Notes

Echocardiography in thought coronavirus disease: symptoms, limits along with impact on medical operations.
Residential exposure to air pollution (AP) has been shown to activate the immune system (IS). Although innate immune responses to AP have been studied extensively, investigations on the adaptive IS are scarce.

The aim of this study was to investigate the association between short- to long-term AP exposure and polyclonal free light chains (FLC) produced by plasma cells.

We used repeated data from three examinations (





t




0




2000-2003;





t




1




2006-2008; and





t




2




2011-2015) of the population-based German Heinz Nixdorf Recall cohort of initially 4,814 participants (45-75 y old). Residential exposure to total and source-specific particulate matter (PM) with an aerodynamic diameter of 10 or



2.5



μ


m


(






PM

AM





estimates remained stable upon adjustment for PM, PM estimates decreased considerably upon adjustment for





NO




2




and






PN






AM





.

Our results suggest that middle-term AP exposures in particular might be positively associated with activation of the adaptive IS. Traffic-related PM,






PN






AM





, and





NO




2




showed strongest associations. https//doi.org/10.1289/EHP7164.
Our results suggest that middle-term AP exposures in particular might be positively associated with activation of the adaptive IS. Traffic-related PM, PNAM, and NO2 showed strongest associations. https//doi.org/10.1289/EHP7164.
Operating rooms (ORs) generate 70% of hospital waste, leading to increased costs for the hospital, patient, and the environment. The lack of cost awareness among physicians has been well documented; however, there is little information on anesthesiologists or ancillary OR staff. This study aimed to evaluate the cost awareness of commonly used items at an academic medical center among OR personnel.

Anonymous surveys were distributed to OR personnel (nurses, surgical technicians (STs), nurse anesthetists, anesthesiologists, surgeons, and residents), asking for the estimated costs of ten commonly used items. Smad inhibitor These costs were then compared against actual costs to evaluate the accuracy of participants' estimates. Responders were clustered by job, highest level of education, and years of experience for comparison.

167 surveys were collected, and overall only 16.4% of estimates were accurate within 50% of actual price. No significant differences in accuracy between groups were identified overall (
= .2), but both surgical and anesthesia attendings had significantly higher rates of correct responses than their respective residents. No difference was seen in accuracy when all attendings (surgeons and anesthesiologists) were compared with either nurses or STs. Linear regression demonstrated no correlation between number of years at current position or years at institution and number of correct responses (

= .0025 and

= .005, respectively).

Addressing the knowledge deficit around item costs via global education of all OR personnel (surgeons, anesthesia providers, and ancillary staff) could be a viable pathway to reduce waste, and thus cost, for our healthcare system.
Addressing the knowledge deficit around item costs via global education of all OR personnel (surgeons, anesthesia providers, and ancillary staff) could be a viable pathway to reduce waste, and thus cost, for our healthcare system.
Traumatic duodenal injury is a rare, potentially devastating condition with challenging management decisions. Contemporary literature on operative management of duodenal injury is lacking. The purpose of this study is to assess optimal management strategies based on outcomes of patients with traumatic duodenal injury at a single trauma center.

A retrospective study of patients with traumatic duodenal injury from 2013-2020 at a level 1 trauma center was performed. Patient demographics, grade of injury as noted on CT scan or intraoperatively, surgical procedure(s) performed, and resultant outcomes were extracted.

After excluding one patient due to death on arrival, 23 patients met inclusion criteria. Injuries consisted of grade 1 (n = 7), grade 2 (n = 2), grade 3 (n = 12), and grade 5 (n = 2); there were no grade 4 injuries. Patients were predominantly male (83%) with a median age of 30 years old. Nineteen patients (82%) underwent surgery. Four of nine patients (44%) with grade 1/2 injuries had hematomas and were managed non-operatively. The remaining five patients (56%) with grade 1/2 injuries underwent operation, which included primary repair (n = 3), duodenal exclusion (n = 1), and periduodenal drainage (n = 1). Of 12 patients with grade 3 injury, 6 underwent primary repair and 6 underwent resection. Three patients who underwent primary repair and one who underwent resection developed a duodenal leak. All patients with grade 5 injury (n = 2) underwent pancreaticoduodenectomy.

Grade 1 and 2 duodenal hematomas can be managed non-operatively, while lacerations require operative repair. Outcomes may be better following resection in patients with grade 3 injury.
Grade 1 and 2 duodenal hematomas can be managed non-operatively, while lacerations require operative repair. Outcomes may be better following resection in patients with grade 3 injury.
Diffusion-weighted imaging (DWI) plays a crucial role in the diagnosis of ischemic stroke. We assessed the value of computed and acquired high b-value DWI in comparison with conventional
= 1000 s mm
DWI for ischemic stroke at 3T.

