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Recent Research Articles from JPS Health Network

Immediate Teeth in Fibulas: Planning and Digital Workflow With Point-of-Care 3D Printing.

Fri, 05/15/2020 - 06:13

Immediate Teeth in Fibulas: Planning and Digital Workflow With Point-of-Care 3D Printing.

J Oral Maxillofac Surg. 2020 Apr 14;:

Authors: Williams FC, Hammer DA, Wentland TR, Kim RY

Abstract
PURPOSE: Point-of-care 3-dimensional (3D) printing has become more common in recent years because many hospitals have created 3D printing laboratories. Traditional techniques to fabricate an immediate dental prosthesis for fibula and implant reconstructions have involve outsourcing to dental laboratories. This results in delays, making it suitable only for benign disease. In the present report, we have demonstrated a technique for in-house creation of a 3D printed dental prosthesis for placement of implants at free fibula maxillofacial reconstruction. Our digital method has reduced costs and shortened the interval to surgery compared with traditional laboratory techniques.
MATERIALS AND METHODS: Twelve patients underwent free fibula reconstruction of the mandible or maxilla with immediate implants and immediate teeth. A dental implant-retained restoration was created before surgery for immediate placement at fibula reconstruction. For the first 5 patients, the prosthesis was fabricated by a dental laboratory after virtual surgical planning. For the next 7 patients, the prosthesis was designed by the surgeon and 3D printed via the in-house laboratory. Four of these in-house cases were performed for malignant disease with skin paddles.
RESULTS: All 12 patients had received an immediate implant-retained fixed prosthesis at fibula reconstruction. The time required to generate the in-house 3D printed prostheses was significantly shorter than that required to create the dental laboratory-fabricated prostheses. The costs were also less with the 3D printed prostheses compared with the dental laboratory-fabricated prostheses.
CONCLUSIONS: The digital workflow we have presented eliminates the delay in creating a dental laboratory-fabricated provisional dental prosthesis for fibula and implant reconstruction. This allows for immediate dental restoration for patients with malignant disease previously considered unsuitable owing to the inherent delay required using an offsite dental laboratory. A decrease in cost to create in-house 3D printed prostheses was noted compared with the prostheses fabricated by a dental laboratory. Case selection is critical to predict the soft tissue needs for composite defects.

PMID: 32404269 [PubMed - as supplied by publisher]

A prospective study on prevalence and causes of insomnia among end-stage renal failure patients on hemodialysis in selected dialysis centers in Qassim, Saudi Arabia.

Wed, 05/13/2020 - 07:31
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A prospective study on prevalence and causes of insomnia among end-stage renal failure patients on hemodialysis in selected dialysis centers in Qassim, Saudi Arabia.

Saudi J Kidney Dis Transpl. 2020 Mar-Apr;31(2):454-459

Authors: Alkhuwaiter RS, Alsudais RA, Ismail AA

Abstract
Studies directed toward improving the life quality of hemodialysis (HD) patients revealed different etiologies for insomnia. We aimed to assess the prevalence of insomnia and determine associated etiologies in the AL Qassim region. This interview-based questionnaire study was conducted in HD centers for assessment of insomnia and its related causes using a validated screening questionnaire, developed by the JPS health network. Accordingly, patients were classified as insomnia, insomnia for further evaluation and management and no insomnia. Of 111 patients, there were 55 males and 56 females. The prevalence of primary insomnia was 28.82%, compared to 44% for secondary insomnia. Significant correlations linked insomnia with apnea, night itching, and not using phosphate binder usage. Primary and secondary insomnia is frequent among dialysis patients and require an application of diagnostic tools and severity scales. The assessment of causes and treatment of the complaints of apnea, usage of phosphate binders, and itching should be considered to decrease complications and improve quality of life.

PMID: 32394919 [PubMed - in process]

Temperature- and Pressure-Regulating Insoles for Prevention of Diabetic Foot Ulcers.

Mon, 05/11/2020 - 05:18

Temperature- and Pressure-Regulating Insoles for Prevention of Diabetic Foot Ulcers.

