Human Amniotic Membrane Wrapping of the Ulnar Nerve During Cubital Tunnel Surgery Reduces Recurrence of Symptoms.

Background: Compare the recurrence rate of paresthesias in patients undergoing primary cubital tunnel surgery in those with and without wrapping of the ulnar nerve with the human amniotic membrane (HAM). Methods: A retrospective investigation of patients undergoing primary cubital tunnel surgery with a minimum 90-day follow-up was performed. Patients were excluded if the nerve was wrapped using another material, associated traumatic injury, simultaneous Guyon's canal release, or revision procedures. Failure was defined as those patients who experienced initial complete resolution of symptoms (paresthesias) but then developed recurrence of paresthesias. Results: A total of 57 controls (CON) and 21 treated with HAM met our inclusion criteria. There was a difference in the mean age of CON (48.4 ± 13.5 years) and HAM (30.6 ± 15) (P< 0.0001). There was no difference in gender mix (P=0.4), the severity of symptoms (P=0.13), and length of follow-up (P=0.084). None of 21 (0%) treated with HAM developed recurrence of symptoms compared to 11 of 57 (19.3%) (P=0.03) (CON). Using a multivariate regression model adjusted for age and procedure type, CON was 24.4 (95% CI=1.26-500, P=0.0348) times higher risk than HAM of developing a recurrence of symptoms. Conclusion: The HAM wrapping used in primary cubital tunnel surgery significantly reduced recurrence rates of paresthesias. Further prospective studies with randomization should be carried out to better understand the role HAM can play in cubital tunnel surgery.

Statin Use and Mortality among Patients Hospitalized with Sepsis: A Retrospective Cohort Study within Southern California, 2008-2018.

Background: Despite early goal-directed therapy, sepsis mortality remains high. Statins exhibit pleiotropic effects. Objective: We sought to compare mortality outcomes among statin users versus nonusers who were hospitalized with sepsis. Methods: Retrospective cohort study of patients (age ≥18 years) during 1/1/2008-9/30/2018. Mortality was compared between statin users and nonusers and within statin users (hydrophilic versus lipophilic, fungal versus synthetic derivation, and individual statins head-to-head). Multivariable Cox regression models were used to estimate hazard ratios (HR) for 30-day and 90-day mortality. Inverse probability treatment weighting (IPTW) analysis was performed to account for indication bias. Results: Among 128,161 sepsis patients, 34,088 (26.6%) were prescribed statin drugs prior to admission. Statin users compared to nonusers had a 30-day and 90-day mortality HR (95% CI) of 0.80 (0.77-0.83) and 0.79 (0.77-0.81), respectively. Synthetic derived statin users compared to fungal derived users had a 30- and 90-day mortality HR (95% CI) of 0.86 (0.81-0.91) and 0.85 (0.81-0.89), respectively. Hydrophilic statin users compared to lipophilic users had a 30-day and 90-day mortality HR (95% CI) of 0.90 (0.81-1.01) and 0.86 (0.78-0.94), respectively. Compared to simvastatin, 30-day mortality HRs (95% CI) were 0.85 (0.66-1.10), 0.87 (0.82-0.92), 0.87 (0.76-0.98), and 1.22 (1.10-1.36) for rosuvastatin, atorvastatin, pravastatin, and lovastatin, respectively. Conclusion: Statin use was associated with lower mortality in patients hospitalized with sepsis. Hydrophilic and synthetic statins were associated with better outcomes than lipophilic and fungal-based preparations.

Urgent PC Versus a Generic Posterior Tibial Neurostimulator for Overactive Bladder: A Retrospective Noninferiority Study.

