bluuebunny/crossref_metadata_2025 huggingface dataset:
Circular RNA circ_0007841 participates in progression of nonsmall cell lung cancer via miR-199a-5p/SphK2 axis
Authors: Long Feihu , Li Zifan , Wei Zichun , Xie Yuancai
Published: September 2022

CircRNAs have been found to be participated in the development of numerous cancers. Nevertheless, the role of circRNAs in the progression of nonsmall cell lung cancer (NSCLC) has not been fully made clear. The purpose of our study was to study and understand the mechanism of circ_0007841 regulating the progression of NSCLC. NSCLC tissue samples and adjacent normal tissue samples used were obtained from 53 NSCLC patients. The expressions of circ_0007841, miR-199a-5p and SphK2 in all samples were detected by the real-time quantitative PCR. Then luciferase reporter gene assay and RNA immunoprecipitation (RIP) assay were used to analyze the relevance between circ_0007841, miR-199a-5p and SphK2. Cell Counting Kit-8, colony-forming, thymidine analog 5-ethynyl-2′-deoxyuridine assays, and transwell assay detect the effects of these three biomolecules on NSCLC carcinogenesis by western blot. We evaluate the effect of circ_0007841 on the growth of NSCLC by establishing the xenograft mice model. Experimental studies have shown that the higher expression of circ_0007841 in NSCLC tissues, and circ_0007841 strengthen cell viability, cell proliferation and cell adhesion. In addition, miR-199a-5p exerts an inhibitory effect in NSCLC cells by inhibiting SphK2. And Sphk2 regulates cell proliferation and adhesion. In addition, in-vivo silencing of circ_0007841 was found to inhibit the growth of NSCLC tumors. This research demonstrated that circ_0007841 had a positive influence in improving NSCLC development by targeting miR-199a-5p and upregulating oncogene SphK2.
Lung metastases after liver cancer resection cured by immunotherapy: case report and literature review
Authors: Ou Limin , Lu Guanhua , Cao Mingrong , Hu Min
Published: September 2022

The lung is the most common metastatic organ of primary liver cancer, accounting for 39.5–53.8% of extrahepatic metastasis, which seriously affects the prognosis of patients. In clinical treatment, it is difficult for one therapeutic schedule to achieve the desired effect sometimes, requiring two or even several combined methods for liver cancer lung metastasis. In this study, we report a liver cancer patient with lung metastases who received various combined therapies. However, the comprehensive treatment did not improve the patient’s pulmonary metastasis symptoms until after the application of immunotherapy, and the lung metastases were gradually cured.
Pediatric Ventilation Liberation: A Survey of International Practice Among 555 Pediatric Intensivists
Authors: Loberger Jeremy M. , Campbell Caitlin M. , Colleti José , Borasino Santiago , Abu-Sultaneh Samer , Khemani Robinder G. ,   on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: September 2022

IMPORTANCE:

Pediatric ventilation liberation has limited evidence, likely resulting in wide practice variation. To inform future work, practice patterns must first be described.

OBJECTIVES:

Describe international pediatric ventilation liberation practices and regional practice variation.

DESIGN, SETTING, AND PARTICIPANTS:

International cross-sectional electronic survey. Nontrainee pediatric medical and cardiac critical care physicians.

MAIN OUTCOMES AND MEASURES:

Practices focusing on spontaneous breathing trial (SBT) eligibility, SBT practice, non-SBT extubation readiness bundle elements, and post-extubation respiratory support.

RESULTS:

Five-hundred fifty-five responses representing 47 countries were analyzed. Most respondents reported weaning followed by an SBT (86.4%). The top SBT eligibility variables reported were positive end-expiratory pressure (95%), Fio
2 (93.4%), and peak inspiratory pressure (73.9%). Most reported use of standardized pressure support regardless of endotracheal tube size (40.4%) with +10 cm H2O predominating (38.6%). SBT durations included less than or equal to 30 minutes (34.8%), 31 minutes to 1 hour (39.3%), and greater than 1 hours (26%). In assigning an SBT result, top variables were respiratory rate (94%), oxygen saturation (89.3%), and subjective work of breathing (79.8%). Most reported frequent consideration of endotracheal secretion burden (81.3%), standardized pain/sedation measurement (72.8%), fluid balance (83%), and the endotracheal air leak test as a part of extubation readiness bundles. Most reported using planned high flow nasal cannula in less than or equal to 50% of extubations (83.2%). Top subpopulations supported with planned HFNC were those with chronic lung disease (67.3%), exposed to invasive ventilation greater than 14 days (66.6%), and chronic critical illness (44.9%). Most reported using planned noninvasive ventilation (NIV) following less than or equal to 20% of extubations (79.9%). Top subpopulations supported with planned NIV were those with neuromuscular disease (72.8%), chronic lung disease (66.7%), and chronic NIV use for any reason (61.6%). Regional variation was high for most practices studied.