J Foot Ankle Surg. 2020 May 06;:

Authors: Yavuz M, Ersen A, Monga A, Lavery LA, Garrett AG, Salem Y, Hirschman GB, Myers R

Abstract
Diabetic foot ulcers (DFUs) pose a major threat to the United States healthcare system as well as patients and their families. High ulcer recurrence rates indicate that existing preventive measures are not effective. A new generation of multimodal preventive devices may reduce ulceration and amputation rates. Because previous research has revealed that tissue maintained at cooler temperatures is more resistant to breaking down, the evaluated technology may prevent foot ulceration. The purpose of this study was to test previously designed Temperature and Pressure Monitoring and Regulating Insoles (TAPMARI) in diabetic neuropathic and healthy subjects. A cooling unit, a mini-water pump, a battery pack, and a microcontroller (or simply thermostat) were placed inside a box attached to the subjects' calf, which provided cooling inside the shoe. The microcontroller was set at 28°C. Eight subjects provided informed consent, 3 of whom had diabetic neuropathy. Subjects used the instrumented shoe on the right foot and the matching control shoe on the left and walked on a treadmill for 5 minutes at self-selected speeds. Baseline and postwalking thermographs were obtained with a thermal camera. At the 2-hour midpoint, subjects again walked on the treadmill for 5 minutes at self-selected speeds. Second baseline and postwalking thermographs were captured. Plantar pressure distributions were also quantified. The TAPMARI successfully regulated foot temperatures at or below the target temperature. The mean baseline temperature of the right (regulated) and left (control) feet were 28.1 ± 1.9°C (mean ± standard deviation) for all subjects. The mean temperatures at the end of the study were 25.9 ± 2.5°C (right) and 31.7 ± 1.6°C (left) in all subjects. In the diabetic neuropathy group, the final mean temperatures were 27.5 ± 2.4°C (right) and 31.6 ± 0.8°C (left), which indicated that the temperature goal was met inside the instrumented shoe. By regulating temperatures, TAPMARI may reduce the metabolic demands in the foot and prevent cell autolysis by eliminating the imbalance between oxygen demand and supply. This study warrants further development and testing of TAPMARI as well as investigating the clinical effectiveness in preventing DFUs.

PMID: 32386918 [PubMed - as supplied by publisher]

Readmission Outcomes of Sliding Scale Insulin Compared to Basal-Bolus Insulin Prescribed at Discharge in an Insulin-Naive Patient Population.

Sat, 05/02/2020 - 05:53

Readmission Outcomes of Sliding Scale Insulin Compared to Basal-Bolus Insulin Prescribed at Discharge in an Insulin-Naive Patient Population.

J Pharm Pract. 2020 May 01;:897190020921028

Authors: Carter P, Eshelbrenner T, Kirk L, Fisk M, Rodrigues C

Abstract
BACKGROUND: Limited data are available that examine hospital readmission outcomes of sliding scale compared to basal-bolus insulin in indigent and insulin-naive patients.
OBJECTIVE: To evaluate hospital readmission outcomes in patients who are insulin naive with type 2 diabetes mellitus who are initiated on either sliding scale or basal-bolus insulin upon hospital discharge.
METHODS: A retrospective chart review was conducted of adult patients with a history of type 2 diabetes mellitus, who were insulin naive, had a hemoglobin A1c (HbA1c) 10% or greater, and were discharged with a prescription for sliding scale or basal-bolus insulin from January 2015 to July 2018. The primary objective measured all-cause 30-day hospital readmissions. The secondary objectives measured diabetes-related 30-day hospital readmissions and HbA1c change after 3 months of initial hospital admission. Data were analyzed using descriptive statistics, χ2 test, paired sample t test, and logistic regression.
RESULTS: Forty-one patients were prescribed sliding scale insulin and 105 patients were prescribed basal-bolus insulin. The majority were male (60%), spoke English (84%), were self-pay (39%), and had a mean age of 51 ± 10.2 years, initial HbA1c of 13% ± 1.9%, and LACE+ score of 51 ± 15.6 upon discharge. All-cause 30-day hospital readmissions occurred in 14.6% of sliding scale and 6.7% of basal-bolus insulin groups (odds ratio [OR]: 2.40, 95% confidence interval [CI]: 0.75-7.63). Hyperglycemia occurred in 7.3% of sliding scale and 0.9% of basal-bolus insulin groups. Mean HbA1c difference for basal-bolus and sliding scale insulin was 3.3 ± 3.1 and 2.9 ± 2.7, respectively (P = 0.459).
CONCLUSION: There was no significant difference in all-cause 30-day hospital readmissions comparing sliding scale to basal-bolus insulin.

PMID: 32356506 [PubMed - as supplied by publisher]

A Brief Review of Lung Ultrasonography in COVID-19: Is It Useful?

Sat, 05/02/2020 - 05:53
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A Brief Review of Lung Ultrasonography in COVID-19: Is It Useful?

Ann Emerg Med. 2020 Apr 08;:

Authors: Fiala MJ

PMID: 32354670 [PubMed - as supplied by publisher]

An Alternative Technique for Fixation of Tongue-Type Calcaneal Fractures: The "Hurricane Strap".

