Publications by authors named "Pedro Teixeira"

369 Publications

A national trauma data bank analysis of large animal-related injuries.

Injury 2021 Mar 12. Epub 2021 Mar 12.

Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Trauma Services, 1500 Red River St, TX 78701, Austin. Electronic address:

Introduction: Large animal-related injuries (LARI) are relatively uncommon, but, nevertheless, a public hazard. The objective of this study was to better understand LARI injury patterns and outcomes.

Materials And Methods: We performed a retrospective review of the 2016 National Trauma Data Bank and used ICD-10 codes to identify patients injured by a large animal. The primary outcome was severe injury pattern, while secondary outcomes included mortality, hospital length of stay, ICU admission, and mechanical ventilation usage.

Results: There were 6,662 LARI included in our analysis. Most LARI (66%) occurred while riding the animal, and the most common type of LARI was fall from horse (63%). The median ISS was 9 and the most severe injuries (AIS ≥ 3) were to the chest (19%), head (10%), and lower extremities (10%). The overall mortality was low at 0.8%. Compared to non-riders, riders sustained more severe injuries to the chest (21% vs. 16%, p<0.001) and spine (4% vs. 2%, p<0.001). Compared to motor vehicle collisions (MVC), riders sustained fewer severe injuries to the head (10% vs. 12%, p<0.001) and lower extremity (10% vs. 12%, p=0.01). Compared to auto-pedestrian accidents, non-riders sustained fewer severe injuries to the head (11% vs. 19%, p<0.001) and lower extremity (10% vs. 20%, p<0.001).

Conclusion: Patients involved in a LARI are moderately injured with more complex injuries occurring in the chest, head, and lower extremities. Fall from horse was the most common LARI mechanism. Overall mortality was low. Compared to non-riders, riders were more likely to sustain severe injuries to the chest and spine. Severe injury patterns were similar when comparing riders to MVC and, given that most LARI are riding injuries, we recommend trauma teams approach LARI as they would an MVC.
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http://dx.doi.org/10.1016/j.injury.2021.03.020DOI Listing
March 2021

A safer placement technique for percutaneous dilatational tracheostomy.

Am J Surg 2021 Apr 2. Epub 2021 Apr 2.

Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, TX, 78712, USA. Electronic address:

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http://dx.doi.org/10.1016/j.amjsurg.2021.03.050DOI Listing
April 2021

Development of symptomatic inflammatory aneurysm treated with endovascular repair in COVID-19 infected patient.

J Vasc Surg Cases Innov Tech 2021 Mar 23. Epub 2021 Mar 23.

University of Texas at Austin Dell Medical School.

Sequelae and complications of COVID-19 infection continue to emerge during this pandemic era. While long term effects are continually being monitored and studied, we are seeing more acute and subacute medical complications requiring thorough discussion and sometimes adjustment of our standard care and intervention. In this report, we describe a case of an acute, symptomatic inflammatory vs mycotic abdominal aortic aneurysm in a COVID-19 positive patient undergoing urgent endovascular repair.
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http://dx.doi.org/10.1016/j.jvscit.2021.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985605PMC
March 2021

Solitary bone tumor imaging reporting and data system (BTI-RADS): initial assessment of a systematic imaging evaluation and comprehensive reporting method.

Eur Radiol 2021 Mar 25. Epub 2021 Mar 25.

Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy Cedex, France.

Objectives: Identify the most pertinent imaging features for solitary bone tumor characterization using a multimodality approach and propose a systematic evaluation system.

Methods: Data from a prospective trial, including 230 participants with histologically confirmed bone tumors, typical "do not touch" lesions, and stable chondral lesions, were retrospectively evaluated. Clinical data, CT, and MR imaging features were analyzed by a musculoskeletal radiologist blinded to the diagnosis using a structured report. The benign-malignant distribution of lesions bearing each image feature evaluated was compared to the benign-malignant distribution in the study sample. Benign and malignant indicators were identified. Two additional readers with different expertise levels independently evaluated the study sample.

Results: The sample included 140 men and 90 women (mean age 40.7 ± 18.3 years). The global benign-malignant distribution was 67-33%. Seven imaging features reached the criteria for benign indicators with a mean frequency of benignancy of 94%. Six minor malignant indicators were identified with a mean frequency of malignancy of 60.5%. Finally, three major malignant indicators were identified (Lodwick-Madewell grade III, aggressive periosteal reaction, and suspected metastatic disease) with a mean frequency of malignancy of 82.4%. A bone tumor imaging reporting and data system (BTI-RADS) was proposed. The reproducibility of the BTI-RADS was considered fair (kappa = 0.67) with a mean frequency of malignancy in classes I, II, III, and IV of 0%, 2.2%, 20.1%, and 71%, respectively.

Conclusion: BTI-RADS is an evidence-based systematic approach to solitary bone tumor characterization with a fair reproducibility, allowing lesion stratification in classes of increasing malignancy frequency.

