Differences In Need Research Articles

Aflibercept and navigated versus conventional laser in diabetic macular oedema: a 12-month randomized clinical trial.

To examine the efficacy of intravitreal aflibercept and navigated laser as compared to intravitreal aflibercept and conventional laser in diabetic macular oedema (DME) treatment. In 12-month randomized clinical trial, 48 eyes of 37 patients with centre-involved DME at Odense University Hospital were randomized 1:1 to receive three monthly injections of aflibercept followed by navigated (group A) or conventional (group B) focal/grid laser. From month four through twelve, patients were examined monthly, and additional injections were given pro re nata (PRN) (central retinal thickness [CRT]>20% from lowest measurement or loss in visual acuity [VA]>5 Early Treatment Diabetic Retinopathy Study [ETDRS] letters compared with baseline). Outcome measures; (1) percentage of eyes that needed additional injections after laser in group A and B, (2) mean number of injections in group A and B, and (3) mean change in VA and CRT in group A and B. In the PRN phase, 60.5% of patients needed additional injections without differences between groups A and B (58.3 versus 63.2%, p>0.99). The mean number of injections between baseline and month 12 was 4.4 (4.2 versus 4.6, p=0.41). From baseline to month 12, VA improved by 8.4 ETDRS letters, and CRT was reduced by 97.4μm (+9.4 versus +7.1 letters, p=0.17, and -83.2 versus -115.4μm, p=0.21). No difference in need for retreatment was detected between treatment arms of aflibercept and navigated versus conventional laser.

PROTON PUMP INHIBITORS VS H2 ANTAGONISTS FOR STRESS ULCER PROPHYLAXIS: IS THERE A ROLE FOR NEPHROPROTECTION?

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Proton pump inhibitors (PPI) are a commonly prescribed medication for stress ulcer prophylaxis in critically ill patients. With ubiquitous nature of these prescribed medications, increasing literature is available regarding adverse effects including: increased risk of developing clostridium difficile colitis, pneumonia, chronic renal failure, interstitial nephritis, nutrient malabsorption, and osteoporosis. More recent data has also implicated proton pump inhibitors with development of acute kidney injury (AKI). In our urban level 1 trauma center, we sought to compare the risk of developing acute kidney injury between patients given H2 antagonists and PPI in elderly trauma patients. METHODS: A retrospective data analysis was performed with consecutive trauma patients over the age of 65 who were started on either PPI or H2 antagonists for stress ulcer prophylaxis. Development of AKI was based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria and documented over the course of hospitalization. Each group was also evaluated for dialysis requirement (either new-onset or pre-existing) during hospitalization. Data obtained also included Injury Severity Scale (ISS). Data were analyzed using one way ANOVA. RESULTS: 205 patients consecutive trauma patients over the age of 65 were enrolled and monitored for the development of AKI and the need for dialysis over the course of hospitalization. Compared to H2 antagonists, patients on PPI demonstrated no statistically significant difference in AKI development (26.2% vs. 18.2%, p = 0.17) or need for dialysis (4.8% vs. 4.1%, p = 0.82). No difference in ISS was noted between the two groups. CONCLUSIONS: Given the ubiquitous use of PPI, general public awareness has increased regarding potential adverse effects of this medication class. The aim of our study was to evaluate the role of PPI in comparison to H2 antagonist in the setting of acute trauma patients. Despite studies demonstrating a role for PPI in development of AKI, our study found that PPI did not inherently predispose elderly trauma patients to worsening AKI in comparison to H2 antagonists. Additionally these patient groups did not demonstrate a difference in need for dialysis (new onset or chronic). Our data suggests that in patients with a significant concurrent disease burden, the use of PPI for stress ulcer prophylaxis does not result in acute iatrogenic renal injury. CLINICAL IMPLICATIONS: PPI for stress ulcer prophylaxis does not uniquely predispose elderly trauma patients to worsening renal injury. DISCLOSURES: No relevant relationships by Krishna Akella, source=Web Response No relevant relationships by Brian Boden, source=Web Response No relevant relationships by Akella Chendrasekhar, source=Web Response No relevant relationships by Priscilla Chow, source=Web Response No relevant relationships by Kashif Hussain, source=Web Response No relevant relationships by Samer Ibrahim, source=Web Response No relevant relationships by Gunjan Joshi, source=Web Response No relevant relationships by Howard Sklarek, source=Web Response No relevant relationships by Liana Tatarian, source=Web Response No relevant relationships by Daisy Young, source=Web Response

