Search

Targeted temperature management (TTM) is associated with corrected QT (QTc) prolongation and decrease in serum magnesium (Mg) levels that may lead to recurrent ventricular arrhythmia and poor neurological outcomes. We aimed to evaluate the association between QTc interval and Mg levels during TTM with neurological outcomes. We reviewed the electrocardiograms of 366 patients who underwent TTM during the induction, maintenance, and rewarming phase after cardiac arrest. We reviewed the association of change in QTc interval, and Mg levels with neurological outcomes. In total, 71.3% of the patients had a significant increase in QTc interval defined as60 ms or any QTc500 ms during TTM. Poor neurological outcome was associated with persistent prolongation of QTc after rewarming (507 vs. 483 ms

The current study was designed to examine if improvements in high school graduation and attendance rates persist 4 years after start times later than 8:30 am. Socioeconomic status and race were accounted for in the graduation analysis.School-wide attendance and graduation records (n = 28 schools) from 1999-2017 were analyzed in August of 2021 using a repeated-measures analysis of variance at 5 points in time, 1 year predelay and 4 consecutive years postdelay start times.Graduation rates for students in grade 12 (n47,000) after postdelay year 4 increased from 80% to 90% (Attendance and graduation rates for all students improved after 4 years following a delayed start. Economically disadvantaged students and Black students showed significant changes in graduation rates postdelay year 4 and White students significantly improved postdelay years 2, 3, and 4. Adolescent students, especially economically and racially disadvantaged students, have a vulnerability for obtaining adequate sleep. Delaying high school start times is a cost-effective intervention that could promote sufficient sleep and boost graduation and attendance rates.McKeever PM, Dodd R, O'Sullivan DM. Delayed high school start times and graduation and attendance rates over 4 years: the impact of race and socioeconomics.

Background The high incidence of suboptimal antibiotic use at transitions of care represents a novel area for antimicrobial stewardship for community-acquired pneumonia (CAP), urinary tract infection (UTI), and skin and soft tissue infections (SSTIs). The objective of this study was to investigate the role of a pharmacist intervention at discharge to improve antibiotic use. Methods This was a single-center, retrospective, crossover analysis of patients admitted to general medicine units from 11/1/21 to 3/31/22 with a diagnosis of CAP, UTI, or SSTI. The study was divided into two phases separated by a one-month washout. Each two-month phase included two pre-specified units, an intervention and control. During phase 2, the intervention and control units were switched. Patients on antibiotics identified for discharge were reviewed and interventions were communicated by the pharmacist to the provider. Interventions were made based on predefined guidance for oral step-down therapy and total duration. The primary outcome, discharge antibiotic days of therapy (DOT), was compared between the intervention and control cohorts. Secondary outcomes included total DOT, hospital length of stay (LOS), 30-day readmission, and appropriateness of drug selection, dose, and duration. Results Records of 161 patients were included in this study, 85 in the intervention cohort (47 in phase 1, 38 in phase 2) and 76 in the control (41 in phase 1, 35 in phase 2). Overall discharge DOT was 3 (IQR 0–4.5) in the intervention cohort and 3 (IQR 0-5) in the control cohort (P = 0.8), and overall total DOT was 7 (IQR 5-9) and 7 (IQR 5-10) respectively (P = 0.27). Patients in the intervention group were more likely to have appropriate total duration (61.2% vs 44.7%, P = 0.001) and discharge duration of antibiotics (67.1% vs 53.9%, P = 0.013) for all three indications based on predefined guidance. Hospital LOS was 4 (IQR 3-5) vs 5 days (IQR 3-6.3) in the intervention and control cohorts (P = 0.001) respectively, and a lower 30-day readmission (14.1% vs. 23.7%, resp.). Conclusion Despite similar antibiotic DOTs, pharmacist intervention at discharge appeared to improve overall antibiotic total duration and discharge duration for CAP, UTI, and SSTI. Opportunities to improve discharge stewardship processes should be further explored. Disclosures Joseph L. Kuti, PharmD, Abbvie: Honoraria|bioMeriuex: Advisor/Consultant|bioMeriuex: Grant/Research Support|Contrafect: Grant/Research Support|Entasis: Grant/Research Support|Merck and Co: Grant/Research Support|Roche Diagnostics: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Shionogi: Honoraria|Summit: Grant/Research Support David P. Nicolau, PharmD, Shionogi: Grant/Research Support.

Vaginal epithelial abnormalities (VEA) are a common complication associated with pessary use. The objective of this study was to determine if there is a host pro-inflammatory response associated with pessary use and VEA. Patients wearing pessaries for at least two weeks for the management of pelvic organ prolapse and/or urinary incontinence were screened for eligibility. Vaginal swabs were collected from women with VEA (cases) and without VEA (controls). Cases were matched to controls in a 1:3 ratio. Cytokine analysis of the collected samples was performed using multiplex analysis to determine the concentrations of interleukin (IL)6, interferon alpha 2 (IFNα2), tumor necrosis factor alpha (TNFα) and IL1β. A cross-sectional analysis was performed, comparing vaginal cytokine concentrations in women with and without VEA. We enrolled 211 patients in this analysis: 50 cases and 161 controls. The median concentrations (pg/mL) of the four cytokines for cases and controls respectively were; IL6: 6.7 (IQR

OBJECTIVE The aim of this study is to analyze the association between coronary artery vitamin D receptor (VDR) expression and systemic coronary artery atherosclerosis (CAA) risk factors. METHODS Female cynomolgus monkeys (n = 39) consumed atherogenic diets containing the women's equivalent of 1000 IU/day of vitamin D3. After 32 months consuming the diets, each monkey underwent surgical menopause. After 32 postmenopausal months, CAA and VDR expression were quantified in the left anterior descending coronary artery. Plasma 25OHD3, lipid profiles and serum monocyte chemotactic protein-1 (MCP-1) were measured. RESULTS In postmenopausal monkeys receiving atherogenic diets, serum MCP-1 was significantly elevated compared with baseline (482.2 ± 174.2 pg/ml vs. 349.1 ± 163.2 pg/ml, respectively; p

