bluuebunny/crossref_metadata_2025_split huggingface dataset:
A CONSENSUS ON RISK MITIGATION FOR BROLUCIZUMAB IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Holz Frank G. , Iida Tomohiro , Maruko Ichiro , Sadda SriniVas R. 
Published: August 2022

Purpose:
Brolucizumab has high efficacy in retinal fluid resolution and provides the possibility for longer dosing intervals in the treatment of neovascular age-related macular degeneration. However, brolucizumab has been associated with events of retinal vasculitis and retinal vascular occlusion typically in the presence of other signs of intraocular inflammation (IOI). The purpose of this report is to provide guidance on the use of brolucizumab for neovascular age-related macular degeneration to a global audience.

Methods:
A literature review was conducted on adverse events related to IOI after administration of brolucizumab in eyes with neovascular age-related macular degeneration.

Results:
Possible risk factors for IOI and retinal vascular occlusion after brolucizumab should be considered before administering brolucizumab. Patients who receive brolucizumab should be educated on the symptoms, signs, and time course of IOI after brolucizumab. Before each injection of brolucizumab, physicians should assess the eye for any signs of inflammation and not treat with brolucizumab if inflammation is detected. Treatment of IOI should be prompt and provided with particular attention to the posterior segment.

Conclusion:
Careful patient selection, patient education, assessment for inflammation, and intensive treatment of possible inflammation are important when using brolucizumab in patients with neovascular age-related macular degeneration.
Stimulation of alpha-1 adrenoceptors may intensify cutaneous inflammation in complex regional pain syndrome
Authors: Wijaya Linda K. , Morici Michael V. , Stumbles Philip A. , Finch Philip M. , Drummond Peter D. 
Published: August 2022

Abstract
Alpha-1 adrenoceptors are overexpressed in the epidermis of a subgroup of patients with complex regional pain syndrome (CRPS). Activating α1-adrenoceptors in epidermal cells increases production of the proinflammatory cytokine interleukin-6 (IL-6), a mediator of inflammation. To investigate whether this might exacerbate inflammation in CRPS, primary keratinocytes or dermal fibroblasts were cultured from skin biopsies obtained from the affected limb of 25 patients and a similar site in 28 controls. The fundamental proinflammatory cytokine, tumor necrosis factor alpha, was administered for 24 hours to initiate inflammation. After this, cells were incubated for 6 hours with the α1-adrenoceptor agonist phenylephrine. Exposure to tumor necrosis factor alpha induced proinflammatory cytokine mRNA production and protein secretion in keratinocytes and fibroblasts and enhanced α1B-adrenoceptor mRNA expression in keratinocytes. Additional stimulation of α1 adrenoceptors with phenylephrine increased the production of IL-6 mRNA and protein secretion in both cell types. Under all conditions, gene and protein α1-adrenoceptor levels and cytokine gene expression and protein secretion were similar, overall, in patients and controls, except for abnormally high α1-adrenoceptor protein levels in the keratinocytes of 3 of 17 patients. These findings suggest that persistent inflammation in CRPS is not due to dysfunction of skin cells but is a normal response to extrinsic signals. After α1-adrenoceptor stimulation of keratinocytes, increases in IL-6 mRNA but not protein were proportional to basal α1-adrenoceptor protein levels. Skin cells play an important role in persistent inflammation in CRPS. Potentially, a positive feedback loop between α1-adrenoceptors and IL-6 production in skin cells contributes to this inflammatory state.
Effects of the Collective Gratitude on Work Engagement
Authors: Komase Yu , Akiyama Hiroto , Kawakami Norito 
Published: August 2022

ObjectiveWork engagement is a key concept because of its positive association with physical/mental health, job performance, and well-being. This study aims to examine the relationship between organizational-level gratitude (collective gratitude) as a work climate and work engagement.MethodsUtrecht Work Engagement Scale measured work engagement. Gratitude at Work Scale measured individual-level gratitude, and collective gratitude was calculated by aggregating individual-level gratitude after confirming within-group agreement and the intraclass correlations. Multilevel analysis was conducted.ResultsA total of 1187 workers from 72 organizations were analyzed. The multilevel analysis showed a significant positive association between collective gratitude and work engagement while controlling for individual-level confounders.ConclusionsThe findings indicated developing collective gratitude would improve work engagement in the workplace. It would be useful for managers and occupational health staff to consider collective gratitude initiatives.
Mifepristone: A Safe Method of Medical Abortion and Self-Managed Medical Abortion in the Post-Roe Era
Authors: Schmidt Elizabeth O. , Katz Adi , Stein Richard A. 
Published: August 2022