감성 욕구와 인지 욕구의 개인차가 가상현실의 건강 조언에 미치는 영향

감성 욕구와 인지 욕구의 개인차가 가상현실의 건강 조언에 미치는 영향

Hospital utilization for orbital and intracranial complications of pediatric acute rhinosinusitis

BackgroundOrbital and intracranial complications of pediatric acute rhinosinusitis (ARS) are uncommon. With a risk of significant morbidity, hospital utilization and the financial burden of these entities are often high. We sought to assess utilization trends for complicated ARS and elucidate which factors influence cost. MethodologyAnalysis of Kids’ Inpatient Database (2006, 2009 and 2012). Children were selected based on diagnosis codes for ARS and grouped as: uncomplicated ARS, orbital complications (OC), or intracranial complications (IC). Patients with IC were subdivided into abscess (ICa), meningitis, or sinus thrombosis. Length of stay (LOS), cost and management information were analysed. Data presented as median [IQR]. ResultsA weighted total of 20,775 children were included. OC and IC were observed in 10.9% and 2.7% of these patients. LOS was longer for IC compared to OC (9 [8] v 4 [3]days, p < 0.001). Daily cost for IC was greater than OC ($2861 [4044] v $1683 [1187], p < 0.001), likely due to differences in need for surgery (IC 66.3% v OC 37.1%, p < 0.001). Within the ICa group, patients who received both otolaryngologic (ENT) and neurosurgery, compared to neurosurgery alone, had higher total cost ($41,474 [41,976] v $32,299 [18,235], p < 0.001) but similar LOS (12 [10] v 11 [9] days, p = 0.783). ConclusionsChildren with IC required more surgery than their OC counterparts, resulting in a longer LOS and increased cost. Within the ICa group, the addition of ENT surgery to neurosurgery resulted in higher costs, but with a similar LOS. Considering the increased costs, the additional benefit of ENT surgery to those with children with IC should be investigated further.

Changing attitudes and intentions related to doping: An analysis of individual differences in need for cognition

ABSTRACTResearch has shown that athletes’ attitudes towards the use of banned performance-enhancing substances are reliable predictors of their intentions to use these substances, which in turn can be relevant predictors of their actual doping behaviours. Despite the important role played by attitudes and intentions in doping, research analysing how to change those attitudes and intentions is relatively scarce. The present study examined how individual differences in Need for Cognition (NC, Cacioppo & Petty, 1982) influenced doping-related attitude change and subsequent behavioural intentions. Participants were randomly assigned to read a persuasive message either against or in favour of legalising the use of several banned substances, including anabolic androgenic steroids (AAS) and Erythropoietin (EPO). In addition, participants completed the NC scale, and finally reported their attitudes and behavioural intentions regarding the legalisation proposal. As hypothesised, results showed that participants who received an anti-legalisation message had significantly more unfavourable attitudes towards the proposal than participants who received a pro-legalisation message, regardless of NC. However, as predicted, NC moderated the relationship between individuals’ attitudes and their intentions. That is, high-NC participants showed greater attitude-intention correspondence than low-NC participants.

Konseling Kognitif Behavioral Dengan Teknik Self Management dan Teknik Modeling Terhadap Motivasi Berprestasi Ditinjau dari Tipe Belajar

The purpose of this research for to known the effectiveness of cognitive behavioral counseling with Self Management Technique and Modeling Technique toward Need for Achievment Reviewed on Studying Type. This research design by two factor design. The sampling are 90 person students of X grade SMA Negeri 1 Kintamani academic year 2015/2016 and analyzed by analysis of varians (anava) and Tukey. The result of the research is: (1) there are a difference of need for achievement between students who follows humanistic counseling with self management technique with students who follows modeling.technique.; (2) there are a difference of need for achievement reviewed of studying type. (3) there are an interactions effect of humanistic counseling with self management technique and modeling technique with studying type of need for achievement.; (4) there are a difference of need for achievement between students who follows humanistic counseling with self management with students who follows modeling technique on students based auditory studying type; (5) there are no difference of need for achievement between students who follows humanistic counseling with self management technique with modeling technique on students based visual studying type; (6) there are no difference of need for achievement between students who follows self management technique with modeling technique on students based kinesthetic.