We included 36 patients with acute ischemic stroke who presented with diffusion abnormalities on DWI performed within 24 h of symptom onset. B-values of 0, 500, 1000 and 2000 s mm
were acquired. Synthetic images with b-values of 1000, 1500, 2000 and 2500 s mm
were computed. Two readers compared synthetic (syn) and acquired (acq)
= 2000 s mm
images with acquired
= 1000 s mm
images in terms of lesion detection rate, image quality, presence of uncertain hyperintensities and lesion conspicuity. Readers also selected their preferred b-value. Contrast ratio (CR) measurements were performed. Non-parametrical statistical tests and weighted Cohens' κ tests were computed.

Syn1000 and syn1500 matched acq1000 images in terms of lesion detection rate, image quality and presence of uncertain hyperintensities but presented with significantly improved lesion conspicuity (
< 0.01) and were frequently selected as preferred b-values. Acq2000 images exhibited a similar lesion detection rate and improved lesion conspicuity (
< 0.01) but worse image quality (
< 0.01) than acq1000 images. Syn2000 and syn2500 images performed significantly worse (
< 0.01) than acq1000 images in most or all categories. CR significantly increased with increasing b-values.

Synthetic images at
= 1000 and 1500 s mm
and acquired DWI images at
= 2000 s mm
may be of clinical value due to improved lesion conspicuity.

Synthetic b-values enable improved lesion conspicuity for DWI of ischemic stroke.
Synthetic b-values enable improved lesion conspicuity for DWI of ischemic stroke.The Covid-19 pandemic has provided challenges for surgical residency programs demanding fluid decision making focused on providing care for our patients, maintaining an educational environment, and protecting the well-being of our residents. This brief report summarizes the impact of the impact on our residency programs clinical care and education. We have identified opportunities to improve our program using videoconferencing, managing recruitment, and maintaining a satisfactory caseload to ensure the highest possible quality of surgical education.
Hope is a modifiable entity that can be augmented. We evaluated the feasibility, acceptability, and efficacy of a short intervention to increase hopefulness in patients with advanced breast cancer and oncologists.

We enrolled eligible participants to two cohorts one for patients with metastatic breast cancer and one for medical, radiation, or surgical oncologists. The intervention, a half-day hope enhancement workshop, included groups of 10-15 participants within each cohort. Participants in both cohorts completed preworkshop, postworkshop, and 3-month evaluations, which included the Adult Hope Scale (AHS), Herth Hope Index (HHI), and Patient-Reported Outcomes Measurement Information System-Global Health (PROMIS-GH) measures in patients, and the AHS, HHI, and a burnout self-assessment tool in physicians.

We consented 13 patients and 26 oncologists for participation in the workshop and 76.9% (n = 10) of consented patients and 100% (n = 26) of consented physicians participated. Postworkshop, all participad hopefulness in patients. Next steps should focus on confirming this effect in a randomized study and maintaining this effect in the postworkshop interval.
Investigations have demonstrated that trocar site hernia (TSH) is an under-appreciated complication of laparoscopic surgery, occurring in as many as 31%. We determined the incidence of fascial defects prior to laparoscopic appendectomy and its impact relative to other risk factors upon the development of TSH.

TSH was defined as a fascial separation of ≥ 1 cm in the abdominal wall umbilical region on abdominal computerized tomography scan (CT) following laparoscopic appendectomy. Patients admitted to our medical center who had both a preoperative CT and postoperative CT for any reason (greater than 30 days after surgery) were reviewed for the presence of TSH from May 2010 to December 2018. CT scans were measured for fascial defects, while investigators were blinded to film timing (preoperative or postoperative) and patient identity. Demographic information was collected.

241 patients undergoing laparoscopic appendectomy had both preoperative and late postoperative CT. TSH was identified in 49 (20.3%) patients. Mean preoperative fascial gap was 3.3 ± 4.3 mm in those not developing a postoperative hernia versus 14.8 ± 7.3 mm in those with a postoperative hernia (
< .0001). Preoperative fascial defect on CT was predictive of TSH (
< .001, OR = 1.44), with an Area Under the Curve (AUC) of .921 (95%CI .88-.92). Other major risk factors for TSH were age greater than 59 years (
< .031, OR = 2.48); and obesity, BMI > 30 (
< .012, OR = 2.14).

The incidence of trocar site hernia was one in five following laparoscopic appendectomy. The presence of a pre-existing fascial defect, advanced age, and obesity were strong predictors for the development of trocar site hernia.
The incidence of trocar site hernia was one in five following laparoscopic appendectomy. The presence of a pre-existing fascial defect, advanced age, and obesity were strong predictors for the development of trocar site hernia.
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