bluuebunny/crossref_metadata_2025_split huggingface dataset:
May-Thurner Syndrome and Lymphedema Reconstruction
Authors: Gupta Rohun , Mathijs Emily , Hart Justin , Bates John , Powers Jeremy , Chaiyasate Kongkrit 
Published: June 2022

Background:
May-Thurner syndrome (MTS) is an anatomical variant that results in compression of the left common iliac vein by the right common iliac artery. Although often asymptomatic, lower extremity swelling/edema, deep venous thrombosis, post-thrombotic syndrome, and eventual lymphedema (due to long-standing venous obstruction) can develop. The clinical management of patients presenting for lymphedema surgery with concomitant or undiagnosed MTS is not well described.

Methods:
This review investigates two patients who were evaluated for unilateral lower extremity lymphedema, both of whom were subsequently diagnosed with MTS. Standard imaging (including lymphoscintigraphy, indocyanine green lymphangiography, and magnetic resonance venography) were performed to identify proximal venous obstruction. Treatment was accomplished using vascular surgical management, including stenting of the iliac vein before lymphedema reconstruction with vascularized lymph node transfer and multiple lymphovenous bypass.

Results:
Both patients we examined in this review had improvement of lymphedema with vascular surgical management. Literature review reveals that MTS has an incidence as high as 20% in the population, although commonly unidentified due to lack of symptomatology.

Conclusions:
There are no studies documenting the incidence of MTS in patients referred for lymphedema surgical management. Routine studies should be obtained to screen for proximal venous obstruction in patients presenting for surgical management of lower extremity lymphedema. Additional research is needed regarding the approach to managing patients with both MTS and lymphedema. Careful observational and prospective studies may elucidate the appropriate time interval between venous stenting and lymphedema microsurgical reconstruction.
Adolescent Occupational Exposures Reported to United States Poison Centers, 2011–2020
Authors: Lam Angela H. , Leonard James B. , Klein-Schwartz Wendy 
Published: June 2022

Objective
The aim of this study was to perform an updated description of adolescent occupational exposures reported to the US poison centers.

Methods
We performed a descriptive analysis of adolescents aged 13 to 19 years with unintentional occupational exposures from 2011 to 2020 using the National Poison Data System. A clinically significant occupational poisoning (CSOP) case is defined as exposures with moderate effect, major effect, or death. Differences in substance categories between younger (13 to 17 years) and older (18 to 19 years) adolescents with CSOP were compared.

Results
There were 14,374 adolescent occupational exposures. There were 2151 CSOPs. The most common substance categories associated with CSOP were household cleaners (22.3%), chemicals (20.8%), industrial cleaners (14.2%), fumes/gases/vapors (10.8%), and hydrocarbons (5.9%). Categories of exposures were similar across age groups.

Conclusions
This study found that, despite a reduction in the number of adolescent occupational exposures, CSOPs persist.
Altered Mental Distress Among Employees From Different Occupational Groups and Industries During the COVID-19 Pandemic in Germany
Authors: Casjens Swaantje , Taeger Dirk , Brüning Thomas , Behrens Thomas 
Published: June 2022

ObjectiveMental distress of employees from the financial, public transport, public service, and industrial sector was examined in a cross-sectional study during the second COVID-19 (coronavirus disease 2019) wave in Germany and retrospectively at its beginning.MethodsMental distress in terms of anxiety and depression symptoms was assessed with the Patient Health Questionnaire-4. High and potential occupational SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection risk (OSIR) was defined based on job information from 1545 non–health care workers.ResultsThe risks for more severe mental distress symptoms increased threefold and twofold, respectively, among employees with high and potential OSIR compared with employees without OSIR. Mental distress severity differed by the extent of work-privacy conflicts, perceived job protection, interactions with colleagues, and overcommitment.ConclusionsReducing COVID-19 exposure through workplace protective measures, strengthening interactions among colleagues, and supporting employees with work-privacy conflicts could help better protect employees' mental health.
Non-diabetic ketoacidosis secondary to primary hyperthyroidism
Authors: Al-Mashdali Abdulrahman F. , Gul Mohammadshah , Umer Waseem , Omar Abeer , Jones Akhnuwkh 
Published: June 2022

Abstract

Introduction:
There are variable complications of hyperthyroidism, including atrial fibrillation, heart failure, osteoporosis, and thyroid storm. One infrequent complication of hyperthyroidism is non-diabetic ketoacidosis (NDKA). To the best of our knowledge, our case is the third report of NDKA related to thyrotoxicosis.