Geographic Variation in the Availability of Deceased Donor Kidneys per Wait-Listed Candidate in the United States

Geographic Variation in the Availability of Deceased Donor Kidneys per Wait-Listed Candidate in the United States

Gender differences among Indigenous Canadians experiencing homelessness and mental illness

BackgroundIndigenous people are over represented among homeless populations worldwide and the prevalence of Indigenous homelessness appears to be increasing in Canadian cities. Violence against Indigenous women in Canada has been widely publicized but has not informed the planning of housing interventions. Despite historical policies leading to disenfranchisement of Indigenous rights in gender-specific ways, little is known about contemporary differences in need between homeless Indigenous men and women. This study investigated mental health, substance use and service use among Indigenous people who met criteria for homelessness and mental illness, and hypothesized that, compared to men, women would have significantly higher rates of trauma, suicidality, substance dependence, and experiences of violence.MethodsThis study was conducted using baseline (pre-randomization) data from a multi-site trial. Inclusion in the current analyses was restricted to participants who self-reported Indigenous ethnicity, and combined eligible participants from Vancouver, BC and Winnipeg, MB. Logistic regression analyses were used to model the independent associations between gender and outcome variables.ResultsIn multivariable regression models among Indigenous participants (n = 439), female gender was predictive of meeting criteria for PTSD, multiple mental disorders, current high suicidality and current substance dependence. Female gender was also significantly associated with reported physical (AOR: 1.52, 95% CI = 1.10–2.23) and sexual (AOR: 6.31, 95% CI = 2.78–14.31) violence.ConclusionsOur analyses of Indigenous men and women who are homeless illustrate the distinct legacy of colonization on the experiences of Indigenous women. Our findings are consistent with the widely documented violence against Indigenous women in Canada. Housing policies and services are urgently needed that take Indigenous historical contexts, trauma and gender into account.Trial registrationThis trial has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374; ISRCTN57595077; ISRCTN66721740.

A Retrospective Case Series of Synovial Sarcoma of the Upper Extremity.

Purpose Previous studies have grouped the treatment of axial and appendicular synovial sarcomas. The purpose of this study was to assess the prognostic variables of upper extremity synovial sarcomas (UESS) and compare the outcomes of those who underwent a nononcologic or inadvertent excision prior to definitive resection to those who underwent an initial oncologic resection. Methods We reviewed the records of 23 UESS treated with definitive surgery at our institution between 1990 and 2014. There were 13 women and 10 men with a median age of 30 years (6–60) and median follow-up of 63 months (15–248). Prognostic variables, recurrence-free survival (RFS), and overall survival (OS) were then assessed. Results Fifteen patients (65%) had a prior unplanned excision. Five patients required an amputation to obtain local control of disease. There were 3 observed local recurrences and 2 distant metastases at a median of 45 months from presentation. We found no difference in need for amputation, RFS, or OS between those who had undergone a planned excision and those who had an unplanned excision. Conclusion While we were unable to find a significant difference in outcomes or amputation rates between those who underwent reexcision of a previously unplanned excision and those who underwent an initial planned resection, the high rate of unplanned excision is troubling and should remind practitioners to consider sarcoma in the differential of all upper extremity masses.

An explorative study of the differences in feeding patterns of children with and without disabilities in a rural community in Karnataka.