An evaluation of Enhanced Recovery After Surgery (ERAS) effect on perioperative patient phone calls.The aim of this study was to compare perioperative patient phone calls before and after implementation of ERAS.This is a retrospective chart review of women who underwent surgery by urogynecologists where ERAS was implemented. Patients who underwent surgery were identified before the implementation and compared with the same time period after implementation. Perioperative phone calls were reviewed and categorized by reason for call. Differences between the 2 groups were compared with a Student t test if normally distributed or with a Mann-Whitney U test if not. Categorical outcomes were reported with a percentage and compared with a χ2 test with an α level of 0.05.We reviewed 387 records. There was no difference in the percentage of patient calls before and after implementation of ERAS (preoperatively: 19.8% vs 25.1% [ P = 0.21], postoperatively: 64.1% vs 61.5% [ P = 0.61]). Questions about chronic home medications were the most common reasons for calling before surgery (pre-ERAS: 16 [42.1%]; post-ERAS: 12 [28.6%]). Questions related to medications, pain, and bowels were the top reasons people called postoperatively. These remained the top 3 in the post-ERAS time period; however, bowel-related questions switched with medications for the top reason.Despite patient education being an essential component of ERAS with written and verbal instructions provided, our study found no difference in preoperative or postoperative calls with the implementation. By focusing on common concerns, we may be able to improve the patients experience and reduce office phone calls.

This study was performed to understand opioid consumption after midurethral sling (MUS) procedures to provide surgeons with guidelines on appropriate prescription regimens.This study aimed to evaluate postdischarge narcotic use (PDNU) after MUS surgery using a restrictive postdischarge opioid regimen.This prospective clinical practice study included women undergoing MUS surgery from December 2018 to October 2019. Patients were discharged with an electronic prescription for 5 tablets of an oral narcotic. Brief Pain Inventory (BPI) surveys were collected preoperatively. Patients answered questions regarding remaining number of opioid tablets, BPI scores, and patient satisfaction on day 1, week 1 (postoperative week [POW] 1), and 4-6 weeks (POW4-6) postoperatively. Electronic records were reviewed to determine narcotic refills. Primary outcome was PDNU measured in morphine milligram equivalents (MME). Secondary outcomes evaluated refill rate, BPI scores, and patient satisfaction. Standard statistical tests were applied.Fifty-six patients were included in the analysis. Total median (interquartile range) PDNU was 12.5 (0-37.5) MME at POW1 and 15.0 (0-37.5) MME at POW4-6, which is approximately equivalent to 2 oxycodone (5 mg) tablets. Eighteen patients (32.1%) took 0 narcotics postdischarge. Brief Pain Inventory scores showed that "worst pain" was highest on postoperative day 1 with a median (interquartile range) score of 6 (4-8). At the POW1 and POW4-6 mark, 94.3% and 92% of patients, respectively, were satisfied or extremely satisfied with their pain control. Seven patients (11.8%) required a refill.Most patients undergoing MUS surgery used no more than 2 oxycodone (5 mg) tablets during their 6-week postoperative course, with almost a third not requiring any narcotics. Low pain scores and high patient satisfaction rates were noted.

Summary Background Healthcare workers (HCWs) are at the front line of the ongoing coronavirus 2019 (COVID-19) pandemic. Comprehensive evaluation of the seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) among HCWs in a large healthcare system could help to identify the impact of epidemiological factors and the presence of symptoms on the immune response to the infection over time. Aim To determine the seroprevalence of SARS-CoV-2-specific antibodies among HCWs, identify associated epidemiological factors and study antibody kinetics. Methods A longitudinal evaluation of the seroprevalence and epidemiology of SARS-CoV-2-specific antibodies was undertaken in approximately 30,000 HCWs in the largest healthcare system in Connecticut, USA. Findings At baseline, the prevalence of SARS-CoV-2 antibody among 6863 HCWs was 6.3% [95% confidence interval (CI) 5.7–6.9%], and was highest among patient care support (16.7%), medical assistants (9.1%) and nurses (8.2%), and lower for physicians (3.8%) and advanced practice providers (4.5%). Seroprevalence was significantly higher among African Americans [odds ratio (OR) 3.26 compared with Caucasians, 95% CI 1.77–5.99], in participants with at least one symptom of COVID-19 (OR 3.00, 95% CI 1.92–4.68), and in those reporting prior quarantine (OR 3.83, 95% CI 2.57–5.70). No symptoms were reported in 24% of seropositive participants. Among the 47% of participants who returned for a follow-up serological test, the seroreversion rate was 39.5% and the seroconversion rate was 2.2%. The incidence of re-infection in the seropositive group was zero. Conclusion Although there is a decline in the immunoglobulin G antibody signal over time, 60.5% of seropositive HCWs had maintained their seroconversion status after a median of 5.5 months.

BACKGROUND Current research on genu varum shows the favorable influence of exercise on the biomechanics of the knee joint by reducing the static malalignment and mechanical imbalances, however the transference to a more optimum gait has not been investigated.OBJECTIVES To investigate the effects of Pilates exercise on the changes of gait and lower limb malalignment in female students with genu varum.METHODS A total of 23 female college students with verified genu varum participated in this study. The participants were randomly assigned to two groups a Pilates exercise group (n=15) and a control group (n=8). The Pilates exercise group participated in 1 hour Pilates exercise 3 times per week for a total of 10 weeks. Each of the participants had an X-ray and performed gait 5 times before and after the exercise treatment. The participants kinetic and kinematic data were gathered using an eight Vicon Motion camera system and two force platforms.RESULTS For the Pilates group gait their maximum extension and internal rotation knee moment, and maximum adduction and internal rotation hip moment significantly increased, while the maximum knee moment flexion decreased. For the control group gait their maximum hip extension and hip adduction moment significantly decreased. For the Pilates group there was a significant reduction in the distance from the anatomical axis to the weight bearing line in the left leg, but there was no significant change for the control group.CONCLUSIONS The results suggest that Pilates exercise may be beneficial for females with genu varum by helping to improve both their static alignment and helping their gait to become more balanced.