Sat, 05/02/2020 - 05:53
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An Alternative Technique for Fixation of Tongue-Type Calcaneal Fractures: The "Hurricane Strap".

J Foot Ankle Surg. 2020 May - Jun;59(3):560-567

Authors: Ernst J, Ryba D, Duncan K, Motley T

Abstract
Traditionally, tongue-type calcaneal fractures have been treated using screw fixation or tension band wiring. In this work, we aim to present a technique guide for an alternative approach to fixation of these fractures given the high potential for failure with traditional methods. Additionally, we present the results of 4 patients treated with this technique. A modified lateral extensile incision is made for application of a midfoot fusion plate that is pre-bent and fit to the calcaneus with 2 holes covering the superior surface of the calcaneus for bicortical interfragmentary purchase. Four screws are then placed orthogonally into the calcaneus through the plate. Typically, this allows for 2 screws to be placed in the superior fragment and 2 screws to be placed in the inferior fragment. All 4 patients went on to timely osseous union and were weightbearing in regular shoe gear at their last follow-up appointment. Average follow-up time was 16.5 (range 15 to 21) months. We believe that the "hurricane strap" provides a more mechanically sound construct than other methods. This construct may be especially useful in patients with osteoporotic bone where screws alone may not maintain adequate reduction or in neuropathic patients where noncompliance with weightbearing status may jeopardize maintenance of reduction.

PMID: 32354512 [PubMed - in process]

The effect of lifelong endurance exercise on cardiovascular structure and exercise function in women.

Thu, 04/30/2020 - 05:50

The effect of lifelong endurance exercise on cardiovascular structure and exercise function in women.

J Physiol. 2020 Apr 29;:

Authors: Carrick-Ranson G, Sloane NM, Howden EJ, Bhella PS, Sarma S, Shibata S, Fujimoto N, Hastings JL, Levine BD

Abstract
KEY POINTS: The beneficial effects of sustained or lifelong (>25 years) endurance exercise on cardiovascular structure and exercise function have been largely established in men. The current findings indicate that committed (≥ 4 weekly exercise sessions) lifelong exercise results in substantial benefits in exercise capacity (V̇O2 max), cardiovascular function at submaximal and maximal exercise, left ventricular mass and compliance, and blood volume compared to similarly aged or even younger (middle-age) untrained women. Endurance exercise training should be considered a key strategy to prevent cardiovascular disease with aging in women as well as men.
ABSTRACT: This study was a retrospective, cross-sectional analysis of exercise performance and left ventricular (LV) morphology in 70 women to examine whether women who have performed regular, lifelong endurance exercise acquire the same beneficial adaptations in cardiovascular structure and function and exercise performance that have been reported previously in men. Three groups of women were examined: 1) 35 older (>60 years) untrained women (older untrained, OU), 2) 13 older women who had consistently performed 4 or more endurance exercise sessions weekly for at least 25 years (older trained, OT), and 3) 22 middle-aged (range 35-59 years) untrained women (middle-age untrained, MU) as a reference control for the appropriate age-related changes. Oxygen uptake (V̇O2 ) and cardiovascular function [cardiac output (Q̇); stroke volume (SV)] (acetylene rebreathing) were examined at rest, steady-state submaximal exercise, and maximal exercise (maximal oxygen uptake, V̇O2 max). Blood volume (CO rebreathing) and LV mass (cardiac MRI), plus invasive measures of static and dynamic chamber compliance were also examined. V̇O2 max (p < 0.001) and maximal exercise Q̇ and SV were larger in older trained women compared to the two untrained groups (∼17% and ∼27% for Q̇ and SV respectively versus MU; ∼40% and ∼38% versus OU, all p < 0.001). Blood volume (ml.kg-1 ) and LV mass index (g.m2 ) were larger in OT versus OU (∼11% and ∼16% respectively, both p ≤ 0.015) Static LV chamber compliance was greater in OT compared to both untrained groups (median (25 - 75%): MU: 0.065(0.049 - 0.080); OU: 0.085(0.061 - 0.138); OT: 0.047(0.031 - 0.054), p ≤ 0.053). Collectively, these findings indicate that lifetime endurance exercise appears to be extremely effective at preserving or even enhancing cardiovascular structure and function with advanced age in women. This article is protected by copyright. All rights reserved.

PMID: 32347540 [PubMed - as supplied by publisher]

Ultrasound in COVID-19: a timeline of ultrasound findings in relation to CT.