Background: Children with disabilities are nutritionally vulnerable due to feeding difficulties associated with disabilities. Aim &amp; Objective: To investigate factors associated with feeding difficulties in children with/without disabilities. Settings and Design: A cross-sectional analytical study was undertaken in the rural field practice area of a medical college in Karnataka. Methods and Material: Data collected on 145 children with disability and 145 neighbors/sibling/ classmates of the child using a pretested semi-structured questionnaire was analyzed using SPSS 20.0 Statistical analysis: Difficulties faced by feeding children with/without disabilities were expressed in percentages. Chi-square test was used to determine the association between feeding time, challenges encountered, and need for assistance p (&lt;0.05). Results: The mothers mostly assisted feeding. Significant differences in need for support among children with disabilities 19 (13.5%) and without disabilities 3(2.1%) during meals and time taken to feed were seen. The most common difficulty was the improper position 13(9.0%) among children with disabilities. Conclusions: Mother is the significant person involved in feeding children with &amp; without disabilities. Help in feeding, improper position of the child, vomiting tendency while feeding was more common with children with disabilities than without disabilities.&#x0D; Disabled children, Intellectual disability, Vomiting, Caregivers.

NEED ANALYSIS ON THE DEVELOPMENT OF WRITING COMPETENCY TEST FOR FOREIGN UNIVERSITY STUDENTS

Purpose of Study: This study aims to explore the needs of BIPA learners and BIPA program managers. The research strategy applied in this research is descriptive explanatory. The subjects of this study are foreign students of Darmasiswa and KNB programs and the managers of BIPA programs at Muhammadiyah Universities that manage BIPA programs.&#x0D; Methodology: Data collection is done by document (document analysis), participant observation, in-depth interviewing, and questionnaire. The data validity test is done by data triangulation technique, investigative triangulation, and source triangulation.&#x0D; Results: Based on the results of the analysis, it is known that there is a difference of need between BIPA learner and BIPA manager in developing writing competence test for foreign students.&#x0D; Implications/Applications: This has an impact on the importance of needs considerations as a basis for developing the competency test of foreign students writing.

The reciprocal impact of both visual and verbal metaphors in advertisements: the moderating role of need for cognition

Metaphors, one of the attractive strategies in communication, can have a significant impact visually and verbally on the persuasion of targeted consumers. The current study investigates the interaction effects when using pictorial and verbal metaphors in ads on consumers’ attitude toward the ad, the brand, and purchase intention while considering the moderating effect of individuals’ differences in need for cognition (NFC). Experimental results indicate the reciprocal impact of metaphor in both image and copy in ads under different combination-conditions considering the individual differences in information processing (i.e. NFC) with low-involvement products. Furthermore, the results highlight a significant three-way interaction effect on the consumers’ attitudes toward the ad and the brand with the individuals’ differences in the NFC. The findings illustrate the effective combination and the optimisation of visual and verbal metaphors in order to enhance the ad effects with metaphors. The implications and limitations are discussed.

Effectiveness of Self-Generation During Learning is Dependent on Individual Differences in Need for Cognition.

Self-generated information is better recognized and recalled than read information. This so-called generation effecthas been replicated several times for different types of stimulus material, different generation tasks, and retention intervals. The present study investigated the impact of individual differences in learners’ disposition to engage in effortful cognitive activities (need for cognition, NFC) on the effectiveness of self-generation during learning. Learners low in NFC usually avoid getting engaged in cognitively demanding activities. However, if these learners are explicitly instructed to use elaborate learning strategies such as self-generation, they should benefit more from such strategies than learners high in NFC, because self-generation stimulates cognitive processes that learners low in NFC usually tend not to engage in spontaneously. Using a classical word-generation paradigm, we not only replicated the generation effect in free and cued recall but showed that the magnitude of the generation effect increased with decreasing NFC in cued recall. Results are consistent with our assumption that learners higher in NFC engage in elaborate processing even without explicit instruction, whereas learners lower in NFC usually avoid cognitively demanding activities. These learners need cognitively demanding tasks that require them to switch from shallow to elaborate processing to improve learning. We conclude that self-generation is beneficial regardless of the NFC level, but our study extends the existing literature on the generation effect and on NFC by showing that self-generation can be particularly useful for balancing the learning disadvantage of students lower in NFC.