Trial Registration: Clinical trial number NCT02895633 .

Key Points: • The most pertinent CT and MRI criteria allowing bone tumor characterization were defined and presented. • Lodwick-Madewell grade III, aggressive periosteal reaction, and suspected metastatic disease should be considered major malignant indicators associated with a frequency of malignancy over 75%. • The proposed evidence-based multimodality reporting system stratifies solitary bone tumors in classes with increasing frequencies of malignancy.
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http://dx.doi.org/10.1007/s00330-021-07745-9DOI Listing
March 2021

Chest and Pelvis X-Rays as a Screening Tool for Abdominal Injury in Geriatric Blunt Trauma Patients.

Am Surg 2021 Mar 11:3134821998665. Epub 2021 Mar 11.

Dell Medical School at the University of Texas, Austin, TX, USA.

Background: This study evaluates the utility of chest (CXR) and pelvis (PXR) X-ray, as adjuncts to the primary survey, in screening geriatric blunt trauma (GBT) patients for abdominal injury or need for laparotomy.

Methods: We performed a retrospective analysis of patients 65-89 years in the 2014 National Trauma Data Bank. X-ray injuries were identified by ICD9 codes and defined as any injury felt to be readily detectable by a non-radiologist. X-ray findings were dichotomized as "both negative" (no injury presumptively apparent on CXR or PXR) or "either positive" (any injury presumptively apparent on CXR or PXR). Rates of abdominal injuries and laparotomy were compared and used to calculate sensitivity and specificity. The primary outcomes were abdominal injury and laparotomy. The secondary outcomes included mortality, ventilator days, and hospital days.

Results: A total of 202 553 patients met criteria. Overall, 9% of patients with either positive X-rays had abdominal injury and 2% laparotomy vs. 1.1% and .3% with both negative ( < .001). The specificity for any positive X-ray was 79% for abdominal injury and 78% for laparotomy. The sensitivity was 69% for abdominal injury and laparotomy. The either positive group had fewer ventilator days (.3 vs. .8, < .0001), longer length of stay (7 vs. 5, < .0001), and higher mortality (6% vs. 4%, < .0001) vs both negative.

Conclusion: CXR and PXR can be used to assess for intra-abdominal injury and need for laparotomy. GBT patients with either positive X-rays should continue workup regardless of mechanism due to the high specificity of this tool for abdominal injury and need for laparotomy.
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http://dx.doi.org/10.1177/0003134821998665DOI Listing
March 2021

Likelihood of injury due to vasovagal syncope: a systematic review and meta-analysis.

Europace 2021 Mar 8. Epub 2021 Mar 8.

Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.

Aims: Vasovagal syncope (VVS) is the most common type of syncope and is usually considered a benign disorder. The potential for injury is worrisome but the likelihood is unknown. We aimed to determine the proportion of patients injured due to VVS.

Methods And Results: A systematic search of studies published until August 2020 was performed in multiple medical and nursing databases. Included studies had data on the proportion of patients with injury due to VVS prior to study enrolment. Random effects methods were used. Twenty-three studies having 3593 patients met inclusion criteria. Patients were diagnosed clinically with VVS, and 82% had >2 syncopal episodes before enrolment. Tilt test was positive in 60% and 14 studies reported comorbidities (32.6% hypertensive). The weighted mean injury rate was 33.5% [95% confidence interval (CI): 27.3-40.5%]. The likelihood of injury correlated with population age (r = 0.4, P = 0.05), but not with sex, positive tilt test, or hypertension. The injury rates were 25.7% (95% CI: 19.1-32.8%) in studies with younger patients (mean age ≤50 years, n = 1803) and 43.4% (95% CI: 34.9-52.3%) in studies with older patients (P = 0.002). Nine studies reported major injuries; with a weighted mean rate of major injuries of 13.9% (95% CI: 9.5-19.8%).

Conclusion : Injuries due to syncope are frequent, occurring in 33% of patients with VVS. The risk of major injuries is substantial. Older patients are at higher risk. Clinicians should be aware of the risk of injuries when providing care and advice to patients with VVS.
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http://dx.doi.org/10.1093/europace/euab041DOI Listing
March 2021

Intra-abdominal resection of the umbilical vein and urachus of bovine fetuses using laparoscopy and celiotomy: surgical time and feasibility (cadaveric study).

Sci Rep 2021 Mar 5;11(1):5328. Epub 2021 Mar 5.

Institute of Veterinary Medicine, Federal University of Pará (UFPA), Castanhal Campus, Castanhal, Pará, Brazil.

