Notes

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08), thyroid gland (3.31), and mobilization of the lobe (3.23), identifying aspects to improve. All participants reported increased confidence with thyroid surgery after using the model; this was most pronounced among junior residents (1.5±0.76 versus 3.13±1.13; p=0.016).

Thyroidectomy requires repetition and volume to gain competence. Use of the simulator early in training will provide confidence and familiarity, to enhance the educational value of subsequent live surgery.
Thyroidectomy requires repetition and volume to gain competence. Use of the simulator early in training will provide confidence and familiarity, to enhance the educational value of subsequent live surgery.Chromatin structure is critically involved in gene regulation and cell fate determination. How this structure is established and maintained in distinct, terminally differentiated cells remains elusive. Winick-Ng et al. address this puzzle by applying immunoGAM in different brain cell types and reveal cell type-specific chromatin topologies, long gene decompaction, and the involvement of transcription factors (TFs).Graves' orbitopathy is the most common extra-thyroid complication of Graves' disease and can be a potentially severe affection, therefore requiring multidisciplinary treatment support according to clinical activity and severity assessments. This review proposes to determine physiopathological mechanisms, epidemiology and therapeutic management of Graves' orbitopathy.
This study aimed to evaluate the indirect relationship of job stress with triage competency through professional self-concept among emergency nurses in Korea.

A secondary data analysis of survey data from 132 questionnaires was used. A convenience sample of emergency nurses working in regional or local emergency centers in 2 Korean cities was recruited for the survey. Study variables were analyzed using descriptive statistics, correlation, and a model tested using the Hayes PROCESS macro (Model 4) mediationmodel.

Job stress alone was not associated directly with triage competency (β= 0.01, P= .74). An indirect pathway was observed between job stress and triage competency through professional self-concept (F= 5.85, P< .001, R
= 0.33). In the tested model, job stress was associated with professional self-concept (β=-0.05, P < .05) and professional self-concept was associated with triage competency (β= 0.79, P ≤ .001).

Professional self-concept may be an important determinant of triage competency among emergency nurses. To increase triage competency among emergency nurses, individual nurse and management efforts are recommended to foster professional self-concept and reduce emergency nurse job stress.
Professional self-concept may be an important determinant of triage competency among emergency nurses. To increase triage competency among emergency nurses, individual nurse and management efforts are recommended to foster professional self-concept and reduce emergency nurse job stress.
The aim of this study was to evaluate feasibility and impact of an intraoperative surgical site infection prevention bundle for emergency appendectomy.

Consecutive adult patients undergoing emergency appendectomy were prospectively included during a 10-year study period (2011-2020). The care bundle was implemented as of November 1, 2018, and focused on 4 intraoperative items (disinfection, antibiotic prophylaxis, induction temperature control >36.5°C, and intracavity lavage). The primary outcome was the compliance to bundle items. Thirty-day surgical site infections were assessed by the independent Swiss National SSI Surveillance Program (2011 to October 2018) and by an institutional audit (November 2018-2020). Independent risk factors for surgical site infection were identified through multinominal logistic regression analysis.

Of 1,901 patients, 449 (23.6%) were included after bundle implementation. Overall surgical site infection rate was 111 (5.8%). In 42 patients with surgical site infection (37n prevention bundle was feasible and might have a beneficial impact on surgical site infection rates after emergency appendectomy.
The complexity of pancreaticoduodenectomy and fear of morbidity, particularly postoperative pancreatic fistula, can be a barrier to surgical trainees gaining operative experience. This meta-analysis sought to compare the postoperative pancreatic fistula rate after pancreatoenteric anastomosis by trainees or established surgeons.

A systematic review of the literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with differences in postoperative pancreatic fistula rates after pancreatoenteric anastomosis between trainee-led versus consultant/attending surgeons pooled using meta-analysis. Variation in rates of postoperative pancreatic fistula was further explored using risk-adjusted outcomes using published risk scores and cumulative sum control chart analysis in a retrospective cohort.

Across 14 cohorts included in the meta-analysis, trainees tended toward a lower but nonsignificant rate of all postoperative pancreatic fistula (odds ratio 0.77, P= .45)e is evidence of case selection among patients undergoing surgery by trainees; hence, risk adjustment provides a critical tool for the objective evaluation of performance.
Pancreatoenteric anastomosis, when performed by trainees, is associated with acceptable outcomes. There is evidence of case selection among patients undergoing surgery by trainees; hence, risk adjustment provides a critical tool for the objective evaluation of performance.
Prognostic stratification of patients with colorectal cancer liver metastasis based solely on tumor-related factors has only moderate discriminatory ability. We hypothesized that the inclusion of nontumor related factors can improve prediction of long-term prognosis of patients with colorectal cancer liver metastasis.

