (149 breasts) from 2015 to 2019 were included. Patients underwent either unilateral or bilateral breast reconstruction with either LD with immediate fat grafting or abdominal-based free tissue transfer. Included patients had a body mass index ≥ 30 kg/m2 at the time of surgery. Complication data were recorded as minor, major, and medical complications. Procedure characteristics and postoperative data were also studied.

Results:
Minor complication rates between the LD with immediate fat grafting and free tissue transfer cases were similar (26.9% versus 26%, respectively). The free tissue transfer group had a significantly higher rate of major complications (20.3% versus 3.8%; P = 0.048) and medical complications (10.6% versus zero). Finally, the LD with immediate fat grafting group had significantly shorter operating room times, hospital length of stay, and fewer donor-site revisions.

Conclusions:
LD with immediate fat grafting offers the benefit of a totally autologous reconstruction without the risks of abdominal-based microvascular free tissue transfer or an implant. Favorable complication rates, shorter operative times, and shorter hospital length of stay make this reconstructive option a safe alternative to free tissue transfer in the obese population.
Liposuction: Drains, Are They Adequate?
Authors: Taha Ahmed A. , Wahba Mohamed M. , Tahseen Hossam 
Published: March 2020

Background:
Seroma following liposuction (especially mega-sessions; more than 5 L) is a common complication that causes much distress to the surgeon and the patient. This will eventually affect the overall satisfaction and patient’s experience regarding liposuction. If not detected promptly, seromas can impair the results.

Methods:
This is a prospective analysis performed by the authors in a private practice. All our patients had mega-liposuction sessions (more than 5 L, range 8–12 L) using Power-assisted Liposuction with Lipomatic by Euromai and VASER. Tumescent infiltration was used. Fifty male patients participated after providing their informed consent. Their mean age was 35 years (range, 21–50) and mean body mass index was 29 (range, 28–33). Patients were divided into 2 groups. Group A consisted of 25 patients with no adjunctive draining procedures done, and group B consisted of 25 patients with drainage procedures done. Patients were followed up every other day for 3 weeks for detection of seroma.

Results:
Seventeen patients had post-operative seroma: 13 in group A and 4 in group B. The volume of seromas was further subdivided into mild (<50 cc), moderate (50–100 cc), and severe (>100 cc).

Conclusions:
High definition liposuction is a demanding procedure by both the surgeon and the patient to achieve the best results and contour. Drainage procedures and drains placement are truly effective methods for minimizing seroma formation, enhancing the recovery, and eventually improving the results.
Characteristics of Iatrogenic Nerve Injury from Orthopedic Surgery Correlate with Time to Subspecialty Presentation
Authors: Lefebvre Rachel , Russo Franco , Navo Paul , Stevanovic Milan 
Published: March 2020

Background:
There is no current literature examining iatrogenic nerve injury resulting from orthopedic procedures across subspecialties and anatomic areas. This study uses a single peripheral nerve surgeon’s experience to investigate the variable time to presentation of adult patients with iatrogenic nerve injury after orthopedic surgery.

Methods:
A retrospective review of patients examined in Peripheral Nerve Clinic (PNC) from January 1, 2012, to April 1, 2018, at a single, private, university hospital was performed. Fifty-eight adult patients met inclusion criteria. Charts were reviewed to determine the index orthopedic procedure, peripheral nerve affected, clinical deficits, patient demographics, and time from injury to PNC presentation.

Results:
The average patient age was 51.2 years, and the average time to PNC referral was 10.9 months after the procedure that resulted in nerve injury. The orthopedic procedures included fracture fixation (13), joint arthroplasty (10) knee arthroscopy and ligament reconstruction (9), mass excision (9), shoulder arthroscopy (7), irrigation and debridement (2), removal of deep hardware (2), tendon procedures (2), trigger digit release (2), nerve decompression (1), and release of exertional compartment syndrome (1). Time from injury to PNC presentation was substantially shorter for patients with upper extremity versus lower extremity deficits (5.9 months vs 19.8 months; P = 0.0173) and for patients with motor nerve involvement versus those with isolated sensory nerve injury (4.5 months vs 24.3 months; P = 0.0164).