Surgical intervention for umbilical diseases in calves, when indicated, is a complementary and indispensable therapeutic resource for the treatment of umbilical conditions and is commonly performed using celiotomy. However, laparoscopy has demonstrated feasibility in many diagnostic and therapeutic procedures. The aim of this study was to assess the feasibility of the techniques and the surgical time of laparoscopy and celiotomy used in intra-abdominal resection of the umbilical vein and urachus of bovine fetuses (cadavers). Resection of the umbilical vein and urachus using laparoscopy and celiotomy was performed in 26 anatomical specimens (bovine fetuses obtained from an official slaughterhouse). Resection of umbilical structures was feasible with both techniques, but shorter surgical time and minimal tissue damage were achieved using laparoscopy. Laparoscopy requires specialized training and appropriate instruments and is an important tool for diagnostic and therapeutic exploration of the umbilical structures, liver, bladder, and associated/adjacent structures.
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http://dx.doi.org/10.1038/s41598-021-84621-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935971PMC
March 2021

The H2020 "NoHoW Project": A Position Statement on Behavioural Approaches to Longer-Term Weight Management.

Obes Facts 2021 Mar 4:1-13. Epub 2021 Mar 4.

Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.

There is substantial evidence documenting the effects of behavioural interventions on weight loss (WL). However, behavioural approaches to initial WL are followed by some degree of longer-term weight regain, and large trials focusing on evidence-based approaches to weight loss maintenance (WLM) have generally only demonstrated small beneficial effects. The current state-of-the-art in behavioural interventions for WL and WLM raises questions of (i) how we define the relationship between WL and WLM, (ii) how energy balance (EB) systems respond to WL and influence behaviours that primarily drive weight regain, (iii) how intervention content, mode of delivery and intensity should be targeted to keep weight off, (iv) which mechanisms of action in complex interventions may prevent weight regain and (v) how to design studies and interventions to maximise effective longer-term weight management. In considering these issues a writing team within the NoHoW Consortium was convened to elaborate a position statement, and behaviour change and obesity experts were invited to discuss these positions and to refine them. At present the evidence suggests that developing the skills to self-manage EB behaviours leads to more effective WLM. However, the effects of behaviour change interventions for WL and WLM are still relatively modest and our understanding of the factors that disrupt and undermine self-management of eating and physical activity is limited. These factors include physiological resistance to weight loss, gradual compensatory changes in eating and physical activity and reactive processes related to stress, emotions, rewards and desires that meet psychological needs. Better matching of evidence-based intervention content to quantitatively tracked EB behaviours and the specific needs of individuals may improve outcomes. Improving objective longitudinal tracking of energy intake and energy expenditure over time would provide a quantitative framework in which to understand the dynamics of behaviour change, mechanisms of action of behaviour change interventions and user engagement with intervention components to potentially improve weight management intervention design and evaluation.
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http://dx.doi.org/10.1159/000513042DOI Listing
March 2021

Development and cross-cultural validation of the Goal Content for Weight Maintenance Scale (GCWMS).

Eat Weight Disord 2021 Mar 1. Epub 2021 Mar 1.

Applied Psychology Research Center Capabilities & Inclusion (APPsyCI), ISPA - Instituto Universitário, Lisboa, Portugal.

Purpose: Long-term weight management requires sustained engagement with energy-balance-related behaviours. According to self-determination theory, behaviour goals can support or undermine motivation depending on the quality of their content (i.e., extrinsic and intrinsic motivation). This study aimed to develop and validate the goal content for weight loss maintenance scale (GCWMS).

Methods: The GCWMS was administered to 1511 participants who had achieved clinically significant weight losses and were taking part in a large weight loss maintenance study: the NoHoW Trial (ISRCTN88405328). The scale derived from two well-established questionnaires regarding exercise goals. Construct validity was examined for 4 theory-driven domains: Health Management, Challenge, Image, and Social Recognition. Split-sample confirmatory factor analysis was conducted to test the factorial validity and multi-group measurement invariance (configural, metric, scalar, and residual invariance). The reliability estimates were also assessed, and discriminant validity was evaluated using 2 conceptually related questionnaires.

Results: The first analysis showed a poor fit of the original factorial structure. Subsequent investigation with a new specified model indicated close fit to the data after removal of 3 items χ(58) = 599.982; p < .001; χ/df = 10.345; CFI = 0.940; GFI = 0.941; SRMR = 0.063; RMSEA = 0.079 (LL = 0.073; UL = .084). Good internal consistency was achieved in all subscales (α > .775), convergent and divergent validity were verified through associations with other theoretical related constructs. Findings from multi-group invariance test demonstrated that the specified model of GCWMS achieved full measurement invariance for gender but did not support residual invariance across countries.

Conclusion: Findings support the hypothesised four-dimension structure of the GCWMS, confirming reliability and multi-group invariance in factor structure. Analysis also supports valid group means comparisons on latent factors at gender and at cross-cultural level. Ways to improve the quality of the scale are discussed.

Level Of Evidence: Level V, cross-sectional descriptive.
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http://dx.doi.org/10.1007/s40519-021-01148-xDOI Listing
March 2021

Risk scoring models fail to predict pulmonary embolism in trauma patients.

Am J Surg 2021 Feb 11. Epub 2021 Feb 11.