The objectives of this study were to investigate the feasibility of applying computer vision techniques and to analyse changes in behaviour and movement of high school students during class. The study is performed over two phases. Phase one focuses on developing a feasible method to use computer vision-based techniques in high school classes and phase two focuses on the testing of aromatherapy to affect student’s movement. All camera data was processed and analysed by OpenPose, Matlab and EyesWeb. Movement features such as velocity, acceleration, and kinetic energy and postural variables, spinal extension and neck flexion were calculated. Results of phase one, shows significant differences in the overall segment velocity, acceleration, energy, and neck flexion. Similarly, the second phase shows significant differences in velocity, acceleration and jerk for the left shoulder and elbow joints of the group exposed to aroma. In conclusion, the results show the feasibility of using computer vision techniques to apply in a classroom setting.

PURPOSE: To evaluate the utilization of single-embryo transfer (SET) and preimplantation genetic testing (PGT) in gestational carrier IVF cycles in the USA with donor oocyte and examine the impact on live birth and multiple gestation. METHODS: Retrospective cohort study using the Society of Assisted Reproductive Technology (SART) clinic database of 4776 donor oocyte–recipient IVF cycles in which a GC was used. The cycles were separated into 4 groups by use of PGT and number of embryos transferred as follows: (1) PGT and single-embryo transfer (PGT-SET); (2) PGT and multiple embryo transfer (PGT-MET); (3) no PGT and SET (NoPGT-SET); (4) no PGT and MET (NoPGT-MET). Primary outcomes were live birth rate (LBR) and multiple pregnancy rate (MPR). RESULTS: More than one blastocyst was transferred in 48.7% (2323/4774) of the cycles. When ≥1 blastocyst was transferred, with or without the use of PGT, the MPR was 45.5% and 42.0%, respectively. In comparison, in the PGT-SET and NoPGT-SET groups, the MPR was 1.4% (8/579) and 3.3% (29/883), respectively. Live birth rates increased with the use of PGT-A and with MET. CONCLUSION: This study shows that SET, with or without PGT, is associated with a significantly reduced MPR in donor oocyte–recipient GC IVF cycles while maintaining high LBR. It also demonstrates that many infertility centers in the USA are not adhering to ASRM embryo transfer guidelines. Our findings highlight an opportunity to increase GC safety, which ultimately may lead to widened access to this increasingly restricted service outside the USA. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10815-021-02112-5.

Context Taekwondo epidemiology studies have been in short supply since the rule changes introduced by World Taekwondo in 2017. Objective To describe injury and illness patterns at the 2017 World Taekwondo Championships (WTC) in Muju, South Korea, after the implementation of the web-based surveillance system by World Taekwondo. Design Prospective cohort study. Setting All injuries and illnesses were recorded during the 2017 WTC using a web-based system developed by the International Olympic Committee. Patients or Other Participants A total of 971 athletes who participated in the 2017 WTC. Main Outcome Measure(s) Profiles and mechanisms of injury and illness in the 2017 WTC. Results We analyzed a total of 131 injuries and 26 illnesses, corresponding to an overall clinical incidence of 13.5 (95% CI = 11.2, 15.8) injuries and 2.7 (95% CI = 1.6 3.7) illnesses per 100 athletes and an overall incidence rate of 19.3 (95% CI = 16.0, 22.6) injuries and 3.8 (95% CI = 2.4, 5.3) illnesses per 1000 athlete-days. Most injuries occurred in the lower extremities (n = 61, 46.6%), and knee injuries were most frequent (n = 26, 19.8%). Among head and trunk injuries (n = 39, 29.8%), face injuries (n = 32, 24.4%) were most common, whereas among upper extremity injuries (n = 31, 23.7%), finger injuries (n = 8, 6.1%) were seen most often. Contusions (n = 44, 33.6%) were the most frequent injury type, followed by fractures and ligamentous ruptures or sprains. The most common injury mechanism was contact with another athlete (n = 97, 74.0%), whereas the least common was concussion (n = 5). The major affected system was the respiratory system (n = 11, 42.3%), with major symptoms being pain (n = 11, 42.3%) and fever (n = 7, 26.9%). Environmental factors were the most typical cause of illness (n = 15, 57.7%). Conclusions The web-based surveillance system used at the 2017 WTC revealed that 13.5 per 100 athletes (77.8/1000 athlete-exposures, 13.9/1000 minute-exposures) had new or recurrent injuries, whereas 2.7 per 100 athletes became ill.

OBJECTIVE: This study aims to compare and analyze the difference of impact force attenuation according to size and impact location on a Taekwondo body protector. METHODS: Body protectors sized 1 to 5, were impact tested by equipment based on the specifications in the European standard manual (EN 13277-1, 3). The impactor release heights were set to match impact energies of 3 and 15 J. The impactor was made from a 2.5 kg cylindrically cut piece of aluminum. Each body protector was impacted 10 times at the two impact energies and two locations. The differences in performance for each body protector size were compared using a two-way analysis of variance with a significance level of p< 005. The effect sizes were investigated using a partial eta squared value (η2). RESULTS: The significant mean differences between the body protector size and impact area (p< 005) and the average impact time of impact strengths 3 and 15 J were 0.0017 and 0.0012 s, respectively In addition, when an impact strength of 15 J was applied, the maximum resulting impact force exceeded 2000 N for both locations on all sizes. Furthermore, at an impact strength of 3 J size 3 significantly reduced the impact force more than the other sizes; however, size 1 showed the greatest shock absorption at an impact of 15 J. CONCLUSION: The results of this study show that the shock absorption of body protectors does not increase according to size; i.e., a larger body protector does not reduce the impact load more effectively. To improve safety performance, we recommend a maximum impact force of 2000 N or less for all body protectors.