Nontumor related laboratory markers were assessed utilizing a training cohort from 2 U.S. institutions (n= 1,205). Factors independently associated with prognosis were used to develop a nontumor related prognostic score. click here The discriminatory ability, assessed by Harrell's C-statistics (C-index) and net reclassification improvement, was validated and compared with 3 commonly used tumor-related clinical risk scores Fong clinical risk scores, m-clinical risk scores, and Genetic and Morphological Evaluation (GAME) score in an external validation cohort from 5 Asian (n= 1,307) and 3 European (n= 1,058) institutions. The discriminatory ability of nontumor related prognostic score combined with each -related prognostic scores enhanced the discriminatory ability in the entire study cohort (C-index nontumor related score+Fong, 0.60, nontumor related score+m-clinical risk scores, 0.61, nontumor related score+GAME, 0.64), as well reclassification improvement (42.5, 42.7%, and 21.2%, respectively).

Nontumor related prognostic information may help improve the prognostic stratification of patients after resection of colorectal cancer liver metastasis. The nontumor related prognostic score may be combined with tumor-related prognostic tools to enhance prognostic stratification of patients with colorectal cancer liver metastasis.
Nontumor related prognostic information may help improve the prognostic stratification of patients after resection of colorectal cancer liver metastasis. The nontumor related prognostic score may be combined with tumor-related prognostic tools to enhance prognostic stratification of patients with colorectal cancer liver metastasis.Bleeding is known to influence the prognosis in patients with acute coronary syndromes. In this predefined secondary outcome analysis of the Very EaRly vs Deferred Invasive evaluation using Computerized Tomography (VERDICT) trial, we investigated whether a very early invasive coronary angiography (ICA), compared with one performed within 48 to 72 hours (standard care), was associated with fewer serious bleedings. Furthermore, we tested the association between demographic data including GRACE score and serious bleedings as well as bleedings and mortality. In the 2,147 patients included in the main study, bleedings within 30 days of admission were assessed based on Thrombolysis In Myocardial Infarction and Bleeding Academic Research Consortium criteria. Differences were calculated by cumulative incidence methods and Grays test. Variables associated with bleeding and mortality were estimated by Cox proportional hazard models. Serious (Bleeding Academic Research Consortium 3abc) bleeding rates were low (15 [1.4%, standard] vs 12 [1.2%, early], p = 0.56). There were no fatal bleedings or serious bleedings before ICA in either group. By multivariate analysis, there was no difference in bleedings between the 2 groups. Female gender (hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.2 to 6.4; p = 0.02), anemia (HR 7.0, 95% CI 2.8 to 17.0; p 140 was not (HR 1.03, 95% CI 0.4 to 2.9; p = 0.96). In conclusion, serious bleedings were few, and there were none before ICA in either group. A very early invasive strategy did not reduce serious bleedings within 30 days, which was associated with female gender, increasing blood pressure, and anemia.Myocardial injury in COVID-19 is associated with in-hospital mortality. However, the development of myocardial injury over time and whether myocardial injury in patients with COVID-19 at the intensive care unit is associated with outcome is unclear. This study prospectively investigates myocardial injury with serial measurements over the full course of intensive care unit admission in mechanically ventilated patients with COVID-19. As part of the prospective Maastricht Intensive Care COVID cohort, predefined myocardial injury markers, including high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and electrocardiographic characteristics were serially collected in mechanically ventilated patients with COVID-19. Linear mixed-effects regression was used to compare survivors with nonsurvivors, adjusting for gender, age, APACHE-II score, daily creatinine concentration, hypertension, diabetes mellitus, and obesity. In 90 patients, 57 (63%) were survivors and 33 (37%) nonsurvivors, and a total of 628 serial electrocardiograms, 1,565 hs-cTnT, and 1,559 NT-proBNP concentrations were assessed. Log-hs-cTnT was lower in survivors compared with nonsurvivors at day 1 (β -0.93 [-1.37; -0.49], p less then 0.001) and did not change over time. Log-NT-proBNP did not differ at day 1 between both groups but decreased over time in the survivor group (β -0.08 [-0.11; -0.04] p less then 0.001) compared with nonsurvivors. Many electrocardiographic abnormalities were present in the whole population, without significant differences between both groups. In conclusion, baseline hs-cTnT and change in NT-proBNP were strongly associated with mortality. Two-thirds of patients with COVID-19 showed electrocardiographic abnormalities. Our serial assessment suggests that myocardial injury is common in mechanically ventilated patients with COVID-19 and is associated with outcome.
In sawbones with proximal humerus fracture model, three different fixation configurations, Parallel-Straight K-wires, Cross-Straight K-wires and Palm-Tree Method, were biomechanically compared.

A total of 36 anatomical pediatric humerus sawbones models were used. They were divided into three equal groups; parallel fixation with straight K-wires (Group PS), cross fixation with straight K-wires (Group CS), and Palm-Tree Method (Group PT). Models were tested in abduction and torsional at a speed of 0.5mm/s and a 0-5mm displacement range. Loading (N) and Stiffness (N/mm) data were calculated and compared statistically.

Group PS was significantly higher than the other two groups in abduction bending cyclic load values (P<0.001). It was also significantly higher in Group CS than in Group PT (P<0.001). No significant differences were detected between the three different fixation groups' cyclic torsional load values (p<0.05).

The parallel configuration with straight K-wires will provide a more stable fixation than the cross configuration with straight or Palm-Tree Method in pediatric proximal humeral sawbones fracture modeling.
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