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CASE PRESENTATION: A 13-year-old male patient with intermittent asthma and joint hypermobility presented to the ED in acute hypoxemic respiratory distress. He reported experiencing cough, increased work of breathing, and worsening chest pain for 3 days before presentation. He also reported fatigue and decreased appetite for 2 weeks. He had no known fever, myalgias, or recent weight loss. His medical history included two hospitalizations during early childhood for viral respiratory illnesses, one of which required intubation at 8 months of age. He had a gastrostomy tube placed shortly after his hospitalization because of failure to thrive secondary to aspiration based on a swallow study. His weight gain and growth improved with adequate nutrition, and his gastrostomy tube was removed at 2 years of age. His newborn screen, which included immunoreactive trypsinogen, was normal. He was noted to have hypermobile joints on physical examination at a clinic visit in childhood, but his examination results were not concerning for a hypermobility syndrome, and further diagnosis was not pursued. His parents endorsed that he has been a "healthy child" overall other than the occasional cough, which was attributed to asthma. His lifestyle was described as sedentary; he did not play any sports or have any unusual hobbies. He did not take any daily medications and no environmental exposures were reported. There was no family history of pulmonary, autoimmune, or connective tissue disease.
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Asma , Bronquiectasia , Oxigenação por Membrana Extracorpórea , Pneumonia , Adolescente , Humanos , Masculino , Asma/tratamento farmacológico , Bronquiectasia/complicações , Bronquiectasia/terapia , Tosse/etiologiaRESUMO
Purpose: Etonogestrel subdermal implants are a commonly used contraceptive device placed in the medial upper arm. Plastic and orthopedic surgeons may be consulted for difficult implant removals. We performed a case-control study comparing patients undergoing surgical and uncomplicated in-office removal at our institution. Patients and Methods: We identified patients who underwent operative removal of implantable contraceptive devices by plastic or orthopedic surgeons at our institution from January 2014 to October 2019. Patients who underwent uncomplicated office removal during the same time were compared. Demographic and surgical variables were collected, and descriptive statistics were calculated. Univariate and multivariate logistic regression was performed with surgical versus outpatient removal as the outcome of interest. Results: A total of 669 patients undergoing etonogestrel subdermal implant removals were identified during the five-year study period, of which thirteen patients required surgical removal (1.9%) and 326 were selected as uncomplicated removal comparisons. There were no significant differences in median (IQR) body mass index (BMI) (31.1 [28.2, 35.2] versus 29.3 [24.0, 35.1], p = 0.19), median (IQR) weight gain since device placement (5 [-0.6, 14.7] kilograms versus 1.6 [-1.2, 5.8] kilograms, p = 0.15), or length of time since device insertion (2.3 [0.8, 2.8] years versus 1.0 [0.4, 2.2] years, p = 0.17). Of those who needed surgical removal, the most common indication for implant removal was device expiration (n = 5, 38.5%). Devices placed by OBGYN attendings were less likely to require surgical removal (p = 0.02). Family medicine attendings were more likely to refer patients for surgical removal (p = 0.02). No significant findings were detected on univariate or multivariate regression. Among surgical removals, radiography was the most frequently used imaging modality. Implants were most frequently subdermal (n = 11, 84.6%) though intramuscular placement was also identified (n = 2, 15.4%). Only one patient had residual paresthesia along the length of the incision. No other complications were identified. Conclusion: We did not identify risk factors associated with the difficult removal of etonogestrel subdermal implants. Practitioners should consult upper extremity surgeons if they encounter difficult removals.
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BACKGROUND: Reproducible research-defined as the ability to replicate a study with its published materials and procedures-is integral to ensuring the validity of published studies and promoting scientific advancement. The primary aim of this study was to quantitatively evaluate the reproducibility and transparency of research in the plastic surgery literature. METHODS: A cross-sectional study was performed. Articles published in 12 plastic surgery journals over a 5-year period were randomly selected. Reproducibility-related and transparency-related variables were blindly and independently collected by two reviewers using previously published methods. Descriptive statistics and univariate analysis were performed for outcomes of interest. RESULTS: The initial search yielded 18,461 publications, from which 400 were randomly selected. A total of 397 publications met inclusion criteria, of which 203 were empirical studies eligible for analysis of reproducibility-related and transparency-related variables. Among the empirical studies, most did not have a data availability statement (97.0 percent; 95 percent CI, 93.7 to 98.9). Only seven (3.4 percent; 95 percent CI, 1.4 to 7.0) were linked to an accessible protocol, four (2.0 percent; 95 percent CI, 0.5 to 5.0) were preregistered, and no studies provided analysis scripts or claimed to replicate another study. Of the 202 studies evaluated for material availability, only 17 (8.4 percent; 95 percent CI, 5.0 to 13.1) had a material availability statement. CONCLUSIONS: There is an evident lack of reproducible research practices in plastic surgery literature. The majority of plastic surgery publications do not provide information and raw materials necessary to reproduce empirical studies. Increasing awareness at the individual and institutional levels can improve research quality and transparency.