The influence of neoadjuvant chemotherapy on complications of immediate DIEP flap breast reconstructions

PurposeThe impact of neoadjuvant chemotherapy on the surgical outcomes of immediate breast reconstruction remains controversial. The aim of this study was to analyze the incidence of complications of immediate deep inferior epigastric artery perforator (DIEP) flap breast reconstructions in patients who received neoadjuvant chemotherapy compared to patients without neoadjuvant chemotherapy prior to surgery.MethodsA multicenter, retrospective cohort study was conducted of all patients who underwent immediate DIEP flap breast reconstruction between January 2010 and June 2017. Patients were divided in two groups as breast reconstructions with or without neoadjuvant chemotherapy, respectively. The primary outcome was the incidence of postoperative flap re-explorations, recipient-site complications and donor-site complications.ResultsIn total 432 immediate DIEP flap breast reconstructions in 326 patients were included. Forty-eight patients (n = 67 flaps) received neoadjuvant chemotherapy prior to immediate breast reconstruction and 278 patients (n = 365 flaps) did not. No statistically significant differences for any major (4.5% vs. 10.4%; p = 0.175) or minor (16.4% vs. 24.7%; p = 0.191) recipient-site complication were observed. Donor-site complications were recorded in 9 (18.8%) and 62 (22.2%) patients, respectively (p = 0.587). There was no difference in need for flap re-exploration between groups (3.0% vs. 8.5%; p = 0.139). Correction for potential confounding variables did not result in significant differences.ConclusionsThis study demonstrated similar complication rates for patients with and without neoadjuvant chemotherapy prior to immediate breast reconstruction, indicating that it is safe to perform an immediate DIEP flap breast reconstruction after neoadjuvant chemotherapy.

Impact of American Academy of Pediatrics Palivizumab Guidance for Children ≥29 and

To evaluate the impact of the American Academy of Pediatrics revised recommendations (2014) for palivizumab prophylaxis on respiratory syncytial virus (RSV) admissions and severity of illness among children ≥29weeks and <35weeks of gestational age. We evaluated patients hospitalized with RSV infection from October 1, 2012, through April 30, 2017. RSV hospitalizations, community RSV activity, duration of hospitalization, disease severity, and mortality were reviewed. Data were compared before and after implementation of the guideline changes. A total of 91 patients were born at ≥29weeks and <35weeks of gestational age and hospitalized within the first year of life during the evaluation period. Gestational age, birth weight, age at diagnosis, and sex remained constant over the seasons evaluated. RSV hospitalizations and activity in the community were unchanged over 5years. Duration of hospitalization increased. There was no difference in need for intensive care, supplemental oxygen, or mechanical ventilation or mortality. Implementation of the 2014 American Academy of Pediatrics guidelines regarding eligibility for palivizumab prophylaxis in older infants born preterm did not increase RSV hospitalizations or disease severity among children hospitalized for RSV at our hospital. Our data support continued adherence to the guidelines.

03:18 PM Abstract No. 337 Transcatheter embolization for upper GI bleed: outcomes of empiric vs. selective embolization

To compare clinical outcomes between empiric embolization for angiographically occult upper GI bleed with selective embolization for angiographically detectable upper GI bleed. This IRB-exempt retrospective study reviewed 47 patients who underwent gastroduodenal artery (GDA) and left gastric artery (LGA) embolization for acute upper GI bleed at our institution between June 2009 to April 2017. 22 patients underwent prophylactic embolization while 25 patients underwent selective embolization. Demographics, smoking history, alcohol use, ICU needs, 30-day mortality rates, endoscopic interventions, major IR complication rates, rebleed rates and transfusion requirements were compared between groups using student T test and Chi-square test. There were significant gender differences between the empiric embolization group (14% females) and the selective embolization group (48% females, p=.014). There was no significant difference in age distribution, smoking history, or past and current alcohol use between the two groups. There were no differences in major IR complication rates after embolization. In the empiric embolization group, ICU needs (86% vs. 44%, p=.003) were greater. The empiric embolization group had greater rebleeding rate (41% vs. 12%, p=.024) and had higher proportion of cases requiring greater than 5 units of PRBC after embolization (32% vs. 0%, p=.002). However, there were no significant differences in need for endoscopic intervention post embolization (14% vs. 8%, p=.5). There were no significant differences in 30 day mortality rates (22.7% vs. 20%, p=.82). Selective embolization is more clinically effective for cessation of upper GI bleeding when compared to empiric embolization of the GDA and LGA with less rebleeding rates and transfusion requirements. However, the difference in 30 day mortality rates and the need for endoscopic intervention post embolization between the two groups are insignificant.