Background:
The U.S. Supreme Court's Dobbs v. Jackson Women's Health Organization decision on June 24, 2022 effectively overturned federal constitutional protections for abortion that have existed since 1973 and returned jurisdiction to the states. Several states implemented abortion bans, some of which banned abortion after 6 weeks and others that permit abortion under limited exceptions, such as if the health or the life of the woman is in danger. Other states introduced bills that define life as beginning at fertilization. As a result of these new and proposed laws, the future availability of mifepristone, one of two drugs used for medical abortion in the United States, has become the topic of intense debate and speculation.

Areas of Uncertainty:
Although its safety and effectiveness has been confirmed by many studies, the use of mifepristone has been politicized regularly since its approval. Areas of future study include mifepristone for induction termination and fetal demise in the third trimester and the management of leiomyoma.

Data Sources:
PubMed, Society of Family Planning, American College of Obstetricians and Gynecologists, the World Health Organization.

Therapeutic Advances:
The use of no-touch medical abortion, which entails providing a medical abortion via a telehealth platform without a screening ultrasound or bloodwork, expanded during the COVID-19 pandemic, and studies have confirmed its safety. With the Dobbs decision, legal abortion will be less accessible and, consequently, self-managed abortion with mifepristone and misoprostol will become more prevalent.

Conclusions:
Mifepristone and misoprostol are extremely safe medications with many applications. In the current changing political climate, physicians and pregnancy-capable individuals must have access to these medications.
Racial/Ethnic Disparities in the Management of Pediatric Acute Pancreatitis Across Children’s Hospitals
Authors: Dike Chinenye R. , Lyden Elizabeth , Quirós‐Tejeira Ruben E. , Ma Jihyun , McCulloh Russell 
Published: August 2022

Objectives:Racial or ethnic disparities in health care delivery and resource utilization have been reported in a variety of pediatric diseases. In acute pancreatitis (AP), there is an association between Black race and increased inpatient mortality. Data on the association of race and ethnicity and resource use for managing pediatric AP are lacking. The aim of this study is to investigate this potential association in pediatric AP.Methods:Retrospective study of children 0–18 years diagnosed with AP in the Pediatric Health Information System (PHIS) database from 2012 to 2018. Descriptive statistics were used to summarize cohort characteristics. Race/ethnicity classifications included non‐Hispanic Black (NHB), non‐Hispanic White (NHW, used as reference), Hispanic, and “Other.” Associations between patient characteristics and race/ethnicity were determined using χ2 tests. Generalized linear mixed regression model was used to determine the association of race/ethnicity with odds of resource utilization, costs, and length of hospital stay after adjusting for covariates with a random intercept for site.Results:Five thousand nine hundred sixty‐three patients from 50 hospitals were included. Adjusted analysis showed that NHB children hospitalized with AP were at lower odds of receiving opioids in the first 24 hours [adjusted odds ratio (aOR) = 0.82, 95% confidence interval (CI) = 0.70–0.98] and receiving intravenous fluids during the hospitalization (aOR = 0.64, 95% CI = 0.43–0.96) when compared with NHW children. Additionally, NHB and Hispanic children had a prolonged adjusted mean length of hospital stay and higher hospital costs when compared with NHW children. Although there was no significant association between race/ethnicity and diagnosis of pancreatic necrosis or sepsis, Hispanic and “Other” children were at higher odds of receiving antibiotics during hospitalization for AP (aOR = 1.33, 95% CI = 1.13–1.57 and aOR = 1.37, 95% CI = 1.09–1.73, respectively) than NHW children.Conclusions:Disparities exist in utilization of health care interventions for pediatric AP patients by race/ethnicity. Future studies should investigate why these disparities exist and if these disparities affect outcomes.
Impressions of Conventional Bedside Discharge Teaching Among Readmitted Heart Failure Patients
Authors: Gatto Dawn , Newcomb Patricia 
Published: August 2022

OBJECTIVE
The purpose of this project was to report patient impressions of discharge teaching delivered by nurses among a population of heart failure (HF) inpatients.

