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This study aimed to describe progressive evidence-based changes in perioperative management of open preperitoneal ventral hernia repair and subsequent surgical outcomes and to analyze factors that affect recurrence and wound complications.Prospective, tertiary hernia center data (2004-2021) were examined for patients undergoing midline open preperitoneal ventral hernia repair with mesh. "Early" (2004-2012) and "Recent" (2013-2021) groups were based on surgery date.Comparison of Early (n = 675) versus Recent (n = 1,167) groups showed that Recent patients were, on average, older (56.9 ± 12.6 vs 58.7 ± 12.1 years; P.001) with a lower body mass index (33.5 ± 8.3 vs 32.0 ± 6.8 kg/mDespite significant increased patient complexity over time, detecting and implementing best practices as determined by recurring data analysis of a center's outcomes has significantly improved patient care results.

The co-morbidities and long-term complications of spontaneous coronary artery dissection (SCAD) are incompletely understood. This study investigated the association of atrial arrhythmias (AA), defined as atrial fibrillation and atrial flutter, with SCAD in a patient registry and population-based cohort. This observational study was performed in 2 parts. The first was a retrospective study reviewing patients diagnosed with AA in the Mayo Clinic SCAD Registry. The second was a population-based, case-control study to assess AA in patients with SCAD compared with age- and gender-matched controls. Of 1,214 patients in the Mayo Clinic SCAD Registry, 45 patients (3.7%) with SCAD were identified with an AA. A total of 8 of those patients (17.8%) had a pre-SCAD AA; 20 (44.4%) had a peri-SCAD AA; and 17 (37.8%) had a post-SCAD AA. The univariate analysis did not reveal significant associations with traditional cardiovascular risk factors. In the population-based cohort, 5 patients with SCAD (4%) and 4 controls (1%) developed an AA before the date of SCAD for each patient (odds ratio 4.5, 95% confidence interval [CI] 1.05 to 19.0, p = 0.04). A total of 5 patients with SCAD (4%) and 3 controls (1%) developed an AA in the 10 years after SCAD (hazard ratio 6.3, 95% CI 1.2 to 32.8, p = 0.03). A subgroup of patients with SCAD experienced AA before and after SCAD. Patients with a history of SCAD were more likely to develop AA in the next 10 years than were age- and gender-matched healthy controls.

OBJECTIVE To compare results of simulator-based versus traditional training of medical students in direct ophthalmoscopy. DESIGN Randomized controlled trial. METHODS First-year medical student-volunteers completed 1 hour of didactic instruction regarding direct ophthalmoscopes, fundus anatomy, and signs of disease. Students were randomized to an additional hour of training on a direct ophthalmoscope simulator (n=17) or supervised practice examining classmates (traditional method, n=16). After 1 week of independent student practice using assigned training methods, masked ophthalmologist-observers assessed student ophthalmoscopy skills (technique, efficiency, global performance) during examination of five patient-volunteers, using 5-point Likert scales. Students recorded findings and lesion location for each patient. Two masked ophthalmologists graded answer sheets independently using 3-point scales. Students completed surveys before randomization and after assessments. Training groups were compared for grades, observer- and patient-assigned scores, and survey responses. RESULTS The simulator group reported longer practice times than the traditional group (p=0.002). Observers assigned higher technique scores to the simulator group after adjustment for practice time (p=0.034). Combined grades (maximum points=20) were higher for the simulator group (median 5.0, range 0.0-11.0) than for the traditional group (median 4.0, range 0.0-9.0), although the difference was not significant. The simulator group was less likely to mistake the location of a macular scar in one patient (odds ratio 0.28, 95% confidence interval, 0.056-1.35, p=0.013). CONCLUSIONS Direct ophthalmoscopy is difficult, regardless of training technique, but simulator-based training has apparent advantages, including improved technique, the ability to localize fundus lesions, and a fostering of interest in learning ophthalmoscopy, reflected by increased practice time.

Objective To describe the clinical data from the first 108 patients seen in the Mayo Clinic post–COVID-19 care clinic (PCOCC). Methods After Institutional Review Board approval, we reviewed the charts of the first 108 patients seen between January 19, 2021, and April 29, 2021, in the PCOCC and abstracted from the electronic medical record into a standardized database to facilitate analysis. Patients were grouped into phenotypes by expert review. Results Most of the patients seen in our clinic were female (75%; 81/108), and the median age at presentation was 46 years (interquartile range, 37 to 55 years). All had post-acute sequelae of SARS-CoV-2 infection, with 6 clinical phenotypes being identified: fatigue predominant (n=69), dyspnea predominant (n=23), myalgia predominant (n=6), orthostasis predominant (n=6), chest pain predominant (n=3), and headache predominant (n=1). The fatigue-predominant phenotype was more common in women, and the dyspnea-predominant phenotype was more common in men. Interleukin 6 (IL-6) was elevated in 61% of patients (69% of women; P=.0046), which was more common than elevation in C-reactive protein and erythrocyte sedimentation rate, identified in 17% and 20% of cases, respectively. Conclusion In our PCOCC, we observed several distinct clinical phenotypes. Fatigue predominance was the most common presentation and was associated with elevated IL-6 levels and female sex. Dyspnea predominance was more common in men and was not associated with elevated IL-6 levels. IL-6 levels were more likely than erythrocyte sedimentation rate and C-reactive protein to be elevated in patients with post-acute sequelae of SARS-CoV-2 infection.