OBJECTIVE: The aim of the study was to determine whether a generic posterior tibial neurostimulator was noninferior to Urgent PC in the treatment of nonneurogenic OAB, urgency urinary incontinence, and mixed urinary incontinence. Secondary outcomes include rates of starting and completing 3 months of maintenance therapy, treatment success after 3 months, and adverse events. METHODS: We performed a retrospective cohort analysis of women whose nonneurogenic OAB, urgency urinary incontinence, or mixed urinary incontinence was treated with either Urgent PC or a generic posterior tibial neurostimulator. Previous research shows a 55% treatment success rate for posterior tibial nerve stimulation (PTNS). To demonstrate noninferiority with a limit of 14% and 80% power, our analysis required 157 patients per group. RESULTS: We included 267 Urgent PC and 234 generic patients and excluded 51 patients from analysis. A per-protocol analysis demonstrated treatment success in 55.3% (121 of 219) of the Urgent PC and 48.6% (85 of 175) of the generic cohort (P = 0.187). An intention-to-treat analysis showed treatment success in 45.3% (121 of 267) of the Urgent PC and 36.3% (85 of 234) of the generic cohort (P = 0.690). There were no significant differences in rates of starting (82.2% vs 78.2%, P = 0.409) or completing (79.9% vs 70.9%, P = 0.129) 3 months of maintenance therapy, treatment success after 3 months (78.5% vs 73.8%, P = 0.485), and adverse events (0.37% vs 0.85%, P = 1.000) in the Urgent PC versus generic group, respectively. CONCLUSIONS: In this cohort of women undergoing PTNS for nonneurogenic OAB, urgency urinary incontinence, or mixed urinary incontinence, the generic neurostimulator demonstrated noninferior rates of treatment success compared with Urgent PC.

Elevated von Willebrand Factor Antigen Is an Early Predictor of Mortality and Prolonged Length of Stay for Coronavirus Disease 2019 (COVID-19) Inpatients.

CONTEXT.­: Coagulation factor and endothelial injury marker, von Willebrand factor antigen (vWF:Ag), is elevated in coronavirus disease 2019 (COVID-19). OBJECTIVE.­: To assess the prognostic value of vWF:Ag for COVID-19 inpatients. DESIGN.­: Citrated plasma samples collected from COVID-19 inpatients for D-dimer measurement were tested for vWF:Ag. Measurements of vWF:Ag and common acute-phase reactants were correlated with clinical outcomes and length of stay (LOS). RESULTS.­: We included 333 samples from a diverse group of 120 COVID-19 inpatients. There was a clear association of higher peak measurements of vWF:Ag and other acute-phase reactants with adverse clinical outcomes. Peak vWF:Ag >300% was associated with a 5-fold increased risk of death (odds ratio [OR], 5.08; P < .001) and a 30-fold increased risk of prolonged (>4 days) LOS (OR, 29.65; P = .001). Peak D-dimer >3.8 fibrinogen equivalent units (FEUs) mg/L was associated with a 15-fold increase in risk of death (OR, 14.73; P < .001) and a 5-fold increased risk of prolonged LOS (OR, 4.55; P = .02). Using the earliest paired measurements of vWF:Ag and D-dimer from each patient and the same cutoffs, vWF:Ag was associated with a 3.5-fold increase in risk of death (OR, 3.54; P = .004) and a 20-fold risk of prolonged LOS (OR, 20.19; P = .004). Yet D-dimer was not significantly associated with either death (OR, 1.9; P = .29) or prolonged LOS (OR, 1.02; P = .98). CONCLUSIONS.­: Both peak and early postadmission vWF:Ag >300% were highly predictive of death and prolonged LOS among COVID-19 inpatients. Measurement of vWF:Ag may prove a valuable tool to guide escalation of COVID-19 treatment, particularly anticoagulation.

Effect of Bisphosphonates on Fracture Incidence in Young Adults With Low Bone Density.

OBJECTIVE: To assess the effect of bisphosphonates on fracture incidence in young adults over a 5-year follow-up period. METHODS: Based on the Kaiser Permanente electronic health record, this retrospective study investigated patients aged 19 to 40 years with abnormal bone density (either any Z-score of ≤-2 standard deviation [SD] or any T-score of ≤-2.5 SD). The incidence and time to fracture between the control (patients with <6 months of bisphosphonate exposure) and treatment (patients with ≥6 months of bisphosphonate use within 4 years of their first dual energy x-ray absorptiometry scan) groups were compared. Comparisons were analyzed with Χ2 test for categorical variables and Wilcoxon rank sum test for continuous variables. RESULTS: A total of 422 patients met the inclusion and exclusion criteria. Fractures occurred in 18 patients (5.0%) of the control group (n = 358) and 5 patients (7.8%) of the treatment group (n = 64; P = .37). T-scores were significantly lower in the treatment group (-2.53 ± 0.58 SD) than those in the control group (-2.30 ± 0.80 SD; P = .002) but did not correlate with fracture risk. No significant differences were found in total fracture incidence (hazard ratio = 1.54; 95% confidence interval, 0.26-6.26). Similarly, no correlation was noted between the length of bisphosphonate therapy and fracture incidence (odds ratio = 0.99; 95% confidence interval, 0.966-1.026). CONCLUSION: In summary, we did not find a clear correlation of fracture incidence with the use of bisphosphonates in young adults. Further research into the pathophysiology, specific etiologies, and treatment options in this population is needed.