Patient concern:
We describe a case of a 41-year-old African lady with no past medical history presented to our hospital with severe abdominal pain and vomiting for three weeks. This was associated with decreased appetite and weight loss.

Diagnosis:
Laboratory findings were significant for high anion gap metabolic acidosis, positive ketones in the urine, and high serum B-hydroxybutyrate. The blood glucose readings and HbA1c were within normal limits. Also, serum lactic acid and salicylate levels were within the normal range. The diagnosis of NDKA was made. Later, the thyroid functions test (TFT) confirmed the diagnosis of primary hyperthyroidism.

Intervention and outcomes:
The patient was managed initially with intravenous fluid and antiemetics. Then, she was started on propranolol and carbimazole. After which, her symptoms improved dramatically, and the metabolic acidosis (with serum ketones) were corrected within a few days of starting anti-thyroid medications.

Conclusion:
Despite its rarity, NDKA can be associated with severe thyrotoxicosis. Vigorous intravenous hydration and anti-thyroid medication are the mainstay treatment. TFT should be requested in a patient with unexplained NDKA
Sacubitril/Valsartan for heart failure
Authors: Dai Wenqin , Luo Jinlan , Huang Xianli 
Published: June 2022

Abstract

Background:
Sacubitril–valsartan has been shown to have superior effects over angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with heart failure (HF). However, the effects of sacubitril–valsartan have never been systematically evaluated. Therefore, we performed a protocol for systematic review and meta-analysis to evaluate the efficacy and safety of sacubitril–valsartan in patients with HF.

Methods:
We selected 8 databases, including PubMed, the Web of Science, Embase, Cochrane Library, the Chinese National Knowledge Infrastructure, the Chinese Science Journal Database, Wanfang Data, and the Chinese Biomedical Literature Database. The search time was from database establishment to March 2022. Two reviewers will screen the records and include quality studies according to inclusion criteria independently. Two reviewers will assess the risk of bias of the included studies by the “Risk of Bias Assessment Tool” of the Cochrane Handbook for randomized controlled trials. Statistical analysis will be performed with Review Manager software 5.3.

Results:
A synthesis of current evidence of sacubitril–valsartan for treating HF will be provided in this protocol.

Conclusion:
The results of this study will provide a theoretical basis for the clinical use of sacubitril–valsartan to treat HF.
The first survey on patient needs for remote monitoring of cardiac implantable electronic device in South Korea
Authors: Hwang You Mi , Kim Ji-Hoon 
Published: June 2022

Abstract

Background/Aims:
Studies showed that remote device monitoring reduced unnecessary outpatient visits and increased patient satisfaction. As there was no local research on remote monitoring (RM) in Korea, there was a lack of evidence for policy or insurance standards due to the lack of domestic data despite high demand by domestic arrhythmia experts. To establish the basis for patient satisfaction, economic efficiency, and safety of wireless monitoring, a survey-based study was planned.

Methods:
This was a single-university hospital survey. The satisfaction index was evaluated using a questionnaire to investigate patient satisfaction in outpatient clinics, economic efficiency (measured as home-to-clinic time, waiting time, and actual clinic time), and demand for RM in patients with implantable cardiac devices. The questionnaire was adopted and modified from the Survey on Telehealth Patient Experience by Bas-Villalobos, 2006 (modified Korean version 2.0 by You Mi Hwang, 2020).

Results:
Surveys were answered by 171 patients. The mean age of these patients was 71.2 ± 12.4 years. Based on the survey, home to clinic time was usually less than one h, mean waiting time in the hospital until clinic time ranged 42.6 ± 24.5 minutes, and mean clinic time ranged 3.1 ± 1.7 minutes. Based on the survey, patients favored RM over hospital visits with cardiac implantable electronic device follow-up mainly because of long travel times from home to clinic.

Conclusion:
Based on the survey results, there is a clear need for RM in patients who have cardiac implantable electronic devices.
Trends in emergency department visits due to back pain and spine surgeries during the COVID-19 pandemic in Finland
Authors: Jäntti Saara , Ponkilainen Ville , Mäntymäki Heikki , Uimonen Mikko , Kuitunen Ilari , Mattila Ville M. 
Published: June 2022