Department of Surgery and Perioperative Care, Dell Seton Medical Center at the University of Texas, 1500 Red River St, Austin, TX, 78701, USA. Electronic address:

Background: We aimed to identify risk factors and risk scoring models to help identify post-traumatic pulmonary embolisms (PE).

Methods: We performed a retrospective review (2014-2019) of all adult trauma patients admitted to our Level I trauma center that received a CT pulmonary angiogram (CTPA) for a suspected PE. A systematic literature search found eleven risk scoring models, all of which were applied to these patients. Scores of patients with and without PE were compared.

Results: Of the 235 trauma patients that received CTPA, 31 (13%) showed a PE. No risk scoring model had both a sensitivity and specificity above 90%. The Wells Score had the highest area under the curve (0.65). After logistic regression, no risk scoring model variables were independently associated with PE.

Conclusions: In trauma patients with clinically suspected PE, clinical variables and current risk scoring models do not adequately differentiate patients with and without PE.
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http://dx.doi.org/10.1016/j.amjsurg.2021.02.007DOI Listing
February 2021

Pain Management in Patients With Kidney Disease-A Nephrologist and Dialysis Care Team Responsibility: KDOQI Controversies Series.

Kidney Med 2021 Jan-Feb;3(1):6-8. Epub 2020 Nov 25.

Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM.

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http://dx.doi.org/10.1016/j.xkme.2020.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873818PMC
November 2020

Running prevalence in Portugal: Socio-demographic, behavioral and psychosocial characteristics.

PLoS One 2021 22;16(1):e0245242. Epub 2021 Jan 22.

Centro Interdisciplinar para o Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada-Dafundo, Portugal.

The purpose of this study was to cross-sectionally estimate the prevalence of recreational running in Portugal and describe characteristics of adult recreational runners. A random representative sample of 1068 Portuguese adults was selected. Socio-demographic information, physical activity habits and running behavior were assessed. Recreational runners' training habits, motivations, barriers, vitality and flow were also assessed. The prevalence of recreational running in Portugal was 10.6%. It was higher in men (14.6% vs. 6.6%, p = .024) and in younger runners (13.6% vs. 7.7%, p = .026). Participants ran on average 3 times, 20 kilometers and 3 hours per week. General health orientation (88%), self-esteem (63%), and life meaning (57%) were the most predominant motives for running, while time was the most prevalent barrier (43%). This first Portuguese running prevalence representative study, indicates that almost 11% of adults ran regularly, and describes correlates of running, which can inform future running promotion interventions.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245242PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822295PMC
January 2021

Valve-in-Valve Transcatheter Aortic Valve Implantation Using Fluoroscopic Guidance for Late Failure of the Bioprosthetic Bentall Conduit BioValsalva™ Vascutek.

Cureus 2020 Dec 10;12(12):e12006. Epub 2020 Dec 10.

Cardiology, Centro Hospitalar de Vila Nova de Gaia / Espinho, Vila Nova de Gaia, PRT.

We describe one of the first-in-human cases of valve-in-valve transcatheter aortic valve implantation (TAVI) using fluoroscopic-only guidance for the treatment of late failure of a bio-prosthetic Bentall conduit, the BioValsalva™ Vascutek (Vascutek Terumo, Renfrewshire, Scotland), using a self-expandable heart valve prosthesis (CoreValve™Evolut™ R, Medtronic, Dublin Ireland).
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http://dx.doi.org/10.7759/cureus.12006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793471PMC
December 2020

Ultrasonography-guided oocyte recovery in owl monkeys (aotus azarai infulatus).

J Med Primatol 2021 Apr 12;50(2):134-137. Epub 2021 Jan 12.

Institute for Animal Health and Production, Federal Rural University of Amazônia - UFRA, Belém, Brazil.

The study evaluated an echo-guided oocyte recovery technique in owl monkeys. Twelve females were selected for the transabdominal ovum retrieval technique. This procedure collected twenty-six follicles, of which nine oocytes were recovered, without harm to the animals. The technique is feasible and is a minimally invasive protocol for neotropical primates.
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http://dx.doi.org/10.1111/jmp.12509DOI Listing
April 2021

Long-term outcomes after radiofrequency catheter ablation of the atrioventricular node: The experience of a Portuguese tertiary center.

Rev Port Cardiol 2021 Feb 6;40(2):95-103. Epub 2021 Jan 6.

Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal.

Introduction: In patients with supraventricular arrhythmias and high ventricular rate, unresponsive to rate and rhythm control therapy or catheter ablation, atrioventricular (AV) node ablation may be performed.

Objectives: To assess long-term outcomes after AV node ablation and to analyze predictors of adverse events.

Methods: We performed a detailed retrospective analysis of all patients who underwent AV node ablation between February 1997 and February 2019, in a single Portuguese tertiary center.