Sun, 04/26/2020 - 06:26
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Ultrasound in COVID-19: a timeline of ultrasound findings in relation to CT.

Clin Radiol. 2020 Apr 18;:

Authors: Fiala MJ

PMID: 32331781 [PubMed - as supplied by publisher]

Fetal Aneuploidy: Screening and Diagnostic Testing.

Thu, 04/16/2020 - 05:45

Fetal Aneuploidy: Screening and Diagnostic Testing.

Am Fam Physician. 2020 Apr 15;101(8):481-488

Authors: LeFevre NM, Sundermeyer RL

Abstract
Aneuploidy is the presence of one or more extra chromosomes or the absence of one or more chromosomes. The risk of fetal aneuploidy rises with increasing maternal age. Because fetal aneuploidy can affect any pregnancy, all pregnant women should be offered screening. First-trimester combined screening performed between 10 and 13 weeks' gestation detects 82% to 87% of trisomy 21 (Down syndrome) cases. Second-trimester serum quadruple screening performed between 15 and 22 weeks' gestation detects 81% of trisomy 21 cases. Combinations of these tests include integrated or serum integrated, stepwise sequential, and contingent sequential screenings, all of which improve detection rates compared with each test alone. Fetal cell-free DNA testing (noninvasive prenatal testing) performed at or after 10 weeks' gestation detects more than 99% of trisomy 21 cases, with a lower false-positive rate than traditional first- or second-trimester screening methods. Fetal cell-free DNA testing has similar detection rates in high- and low-risk populations but has lower positive predictive values in younger women. It may be performed as primary screening or as a follow-up test to abnormal findings on first- or second-trimester screenings. Second-trimester ultrasonography has limited utility in aneuploidy screening in women who have already been screened with a first- or second-trimester serum test. Diagnostic tests following a positive screening result include chorionic villus sampling performed between 10 and 13 weeks' gestation or amniocentesis performed after 15 weeks' gestation.

PMID: 32293844 [PubMed - as supplied by publisher]

Breastfeeding practices among childhood cancer survivors.

Thu, 04/16/2020 - 05:45
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Breastfeeding practices among childhood cancer survivors.

J Cancer Surviv. 2020 Apr 14;:

Authors: Ogg S, Klosky JL, Chemaitilly W, Srivastava DK, Wang M, Carney G, Ojha R, Robison LL, Cox CL, Hudson MM

Abstract
PURPOSE: This cross-sectional study compared breastfeeding outcomes among childhood cancer survivors to those of women in the general population and evaluated whether breastfeeding is adversely affected by cancer treatment or endocrine-related late effects.
METHODS: A self-reported survey ascertained breastfeeding practices and incorporated items from the questionnaires used in the Infant Feeding Practices Study II (IFPS II) to allow comparison with the general population. Among 710 eligible survivors, 472 (66%) responded. The participants were predominantly non-Hispanic White (84%), married (73%), and had some college or less (60%). The mean maternal age at the time of birth of the first child after cancer treatment was 24 years (SD 24.3 ± 4.8).
RESULTS: Fewer survivors planned to breastfeed than did IFPS II controls (67% vs. 82%, P < .0001), and fewer survivors initiated breastfeeding (66% vs. 85%, P < .0001). The median breastfeeding duration was shorter among survivors, with early undesired weaning occurring sooner in the survivor group (1.4 months, interquartile range (IQR) 0.5-3.5 months) than in the IFPS II group (2.7 months, IQR 0.9-5.4 months). A higher proportion of survivors reported an unfavorable breastfeeding experience (19% vs. 7.5%, P < .0001) and early, undesired weaning (57.5%, 95% CI 51-64) than did IFPS II participants (45.2%, 95% CI 44-47, P = .0164). Among survivors who expressed intention and chose to breastfeed, 46% endorsed disrupted lactation related to physiologic problems with high risk in those overweight/obese.
CONCLUSIONS: Survivors are at risk of negative breastfeeding experiences; however, lactation outcomes were not significantly associated with cancer diagnosis, treatments, or endocrine complications.
IMPLICATIONS FOR CANCER SURVIVORS: Prior research has not examined the association of cancer treatments and clinically validated late effects with lactation outcomes in a clinically diverse childhood cancer survivor cohort. Findings from this study suggest that childhood cancer survivors, especially those who are overweight/obese, are at risk of having negative breastfeeding experiences. Early undesired weaning, physiologic problems related to lactation and misconceptions about breastfeeding, especially fears of passing on cancer through breastmilk, highlight the need for counseling and specialized support to optimize lactation outcomes in this vulnerable population.