Abstract
We aim to report the incidences of ED visits due to back pain, hospitalizations, and urgent spine surgeries during the first and second waves of COVID-19 in Finland. The number of emergency department visits and hospitalizations due to back pain as well as urgent spine surgeries in the adult population was collected from hospital discharge registers for the years 2017 through 2019 (reference years) and 2020.
This study was conducted at three large Finnish hospitals. The monthly incidence with 95% confidence intervals (CI) of emergency department visits and hospitalizations due to back pain and spine surgeries in the three participating hospitals were calculated and compared by incidence rate ratios (IRR).
Visits to ED due to back pain decreased during the pandemic. The incidence of ED visits due to back pain was similar in February (IRR 0.95, CI: 0.82-1.10), but a decrease was seen after lockdown began (March IRR 0.67, CI: 0.57-0.78; April IRR 0.65, CI: 0.56-0.76) compared to the reference years. A second decrease in visits was seen after regional restrictions were implemented in October (IRR 0.88, CI: 0.76-1.02). The most common diagnoses were non-specific back pain, lumbar disk herniation, and back contusion. Incidence of non-specific back pain decreased during the lockdown (March IRR 0.65, CI: 0.55-0.78) and regional restrictions (October IRR 0.83, CI: 0.70-0.98), whereas the rates of other diagnoses remained unchanged, and incidences of hospitalizations and urgent spine surgeries remained stable.
A clear decrease in ED visits due to back pain was seen during the first and second waves of the pandemic. This decrease was mainly the result of patients with non-specific back pain avoiding visits to the ED. The incidence of specific back pain, hospitalizations, and urgent spine surgeries remained unchanged during the pandemic.
Effectiveness of Cryotherapy on Cancer Therapy–Induced Oral Mucositis
Authors: Lee Chai-Chun , Kuo Shu-Fen , Chang Wen-Pei , Guo Shu-Liu , Huang Tsai-Wei 
Published: June 2022

BackgroundOral mucositis (OM) considerably affects the experience of patients with cancer during treatment. This study investigated the effects of cryotherapy on cancer therapy–induced OM.ObjectiveThis study aimed to systematically appraise evidence on whether cryotherapy can reduce the incidence and severity of OM.MethodsWe conducted an umbrella review to examine the effect of cryotherapy on cancer-related OM. The primary outcome was the incidence and severity of OM. We performed a subgroup analysis including solid cancers and hematological malignancies.ResultsFive meta-analyses were included. Cryotherapy could more effectively reduce the incidence of severe OM (risk ratio [RR], 0.37; 95% prediction interval [PI], 0.22–0.64). In the subgroup analyses of solid cancers or hematological malignancies, cryotherapy significantly reduced the incidence of grades 2 to 4 OM in patients with solid cancers (RR, 0.51; 95% PI, 0.34–0.78 and RR, 0.52; 95% PI, 0.36–0.74). However, no significant difference was observed in the incidence of OM in patients with hematological malignancies regarding any grade or grade 3 or 4 OM. Moreover, cryotherapy did not significantly reduce the OM duration (mean difference, −0.13; 95% PI, −20.89 to 20.63; mean difference, −2.99, 95% PI, −8.10 to 2.12).ConclusionCryotherapy can reduce the incidence of severe OM induced by chemotherapy or radiotherapy.Implication for PracticeWe recommend the inclusion of this safe, simple, and convenient intervention in chemotherapy or radiotherapy plans. Additional clinical trials are warranted to extend the limited evidence on the effectiveness of cryotherapy in reducing the severity and duration of OM.
Outcomes for Children With Pulmonary Hypertension Undergoing Tracheostomy Placement: A Multi-Institutional Analysis*
Authors: Perez Jennifer M. , Melvin Patrice R. , Berry Jay G. , Mullen Mary P. , Graham Robert J. 
Published: June 2022

OBJECTIVES:
To describe epidemiology, interventions, outcomes, and the health services experience for a cohort of children with pulmonary hypertension (PH) who underwent tracheostomy placement and to identify risk factors for inhospital mortality and 30-day readmissions.

DESIGN:
Retrospective cohort study of the Pediatric Health Information System database.

SETTING:
Thirty-seven freestanding U.S. children’s hospitals.

PATIENTS:
Patients 31 days to 21 years old who were discharged from the hospital between January 1, 2009, and December 31, 2017, with a diagnosis of primary or secondary PH, and who underwent tracheostomy placement. Outcomes were examined over a 2-year period from the time of discharge from the index encounter.

INTERVENTIONS:
None.

MEASUREMENTS and MAIN RESULTS:
There were 793 patients with PH who underwent tracheostomy placement. The overall inhospital mortality rate was 23.7%. Secondary PH due to congenital heart disease (CHD) was significantly associated with overall inhospital mortality (adjusted odds ratio [OR], 2.36; 95% CI, 1.38–4.04). The rate of 30-day readmissions for patients over the 2-year follow-up period was 33.3%. Tracheostomy during the index encounter and the diagnosis of secondary PH due to CHD were significantly associated with lower rates of 30-day readmissions (adjusted OR, 0.34; 95% CI, 0.19–0.61; and adjusted OR, 0.43; 95% CI, 0.24–0.77, respectively).