The use of component separation technique (CST) in complex abdominal wall reconstruction (AWR) increases the rate of primary musculofascial closure but can be associated with increased wound complications, which may require readmission. This study examines 3-year trends in readmissions for patients undergoing AWR with or without CST.The Nationwide Readmissions Database was queried for patients undergoing elective AWR from 2016-2018. CST, demographic characteristics, and 90-day complications and readmissions were determined. CST versus non-CST readmissions were compared, including matched subgroups. Standard statistics and logistic regression were used.Over the 3-year period, 94,784 patients underwent AWR. There was an annual increase in the prevalence of CST: 4.0% in 2016; 6.1% in 2017; 6.7% in 2018 (P.01), which is a 67.5% upsurge during that time. Most cases (82.3%) occurred at urban teaching hospitals, which had more comorbid patients (P .01). The yearly 90-day readmission rate did not change: 16.0%, 18.2%, and 16.9% (P = .26). Readmissions were higher for CST patients than non-CST patients (17.1% vs 15.7%), but not in the matched subgroup (17.0% vs 16.4%; P = .41). Most commonly, readmissions were for infection (28.3%); 14.3% of readmitted patients underwent reoperation. Smoking, morbid obesity, diabetes, chronic lung disease, urban-teaching hospital status, and increased length of stay increased the chance of readmission (all P.05).From 2016 to 2018, the use of CST increased 67.5% nationwide without an increase in readmissions. As we look toward clinical targets to reduce risk of readmission, modifiable health conditions, such as smoking, morbid obesity, and diabetes should be targeted during the prehabilitation process.

Previous research on the Chinese notion of guanxi has tended to use descriptive approaches to study its prevalence and influence on business and Chinese consumers. Relatively less research has focused on perceptions of guanxi in other parts of the world. This paper addresses this important research gap through adopting an “outside-in” global perspective using big data. In particular, the study draws on 162 million guanxi-related news articles during 2017–2020 extracted from the Global Database of Events, Language and Tone (GDELT), an open-source, real-time current affairs repository of online news and event metadata. The findings reveal that guanxi is heavily influenced by geopolitical and public health issues. The study also discovered a major contrast in the overall tone between China, being slightly positive, and the US and Germany, being largely negative, with the association varying according to changes in the marketing ecosystem.

Previously unrecognized mafic and felsic plutonic rocks, formerly interpreted as an anatectic part of the amphibolite-eclogite Marianske Lazně Complex (MLC, Bohemian Massif) were examined together with a possible upper-crustal equivalent represented by the Cista pluton intruding continental crust farther east. These plutonic rocks were studied by whole-rock geochemistry (major and trace elements, Sr-Nd isotopes) and zircon U-Pb geochronology. The MLC magmatic rocks range from pyroxene-amphibole gabbro to trondhjemite and oligoclasite. The Cista pluton consists of porphyritic granitoids. The calc-alkaline nature of these rocks, relative enrichment of fluid-mobile elements (including large-ion lithophile elements), strong fractionation of light rare earth elements over heavy rare earth elements and depletion of high field strength elements are evidence for active margin magmatism. U-Pb zircon dating indicates that the magmatism was Mid-Devonian in both the MLC (ca. 385 Ma) and Cista pluton (ca. 390 up to ca. 365 Ma). Both magmatic units show inherited cores probably linked to recycling of crustal material. Sr-Nd isotopic compositions indicate that the gabbro formed from a depleted MORB mantle source composition with a small contribution of a subduction and crustal component. A three-stage geodynamic model is proposed: 1) ca. 390–380 Ma recycling of a high-pressure accretionary wedge and migration of arc melts into more distal parts of the upper continental plate, 2) ca. 380–370 Ma compression and thickening of the accretionary wedge-arc edifice, and 3) ca. 370–365 Ma development of a giant east-dipping detachment that reworked the whole edifice in the west and also involved emplacement of the supracrustal Cista pluton along antithetic west-dipping shear zone in the east. The studied magmatic rocks record a Mid-Devonian magmatic arc related to the formation of a subduction wedge stacked beneath the upper plate that was followed by formation of a second and independent Carboniferous continental arc further east.

Study Design Clinical measurement study: Level of evidence (N/A) Introduction The Shoulder Pain and Disability Index (SPADI) is a self-reported outcome measure of pain and disability related to shoulder pathology. In comparison to Classical Test Theory (CTT), Rasch analysis offers a more rigorous examination of the measurement properties of a scale. Purpose of the Study This study utilizes Rasch analysis to evaluate the psychometric properties of the SPADI to propose potential modifications and avenues for future investigation. Methods SPADI scores (n = 212) from participants one-year post rotator cuff repair were collected from an outpatient specialty clinic. Fit to the Rasch model, unidimensionality of the subscales, and areas of bias were evaluated. Results Both the pain and disability subscales satisfied the requirements of the Rasch model with very minimal modifications and demonstrated unidimensionality. The person separation index was found to be high (P > .80), indicating reliability and internal consistency. Sex and the affected dominant side influenced how people scored on the SPADI (Differential item functioning (DIF)). Conclusions The findings suggest some patients in our sample have difficulty discriminating between item responses, particularly within the middle of the scale. Rasch analysis supports the clinical measurement properties of consistency and reliability, previously determined by CTT methods.