PMID: 32291564 [PubMed - as supplied by publisher]

Empirical comparison of approaches for odds ratios to risk ratio transformations in meta-analyses of randomized controlled trials with common outcomes.

Thu, 04/09/2020 - 07:53
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Empirical comparison of approaches for odds ratios to risk ratio transformations in meta-analyses of randomized controlled trials with common outcomes.

Ann Epidemiol. 2020 Mar 26;:

Authors: Chu TC, Ojha RP, VanderWeele TJ

PMID: 32265076 [PubMed - as supplied by publisher]

Prolonged Steroid Dependence in Adult Patients With Glioma.

Fri, 04/03/2020 - 07:10
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Prolonged Steroid Dependence in Adult Patients With Glioma.

Anticancer Res. 2020 Apr;40(4):2059-2064

Authors: Mantilla EC, Abramowitz J, Dan TU, Pan E

Abstract
BACKGROUND/AIM: Prolonged use of glucocorticoids (GC) in glioma treatment can lead to adrenal insufficiency (AI) and subsequent steroid dependence due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis. This is challenging to diagnose due to its nonspecific clinical symptoms erroneously ascribed to treatment. This study aimed to evaluate the risk factors predisposing patients with gliomas to develop AI.
PATIENTS AND METHODS: Charts in the neuro-oncology clinic from July 2018 to March 2019 were reviewed. Inclusion criteria included >18 y/o with WHO Grade II-IV gliomas, and secondary AI. Demographic profile, tumor characteristics, and treatment profile were compared.
RESULTS: The majority of patients were started on high dose dexamethasone at >8 mg daily, and were on dexamethasone for 4-8 months. The minimum dose needed to prevent symptoms was 0.5 mg to 2 mg daily. The majority received standard radiation doses ranging from 54-60 Gy. Most patients had radiation exposure to the HPA axis within the prescription isodose levels.
CONCLUSION: Prolonged steroid dependency can result from chronic GC use in patients with glioma. Dose and duration of GC are risk factors for its development. Radiation exposure to the HPA axis may also be a contributing factor.

PMID: 32234897 [PubMed - in process]

Experience With "Jaw in a Day" Technique.

Wed, 04/01/2020 - 08:01
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Experience With "Jaw in a Day" Technique.

J Craniofac Surg. 2020 Mar 27;:

Authors: Sukato DC, Hammer D, Wang W, Shokri T, Williams F, Ducic Y

Abstract
The "Jaw in a Day" (JIAD) technique, first described by Levine and colleagues, establishes immediate functional occlusion through a single-stage maxillomandibular reconstruction with concurrent implant placement and provisional prosthesis delivery. In this study, the authors describe 2 cases exemplifying the reconstructive principles of JIAD. One patient underwent mandibular reconstruction with the JIAD technique and another patient underwent JIAD with an optimized rapid sequence computer-aided design and computer-aided manufacturing (CAD-CAM) for composite maxillomandibular reconstruction. Immediate implant-borne prosthesis was fixated and all implants osseointegrated into the neomandible. Although the authors' patient outcomes are consistent with the literature, the published reports of JIAD remain limited, and further studies are required to assess the long-term functional and aesthetic outcomes as well as cost-effectiveness of this approach.

PMID: 32224781 [PubMed - as supplied by publisher]

A Biomechanical Examination of Prefabricated Total Contact Cast Kits: Relevance to Patients With Diabetic Neuropathy.

Wed, 04/01/2020 - 08:01
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A Biomechanical Examination of Prefabricated Total Contact Cast Kits: Relevance to Patients With Diabetic Neuropathy.

Int J Low Extrem Wounds. 2020 Mar 29;:1534734620914440

Authors: Ersen A, Lavery LA, Monga A, Richardson M, Schwarz B, Quiben MU, Garrett AG, Flyzik M, Wukich DK, Yavuz M

Abstract
The traditional Total Contact Cast (TCC) is considered the gold standard for treating plantar diabetic ulcers. A number of prefabricated TCC kits have been introduced, which offer a user-friendly casting process for health care providers. Our objective was to evaluate pressure reduction and gait characteristics after application of a TCC kit (TCC-EZ) and traditional TCC. Fifteen individuals (9 males, 6 females; median age of 51.5 years [range = 40.5-71.2 years]) completed 30-m walking trials while fitted with TCC-EZ and TCC in a randomized order. A pair of automated wireless photogate sensors captured time to traverse the distance and pedobarographic insoles measured and recorded plantar pressures. Paired t tests were used to compare peak pressure, gait speed, and cast weights across the 2 modalities. Peak pressure and cast weight were significantly lower in the TCC-EZ arm (169.6 ± 41.3 kPa vs 214.9 ± 63.2 kPa, P = .0048; and 1.79 ± 0.17 kg vs 2.11 ± 0.25 kg, P = .0004). Contact area and gait speed were not significantly different between the 2 modalities (140.4 ± 25.8 cm2 vs 126.9 ± 37.8 cm2, P = .0228, Cohen's d = 0.40; and 0.94 ± 0.19 m/s vs 0.83 ± 0.26 m/s, P = .0532, Cohen's d = .48). TCC-EZ was found to provide more favorable pressure distributions compared with TCC. TCC-EZ is also lighter and may be a preferred treatment modality for patients. More research is necessary to reveal the clinical effectiveness of prefabricated total contact kits.