Racial and ethnic minorities are disproportionally affected by end-stage liver disease. Unfortunately, disparities in referrals to liver transplantation (LT), organ allocation, and posttransplant outcomes exist in this population.We performed a retrospective analysis of patients over the age of 18 years undergoing LT in the United States using the Scientific Registry of Transplant Recipients from 2002 to 2016. We evaluated factors associated with patient and graft outcomes and explored the effect of race and ethnicity along with social variables.During the study time period, 78,999 patients received LT. Of these, 60,102 were non-Hispanic White (NHW), 7988 were African American (AA), and 10,909 were Hispanic. AA had significantly lower patient survival, graft survival, and death-censored graft survival at both 1 and 5 years when compared to NHW. Conversely, at 1 and 5 years, patient survival and graft survival were significantly higher for Hispanics compared to NWH. In addition, AA had significantly lower survival outcomes compared to Hispanics. On multivariate analysis after controlling for race/ethnicity, age, AA race, diagnosis, and deceased donor were independent risk factors for patient death and graft failure.Despite socioeconomic disadvantages seen among Hispanics, this population appears to have improved short- and long-term survival after LT compared to NHW and AA.

This study determined brain stress and strain in an unhelmeted sport and correlated this with concussive injuries. Thirteen MMA athletes were fitted with the MiG2.0 Stanford instrumented mouthguard. The mouthguard records linear acceleration and angular velocity in 6 degrees of freedom. Angular acceleration was calculated by differentiation. All events were video recorded, time stamped and reported impacts confirmed. 298 impacts above 10g were recorded during sparring sessions and 153 impacts in competitive events. The competitive events resulted in five concussions which were diagnosed by a medical doctor. The impact with the highest angular acceleration from each sparring session and competitive event was simulated using the GHBMC head and neck model. The model was run on Amazon Web Services using the LS-Dyna explicit solver. The resultant linear acceleration, strain in the corpus callosum and brain stem and shear stress in the corpus callosum were all significantly different in concussed athletes compared to uninjured. Average strain in the corpus callosum of concussed fighters was 0.27 which was 87.9% higher than uninjured fighters and was the best strain indicator of concussion. The best overall predictor of concussion found in this study was shear stress in the corpus callosum which differed by 111.4% between concussed and uninjured athletes. This study is unique in that it measured head accelerations in vivo and determined that high stress and strain in the corpus callosum correlated with the concussive injuries.

The prevalence of substance use disorder in the liver transplantation (LT) population makes postoperative pain management challenging. We report our initial experience with a novel, comprehensive, multidisciplinary opioid avoidance pathway in 13 LT recipients between January 2018 and September 2019. Patients received comprehensive pre-LT education on postoperative opioid avoidance by the surgeon, pharmacist, and psychologist at the time of listing. Immediately after LT, patients received a continuous incisional ropivacaine infusion, ketamine, acetaminophen, and gabapentin as standard nonopioid medications; rescue opioids were used as needed. We compared outcomes with a historical cohort of 27 LT recipients transplanted between August 2016 and January 2018 managed primarily with opioids. On average, opioid avoidance patients used 92% fewer median (interquartile range [IQR]) morphine milligram equivalents (MMEs) versus the historical cohort (7 [1-11] versus 87 [60-130] MME; P

Risk factors can be used to determine what patients will develop delayed postoperative urinary retention after female pelvic reconstructive surgery. A case-control study was performed including all female pelvic reconstructive surgeries necessitating a voiding trial. All patients passed their previous voiding trial. Cases had an acute encounter for urinary retention. Controls did not have acute postoperative urinary retention. Cases and controls were stratified based on procedure. Demographics, medical/surgical histories, voiding symptoms, urodynamic testing, and intraoperative data were collected. Cases were matched to controls in a 1:3 ratio. Mann-Whitney U and chi-square tests were used for univariate analyses; logistic regression was used to determine predictors of delayed postoperative urinary retention (DPOUR). A total of 1219 patients underwent pelvic reconstructive surgery that met eligibility; 51 cases of DPOUR (4.3%) were identified and matched with 153 controls without postoperative urinary retention. Of the procedures performed, 41.2% had prolapse surgery, 10.3% had incontinence surgery, and 48.5% had both prolapse and incontinence surgery. There were no differences between cases and controls in age, race, prior surgery, medical comorbidities, prolapse stage ≥ 3, voiding symptoms, and surgical characteristics. Cases had a lower BMI than controls (p

The objective of this study is to investigate the impact of support person participation during the preoperative appointment.This is a prospective cohort study involving patients scheduled to undergo pelvic reconstructive surgery. Eligible patients were enrolled at the preoperative appointment and compared by presence or absence of a support person. Questionnaires were completed before and after the preoperative appointment, 1-3 days before surgery, and at the postoperative appointment. Previsit questionnaires included the Generalized Anxiety Disorder-7, 6-item short form of the Spielberger State-Trait Anxiety Inventory (STAI-6), and Brief Health Literacy screen. Postvisit questionnaires included the STAI-6, satisfaction with decision scale for pelvic floor disorders, preoperative preparedness questionnaire, and knowledge questionnaire. At the postoperative appointment, participants completed the patient global impression of improvement and postoperative symptom and satisfaction questionnaire. Primary outcome was patient anxiety measured by the STAI-6.Seventy-six patients participated in the study: 37 were categorized in the support person cohort and 39 were categorized in the no support person cohort. The mean scores of the STAI-6 did not differ between the support person and no support person cohorts at all time points (previsit: 42.97 ± 13.23 vs 41.53 ± 17.11, P = 0.68; postvisit: 38.11 ± 12.76 vs 36.33 ± 11.72, P = 0.53, and 1-3 days before surgery: 42.61 ± 13.0 vs 41.05 ± 16.39, P = 0.65). Overall preparedness, satisfaction with decision scale for pelvic floor disorders, and knowledge questionnaire did not differ between cohorts at both time points. Perioperative phone calls were similar between cohorts.Our study suggests that the presence of a support person at preoperative counseling for pelvic floor surgery should be a personal preference and not a recommendation.

