Objective To determine the prevalence, characteristics, risk factors and temporal profile of concurrent ischemic lesions in patients with acute primary intracerebral hemorrhage (ICH). Methods Patients were recruited within a prospective, longitudinal, magnetic resonance imaging (MRI) based study of primary ICH. Clinical, demographic, and MRI data were collected on all subjects at baseline and 1 month. Results Of the 138 patients enrolled, mean age was 59 years, 54% were male, 73% black, and 84% had a history of hypertension. At baseline, ischemic lesions on diffusion-weighted imaging (DWI) were found in 35% of patients. At 1 month, lesions were present in 27%, and of these lesions, 83% were new and not present at baseline. ICH volume (p=0.025), intraventricular hemorrhage (p=0.019), presence of microbleeds (p=0.024), and large, early reductions in mean arterial pressure (p=0.003) were independent predictors of baseline DWI lesions. A multivariate logistical model predicting the presence of 1 month DWI lesions included history of any prior stroke (p=0.012), presence of 1 or more microbleeds (p=0.04), black race (p=0.641), and presence of a DWI lesion at baseline (p=0.007) Interpretation This study demonstrates that more than 1/3 of patients with primary ICH have active cerebral ischemia at baseline remote from the index hematoma, and 1/4 of patients experience ongoing, acute ischemic events at 1 month. Multivariate analyses implicate blood pressure reductions in the setting of an active vasculopathy as a potential underlying mechanism. Further studies are needed to determine the impact of these lesions on outcome and optimal management strategies to arrest vascular damage.

Objective/Hypothesis This study aimed to determine the incidence of facial pressure injuries associated with prone positioning for COVID‐19 patients as well as to characterize the location of injuries and treatments provided. Methods This was a retrospective chart review of 263 COVID‐19 positive patients requiring intubation in the intensive care units at MedStar Georgetown University Hospital and MedStar Washington Hospital Center between March 1st and July 26th, 2020. Information regarding proning status, duration of proning, presence, or absence of facial pressure injuries and interventions were collected. Paired two‐tailed t‐test was used to evaluate differences between proned patients who developed pressure injuries with those who did not. Results Overall, 143 COVID‐19 positive patients required proning while intubated with the average duration of proning being 5.15 days. Of those proned, 68 (47.6%) developed a facial pressure injury. The most common site involved was the cheek with a total of 57 (84%) followed by ears (50%). The average duration of proning for patients who developed a pressure injury was significantly longer when compared to those who did not develop pressure injuries (6.79 days vs. 3.64 days, P < .001). Conclusions Facial pressure injuries occur with high incidence in patients with COVID‐19 who undergo prone positioning. Longer duration of proning appears to confer greater risk for developing these pressure injuries. Hence, improved preventative measures and early interventions are needed. Level of Evidence 4 Laryngoscope, 131:E2139–E2142, 2021

These analyses support the hypothesis that hyponatremia is a risk factor for osteoporosis and fracture. Additional studies are required to evaluate whether correction of hyponatremia will improve patient outcomes.

IMPORTANCE To date, the conversation about facial rejuvenation surgery has focused on one goal: youthfulness. However, human beings are judged throughout life based on many other characteristics and personal qualities conveyed by their faces. The term facial profiling has been used to describe this act of determining personality attributes through visual observation. OBJECTIVES To introduce the concept of facial profiling to the surgical literature and to evaluate and quantify the changes in personality perception that occur with facial rejuvenation surgery. DESIGN, SETTING, AND PARTICIPANTS This study was a retrospective evaluation of preoperative and postoperative photographs of 30 white female patients who underwent facial rejuvenation surgery between January 1, 2009, and December 31, 2013. Procedures included rhytidectomy (face-lift), upper blepharoplasty, lower blepharoplasty, eyebrow-lift, neck-lift, and/or chin implant. The 60 photographs (30 preoperative and 30 postoperative) of these patients were split into 6 groups, each with 5 preoperative and 5 postoperative photographs. The same patient's preoperative and postoperative photographs were not included in any single group to avoid any recall bias. At least 24 individuals rated each photograph for 6 personality traits (aggressiveness, extroversion, likeability, trustworthiness, risk seeking, and social skills), as well as for attractiveness and femininity. The raters were blinded as to the intent of the study. MAIN OUTCOMES AND MEASURES Ratings of personality traits, attractiveness, and femininity. RESULTS Of the 8 traits that were evaluated, analysis revealed 4 traits with statistically significant improvements when comparing preoperative and postoperative scores: likeability (+0.36, P < .01), social skills (+0.38, P = .01), attractiveness (+0.36, P = .01), and femininity (+0.39, P = .02). Improvement in scores for perceived trustworthiness (+0.22, P = .06), aggressiveness (-0.14, P = .32), extroversion (+0.19, P = .14), and risk seeking (+0.10, P = .27) did not demonstrate statistically significant changes. CONCLUSIONS AND RELEVANCE Facial plastic surgery changes the perception of patients by those around them. Traditionally, these interventions have focused on improvements in youthful appearance, but this study illuminates the other dimensions of a patient's facial profile that are influenced by facial rejuvenation surgery. The data in this sample population demonstrate an increase in the perception of likeability, social skills, attractiveness, and femininity. To our knowledge, this is the first study in the surgical literature to evaluate these broader outcome measures after facial rejuvenation surgery. LEVEL OF EVIDENCE NA.

The Agency for Healthcare Research and Quality (ARHQ) patient safety indicators (PSI) were developed as a metric of hospital complication rates. PSI-14 measures postoperative wound dehiscence and specifically how often a surgical wound in the abdominal or pelvic area fails to heal after abdominopelvic surgery. Wound dehiscence is estimated to occur in 0.5–3.4% of abdominopelvic surgeries, and carries a mortality of up to 40%. Postoperative wound dehiscence has been adopted as a surrogate safety outcome measure since it impacts morbidity, length of stay, healthcare costs and readmission rates. Postoperative wound dehiscence cases from the Nationwide Inpatient Sample demonstrate 9.6% excess mortality, 9.4 days of excess hospitalization and $40,323 in excess hospital charges relative to matched controls. The purpose of the current study was to investigate the associations between PSI-14 and measurable medical and surgical co-morbidities by using the Explorys technology platform to query electronic health record (EHR) data from a large hospital system serving a diverse patient population in the Washington DC and Baltimore, MD metropolitan areas. The study population included 25,636 eligible patients who had undergone abdominopelvic surgery between January 1, 2008 and December 31, 2012. Of these cases, 786 (2.97%) had post-operative wound dehiscence. Patient-associated co-morbidities were strongly associated with PSI-14, suggesting that this indicator may not solely be an indicator of hospital safety. There was a strong association between PSI-14 and opioid use after surgery and this finding merits further investigation.