PMID: 32223354 [PubMed - as supplied by publisher]

Cholecystectomy does not worsen progression or outcomes in non-alcoholic fatty liver disease.

Fri, 03/20/2020 - 07:43
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Cholecystectomy does not worsen progression or outcomes in non-alcoholic fatty liver disease.

Transl Gastroenterol Hepatol. 2020;5:3

Authors: Kakati D, Kumar U, Russ K, Shoreibah M, Kuo YF, Jackson B, Singal AK

Abstract
Background: Cholecystectomy is a frequently performed surgical procedure for symptomatic cholelithiasis, which is reported to be more common in patients with non-alcoholic steatohepatitis (NASH), given the common risk factors. However, the data remains unclear on the association of cholecystectomy with NASH. We performed a retrospective study to examine the association of cholecystectomy and NASH.
Methods: Medical charts of patients with steatohepatitis related liver disease at a tertiary care center from 2004 to 2011 were stratified by cholecystectomy and defined by its history and/or absence of gallbladder on ultrasonography. Logistic regression model was built for predictors of cholecystectomy. Patients with NASH were stratified based on timing of cholecystectomy. The diagnosis of NASH and timing of cholecystectomy were compared based on baseline characteristics and outcomes (liver disease complications and survival) on follow up. Kaplan-Meier curves were generated for the two group comparisons. Chi-square and unpaired t-tests were used for comparing outcomes on follow up. P value <0.05 was considered significant.
Results: Analysis of 584 patients [379 non-alcoholic fatty liver disease (NAFLD)] showed that patients with cholecystectomy (N=191) were more likely to be female (57% vs. 44%), diabetic (53% vs. 37%), have liver biopsy (43% vs. 25%) and diagnosis of NAFLD (80% vs. 58%) P<0.001 for all. NAFLD diagnosis was associated with 2.79 folds odds of cholecystectomy. Among 379 (192 cholecystectomy) NAFLD patients, cirrhosis and female gender were associated with over 2 and 1.5 folds of cholecystectomy. Of 141 patients with data on timing of cholecystectomy, 55 (39%) with cholecystectomy at or after NAFLD diagnosis vs. 86 with cholecystectomy within median of 6 years prior to NAFLD diagnosis were similar on all characteristics except on model for end-stage liver disease (MELD) score (9.2±8.4 vs. 6.4±7.1, P=0.045). Of 28 with available histology data, there were no differences on histology based on timing of cholecystectomy. On a median follow up of 5 years, timing of cholecystectomy did not impact on development of cirrhosis (74% vs. 67%, P=0.45), ascites (31% vs. 38%, P=0.76), variceal bleeding (11% vs. 16%, P=0.44), hepatic encephalopathy (22% vs. 29%, P=0.74), hepatocellular carcinoma (HCC) (15% vs. 9%, P=0.59), and patient survival (95% vs. 98%, P=0.3).
Conclusions: Cholecystectomy is associated with NAFLD diagnosis. We did not find cause and effect of cholecystectomy in the development of severity of NAFLD. Prospective studies are suggested to examine the role of cholecystectomy and bile acids in the pathogenesis of NAFLD.

PMID: 32190771 [PubMed]

Getting It Off the Ground: Key Factors Associated With Implementation of Wellness Programs.

Thu, 03/12/2020 - 06:43
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Getting It Off the Ground: Key Factors Associated With Implementation of Wellness Programs.