BACKGROUND
Heart failure readmissions are frequently attributed to the quality of discharge teaching delivered by nurses.

METHODS
Thematic analysis, an atheoretical approach to the identification, organization, and analysis of themes in texts, was used to explore the data collected from patient interviews.

RESULTS
Sixteen interviews were conducted with patients readmitted for HF on dedicated cardiac units. Six major themes were identified including: 1) recall of instructions; 2) comprehension; 3) teaching media; 4) follow-up; 5) role of caregivers; 6) mismatch between nurse and patient concerns; and 7) readmission stories.

CONCLUSION
Discharge teaching could be improved by diminishing the volume of print materials distributed to HF patients, providing simple summaries of the most relevant advice, focusing on patient concerns more than the hospital agenda, and directly including home caregivers in teaching.
Desmoplastic Adamantinoma-like Thymic Carcinoma
Authors: Suster David I. , Mejbel Haider , Mackinnon Alexander C. , Suster Saul 
Published: August 2022

Five cases of a heretofore unreported rare variant of thymic carcinoma characterized by a striking resemblance to adamantinoma of the mandible are described. The tumors occurred in 4 women and 1 man aged 58 to 76 years (mean: 67.8 y); they arose in the anterior mediastinum and measured from 5.3 to 12.0 cm in greatest diameter (mean: 8.9 cm). Presenting symptoms included chest pain, shortness of breath, and in 2 patients, pleural effusion. One tumor was asymptomatic and discovered incidentally. Histologically, the tumors were extensively desmoplastic, and the cellular proliferation was characterized by multiple islands of squamous epithelium with striking peripheral palisading of nuclei and central areas containing clear cells resembling a stellate reticulum. Areas of preexisting spindle cell thymoma were identified in 2 cases; these areas gradually merged with the higher-grade component of the lesion. Cystic changes were noted in 3 cases. Immunohistochemical studies in 3 cases showed the tumor cells were positive for cytokeratins, p40 and p63, and all showed a high proliferation rate (>50% nuclear positivity) with Ki-67. Next-generation sequencing was performed in 2 cases that showed amplification of the AKT1 gene (copy numbers 6 and 13). Clinical follow-up in 3 patients showed recurrence and metastasis after 1 and 2 years; 1 patient passed away 2 years after diagnosis due to the tumor. Desmoplastic adamantinoma-like thymic carcinoma represents an unusual histologic variant of thymic carcinoma that needs to be distinguished from metastases from similar tumors to the mediastinum.
CD163 Immunohistochemical “Circle Sign” Staining Pattern Differentiates Sinonasal Papillomas From Morphologically Similar Non-neoplastic Lesions
Authors: Sterling Brent C. , Mehrad Mitra , Ely Kim A. , Lewis James S. 
Published: August 2022

Sinonasal papillomas are a diverse group of benign epithelial neoplasms of the sinonasal tract. Inverted papilloma, in particular, must be distinguished from other lesions with no malignant potential. The aim of this study was to distinguish sinonasal papillomas from morphologically similar lesions using CD163 immunostaining. Cases from a 19-year period were identified. These included 49 inverted, 10 exophytic, and 12 oncocytic papillomas, 21 chronic sinusitides with squamous metaplasia, 27 inflammatory polyps, 5 verrucae vulgares, 5 respiratory epithelial adenomatoid hamartomas, and 6 DEK::AFF2 carcinomas of the sinonasal tract. A subset of biopsy cases (8 inverted papillomas, 5 inflammatory polyps) was separately analyzed. CD163 immunohistochemistry (IHC) was performed. A unique “circle” staining pattern was identified in the surface epithelium. After locating a hotspot, circles were quantified in 10 consecutive high-power fields. Circles were present in 66/71 (93%) cases of sinonasal papilloma, with a mean of 35 circles/10 HPF (range: 0 to 160/10 HPF) and a median of 19 circles/10 HPF. Circles were present in 20/58 (34%) non-neoplastic cases, with a mean of 2 circles/10 HPF (range: 0 to 27/10 HPF) and a median of 0. Considering all resection and biopsy cases, performance for distinguishing papillomas from non-neoplastic lesions was best at a cutoff of 10 circles/10 HPF (2-tailed P<0.0001) with sensitivity, specificity, positive predictive value, and negative predictive value of 66.2%, 93.1%, 92.1%, and 69.2%, respectively. The results were similar in the biopsy subset. One other neoplastic entity, the DEK::AFF2 carcinomas, also showed prominent CD163 circle staining. In summary, sinonasal papillomas demonstrate extensive CD163 “circle” staining in the epithelium compared with the non-neoplastic lesions studied. As such, the “circle sign” on CD163 IHC may be helpful in distinguishing between diagnoses, particularly on small biopsies or equivocal specimens.
Digital rehabilitation for hand and wrist pain: a single-arm prospective longitudinal cohort study
Authors: Costa Fabíola , Janela Dora , Molinos Maria , Moulder Robert G. , Lains Jorge , Francisco Gerard E. , Bento Virgílio , Yanamadala Vijay , Cohen Steven P. , Correia Fernando Dias 
Published: August 2022