Results: A total of 123 patients, mean age 69±9 years and 52% male, underwent AV node ablation. Most of them presented atrial fibrillation at baseline (65%). During a median follow-up of 8.5 years (interquartile range 3.8-11.8), patients improved heart failure (HF) functional class (NYHA class III-IV 46% versus 13%, p=0.001), and there were reductions in hospitalizations due to HF (0.98±1.3 versus 0.28±0.8, p=0.001) and emergency department (ED) visits (1.1±1 versus 0.17±0.7, p=0.0001). There were no device-related complications. Despite permanent pacemaker stimulation, left ventricular ejection fraction did not worsen (47±13% vs. 47%±12, p=0.63). Twenty-eight patients died (23%). The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome (OR 1.8, 95% CI 1.24-2.61, p=0.002).

Conclusions: Despite pacemaker dependency, the clinical benefit of AV node ablation persisted at long-term follow-up. The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome. AV node ablation should probably be considered earlier in the treatment of patients with supraventricular arrhythmias and HF, especially in cases that are unsuitable for selective ablation of the specific arrhythmia.
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http://dx.doi.org/10.1016/j.repc.2020.05.016DOI Listing
February 2021

Corrigendum to "Fatal crashes in the 5 years after recreational marijuana legalization in Colorado and Washington" [Accid. Anal. Prev. 132 (2019) 105284].

Accid Anal Prev 2021 Mar 24;151:105757. Epub 2020 Dec 24.

Division of Emergency Medicine, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas Austin, 1400 N IH35, Suite 2.230, Austin, TX, 78701, USA. Electronic address:

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http://dx.doi.org/10.1016/j.aap.2020.105757DOI Listing
March 2021

A Prospective Study of Family Satisfaction Changes After Tracheostomy Placement in Trauma Patients.

Am Surg 2020 Dec 9:3134820954831. Epub 2020 Dec 9.

Dell Medical School, The University of Texas, Austin, USA.

Background: Tracheostomy is a commonly performed procedure in surgical intensive care units. Although the indications and benefits of this procedure are well known, little has been studied in the adult surgical/trauma population about patient family satisfaction after tracheostomy placement.

Materials And Methods: We performed a prospective study at our academic level I trauma center from 2015-2016 in patients who underwent elective tracheostomy. Family members were asked to complete an eight-point questionnaire using a forced Likert scale of graded responses. Questionnaires were administered prior to tracheostomy and again at 24-and 72-hour post-tracheostomy placement. Responses were compared using univariate analysis.

Results: A total of 26 family members completed all 3 surveys. Family members believed loved ones appeared more comfortable, were more interactive, and were better progressing clinically. After 72 hours, family members felt less anxiety. There was no difference in perceptions of patient distress, ability to provide support, or their worry about scars, or comfort in visiting them.

Discussion: Family members believed tracheostomies provided greater patient comfort, increased interactive abilities, better progress in their care, and experienced less anxiety after placement. Family satisfaction may therefore be an additional benefit in support of earlier tracheostomy.
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http://dx.doi.org/10.1177/0003134820954831DOI Listing
December 2020

[Risk Communication and Community Engagement in the COVID-19 Pandemic in Portugal].

Acta Med Port 2021 Jan 3;34(1):1-2. Epub 2020 Dec 3.

Unidade de Saúde Pública Entre Douro e Vouga I. Administração Regional de Saúde do Norte. Porto. Instituto de Saúde Pública. Universidade do Porto. Porto. Portugal.

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http://dx.doi.org/10.20344/amp.15145DOI Listing
January 2021

Aborted Sudden Cardiac Death in a Young Adult: An Exceptionally Rare Cause.

Cureus 2020 Oct 18;12(10):e11013. Epub 2020 Oct 18.

Cardiology, Centro Hospitalar Vila Nova De Gaia, Vila Nova de Gaia, PRT.

Out-of-hospital cardiac arrest has an underlying cardiac cause in the vast majority of adult patients, most frequently related to an acute manifestation of atherosclerotic coronary artery disease. Nonetheless, it represents a relatively uncommon event in young adults and athletes, and a thorough investigation of less frequent causes is warranted in this subset. Anomalous origin of a coronary artery is an important, under-recognized, cause of sudden cardiac death in young patients and athletes. Anomalous left coronary artery from pulmonary artery (ALCAPA) is an exceptionally rare variant of these congenital coronary artery origin and/or trajectory anomalies. This case reports the association of ALCAPA with sudden cardiac death in a young patient and highlights some important diagnostic and therapeutic challenges.
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http://dx.doi.org/10.7759/cureus.11013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671081PMC
October 2020

Late gadolinium enhancement location assessed by magnetic resonance and arrhythmogenic risk in hypertrophic cardiomyopathy.

Rev Port Cardiol 2020 11 7;39(11):615-621. Epub 2020 Nov 7.

Department of Cardiology, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal.

Introduction And Objectives: Late gadolinium enhancement (LGE) extent has emerged as a predictor of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM), however little is known about the arrhythmogenic relevance of its specific location in the left ventricle. Our aim was to analyze the influence of LGE location on the occurrence of ventricular arrhythmias (VA) and SCD in patients with HCM.