Fam Med. 2020 Mar;52(3):182-188

Authors: Penwell-Waines L, Cronholm PF, Brennan J, Romain A, Runyan C, Buck K, Fazio L, Grace A, Ricker M, Ross V, Schneiderhan J, Talen M

Abstract
BACKGROUND AND OBJECTIVES: Many residency programs are developing resident wellness curricula to improve resident well-being and to meet Accreditation Council for Graduate Medical Education guidelines. However, there is limited guidance on preferred curricular components and implementation. We sought to identify how specific driving factors (eg, having an identified wellness champion with a budget and protected time to develop wellness programs) impact implementation of essential elements of a resident wellness curriculum.
METHODS: We surveyed 608 family medicine residency program directors (PDs) in 2018-2019 on available resources for wellness programs, essential wellness elements being implemented, and satisfaction with wellness programming; 251 PDs provided complete responses (42.5% response rate). Linear and logistic regressions were conducted for main analyses.
RESULTS: Having an identified wellness champion, protected time, and dedicated budget for wellness were associated with greater implementation of wellness programs and PD satisfaction with wellness programming; of these, funding had the strongest association. Larger programs were implementing more wellness program components. Program setting had no association with implementation.
CONCLUSIONS: PDs in programs allocating money and/or faculty time can expect more wellness programming and greater satisfaction with how resident well-being is addressed.

PMID: 32159829 [PubMed - as supplied by publisher]

Spindle Cell Sarcoma of the Maxilla: A Rare Entity, Case Report, and Review of the Literature.

Tue, 03/10/2020 - 06:06
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Spindle Cell Sarcoma of the Maxilla: A Rare Entity, Case Report, and Review of the Literature.

J Oral Maxillofac Surg. 2020 Feb 12;:

Authors: Schwitzer D, Kim R, Williams F, Hammer D

Abstract
Spindle cell sarcoma (SCS) is a malignancy, with the most recent Surveillance, Epidemiology, and End Results (SEER) data citing a total of 250 reported cases occurring in the head and neck. Of these cases, none originated in the maxillofacial hard tissue. To the best of our knowledge, only 2 cases of primary osseous SCS of the maxillofacial region have been reported. These cases were not accounted for in the SEER data. The diagnosis of SCS requires its differentiation from other sarcomas and spindle cell neoplasms. Therefore, a comprehensive review to reinforce its inclusion in oral and maxillofacial surgeons' differential diagnosis for osseous neoplastic pathology is desired. In the present case report, we have described a maxillary SCS in a patient with an initial diagnosis of a spindle cell lesion of uncertain biologic behavior. We reviewed the data for SCS, including the epidemiologic data, diagnostic challenges, clinical and radiographic presentations, prognostic indicators, and treatment.

PMID: 32147227 [PubMed - as supplied by publisher]

Peripheral nerve repair throughout the body with processed nerve allografts: Results from a large multicenter study.

Thu, 02/27/2020 - 05:20
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Peripheral nerve repair throughout the body with processed nerve allografts: Results from a large multicenter study.

Microsurgery. 2020 Feb 26;:

Authors: Safa B, Jain S, Mihir DJ, Greenberg JA, Niacaris TR, Nydick JA, Leversedge FJ, Megee DM, Zoldos J, Rinker BD, McKee DM, MacKay BJ, Ingari JV, Nesti LJ, Cho M, Valerio IL, Kao DS, El-Sheikh Y, Weber RV, Shores JT, Styron JF, Thayer WP, Przylecki WH, Hoyen HA, Buncke GM

Abstract
BACKGROUND: Peripheral nerve damage resulting in pain, loss of sensation, or motor function may necessitate a reconstruction with a bridging material. The RANGER® Registry was designed to evaluate outcomes following nerve repair with processed nerve allograft (Avance® Nerve Graft; Axogen; Alachua, FL). Here we report on the results from the largest peripheral nerve registry to-date.
METHODS: This multicenter IRB-approved registry study collected data from patients repaired with processed nerve allograft (PNA). Sites followed their own standard of care for patient treatment and follow-up. Data were assessed for meaningful recovery, defined as ≥S3/M3 to remain consistent with previously published results, and comparisons were made to reference literature.
RESULTS: The study included 385 subjects and 624 nerve repairs. Overall, 82% meaningful recovery (MR) was achieved across sensory, mixed, and motor nerve repairs up to gaps of 70 mm. No related adverse events were reported. There were no significant differences in MR across the nerve type, age, time-to-repair, and smoking status subgroups in the upper extremity (p > .05). Significant differences were noted by the mechanism of injury subgroups between complex injures (74%) as compared to lacerations (85%) or neuroma resections (94%) (p = .03) and by gap length between the <15 mm and 50-70 mm gap subgroups, 91 and 69% MR, respectively (p = .01). Results were comparable to historical literature for nerve autograft and exceed that of conduit.
CONCLUSIONS: These findings provide clinical evidence to support the continued use of PNA up to 70 mm in sensory, mixed and motor nerve repair throughout the body and across a broad patient population.