Locoregional Anesthesia Offers Improved Outcomes after Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

General anesthesia (GA) and locoregional anesthesia (LA) are two anesthetic options for endovascular repair of ruptured abdominal aortic aneurysms (REVAR). Studies on elective endovascular repair of nonruptured aneurysms have indicated that in select patients, LA may provide improved outcomes compared with GA. We aimed to examine the 30-day outcomes in patients undergoing REVAR using GA and LA in a contemporary nationwide cohort of patients presenting with ruptured abdominal aortic aneurysms. Patients who underwent REVAR using GA and LA from January 2011 through December 2015, inclusively, were studied in the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP)-targeted EVAR database. Univariate and multivariate analyses were used to compare preoperative demographics, operation-specific variables, and 30-day postoperative outcomes between the two groups. Six-hundred ninety patients were identified to have undergone REVAR from 2011 to 2015, of which 12.5% (86) were performed under LA. For the entire cohort, the mean age was 74.3years, and 80% were male. Mean aneurysm size was 7.6cm and did not differ between the two anesthetic groups. Major comorbidities were similar between both groups, except a slightly higher rate of congestive heart failure in the LA group (7.0% vs. 2.5%, P=0.02). Proximal or distal aneurysm extent also did not differ between the two groups. There was a significantly higher rate of bilateral percutaneous access in the LA group (59.3% vs. 25.2%, P<0.01). REVAR under LA had shorter mean operative time (132 vs. 166min, P<0.01) and lower rate of concomitant lower extremity revascularization (2.3% vs. 10.6%, P<0.01). There were no differences in need for perioperative transfusion or any other adjunctive procedures. Ultimately, 30-day mortality was significantly lower in the LA group (16.3% vs. 25.2%, P<0.01). This difference was more pronounced in the subgroup of patients with hemodynamic instability (15.4% vs. 39.4%, P<0.01). The LA group also demonstrated significantly shorter intensive care unit (ICU) length of stay (3.0 vs. 5.0days, P=0.01) and low rates of postoperative pneumonia (3.5% vs. 10.9%, P=0.03). After adjustment for demographics, comorbid conditions, hypotensive status, and aneurysm characteristics, there was a two-fold higher mortality in patients undergoing REVAR using GA versus LA, with a four-fold increase in the hemodynamically unstable cohort. The ACS NSQIP-targeted EVAR database shows that LA is used in only 12.5% of patients undergoing REVAR in this nationwide cohort. This rate does not change when examining the subset of patients who are hemodynamically unstable. Other benefits include shorter ICU lengths of stay and lower rates of pneumonia. These data suggest that LA should be considered in patients undergoing REVAR, regardless of hemodynamic instability.

Pediatric Handlebar Injuries: More Than Meets the Abdomen.