Methods: We performed a retrospective analysis of clinical and Holter records of HCM patients who underwent cardiac magnetic resonance at our center. LGE extent and distribution were assessed using the American Heart Association 17-segment model. VA was defined as non-sustained or sustained ventricular tachycardia, ventricular fibrillation or SCD.

Results: Sixty-one patients (age 57.0±16.7 years) were included and VA occurred in 24.6% (n=15). Patients with VA showed greater LGE extent than those without (7.40±5.3 vs. 3.52±3.0 segments, p=0.007). Analyzing the distribution of LGE, a set of arrhythmogenic segments (apex/basal inferior/basal anterolateral/mid inferoseptal) was found. The extent of LGE involvement in these segments was also greater in patients with VA (2.07±1.03 vs. 0.65±0.71 segments, p<0.001; area under the curve 0.861 for VA) and this difference remained significant after adjustment for potentially confounding variables.

Conclusions: The extent of LGE involvement of a set of segments with an apparent relation to cardiac areas of increased mechanical stress was significantly and independently associated with the occurrence of VA, suggesting that not only the extent but also the location of LGE is important for the assessment of SCD risk in HCM patients.
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http://dx.doi.org/10.1016/j.repc.2019.12.009DOI Listing
November 2020

"Follow the Whistle: Physical Activity Is Calling You": Evaluation of Implementation and Impact of a Portuguese Nationwide Mass Media Campaign to Promote Physical Activity.

Int J Environ Res Public Health 2020 11 2;17(21). Epub 2020 Nov 2.

School of Public Health and Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia.

To raise perceived capability (C), opportunity (O) and motivation (M) for physical activity (PA) behaviour (B) among adults, the Portuguese Directorate-General of Health developed a mass media campaign named "Follow the Whistle", based on behaviour change theory and social marketing principles. Comprehensive formative and process evaluation suggests this media-led campaign used best-practice principles. The campaign adopted a population-wide approach, had clear behavioural goals, and clear multi-strategy implementation. We assessed campaign awareness and initial impact using pre ( = 878, 57% women) and post-campaign ( = 1319, 58% women) independent adult population samples via an online questionnaire, comprising socio-demographic factors, campaign awareness and recall, and psychosocial and behavioural measures linked to the COM-B model. PA was assessed with IPAQ and the Activity Choice Index. The post-campaign recall was typical of levels following national campaigns (24%). Post-campaign measures were higher for key theory-based targets (all < 0.05), namely self-efficacy, perceived opportunities to be more active and intrinsic motivation. The impact on social norms and self-efficacy was moderated by campaign awareness. Concerning PA, effects were found for vigorous activity ( < 0.01), but not for incidental activity. Overall the campaign impacted key theory-based intermediate outcomes, but did not influence incidental activity, which highlights the need for sustained and repeated campaign efforts.
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http://dx.doi.org/10.3390/ijerph17218062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663013PMC
November 2020

Does preoperative magnetic resonance imaging alter the surgical plan in patients with acute traumatic cervical spinal cord injury?

J Trauma Acute Care Surg 2021 01;90(1):157-162

From the Department of Surgery and Perioperative Care (F.R.B., V.Y.W., J.P.A., J.R.O.-B., L.H.B., P.G.T., J.D.A., E.L., S.A.), Dell Medical School, and Trauma Services, Dell Seton Medical Center (C.V.R.B.), University of Texas at Austin, Austin, Texas.

Background: Whether magnetic resonance imaging (MRI) adds value to surgical planning for patients with acute traumatic cervical spinal cord injury (ATCSCI) remains controversial. In this study, we compared surgeons' operative planning decisions with and without preoperative MRI. We had two hypotheses: (1) the surgical plan for ATCSCI would not change substantially after the MRI and (2) intersurgeon agreement on the surgical plan would also not change substantially after the MRI.

Methods: We performed a vignette-based survey study that included a retrospective review of all adult trauma patients who presented to our American College of Surgeons-verified level 1 trauma center from 2010 to 2019 with signs of acute quadriplegia and underwent computed tomography (CT), MRI, and subsequent cervical spine surgery within 48 hours of admission. We abstracted patient demographics, admission physiology, and injury details. Patient clinical scenarios were presented to three spine surgeons, first with only the CT and then, a minimum of 2 weeks later, with both the CT and MRI. At each presentation, the surgeons identified their surgical plan, which included timing (none, <8, <24, >24 hours), approach (anterior, posterior, circumferential), and targeted vertebral levels. The outcomes were change in surgical plan and intersurgeon agreement. We used Fleiss' kappa (κ) to measure intersurgeon agreement.

Results: Twenty-nine patients met the criteria and were included. Ninety-three percent of the surgical plans were changed after the MRI. Intersurgeon agreement was "slight" to "fair" both before the MRI (timing, κ = 0.22; approach, κ = 0.35; levels, κ = 0.13) and after the MRI (timing, κ = 0.06; approach, κ = 0.27; levels, κ = 0.10).