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Pesquisa Biomédica , Cirurgia Plástica , Estudos Transversais , Humanos , Publicações , Reprodutibilidade dos TestesRESUMO
PURPOSE: To evaluate the effect of enema and dietary restrictions on prostate MR image quality metrics and to assess inter-reader agreement for these metrics. METHODS: This retrospective study included 195 men divided into groups based on their compliance with preparation instructions before prostate MRI (Enemaâ¯+â¯Diet, nâ¯=â¯98; Enema, nâ¯=â¯42; Diet, nâ¯=â¯35; Control [no compliance], nâ¯=â¯20). Four readers independently assessed six image quality metrics on a 5-point scale. Between-group comparisons were made using Wilcoxon rank sum test. Inter-reader agreement was calculated using Fleiss' kappa. RESULTS: Compared with the Control group, image quality with respect to rectal stool/gas, distortion of diffusion-weighted images, overall image quality, and confidence in assessment was higher in the Enemaâ¯+â¯Diet, Enema, and Diet groups (p⯠<â¯0.05 for all comparisons). The Enemaâ¯+â¯Diet and Enema groups had significantly higher scores than the Diet group for rectal stool/gas (p < 0.001 and 0.005, respectively). The Enemaâ¯+â¯Diet and Diet groups had higher scores than the Control group for rectal peristalsis (pâ¯=â¯0.027 and 0.009, respectively), but there were no significant differences in motion artifacts on T2-weighted images. Agreement among readers was fair, with kappa values ranging from 0.25 to 0.37. CONCLUSION: Enema and dietary restriction can improve the quality of prostate MRI by decreasing rectal distension and distortion of diffusion-weighted images and by increasing reader confidence in image assessment. Inter-reader agreement using subjective criteria for analysis of MRI quality is fair.
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Próstata , Neoplasias da Próstata , Imagem de Difusão por Ressonância Magnética , Enema , Humanos , Imageamento por Ressonância Magnética , Masculino , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Estudos RetrospectivosRESUMO
PURPOSE: The goal of this study was to determine the predictive value of prostate-specific antigen density (PSAD) plus Prostate Imaging Reporting and Data System (PI-RADS) category for the detection of clinically significant prostate cancer. MATERIALS AND METHODS: This retrospective study included 526 men without known prostate cancer (initial diagnosis group) and 133 men with prostate cancer grade group 1 (active surveillance group) who underwent magnetic resonance imaging-guided and/or systematic prostate biopsy procedures between August 2014 and October 2018. Prostate specific antigen (PSA), PSAD, and PI-RADS category were entered into logistic regression models for predicting clinically significant prostate cancer (grade group ≥2) at biopsy. Receiver operating characteristic curve analysis was performed to assess model accuracy. RESULTS: The area under the curve (AUC) increased when PSAD was combined with PI-RADS in the initial diagnosis group (difference in AUCâ¯=â¯0.031; 95% confidence interval: 0.012, 0.050; Pâ¯=â¯0.002) but not in the active surveillance group (difference in AUCâ¯=â¯0.016; 95% confidence interval: -0.040, 0.071; Pâ¯=â¯0.579). When a PSAD threshold of 0.15 was applied, the frequency of clinically significant prostate cancer in patients with a PI-RADS score of 3 or lower decreased from 9.8% to 5.6% in the initial diagnosis group and from 10.7% to 2.7% in the active surveillance group. CONCLUSIONS: The addition of PSAD improves the predictive performance of PI-RADS in men without known prostate cancer. A PSAD threshold of 0.15 can help to minimize the number of missed clinically significant prostate cancer cases in men with a PI-RADS score of 3 or lower who decide to defer biopsy.
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Antígeno Prostático Específico/sangue , Próstata/patologia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Idoso , Sistemas de Dados , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Valor Preditivo dos Testes , Neoplasias da Próstata/patologia , Estudos RetrospectivosRESUMO
Binder jet printing (BJP) is a metal additive manufacturing method that manufactures parts with complex geometry by depositing powder layer-by-layer, selectively joining particles in each layer with a polymeric binder and finally curing the binder. After the printing process, the parts still in the powder bed must be sintered to achieve full densification (A. Mostafaei, Y. Behnamian, Y.L. Krimer, E.L. Stevens, J.L. Luo, M. Chmielus, 2016; A. Mostafaei, E. Stevens, E. Hughes, S. Biery, C. Hilla, M. Chmielus, 2016; A. Mostafaei, Y. Behnamian, Y.L. Krimer, E.L. Stevens, J.L. Luo, M. Chmielus, 2016) [1-3]. The collected data presents the characterization of the as-received gas- and water-atomized alloy 625 powders, BJP processing parameters and density of the sintered samples. The effect of sintering temperatures on the microstructure and the relative density of binder jet printed parts made from differently atomized nickel-based superalloy 625 powders are briefly compared in this paper. Detailed data can be found in the original published papers by authors in (A. Mostafaei, J. Toman, E.L. Stevens, E.T. Hughes, Y.L. Krimer, M. Chmielus, 2017) [4].
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Although significant data highlight the extent of health disparities, data regarding dermatologic health disparities are limited. Ethnic minorities, people of low socioeconomic status, the less educated, elderly, and uninsured have poorer melanoma and nonmelanoma skin cancer outcomes. Atopic dermatitis is more prevalent among ethnic minorities, but whether morbidity is also increased in these populations is unclear. Given the current dermatology workforce shortage, increased patient load from health care reform may have an adverse effect on access to dermatologic care. Additional concerns include status of dermatologic training, insufficient research involving ethnic minorities, and lack of investigation of dermatologic health disparities.