Injuries associated with bicycles can generally be categorized into 2 types: injuries from falling from/off bicycles and injuries from striking the bicycle. In the second mechanism category, most occur as a result of children striking their body against the bicycle handlebar. The purpose of this study was to evaluate the presentation, body location, injury severity, and need for intervention for pediatric handlebar injuries at a single level one pediatric trauma center and contrast these against other bicycle-related injuries in children. This work is a retrospective review of the trauma registry over an 8-year period. Individual charts were then reviewed for patients' demographic factors, injury details, and other clinical/radiographic findings. Each patient was then categorized as either having a handlebar versus nonhandlebar injury. Additionally, each patient's injuries were classified according to affected body "zone(s)" and the need for intervention in relation to these injuries. During the course of chart review, several unique radiographic and history/physical findings were noted and are also reported. During the study period, 385 patients were identified that met study criteria. Bicycle handlebars were involved in 27.8% (107/385) of injuries and 72.2% (278/385) were nonhandlebar injuries. There were differences in injury severity score, Head Abbreviated Injury Scale, length of stay between patients with handlebar versus nonhandlebar injuries, respectively. There were also differences in incidence of injuries across most body zones between patients with handlebar versus nonhandlebar injuries. There was statistically significant difference in need for intervention for abdominal solid organ injuries among handlebar versus nonhandlebar injuries mechanisms (21.6% vs 0%; P = 0.026), respectively. Sixteen patients with a handlebar injury underwent abdominal computed tomography (CT), which found only pericolic/pelvic free fluid or were negative for any disease and had normal/mildly elevated liver function test results at the time of arrival with otherwise normal laboratory workup results. Two patients required laparotomy for bowel injury and presented with peritonitis less than 12 hours after injury. The remaining patients did not have peritonitis on examination and were discharged without operative intervention 12 to 24 hours after injury without further event. The bicycle handlebar is a unique mechanism of injury. The location, need for intervention, and the nature of the injury can vary significantly compared to other bicycle injuries. Handlebar injuries are more likely to cause abdominal and soft tissue injuries, whereas nonhandlebar injuries are more likely to cause extremity and skull/neck/central nervous system injuries. Because more than 20% of the reported handlebar injuries did not involve the abdomen or thoracoabdominal/extremity soft tissue as well as the variable presentation of handlebar injuries, it is imperative for the physician to consider this mechanism in all bicycle injuries. In addition, even within the same area of the body, handlebar injuries can be very different compared to nonhandlebar (i.e., orthopedic vs vascular injuries in the extremities). Physical examination and observation remain paramount when laboratory and radiographic workups are equivocal.

Impact of chronic right ventricular pressure overload in short-term outcomes of acute pulmonary embolism: A retrospective analysis

PurposeEvaluate the association between chronic right ventricle (RV) dysfunction by transthoracic echocardiogram (TTE) and outcomes in patients with acute pulmonary embolism (PE). MethodsThis was a retrospective analysis of TTE findings in acute PEs. TTEs were used to classify the presence of chronic right ventricular pressure overload (RPVO), defined as RV hypertrophy or RV systolic pressure (RVSP) >50 mmHg, acute RVPO, defined as RV dysfunction not meeting the chronic RVPO definition, or no RV dysfunction. The primary outcome was a composite of death or need for advanced PE therapies at 7 days. ResultsOf 466 patients, 288 had evidence of RV dysfunction. Thirty percent (140) had evidence of chronic RVPO and 148 patients had evidence of acute RVPO. Chronic RVPO patients were older (P = .004), more likely to have COPD, and had lower heart rates and troponin-t values. The acute RVPO patients included more women and were less likely to have a prior PE. There was no difference in outcomes between the acute and chronic RVPO cohorts. ConclusionsChronic RVPO patients had lower heart rates and troponin-t values. Despite these differences there were no differences in need for advanced therapeutic interventions or 7 day mortality.

OPTN Vascularized Composite Allograft Waiting List: Current Status and Trends in the United States.

Vascularized composite allograft (VCA) transplantation is a developing area in the field of transplantation. This study used Organ Procurement and Transplantation Network (OPTN) VCA waiting list and transplant data from July 3, 2014 through February 28, 2018, to characterize the OPTN VCA waiting list in terms of composition, removal patterns, waiting time, resulting transplants, and trends over time. Between implementation of the OPTN VCA waiting list on July 3, 2014 and February 28, 2018, 54 candidates-53.7% were male, 79.6% were white, and 70.4% aged 18 to 44 years-were added to the OPTN VCA waiting list. Of these, 22 received deceased donor VCA transplants (6 bilateral upper limb, 4 unilateral upper limb, 5 craniofacial, 1 scalp, 1 abdominal wall, 1 penile, and 4 uterine), and 6 received living donor uterine transplants. Registrations increased in 2016 after uterine and penile transplants were introduced in the United States, resulting in a large shift in the composition of the VCA waiting list. Waiting times for VCA candidates vary greatly, with some VCA candidates receiving deceased donor transplants quickly and others waiting more than 3 years before transplantation. The field of VCA transplantation and the composition of the OPTN VCA waiting list are evolving rapidly. Additional research is needed to understand these changes and investigate whether differences in need or differences in access have resulted in the variation seen on the VCA waiting list.