CONCLUSIONS:
In the context of expanding utilization of tracheostomy and long-term ventilation, children with PH are among the highest risk cohorts for extended and repeated hospitalization and death. Tracheostomy placement during the index encounter was associated with fewer 30-day readmissions over the 2-year follow-up period. Further understanding of which subgroups may benefit from earlier intervention and which subgroups are at highest risk may offer important clinical insight when considering optimal timing of tracheostomy and may enhance informed decision-making for all stakeholders.
Favorable Transverse Maxillary Development after Covering the Lateral Raw Surfaces with Buccal Fat Flaps in Modified Furlow Palatoplasty: A Three-Dimensional Imaging–Assisted Long-Term Comparative Outcome Study
Authors: Lo Chi-Chin , Denadai Rafael , Lin Hsiu-Hsia , Pai Betty Chien-Jung , Chu Yu-Ying , Lo Lun-Jou , Chou Pang-Yun 
Published: June 2022

Background:
The pedicled buccal fat flap has recently been applied to cover the lateral raw surfaces during palatoplasty as an attempt to mitigate scar-induced transverse maxillary constriction during growth, but with no formal long-term comparative analysis. This three-dimensional imaging–assisted study assessed its impact on posterior transverse maxillary development.

Methods:
Cone beam computed tomographic scans from patients with unilateral cleft lip, alveolus, and palate who received buccal fat flap (buccal fat group; n = 22) or Surgicel (Surgicel group; n = 32) for covering lateral raw surfaces during modified Furlow palatoplasty at 9 to 10 months of age and had reached the age of 9 years were retrieved for analysis. Patients with unilateral cleft lip and alveolus (nonpalatoplasty group; n = 24) were also included for comparison. Using three-dimensional maxillary image models, linear (U6T-MSP and U6J-MSP) and area measurements were calculated for cleft and noncleft posterior maxillary sides and for total posterior transverse maxillary dimension.

Results:
The buccal fat group had significantly (all p < 0.05) wider dimensions compared with the Surgicel group for all transverse maxillary measurements on both the cleft and noncleft sides, except for U6J-MSP and posterior palatal area parameters on the cleft side (p > 0.05). The buccal fat group had significantly (all p < 0.05) wider total transverse maxillary dimensions compared with the Surgicel and nonpalatoplasty groups.

Conclusion:
Covering the lateral raw surfaces with buccal fat flaps resulted in less posterior transverse maxillary constriction compared with the Surgicel-based covering procedure.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Safety and Pharmacokinetics of Intravenous 10-1074 and VRC01LS in Young Children
Authors: Capparelli Edmund V. , Ajibola Gbolahan , Maswabi Kenneth , Holme Molly P. , Bennett Kara , Powis Kathleen M. , Moyo Sikhulile , Mohammed Terence , Maphorisa Comfort , Hughes Michael D. , Seaton Kelly E. , Tomaras Georgia D. , Mosher Shad , Taylor Alison , O’Connell Sarah , Narpala Sandeep , Mcdermott Adrian , Caskey Marina , Gama Lucio , Lockman Shahin , Jean-Philippe Patrick , Makhema Joseph , Kuritzkes Daniel R. , Lichterfeld Mathias , Shapiro Roger L. ,   for the Tatelo Study Team
Published: June 2022

Background:
Broadly neutralizing monoclonal antibodies (bNAbs) suppress HIV-1 RNA and may deplete residual viral reservoirs. We evaluated the safety and pharmacokinetics (PK) of dual intravenous VRC01LS and 10-1074 in very early-treated children with HIV-1 on suppressive antiretroviral treatment (ART).

Setting:
Botswana.

Methods:
Children with HIV-1 (median age 3.1 years) on ART from <7 days old were enrolled. In phase A, 6 children received 10-1074 (30 mg/kg at day 0, 28, and 56) and 6 children received VRC01LS (30 mg/kg at day 0, 10 mg/kg at days 28 and 56) by intravenous infusion. In phase B, 6 children received the 2 bNAbs combined (with higher VRC01LS maintenance dose, 15 mg/kg) every 4 weeks for 32 weeks with PK evaluations over 8 weeks. Population PK models were developed to predict steady-state concentrations.