Conclusion: Surgical plans for ATCSCI changed substantially when the MRI was presented in addition to the CT; however, intersurgeon agreement regarding the surgical plan was low and not improved by the addition of the MRI.

Level Of Evidence: Diagnostic, level II.
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http://dx.doi.org/10.1097/TA.0000000000002962DOI Listing
January 2021

Fix it while you can … Mortality after umbilical hernia repair in cirrhotic patients.

Am J Surg 2020 12 1;220(6):1402-1404. Epub 2020 Sep 1.

Dept of Surgery and Perioperative Care, Dell Seton Medical Center at Univ of Texas at Austin, 1500 Red River St Suite G, Austin, Tx, 78701, USA.

Background: We hypothesize that patients with compensated cirrhosis undergoing elective UHR have an improved mortality compared to those undergoing emergent UHR.

Method: The NIS was queried for patients undergoing UHR by CPT code, and ICD-10 codes were used to define separate patient categories of non-cirrhosis (NC), compensated cirrhosis (CC) and decompensated cirrhosis (DC).

Results: A total of 32,526 patients underwent UHR, 97% no cirrhosis, 1.1% compensated cirrhosis, 1.7% decompensated cirrhosis. On logistic regression, cirrhosis was found to be independently associated with mortality (OR 2.841, CI 2.14-3.77). On subset analysis of only cirrhosis patients, elective repair was found to be protective from mortality (OR 0.361, CI 0.15-0.87, p = 0.02).

Conclusions: In this retrospective review, cirrhosis as well as emergent UHR in cirrhotic patients were independently associated with mortality. More specifically, electively (rather than emergently) repairing an umbilical hernia in cirrhotic patients was independently associated with a 64% reduction in mortality.
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http://dx.doi.org/10.1016/j.amjsurg.2020.08.022DOI Listing
December 2020

A mitochondrial prolyl aminopeptidase PAP2 releases N-terminal proline and regulates proline homeostasis during stress response.

Plant J 2020 12 10;104(5):1182-1194. Epub 2020 Oct 10.

School of Molecular Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia.

Most mitochondrial proteins are synthesised in the cytosol and targeted into the organelle via N-terminal targeting peptides that are cleaved upon import. The free targeting peptide is subsequently processed in a stepwise manner, with single amino acids released as final products. Here, we have characterised a proline-cleaving aminopeptidase in Arabidopsis thaliana, prolyl aminopeptidase-2 (PAP2, At3g61540). Activity assays show that PAP2 has a preferred activity to hydrolyse N-terminal proline. Protein localisation studies revealed that PAP2 is exclusively targeted to mitochondria. Characterisation of pap2 mutants show defective pollen, enhanced dark-induced senescence and increased susceptibility to abiotic stresses, which are likely attributed to a reduced level of accumulated free proline. Taken together, these results demonstrate the role of PAP2 in proline cleavage from mitochondrial peptides and proline homeostasis, which is required for the development of male gametophyte, tolerance to abiotic stresses, and leaf senescence.
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http://dx.doi.org/10.1111/tpj.14987DOI Listing
December 2020

Risk Factors for Failure of Splenic Angioembolization: A Multicenter Study of Level I Trauma Centers.

J Surg Res 2021 01 26;257:227-231. Epub 2020 Aug 26.

Department of Surgery and Perioperative Care, Dell Seton Medical Center at the University of Texas at Austin, Austin, Texas.

Background: Angioembolization (AE) is an adjunct to nonoperative management (NOM) of splenic injuries. We hypothesize that failure of AE is associated with blood transfusion, grade of injury, and technique of AE.

Methods: We performed a retrospective (2010-2017) multicenter study (nine Level I trauma centers) of adult trauma patients with splenic injuries who underwent splenic AE. Variables included patient physiology, injury grade, transfusion requirement, and embolization technique. The primary outcome was NOM failure requiring splenectomy. Secondary outcomes were mortality, complications, and length of stay.

Results: A total of 409 patients met inclusion criteria; only 33 patients (8%) required delayed splenectomy. Patients who failed received more blood in the first 24 h (P = 0.009) and more often received massive transfusion (P = 0.01). There was no difference in failure rates for grade of injury, contrast blush on computed tomography, and branch embolized. After logistic regression, transfusion in the first 24 h was independently associated with failure of NOM (P = 0.02). Patients who failed NOM had more complications (P = 0.002) and spent more days in the intensive care unit (P < 0.0001), on the ventilator (P = 0.0001), and in the hospital (P < 0.0001). Patients who failed NOM had a higher mortality (15% versus 3%, P = 0.007), and delayed splenectomy was independently associated with mortality (odds ratio, 4.2; 95% confidence interval, 1.2-14.7; P = 0.03).