Abstract

Introduction:
Wrist and hand represent the third most common body part in work-related injuries, being associated with long-term absenteeism. Telerehabilitation can promote access to treatment, patient adherence, and engagement, while reducing health care–related costs.

Objective:
Report the results of a fully remote digital care program (DCP) for wrist and hand pain (WP).

Methods:
A single-arm interventional study was conducted on individuals with WP applying for a DCP. Primary outcome was the mean change in the Numerical Pain Rating Scale after 8 weeks (considering a minimum clinically important change of 30%). Secondary outcomes were: disability (Quick Disabilities of the Arm, Shoulder, and Hand questionnaire), analgesic intake, surgery intention, mental health (patient health questionnaire [PHQ-9] and generalized anxiety disorder [GAD-7]), fear-avoidance beliefs (FABQ-PA), work productivity and activity impairment, and engagement.

Results:
From 189 individuals starting the DCP, 149 (78.8%) completed the intervention. A significant pain improvement was observed (51.3% reduction (2.26, 95% CI 1.73; 2.78)) and 70.4% of participants surpassing minimum clinically important change. This change correlated with improvements in disability (52.1%), FABQ-PA (32.2%), and activities impairment recovery (65.4%). Improvements were also observed in other domains: surgery intent (76.1%), mental health (67.0% in anxiety and 72.7% in depression), and overall productivity losses (68.2%). Analgesic intake decreased from 22.5% to 7.1%. Mean patient satisfaction score was 8.5/10.0 (SD 1.8).

Conclusions:
These findings support the feasibility and utility of a fully remote DCP for patients with WP. Clinically significant improvements were observed in all health-related and productivity-related outcomes, alongside very high patient adherence rates and satisfaction. This study strengthens that management of WP is possible through a remote DCP, decreasing access barriers and potentially easing health care expenditure.
The clinical relevance of sensory nerve coaptation in DIEP flap breast reconstruction evaluated using the BREAST-Q
Authors: Bijkerk Ennie , Beugels Jop , van Kuijk Sander M.J. , Lataster Arno , van der Hulst René R.W.J. , Tuinder Stefania M.H. 
Published: August 2022

Introduction:
Sensory nerve coaptation in autologous breast reconstruction positively affects the sensory recovery in the reconstructed breast. However, patient-reported outcomes are currently lacking and no conclusions on the clinical relevance of nerve coaptation could be drawn. The aim of this study was to evaluate the clinical relevance of nerve coaptation in deep inferior epigastric perforator (DIEP) flap breast reconstruction.

Methods:
A prospective cohort study was conducted with patients with innervated or noninnervated DIEP flap breast reconstruction between August 2016 and August 2018, and completed a BREAST-Q questionnaire at a minimum of 12 months postoperative, in combination with a preoperative questionnaire or at 6 months postoperative. The domain “Physical well-being of the chest” was the primary outcome and patients answered additional sensation-specific questions. Sensation was measured using Semmes-Weinstein monofilaments.

Results:
In total, 120 patients were included (65 innervated and 55 noninnervated reconstructions). A clinically relevant difference was found in BREAST-Q scores in favor of patients with innervated reconstructions in general, and for delayed reconstructions in specific. Patients with sensate breast reconstruction more often experienced better and pleasant sensation.