Conclusions:
Iatrogenic nerve injury is a risk across orthopedic subspecialties. Nerve injuries in the lower extremity and those with isolated sensory deficits have significantly delayed time to subspecialty presentation.
Orthostatic hypotension: a marker of blood pressure variability and arterial stiffness: a cross-sectional study on an elderly population: the 3-City study
Authors: Cremer Antoine , Boutouyrie Pierre , Laurent Stéphane , Gosse Philippe , Tzourio Christophe 
Published: March 2020

Background:
Orthostatic hypotension, blood pressure (BP) variability, and arterial stiffness are three markers of cardiovascular risk beyond the average BP. However, the relationships between these three parameters are not well known.

Aim:
To examine the relationships between orthostatic hypotension, BP variability, and arterial stiffness.

Methods and results:
In the Three-City study, a sample of 1151 elderly participants (mean age = 80 ± 3 years) was screened for orthostatic hypotension, undertook home BP and pulse wave velocity (PWV) measurements. We performed logistic regression analyses to look at the associations between orthostatic hypotension and both day-to-day (D-to-D) BP variability quartiles and PWV quartiles. Orthostatic hypotension was detected in 210 participants who were more likely to be hypertensive, exhibit higher BP variability and have increased arterial stiffness. In the multivariate logistic regression analysis, the frequency of orthostatic hypotension increased by 20% with every quartile of D-to-D SBP variability and by 20% with every quartile of PWV. PWV and D-to-D BP variability were not associated. In stratified analysis, the use of beta-blocker changes these relationships: orthostatic hypotension was not associated to PWV anymore but its association with D-to-D SBP variability was apparently stronger.

Conclusion:
In this large sample of elderly individuals, orthostatic hypotension was independently associated with both BP variability and PWV. BP variability being more indicative of a baroreflex dysfunction and PWV being a marker of vascular ageing, these two components would participate to the orthostatic hypotension mechanisms.
Dynamic changes in cardiac function before and early postdelivery in women with severe preeclampsia
Authors: Ambrožič Jana , Lučovnik Miha , Prokšelj Katja , Toplišek Janez , Cvijić Marta 
Published: March 2020

Objectives:
In women with severe preeclampsia the period immediately before and early postdelivery carries the greatest risk for cardiac decompensation due to acute changes in loading conditions. The authors aimed to evaluate dynamic changes in hemodynamic and echocardiographic-derived systolic and diastolic function parameters in preeclamptic women compared with healthy controls.

Methods:
Thirty women with severe preeclampsia and 30 healthy controls underwent transthoracic echocardiography 1 day before, 1 and 4 days postdelivery. Fluid responsiveness was assessed by passive leg raising.

Results:
Peak systolic myocardial velocities (s′) and global longitudinal strain (GLS) were significantly lower in preeclamptic group compared with controls only postdelivery (s′: 7.3 ± 0.8 vs. 8.3 ± 0.9 cm/s, P < 0.001; GLS: −21.4 ± 2.0 vs. −23.0 ± 1.4%, P = 0.027). In addition, significant decrease in s′ after delivery was observed only in preeclamptic group (P = 0.004). For diastolic parameters there were differences both before and postdelivery in E/e′ ratio (before: 8.4 ± 2.16 vs. 6.7 ± 1.89, P = 0.002; postdelivery: 8.3 ± 1.64 vs. 6.8 ± 1.27, P = 0.003) and mitral e′ velocity (before: 11.0 ± 2.39 vs. 12.6 ± 1.86, P = 0.004; postdelivery: 11.1 ± 2.28 vs. 14.0 ± 2.40 cm/s, P < 0.001). Significant increase in left ventricular stroke volume (P = 0.005) and transmitral E velocity (P = 0.003) was observed only in control group, reflecting response to volume load after delivery. Accordingly, only the minority of preeclamptic women were fluid responsive (11 vs. 43%, P = 0.014 between groups).