PMID: 32101338 [PubMed - as supplied by publisher]

Validating Invalidation: Examining the Construct Validity of the Illness Invalidation Inventory among Individuals with Chronic Low Back Pain.

Wed, 02/19/2020 - 10:05

Validating Invalidation: Examining the Construct Validity of the Illness Invalidation Inventory among Individuals with Chronic Low Back Pain.

Clin J Pain. 2020 Feb 14;:

Authors: Molzof HE, Newman AK, Barnett MD, Guck A, Scott W, Sturgeon JA, Trost Z

Abstract
OBJECTIVES: The Illness Invalidation Inventory (3*I) was designed to assess individuals' perceived invalidation regarding chronic pain experiences. However, no study has yet investigated the psychometric properties of the 3*I among individuals with chronic low back pain (CLBP). Given the personal and societal impact of CLBP and the potential for invalidation associated with this condition, the current study sought to examine the psychometric properties of the 3*I among individuals with CLBP.
MATERIALS AND METHODS: Community-dwelling adults with CLBP living in the Southwestern United States (N=134) completed the 3*I. In line with previous literature, current analyses focused on the 3*I "family members" subscale. Exploratory and confirmatory factor analysis were performed on participant responses. Hierarchical linear regression analyses examined the relationship between the identified factors and participant self-reported pain severity, disability, and depression.
RESULTS: Exploratory factor analysis conducted on the 3*I "family members" subscale found two factors with high internal consistency (α>0.70) that cumulatively accounted for 49.04% of the variance in scores. Consistent with previous findings, factor loadings suggested that these factors correspond to "discounting" and "lack of understanding." Subsequent confirmatory factor analysis found that this two-factor model demonstrated good fit with the data. Greater perceived discounting by family members was associated with greater pain severity, disability, and depression.
DISCUSSION: The two-factor model of the 3*I "family members" subscale identified in the current study reflects previous findings and further extends the psychometric validity of the 3*I to a US multiethnic sample of individuals with CLBP.

PMID: 32068539 [PubMed - as supplied by publisher]

Association of ultrasound-related interruption during cardiopulmonary resuscitation with adult cardiac arrest outcomes: A video-reviewed retrospective study.

Wed, 02/19/2020 - 10:05

Association of ultrasound-related interruption during cardiopulmonary resuscitation with adult cardiac arrest outcomes: A video-reviewed retrospective study.

Resuscitation. 2020 Feb 14;:

Authors: Chou EH, Wang CH, Monfort R, Likourezos A, Wolfshohl J, Lu TC, Hsieh YL, Haines L, Dickman E, Lin J

Abstract
OBJECTIVES: To determine the association of focused transthoracic echocardiography (ECHO) related interruption during cardiopulmonary resuscitation (CPR) with patient outcomes in the Emergency Department (ED).
METHODS: This was a retrospective, single center, cohort study, conducted in an urban community teaching ED. Eligible study subjects were adult patients in the ED with sustained cardiac arrest. Exclusion criteria include traumatic cardiac arrest and age less than 18. All resuscitations were video recorded and were subsequently reviewed by 2 study investigators. The no-flow time from chest compression interruption was analyzed using video review and separated into ECHO-related and non-ECHOrelated. Our primary outcome was patient survival to hospital discharge and the secondary outcome was the rate of return of spontaneous circulation (ROSC). Multivariate logistic regression analyses were performed to examine the associations between independent variables and outcomes.
RESULTS: From January 2016 to May 2017, a total of 210 patients were included for final analysis. The median total no-flow time observed on video was 99.5 seconds (IQR: 54.0-160.0 seconds). Among these, a median of 26.5 seconds (IQR: 0.0-59.0 seconds) was ECHO-related and a median of 60.5 seconds (IQR: 34.0-101.9) was non-ECHO-related. The ECHO-related noflow time between 77 and 122 seconds (OR: 7.31, 95% confidence interval [CI]: 1.59-33.59; p-value = 0.01) and ECHO-related interruption≦2 times (OR: 8.22, 95% CI: 1.51-44.64; p-value = 0.01) were positively associated with survival to hospital discharge. ECHO-related interruption≦2 times (OR: 5.55, 95% CI: 2.44-12.61; p-value <0.001) was also positively associated with ROSC.
CONCLUSION: Short ECHO-related interruption during CPR was positively associated with ROSC and survival to hospital discharge. While ECHO can be a valuable diagnostic tool during CPR, the no-flow time associated with ECHO should be minimized.

PMID: 32068026 [PubMed - as supplied by publisher]

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