Results:
BNAb infusions were well tolerated. There were no infusion reactions nor any bNAb-related grade 3 or 4 events. The median (range) first dose Cmax and trough (day 28) combined from both phases were 1405 (876–1999) μg/mL and 133 (84–319) μg/mL for 10-1074 and 776 (559–846) μg/mL and 230 (158–294) μg/mL for VRC01LS. No large differences in bNAb clearances were observed when given in combination. The estimated VRC01LS half-life was shorter than in adults. Predicted steady-state troughs [median (90% prediction interval)] were 261 (95–565) and 266 (191–366) μg/mL for 10-1074 and VRC01LS, respectively, when given in combination.

Conclusions:
10-1074 and VRC01LS were safe and well-tolerated among children receiving ART. Troughs exceeded minimal targets with every 4-week administration of 10-1074 at 30 mg/kg and VRC01LS at 15 mg/kg.
Moving Beyond the LGBTQIA+ Acronym
Authors: McEwing Evan , Black Terrie , Zolobczuk Joseph , Dursun Umut 
Published: June 2022

Abstract

Purpose
The LGBTQIA+ communities experience distinct health disparities and inequities in health outcomes. Healthcare providers must be conscious of these factors to facilitate optimal, person-centered care. This narrative briefly covers health disparities in the LGBTQIA+ community and posits strategies to promote inclusive care.

Methods
Current literature and clinical best practices from several authoritative sources on LGBTQIA+-specific issues and gender-affirming care were reviewed. Sources included several LGBTQIA+-specific healthcare organizations, national healthcare provider organizations, and federal agency policy statements. Inclusive terminology and healthcare practices are included.

Results
Healthcare providers must educate themselves on caring for gender- and sexual orientation-diverse populations to optimize the health status of these communities. It is essential that providers examine their own potential biases and maintain an openness to learning about LGBTQIA+ communities.

Conclusions
Healthcare providers have a responsibility to not only understand issues specific to LGBTQIA+ individuals but also advocate for these groups. As nurses, we must continue to support public health policies that seek to end disparities and ensure health equity for all.

Clinical Relevance to the Practice of Rehabilitation Nursing
Rehabilitation nurses are caring for more diverse populations than ever before and must understand how to provide compassionate, individualized care. Although this article focuses on the LGBTQIA+ community, the principles discussed are applicable across all populations.
Tandem use of gastroesophageal resuscitative occlusion of the aorta followed by resuscitative endovascular balloon occlusion of the aorta in a lethal liver laceration model
Authors: Tiba Mohamad Hakam , McCracken Brendan M. , Greer Nicholas L. , Cramer Traci A. , Colmenero Mahmood Carmen I. , Priambada Putra Ketut B. , Plott Jeffery S. , Shih Albert J. , Wang Stewart C. , Eliason Jonathan L. , Ward Kevin R. 
Published: June 2022

BACKGROUND
Gastroesophageal resuscitative occlusion of the aorta (GROA) has been shown effective in creating zone II aortic occlusion capable of temporarily improving survival in animal models of lethal noncompressible torso hemorrhage. In this study, tandem application of GROA transitioning to resuscitative endovascular balloon occlusion of the aorta (REBOA) is explored to demonstrate feasibility as a potential point-of-injury bridge to more advanced care, using a swine model of lethal abdominal hemorrhage.

METHODS
Swine (n = 19) were anesthetized, instrumented, and subjected to a combination of controlled and uncontrolled hemorrhage from a grade-V liver laceration. Animals were designated as intervention (n = 9; GROA to REBOA) or control (n = 10), for 60 minutes. Following intervention, devices were deactivated, and animals received blood and crystalloid resuscitation. Animals were monitored for 4 hours.

RESULTS
Injury resulted in onset of class IV shock in all animals with a mean arterial pressure (SD) of 24.5 (4.11) mm Hg at the start of intervention. Nine of 10 controls died during the intervention period with a median (interquartile) survival time of 8.5 (9.25) minutes. All animals receiving the intervention survived both the 60-minute intervention period demonstrating a significant survival improvement (p = 0.0007). Transition from GROA to REBOA was successful in all animals with a transition time ranging from 30 to 90 seconds. Mean arterial pressure significantly improved in animals receiving GROA to REBOA for the duration of intervention, regardless of the method of aortic occlusion, with a range of 70.9 (16.04) mm Hg to 101.1 (15.3) mm Hg. Additional hemodynamics, metrics of shock, and oxygenation remained stable during intervention.

CONCLUSION
Less invasive technologies such as GROA may present an opportunity to control noncompressible torso hemorrhage more rapidly, with a subsequent transition to more advanced care such as REBOA.