We aimed to describe injury incidence and patterns at the 2019 World Taekwondo Championships (WTC), and to compare them with those of previous WTCs, based on new World Taekwondo (WT) competition rules, medical codes, and the Protector and Scoring System (PSS). This prospective cohort study utilized data obtained through the WT Injury Surveillance System. All athletes with injuries were evaluated by on-site sports medicine specialists, and ultrasonography was used to assess all musculoskeletal injuries. Of 936 athletes, 60 injuries were recorded (6.4 injuries/100 athletes, 95% confidence intervals [CI]: 4.8–8.0), and 4.5% (n = 42) sustained at least one injury. Males had a higher risk of sustaining injuries than females (incidence rate ratio: 1.57; 95% CI: 0.89–2.76). The most common sites, type, and mechanism were lower extremities (n = 26, 43.33%), contusion/hematoma/bruises (n = 33, 55.0%), and contact with another athlete (n = 50, 83.33%). Overall, the injury patterns associated with the mechanism of injury were similar in both the 2019 and 2017 WTCs. Refined WT competition rules and a re-established PSS at the 2019 WTC reduced the overall and severe injury incidence. Our findings can help revise Taekwondo competition rules, enhance protective equipment, optimize on-site venue medical systems, and develop injury prevention projects.

Kidney Donor Profile Index (KDPI) and cold ischemic time (CIT) independently influence recipient outcomes after kidney transplantation; however, the compound effect of these variables on posttransplant outcomes is unknown.The Scientific Registry of Transplant Recipients database of deceased-donor kidney transplant recipients between January 2012 and December 2016 was reviewed. Recipients were stratified based on their KDPI (0%-20%, 21%-85%, 86%-100%) and then based on CIT (0-12, 13-24, 25-30, 31-36, ≥ 37 hours). The primary outcome is 1-year allograft loss. Secondary outcomes include primary nonfunction, delayed graft function, biopsy-proven rejection, and 1-year recipient mortality.Allograft loss was not affected by CIT for KDPI 0% to 20% (P = .898) or KDPI 86% to 100% (P = .731), but was significantly different for KDPI 21% to 85% (P .001). The KDPI 21% to 85% group was the only group with a significant difference in primary nonfunction, demonstrating a linear rise with increasing CIT (P .001). CIT did not affect recipient mortality for any KDPI group (KDPI 0%-20%, P = .306; KDPI 21%-85%, P = .098; KDPI 86%-100%, P = .774). Incidence of delayed graft function was greater for each KDPI group (P .001) with increased CIT. Biopsy-proven rejection was not affected by CIT for KDPI 21% to 85% (P = .244) or KDPI 86% to 100% (P = .946). For KDPI 0% to 20%, there was a significant difference (P = .024); however, the incidence was not linear with increasing CIT. For the KDPI 86% to 100% group, incidence of mortality, allograft loss, primary nonfunction, and biopsy-proven rejection did not differ between CIT groups.Extended CIT alone should not hinder utilization of higher KDPI organs.

Lung cancer is a significant health problem worldwide. Unfortunately, current therapeutic strategies lack a sufficient level of specificity and can harm adjacent healthy cells. Consequently, to address the clinical need, novel approaches to improve treatment efficiency with minimal side effects are required. Nanotechnology can substantially contribute to the generation of differentiated products and improve patient outcomes. Evidence from previous research suggests that nanotechnology-based drug delivery systems could provide a promising platform for the targeted delivery of traditional chemotherapeutic drugs and novel small molecule therapeutic agents to treat lung cancer cells more effectively. This has also been found to improve the therapeutic index and reduce the required drug dose. Nanodrug delivery systems also provide precise control over drug release, resulting in reduced toxic side effects, controlled biodistribution, and accelerated effects or responses. This review highlights the most advanced and novel nanotechnology-based strategies, including targeted nanodrug delivery systems, stimuli-responsive nanoparticles, and bio-nanocarriers, which have recently been employed in preclinical and clinical investigations to overcome the current challenges in lung cancer treatments.

The article's abstract is not available.

Para taekwondo has only recently been added to the Paralympic games scheduled to be held in 2021; however, there is limited research on the classification of the para taekwondo athletes. This study aimed to provide details on the impairments and disabilities of the para taekwondo players. The secondary objective was to investigate the relationship between some of the proposed factors and the athletes' rankings.The data of 556 para taekwondo athletes (119 females and 437 males), who had been classified over the past 5 years, were analyzed.The K44 class was the most popular, and 61% of the classified athletes belonged to this class. Acute injury from trauma was the most frequent cause of impairment, and 62.3% of all impairments/disabilities occurred during 0-5 years of age. Approximately 28% of the athletes had1 year of training prior to international competitions. One-way analysis of variance performed for the combined length of the upper limbs showed significant differences (Finf(3,311)/inf=455.78, P0.001) among the K41-K44 classes. There were weak correlations (ρ0.1) between the ranking and the age of the disability/impairment onset, combined length of the upper limbs, and type of disability.Continued data collection that provides insights into the impairment profiles of para taekwondo athletes is needed to improve the current classification system in order to enhance the safety and fairness.

OBJECTIVES To evaluate the association between pessary use more than 1 year and change in prolapse severity. METHODS This is a secondary analysis of a previously published randomized controlled trial of women undergoing office management of pessaries for management of symptomatic pelvic organ prolapse and incontinence. Primary outcome was change in pelvic organ prolapse quantification measurement genital hiatus (GH). Secondary outcomes included change in prolapse stage, type of pessary, size of pessary, number of pessary changes, and duration of use. Baseline data were collected from the earliest documented examination within the hospital record before pessary placement and compared with their final study visit. Demographics were analyzed using descriptive statistics. Student t test and Mann-Whitney tests were used for categorical comparisons. Pearson and Spearman correlation coefficients were used to evaluate change over time. RESULTS The cohort was 132 predominantly non-Hispanic White (75%) women with symptomatic prolapse >stage 2 (70.5%). All were postmenopausal. Median duration of pessary use was 39.5 months (interquartile range, 17-64.5 months). Genital hiatus (P = 0.014) and prolapse stage (P = 0.001) decreased as duration of pessary use increased. Those with baseline stages ≥3 had a significant decrease in GH as duration of pessary use increased compared with stages