Conclusion:
Variations in cardiac parameters in healthy women seem to follow changes in loading conditions before and early after delivery. Different pattern in preeclamptic women, however, may be related to subtle myocardial dysfunction, that becomes uncovered with augmented volume load in early postpartum period.
Self-blood pressure measurement as compared to office blood pressure measurement in a large Indian population; the India Heart Study
Authors: Kaul Upendra , Wander G.S. , Sinha Nakul , Mohan Jagdish C. , Kumar Soumitra , Dani Sameer , Ponde Chandrashekhar K. , Pinto Brian , Dalal Jamshed , Hiremath Jagdish , Kapoor Sunil , Baruah D.K. , Nair Tiny , Alexander Thomas , Mohan Viswanathan , Joshi Shashank , Sivakadaksham N. , Omboni Stefano , Arambam Priyadarshini , Suvarna Viraj , Verberk Willem J. 
Published: March 2020

Objective:
India Heart Study (IHS) is aimed at investigating the agreement between office blood pressure measurement (OBPM) and self (S)BPM in a hypertension-naive population.

Methods:
A total of 18 918 individuals (aged 42.6 ± 11.7 years, 62.7% men), visiting 1237 primary care physicians across India, underwent OBPM. They performed SBPM for a period of 1 week using a validated oscillometric BP monitor that was preprogrammed to adhere to a guideline-based SBPM-schedule and blinded to the results. Thereafter, individuals underwent a second OBPM. Available laboratory results were obtained. Thresholds for elevated OBPM and SBPM were 140/90 and 135/85 mmHg, respectively.

Results:
On the basis of first-visit OBPM and SBPM, there were 5787 (30.6%) individuals with normotension; 5208 (27.5%) with hypertension; 4485 (23.7%) with white-coat hypertension (WCH) and 3438 (18.2%) with masked hypertension. Thus, a diagnosis contradiction between SBPM and first-visit OBPM was seen in 9870 (41.9%) individuals. On the basis of second-visit OBPM, the normotension, hypertension, WCH and masked hypertension prevalence values were 7875 (41.6%); 4857 (25.7%); 2397 (12.7%) and 3789 (20.0%). There was poor agreement (kappa value 0.37) between OBPM of visit 1 and 2 with a diagnosis difference in 6027 (31.8%) individuals. The majority of masked hypertension and WCH individuals had BP values close to thresholds.

Conclusion:
There was a poor agreement between OBPM of visit1 and visit 2. Likewise, the agreement between OBPM at both visits and SBPM was poor. SBPM being considered to have a better correlation with patient prognosis should be the preferred method for diagnosing hypertension.
INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY AND ENDOSCOPY-GUIDED EXPLANTATION OF ARGUS II DEVICE
Authors: Cai Cindy X. , Vajzovic Lejla 
Published: March 2020

Purpose:
To describe a surgical approach using intraoperative optical coherence tomography and endoscopy for successful Argus II retinal prosthesis system removal.

Methods:
Retrospective review of a patient undergoing Argus II explantation 8 months after initial implantation.

Results:
Successful explantation of the Argus II device was performed in this patient.

Conclusion:
Explantation of the Argus II device can be a difficult surgery, and intraoperative optical coherence tomography and endoscopy can be used to help avoid potential complications.
Gender differences in attention to pain body postures in a social context: a novel use of the bodies in the crowd task
Authors: Walsh Joseph , Eccleston Christopher , Keogh Edmund 
Published: March 2020

Abstract
Pain signals the presence of potential harm, captures attention, and can inhibit performance on concurrent tasks. What is less well known, however, is whether such attentional capture also occurs in a wider social context, such as when observing people in pain. To explore this possibility, we adopted a novel social-cue detection methodology: the bodies-in-the-crowd task. Two experiments are reported that consider whether nonverbal cues of pain, happiness, and anger as expressed through body postures would capture and hold attention. Both experiments recruited 40 (20 male and 20 female) pain-free individuals. Overall, results show that pain postures do not capture attention any more than happiness or anger postures, but disengagement from pain postures was significantly slower across both studies. Gender differences were also found, and were more likely to be found when crowds comprised both men and women. Male pain postures were more likely to capture attention. However, female observers had faster target detection speed, and were quicker to disengage from distractors. They also showed slower disengagement from female expressions overall. Male observers showed no variation based on target or distractor gender. Implications and potential directions for future research are discussed.