Conclusions: AE for splenic injury leads to effective NOM in 92% of patients. Transfusion in the first 24 h is independently associated with failure of NOM. Patients who required a delayed splenectomy suffered more complications and had higher hospital length of stay. Failure of NOM is independently associated with a fourfold increase in mortality.
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http://dx.doi.org/10.1016/j.jss.2020.07.058DOI Listing
January 2021

The effects of transcatheter aortic valve implantation on cardiac electrical properties.

Rev Port Cardiol 2020 Aug 6;39(8):431-440. Epub 2020 Aug 6.

Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal; Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal.

Introduction: Transcatheter aortic valve implantation (TAVI) is associated with cardiac electrical disturbances. However, beyond the risks of pacemaker implantation, few studies have performed a detailed assessment of the effects of TAVI on several cardiac electrical properties.

Objectives: To assess the frequency and type of electrocardiographic disturbances following TAVI, according to the type of prostheses and to assess predictors of these disturbances.

Methods: We performed a detailed retrospective analysis of all electrocardiograms in patients who underwent TAVI, before and after the procedure, at a tertiary center from August 2007 to October 2016. Patients with permanent pacemakers were excluded.

Results: We included 182 patients (78±8 years; 56% female) and self-expanding prostheses (SEP) were implanted in 54%. Most patients (80%) were in sinus rhythm at baseline. After TAVI, 21% of patients developed new-onset atrial fibrillation and there was a significant increase in PR interval at discharge (186±41 ms vs. 176±32; p=0.003), which was not maintained after at six-month follow-up (181±35 ms, p=0.06). There was also a significant increase in QRS duration at discharge (129±28 ms vs. 114±25 at baseline p<0.0001), which persisted at six-months (122±28 ms, p<0.0001). New-onset left-bundle branch block (LBBB) was observed in 25% of patients. The depth of valve implantation was a predictor of new LBBB at discharge after multivariate analysis (OR 37.6, 95% CI 14.6-65.2, p=0.001).

Conclusions: The main electrocardiographic disturbances post TAVI were PR prolongation, increased QRS and new-onset LBBB. These disturbances were more pronounced in patients undergoing SEP implantation and tended to improve at six-month follow-up. The depth of valve implantation was a predictor of conduction disturbances.
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http://dx.doi.org/10.1016/j.repc.2020.02.011DOI Listing
August 2020

Evaluation of Dorsal Subluxation of the Scaphoid in Patients With Scapholunate Ligament Tears: A 4D CT Study.

AJR Am J Roentgenol 2021 01 19;216(1):141-149. Epub 2020 Nov 19.

Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 ave du Maréchal de Lattre de Tassigny, 54035 Nancy Cedex, France.

The purpose of this study was to evaluate the variation of the posterior radioscaphoid (RS) angle in patients with and without scapholunate ligament (SLL) tears during wrist radioulnar deviation. Seventy-three patients with clinically suspected scapholunate instability were prospectively evaluated with 4D CT and CT arthrography from February 2015 to April 2018. The posterior RS angle is formed between the articular surface of the scaphoid fossa of the radius and the most posterior point of the scaphoid in the sagittal plane. Two independent radiologists calculated this angle during radioulnar deviation. Posterior RS angles were correlated with the SLL status and the presence of a scapholunate diastasis on conventional stress radiographs. Readers 1 and 2 found mean posterior RS angles of 99° and 98°, respectively, in patients without and 107° and 111°, respectively, in patients with a scapholunate diastasis. The posterior RS angle amplitude varied 7.6-9.3° in the subgroups studied. The reproducibility of posterior RS angle measurement was considered good (intraclass correlation coefficient, 0.73). Mean posterior RS angles increased 6-10% and 12-14% when patients with an intact SLL were compared with those with partial tears and full tears, respectively ( < 0.001). These values also increased 8-13% when patients with diastasis were compared with those without ( < 0.0001). A dynamic acquisition was not necessary to assess this angle, with neutral posterior RS angles yielding a sensitivity of 64% and 72% and specificity of 79% and 94% for the diagnosis of SLL tears by readers 1 and 2, respectively. Posterior RS angle tended to increase with the severity of SLL tears and with the presence of scapholunate instability and yielded high sensitivity and specificity for the detection of SLL tears.
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http://dx.doi.org/10.2214/AJR.20.22855DOI Listing
January 2021

Vaccination Practices in Trauma Patients Undergoing Splenic Artery Embolization : A Split Practice.

Am Surg 2020 Sep 4;86(9):1202-1204. Epub 2020 Aug 4.

Department of Surgery and Perioperative Care, University of Texas at Austin-Dell Medical School, Austin, TX, USA.

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http://dx.doi.org/10.1177/0003134820942176DOI Listing
September 2020

Publisher Correction: Neck circumference is associated with adipose tissue content in thigh skeletal muscle in overweight and obese premenopausal women.

Sci Rep 2020 Jul 16;10(1):12013. Epub 2020 Jul 16.

Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1495-688, Cruz Quebrada, Portugal.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41598-020-69150-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366931PMC
July 2020