Implantable cardioverter-defibrillator (ICD) shocks are associated with increased mortality risk in heart failure patients. Whether ICD shocks are associated with mortality in continuous flow LVAD (CF-LVAD) patients is unknown. We studied the relationship of ICD shocks and ventricular arrhythmias (VAs) to morbidity and mortality in CF-LVAD-supported patients in our institution. Single-center, retrospective study of prospectively collected ICD and LVAD databases. We analyzed data on VA which received ICD therapy in patients who underwent CF-LVAD implantation at Hartford Hospital between 2008 and 2018. A total of 157 patients were studied. During a median follow-up of 10 months (interquartile range 5–20 months), 48 patients (30.6%) experienced post-LVAD sustained VA. Thirty patients (19.1%) had appropriate shocks for VA and 5 patients (3.1%) had inappropriate shocks. Shocks for any arrhythmia were not associated with an increased risk of death (OR 0.836, 95% CI 0.224–3.115, p = 0.789). Neither post-LVAD VA nor the rate of VA was associated with an increased mortality risk (OR 0.662 [0.329–1.334], p = 0.248; OR 1.001 [0.989–1.014], p = 0.817, respectively). Cox multivariate regression analysis revealed pre-LVAD VA as a significant predictor of VA post LVAD implantation (OR 3.284 [1.584–6.808], p = 0.001). Symptoms with VA occurred in 22 (45.8%) patients, ranging from palpitations to near syncope/syncope. None of the variables including the rate of VA was associated with death or symptoms. VAs are common in CF-LVAD patients and occur with higher frequency in those with pre-LVAD VA and frequently cause symptoms. Neither VA nor ICD shocks are associated with mortality risk.

OBJECTIVE The aim of this study was to evaluate the ability of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator to predict surgical morbidity in patients undergoing pelvic reconstructive surgery. METHODS This was a retrospective study of patients who underwent pelvic reconstructive surgery from 2014 to 2017. Preoperative risk factors were abstracted from medical records and entered into the ACS NSQIP surgical risk calculator. The Current Procedural Terminology code that produced the largest risk was used and compared with actual patient outcomes. Demographic, clinical, and surgical characteristics were analyzed descriptively. Logistic regression evaluated significant factors associated with each outcome; prediction capability of the risk calculator was assessed. RESULTS Seven hundred thirty-one surgical cases were reviewed. The cohort was predominantly younger than 65 years (58.7%), white (77.4%), multiparous (81.1%), and overweight (64.7%); 76.3% were American Society of Anesthesiologists class 2, and 70.2% had vaginal surgery. There was no difference in median risk scores between those with and without postoperative event. Two hundred twenty-one (30.3%) experienced "any serious complication," with 89% of these due to urinary tract infection. Incidence of urinary tract infection was 27%; readmission was 3.2%, and 3.6% returned to the operating room. Decreasing age was predictive of return to the operating room (P < 0.001), and increasingly worse functional status predicted discharge to nursing or skilled rehabilitation facility (P < 0.001). CONCLUSIONS The ACS NSQIP surgical risk calculator is an overall poor predictor of actual outcomes in a sample of patients who underwent pelvic reconstructive surgery, perhaps because of low prevalence of serious events. A more accurate surgical risk calculator is needed for this patient population.

Background Geriatric depression is common due to the high rate of chronic diseases suffered by the older population. There is a well-established effect of exercise on one's wellbeing, however, for the elderly females there is dearth in research addressing exercise and its effect on their neurotransmitters and depression score. Therefore, this study aimed to investigate the effects of 24 weeks of the Growing Stronger program on neurotransmitter and depression of older women. Methods Twenty-one older women, aged between 67 and 81, participated in this study. The participants were randomly assigned into a strength exercise (n = 11) and control group (n = 10) (age 76.40 ± 3.27, height 152.77 ± 5.63 kg, Weight 52.35 ± 2.86Kg, BMI 22.50 ± 1.88). The strength exercise group (age 76.10 ± 3.85, height 151.14 ± 5.42 kg, Weight 54.74 ± 6.73Kg, BMI 23.96 ± 2.70) participated for 50–80 min a day three times per week for a total of 24 weeks. All participants had their height, weight, blood testing and depression score tested before and after the training program. Two-way ANOVA with effect sizes was used to identify differences between times in each group and the statistical significance was set at 0.05. Results In neurotransmitter factor, serotonin, dopamine, epinephrine, and norepinephrine significantly decreased in the strength exercise group but not for the control group. Notably, one participant whose serotonin level was lower than normal range before the exercise program showed normal level in serotonin after the program. In depression factor, there were no significant differences for both the strength exercise group and control group. Conclusion The results suggest that the effect of strength exercise on neurotransmitter and depression score remain unclear, but highlight the need for future studies investigating the relationship between strength training and depression.

OBJECTIVE The aim of the study was to evaluate the association of patient factors, amount of in-hospital postoperative narcotics, and pain scores on postdischarge narcotic use (PDNU). METHODS This is a secondary analysis of a randomized controlled trial comparing a postoperative usual-care regimen with multimodal pain regimen after pelvic reconstructive surgery. This analysis evaluated patients in the multimodal arm. Postdischarge narcotic use (as mg oral morphine equivalents, MME, calculated from narcotic tablets remaining) was assessed postoperative days 7 to 10. Brief Pain Inventory (BPI) surveys were collected preoperatively and at postoperative day 1. Patient factors were evaluated using univariate and multivariate analysis. Correlations examined the relationships between PDNU and postoperative in-hospital narcotic use and BPI scores. RESULTS Sixty-eight patients randomized to the multimodal pain regimen arm had median (interquartile range) PDNU of 22.5 (0-159.4) MME. After excluding postdischarge narcotic nonusers (34.8%), the median PDNU was 127.5 (22.5-180.0) MME. The median PDNU was 172.5 (150.0-180.0) MME after abdominal reconstructive surgery (n = 7), 82.5 (28.1-180.0) MME after laparoscopic reconstructive surgery (n = 22), and 37.5 (13.1-181.2) MME after vaginal reconstructive surgery (n = 14). A linear correlation was noted between the amount of postoperative narcotics used in-hospital and the amount needed postdischarge after abdominal (r = 0.588, P = 0.057), laparoscopic (r = 0.439, P = 0.019), and vaginal (r = 0.455, P = 0.017) reconstructive surgeries. The BPI scores on postoperative day 1 for "average" pain (r = 0.388, P = 0.002) and "now" pain (r = 0.490, P < 0.001), and on postoperative week 1 for "average" pain (r = 0.383, P = 0.002) and "now" pain (r = 0.389, P = 0.002) correlated with PDNU. CONCLUSIONS Amount of postoperative in-hospital use of narcotic medications and BPI scores can be valuable predictors of PDNU in patients undergoing pelvic reconstructive surgery.