Conclusions:
This study demonstrated that nerve coaptation in DIEP flap breast reconstruction, specifically in delayed reconstructions, resulted in clinically relevant higher patient-reported outcomes for the BREAST-Q domain “Physical well-being of the chest” and that better sensation was perceived pleasantly. However, the BREAST-Q does not adequately address sensation, and the introduction and validation of new scales is required to fill in these gaps to confirm the clinical relevance of nerve coaptation reliably.
Efficacy and Safety of Botulinum Toxin Type A in the Treatment of Benign Parotid Hypertrophy: a Prospective, Single-arm Clinical Trial
Authors: Chen Zong , Chen Zhiyou , Liu Wenhui , Wei Zhiru , Pang Ran , Cheng Xu , Wang Shuqi , Chen Shengjun , Liu Linbo , Li Guangshuai 
Published: August 2022

Background:
Benign parotid hypertrophy (BePH) makes the earlobe area appear “swollen”, and weakens the lateral facial contour and esthetics. Efficacious treatment for BePH is not available. We evaluated the efficacy and safety of botulinum toxin type A (BTX-A) for BePH treatment.

Methods:
Thirty-six participants with BePH were enrolled and treated with BTX-A injection. After 6 months of follow-up, changes in the thickness and length of the superficial lobe of the parotid gland (SLPG) were assessed. Analyses of patient subgroups and image analyses were also undertaken to assess improvement.

Results:
Thirty-three participants completed this study. The SLPG thickness was reduced significantly after BTX-A injection, but the longitudinal diameter of the PG was not changed significantly (p < 0.001 and p = 0.146, respectively). Subgroup analyses showed that the degree of PG hypertrophy affected treatment efficacy and degree of improvement, but age and sex did not (p < 0.001, p = 0.137, and p = 0.138, respectively). Image analyses showed improvement in the facial contour (p < 0.05). Serious adverse reactions or complications were not observed.

Conclusions:
BTX-A can be used to treat BePH, reduce PG volume, and improve the facial contour.
DAAM (Dermal Auto-Augmentation Mastopexy) – maintaining maximal volume in primary breast lift surgery and when combined with breast implant removal.
Authors: Rand Richard P. 
Published: August 2022

SUMMARY:
Mastopexy is performed to lift, reshape and restore tone to the ptotic breast. Dermal Auto-Augmentation Mastopexy (DAAM) maintains the maximal existing tissue volume because an average of only 11.3 grams is removed per side. This potentially avoids the need for prosthetic implants in patients concerned about breast implant issues. The procedure utilizes flexible freehand shaping and is also an ideal mastopexy when prosthetic implants are removed because it requires minimal undermining and preserves blood flow to the tissues. Long-term results are extremely stable without revision even in cases of dramatic laxity.
Finding the Balance Between Reduced Opioid Prescribing and Patient-reported Pain Management Among General Surgery Patients
Authors: Gudmundsdottir Hallbera , Ubl Daniel S. , Yost Kathleen J. , Gazelka Halena M. , Habermann Elizabeth B. , Thiels Cornelius A. 
Published: August 2022

Objective:
To compare patient-reported outcomes before and after implementation of evidence-based, procedure-specific opioid prescribing guidelines.

Background:
The opioid epidemic remains a significant public health issue. Many institutions have responded by reducing opioid prescribing after surgery. However, the impact of this on patient-reported outcomes remains poorly understood.

Methods:
Opioid-naïve adults undergoing 12 elective general surgery procedures at a single institution prospectively completed telephone surveys at median 26 days from discharge. Patients were compared before (March 2017–January 2018) and after (May 2019–November 2019) implementation of evidence-based, procedure-specific opioid prescribing guidelines.

Results:
A total of 603 preguideline and 138 postguideline patients met inclusion criteria and completed surveys. Overall, 60.5% of preguideline and 92.5% of postguideline prescriptions fell within recommendations (P<0.001), while refill rates were similar (4.5% vs 5.8%, P=0.50). A statistically significant drop in median morphine milligram equivalent prescribed was observed for 9 of 12 procedures (75%). No opioids were prescribed for 16.7% of patients in both cohorts (P=0.98). While 93.3% of preguideline and 87.7% of postguideline patients were very/somewhat satisfied with their pain control, the proportion of patients who were very/somewhat dissatisfied increased from 4.2% to 9.4% (P=0.039).

Conclusions:
Prescribing guidelines successfully reduced opioid prescribing without increased refill rates. Despite decreased prescribing overall, there was a continued reluctance to prescribe no opioids after surgery. Although most patients experienced good pain control, there remains a subset of patients whose pain is not optimally managed in the era of reduced opioid prescribing.