Perioperative outcomes after robotic versus vaginal surgery for pelvic organ prolapse.

The objectives of the study were to compare post-anesthesia care unit opioid use and pain scores, surgical and hospitalization times, and perioperative adverse events rates following robotic sacrocolpopexy (RSC) versus transvaginal uterosacral ligament suspension (USLS). This was a retrospective analysis of women 18 years and older who underwent either robotic sacrocolpopexy (n = 87) or transvaginal uterosacral ligament suspension (n = 103) between January 1, 2015 to December 31, 2017 at Downey Medical Center by two surgeons. Data including nurses' verbal pain scores and opioid use were abstracted from electronic medical records. Adverse events were classified using the Clavien-Dindo scale. Women in the robotic group were older (62 ± 8 years vs 58 ± 11 years, p = 0.005), had higher rate of stage III or IV prolapse [49/87 (56%) vs 15/103 (15%), p < 0.0002], lower postoperative pain scores (2.6 ± 1.8 vs 4.2 ± 2.4, p < 0.0001), and used less opioids (26 ± 17 mg morphine dose equivalent vs 35 ± 24 mg morphine dose equivalent, p = 0.005) than those in the transvaginal group. Readmissions and reoperations for adverse events were not significantly different between the RSC and USLS groups [5/87 (6%) vs 12/103 (12%), p = 0.16], respectively. Moreover, Dindo-Clavien scores of II or higher occurred at similar rates between the two groups [20/87 (23%) vs 26/103 (25%), p = 0.72]. However, patients had a higher rate of prolonged urethral catheterization following USLS (0/87) than RSC (6/103) (p = 0.03). Robotic sacrocolpopexy was associated with less immediate postoperative pain and opioid use compared to uterosacral ligament vaginal suspension.

Persistent asthma defined using HEDIS versus survey criteria.

OBJECTIVES: To describe the relationships between persistent asthma defined by administrative versus survey data and their stability over time. STUDY DESIGN: Longitudinal survey and retrospective administrative database. METHODS: Administrative data were used to identify patients meeting the Healthcare Effectiveness Data and Information Set (HEDIS) criteria for persistent asthma in year 1 (2006). At the end of year 2 and on 3 occasions during year 3, patients were mailed a survey to define persistent asthma based on symptoms and medication use in the prior month and exacerbations in the prior 12 months. Administrative data were also used to define medical utilization for asthma in year 3. RESULTS: Of 13,833 eligible patients, 2895 (20.9%) returned the survey; 2751 of these respondents reported physician-diagnosed asthma, of whom 2517 (91.5%) had survey-defined persistent asthma. Patients having survey-defined persistent asthma (68.0%) were more likely to requalify as having HEDIS-defined persistent asthma in year 2 than patients not having survey-defined persistent asthma (22.2%). However, 81.6% of survey respondents who did not requalify as having HEDIS-defined persistent asthma in year 2 had survey-defined persistent asthma. Patients with survey-defined persistent asthma in year 2 had significantly more medical utilization for asthma in year 3 than patients without survey-defined persistent asthma. Approximately 82% of the 799 patients completing all 4 surveys had persistent asthma on all surveys. CONCLUSIONS: HEDIS-defined persistent asthma is generally consistent with survey-defined persistent asthma. Persistent asthma usually remains persistent over a 3-year period, indicating that it is a stable characteristic of asthma for most patients. The low survey response rate suggests that further population-based studies will be necessary to confirm the validity and generalizability of our study findings regarding persistent asthma.

Eating patterns and overweight status in young adults: the Bogalusa Heart Study.

Several studies have focused on the association between eating patterns and obesity. However, the findings have not been consistent. The goal of the present study was to identify the eating patterns associated with overweight among young adults aged 19-28 years (n=504) in Bogalusa, Louisiana. Food intake was determined using a single 24-h dietary recall, and height and weights were measured to determine the body mass index. The association between eating patterns and overweight status was evaluated using logistic regression and analysis of covariance. Twenty-four percent of young adults were overweight and 18% were obese; with the highest prevalence of obesity seen among black females. The percentage gram consumption of fruit/fruit juices (P < 0.01) was negatively associated with overweight status, and diet beverage consumption (P < 0.05) was positively associated with obesity. Eating patterns are associated with overweight status in young adults; however, the amount of variance explained in the body mass index was very small.