Postoperative pain is a significant source of morbidity in patients undergoing living donor nephrectomy (LDN) and a deterrent for candidates. We implemented a standardized multimodal analgesic regimen, which consists of pharmacist-led pre-procedure pain management education, a combination transversus abdominis plane and rectus sheath block performed by the regional anesthesia team, scheduled acetaminophen and gabapentin, and as-needed opioids. This single-center retrospective study evaluated outcomes between patients undergoing LDN who received a multimodal analgesic regimen and a historical cohort. The multimodal cohort had a significantly shorter length of stay (LOS) (days, mean ± SD: 1.8 ± 0.7 vs. 2.6 ± 0.8; p < .001) and a greater proportion who were discharged on postoperative day (POD) 1 (38.6% vs. 1.5%; p < .001). The total morphine milligram equivalents (MME) that patients received during hospitalization were significantly less in the multimodal cohort on POD 0-2. The outpatient MME prescribed through POD 60 was also significantly less in the multimodal cohort (median [IQR]; 180 [150-188] vs. 225 [150-300]; p < .001). The mean patient-reported pain score (PRPS) was significantly lower in the multimodal cohort on POD 0-2. The maximum PRPS was significantly lower on POD 0 (mean ± SD: 7 ± 2 vs. 8 ± 1, respectively; p = .02). This study suggests that our multimodal regimen significantly reduces LOS, PRPS, and opioid requirements and has the potential to improve the donation experience.

Vaginal epithelial abnormalities (VEA) are a common complication associated with pessary use. The objective of this study was to determine if there is a host pro-inflammatory response associated with pessary use and VEA.Patients wearing pessaries for at least two weeks for the management of pelvic organ prolapse and/or urinary incontinence were screened for eligibility. Vaginal swabs were collected from women with VEA (cases) and without VEA (controls). Cases were matched to controls in a 1:3 ratio. Cytokine analysis of the collected samples was performed using multiplex analysis to determine the concentrations of interleukin (IL)6, interferon alpha 2 (IFNα2), tumor necrosis factor alpha (TNFα) and IL1β. A cross-sectional analysis was performed, comparing vaginal cytokine concentrations in women with and without VEA.We enrolled 211 patients in this analysis: 50 cases and 161 controls. The median concentrations (pg/mL) of the four cytokines for cases and controls respectively were; IL6: 6.7 (IQR2.9 [the lower limit of detection, LLD]-14.2) and 2.9 (LLD) (IQR2.9 [LLD]-5.5), IFNα2: 8.2 (IQR 6.1-13.9) and 7.9 (IQR 3.9-13.6), TNFα: 15.2 (IQR 6.1-30.4) and 4.68 (IQR2.3 [LLD]-16.3), IL1β 195.7 (IQR 54.5-388.6) and 38.5 (IQR 6.7-154.9). The differences in median cytokine levels were statistically higher in cases for IL6, TNFα, and IL1β (all p 0.001) compared to controls. Older age (OR: 1.062, 95% CI, 1.015-1.112), lower BMI (OR: 0.910, 95% CI, 0.839-0.986) and presence of VEA at last check (OR: 5.377, 95% CI, 2.049-14.108) were associated with higher odds of having VEA on multivariate analysis.Pro-inflammatory cytokines, specifically IL6, TNFα, and IL1β, are elevated in pessary-wearing patients who have VEA. Additional prospective studies are needed to assess baseline vaginal inflammatory profiles before and after pessary placement to understand VEA formation in pessary patients.

Taekwondo has been reported to be one of the most injurious sports in the summer Olympics, however, there is a dearth of data about injury profiles for junior athletes. Therefore, we aimed to identify the incidence and profiles of the injuries and illnesses that occurred during the 2018 World Taekwondo Junior Championships and recorded using an online system. Among the 889 athletes, 67 injuries and four illnesses were reported, corresponding to an overall clinical incidence of 7.5 injuries (95% confidence interval [CI]: 5.7–9.3) and 0.5 illnesses (0.1–0.9) per 100 athletes. The most frequent injuries were lower extremity injuries (n = 33, 3.71% of all athletes), mostly in the foot/toe (n = 11, 1.2% of athletes), followed by head and trunk injuries, mostly in the face (n = 14, 1.6% of athletes), and upper extremity injuries, mostly in the fingers (n = 6, 0.7% of athlete). Contusions (n = 37, 4.2% of athlete) were the most frequent injury type, followed by ligament ruptures/sprains and laceration. The most common injury mechanism was contact during an opponent attack (n = 51, 5.7% of athlete). Three mild concussions none resulted in time loss (none required hospital transfer or had prolonged recovery). The respiratory system was the most affected by illness, with pain and fever as symptoms. Environmental factors were the most common cause of illness. This study shows that 7.5 per 100 athletes (38.5/1000 athlete-exposures and 6.9/1000 min-exposures) had new or recurrent injuries, whereas 0.5 per 100 athletes experienced illness. In conclusion, the data shows male athletes reported more injuries than females and the most common cause of injury was due to contact between athletes. Contusions, ligament rupture/sprains, laceration and fractures to the lower extremities, head, and trunk were the most common injury. Knowing these injury profiles of junior taekwondo athletes can help taekwondo stakeholders, especially medical staff to prepare accordingly to ensure the safety of the athletes.

Introduction: There is a paucity of data evaluating the impact of heart rate (HR) during Targeted Temperature Management (TTM) and neurologic outcomes. Current resuscitation guidelines do not specify a HR goal during TTM. We sought to determine the relationship between HR and neurologic outcomes in a single-center registry dataset. Methods: We retrospectively studied 432 consecutive patients who completed TTM (33°C) after cardiac arrest from 2008 to 2017. We evaluated the relationship between neurologic outcomes and HR during TTM. Pittsburgh Cerebral Performance Categories (CPC) at discharge were used to determine neurological recovery. Statistical analysis included chi square, Student’s t-test and Mann-Whitney U. A logistic regression model was created to evaluate the strength of contribution of selected variables on the outcome of interest. Results: Approximately 94,000 HR data points from 432 patients were retrospectively analyzed; the mean HR was 82.17 bpm over the duration of TTM. Favorable neurological outcomes were seen in 160 (37%) patients. The mean HR in the patients with a favorable outcome was lower than the mean HR of those with an unfavorable outcome (79.98 bpm vs 85.67 bpm p < 0.001). Patients with an average HR of 60-91 bpm were 2.4 times more likely to have a favorable neurological outcome compared to than HR’s < 60 or > 91 (odds ratio [OR] = 2.36, 95% confidence interval [CI] 1.61-3.46, p < 0.001). Specifically, mean HR’s in the 73-82 bpm range had the greatest rate of favorable outcomes (OR 3.56, 95% CI 1.95-6.50), p < 0.001. Administration of epinephrine, a history of diabetes mellitus and hypertension all were associated with worse neurological outcomes independent of HR. Conclusion: During TTM, mean HRs between 60-91 showed a positive association with favorable outcomes. It is unclear whether a specific HR should be targeted during TTM or if heart rates between 60-91 bpm might be a sign of less neurological damage.

Background and Objective: The objective of this study was to investigate various issues surrounding participation in Para-Taekwondo Kyorugi (sparring), with the aim of focusing on future research initiatives to improve the classification system and safety for participation in Para-Taekwondo. Material and Methods: For this, a series of online questionnaires and in-person round-table discussions were conducted prior to the World Para-Taekwondo Championships (Antalya, Turkey, 2019), with a final online questionnaire thereafter. A select group of experts, such as athletes, coaches, administrators, classifiers, and athletes were invited to partake, with the main outcome measures being the expert opinions and ranking of importance for research into issues affecting Para Taekwondo athletes. Results: The results of the discuss provide suggestions and opinions for the following areas are provided for the aim of classification, minimum impairment criteria, fairness of classes, combination of classes, competition time, mixing of different impairments, safety of cerebral palsy athletes, weight classes, gender differences, intentional misrepresentation, personal protectors, time for re-classification, and research priorities. Conclusion: The most prevalent issue highlighted was the concern for athlete safety, especially for the K44 class, which has a mixture of neurological impairments, i.e. an athlete with mild cerebral palsy (CP) competing against an athlete with an amputation. Furthermore, on the issue of safety, developing protectors for athletes was another key issue raised. Therefore, in the future, we can strongly recommend research initiatives to examine the safety of athletes with various impairment types in the same class, and the development of protectors for Para Taekwondo athletes.

The authors sought to quantify the rates of psychological distress among health care workers (HCWs) during the COVID-19 pandemic and to identify job-related and personal risk and protective factors.From April 1 to April 28, 2020, the authors conducted a national survey advertised via e-mail lists, social media, and direct e-mail. Participants were self-selecting, U.S.-based volunteers. Scores on the Patient Health Questionnaire-9, General Anxiety Disorder-7, Primary Care Posttraumatic Stress Disorder Screen, and Alcohol Use Disorders Identification Test-C were used. The relationships between personal resilience and risk factors, work culture and stressors and supports, and COVID-19-related events were examined.Of 1,685 participants (76% female, 88% White), 31% (404 of 1,311) endorsed mild anxiety, and 33% (427 of 1,311) clinically meaningful anxiety; 29% (393 of 1,341) reported mild depressive symptoms, and 17% (233 of 1,341) moderate to severe depressive symptoms; 5% (64 of 1,326) endorsed suicidal ideation; and 14% (184 of 1,300) screened positive for posttraumatic stress disorder. Pediatric HCWs reported greater anxiety than did others. HCWs' mental health history increased risk for anxiety (odds ratio [OR]=2.78, 95% confidence interval [CI]=2.09-3.70) and depression (OR=3.49, 95% CI=2.47-4.94), as did barriers to working, which were associated with moderate to severe anxiety (OR=2.50, 95% CI=1.80-3.48) and moderate depressive symptoms (OR=2.15, 95% CI=1.45-3.21) (p0.001 for all comparisons).Nearly half of the HCWs reported serious psychiatric symptoms, including suicidal ideation, during the COVID-19 pandemic. Perceived workplace culture and supports contributed to symptom severity, as did personal factors.

Cytomegalovirus (CMV) is a significant cause of morbidity in kidney transplant recipients (KTR). Historically at our institution, KTR with low and intermediate CMV risk received 6 months of valganciclovir if they received lymphocyte depleting induction therapy. This study evaluates choice and duration of CMV prophylaxis based on donor (D) and recipient (R) CMV serostatus and the incidence of post-transplant CMV viremia in low (D-/R-) and intermediate (R+) risk KTR receiving lymphocyte-depleting induction therapy. A protocol utilizing valacyclovir for 3 months for D-/R- and valganciclovir for 3 months for R+ was evaluated. Adult D-/R- and R+ KTR receiving anti-thymocyte globulin, rabbit or alemtuzumab induction from 8/20/2016 to 9/30/2018 were evaluated through 1 year post-transplant. Patients were excluded if their CMV serostatus was D+/R-, received a multi-organ transplant, or received basiliximab. Seventy-seven subjects met the inclusion criteria: 25 D-/R- (4 historic group, 21 experimental group) and 52 R+ (31 historic, 21 experimental). No D-/R- patients experienced CMV viremia. Among the R+ historic and experimental groups, there was no significant difference in viremia incidence (35.5% vs 52.4%; P = .573). Of these cases, the peak viral load was similar between the groups (median [IQR], 67 [