CONCLUSION AND RELEVANCE:

International pediatric ventilation liberation practices are heterogeneous. Future study is needed to address key evidence gaps. Many practice differences were associated with respondent region, which must be considered in international study design.
Quantification of Patient-Reported Pain Locations
Authors: Abudawood Khulud , Yoon Saunjoo L. , Garg Rishabh , Yao Yingwei , Molokie Robert E. , Wilkie Diana J.
Published: September 2022

Patient-reported pain locations are critical for comprehensive pain assessment. Our study aim was to introduce an automated process for measuring the location and distribution of pain collected during a routine outpatient clinic visit. In a cross-sectional study, 116 adults with sickle cell disease–associated pain completed PAINReportItⓇ. This computer-based instrument includes a two-dimensional, digital body outline on which patients mark their pain location. Using the ImageJ software, we calculated the percentage of the body surface area marked as painful and summarized data with descriptive statistics and a pain frequency map. The painful body areas most frequently marked were the left leg-front (73%), right leg-front (72%), upper back (72%), and lower back (70%). The frequency of pain marks in each of the 48 body segments ranged from 3 to 79 (mean, 33.2 ± 21.9). The mean percentage of painful body surface area per segment was 10.8% ± 7.5% (ranging from 1.3% to 33.1%). Patient-reported pain locations can be easily analyzed from digital drawings using an algorithm created via the free ImageJ software. This method may enhance comprehensive pain assessment, facilitating research and personalized care over time for patients with various pain conditions.
Nurse-Led Telehealth Interventions During COVID-19
Authors: Joo Jee Young
Published: September 2022

Since the outbreak of COVID-19, telehealth expanded rapidly and was adopted as a substitute for in-person patient and nurse visits. However, no studies have mapped nurse-led telehealth interventions during the pandemic. This study aimed to identify and summarize the strengths and weaknesses of nurse-led telehealth interventions for community-dwelling outpatients during the COVID-19 pandemic. This study used a scoping review methodology and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses Scoping Review Extension. Five electronic databases were searched to find studies published in English peer-reviewed publications between January 2020 and February 2022. A total of 490 articles were retrieved, of which 23 empirical studies were selected based on the inclusion/exclusion criteria. Primary studies from nine countries with a variety of research designs were included. Four strengths and three weaknesses of nurse-led telehealth interventions for patients during COVID-19 were identified. For telehealth services to provide effective, efficient, and quality patient care, future research and nursing practice need to overcome the identified weaknesses of current nurse-led telehealth interventions. More rigorous evidence-based research and updated and standardized guidelines for nurses' telehealth services will help improve the quality of patient care. Nurse managers, leaders, and policymakers can use the findings of this scoping review to refine the current telehealth services system.
A Single Center Retrospective Study of the Impact of COVID-19 Infection on Immune-related Adverse Events in Cancer Patients Receiving Immune Checkpoint Inhibitors
Authors: Guo Mengni , Liu Jieying , Miao Ruoyu , Ahmed Zohaib , Yu James , Guan Jian , Ahmad Sarfraz , Zhou Shuntai , Grove Angela , Manoucheri Manoucher , Socinski Mark A. , Mekhail Tarek
Published: September 2022

Immune checkpoint inhibitors (ICIs) can cause a variety of immune-related adverse events (irAEs). The coronavirus disease 2019 (COVID-19) is associated with increased amounts of pro-inflammatory cytokines, which may affect the outcome of irAEs. Data are limited regarding the impact of COVID-19 on irAEs in ICI-treated cancer patients. Hence, in this study, we retrospectively analyzed ICI-treated adult patients with malignant solid tumors at a single institution between August 2020 and August 2021. Patients who had the most recent ICI treatment over 1-month before or after the positive COVID-19 test were excluded from the study. For the COVID-19 positive group, only the irAEs that developed after COVID-19 infection were considered as events. A total of 579 patients were included in our study, with 46 (7.9%) in the COVID-19 positive group and 533 (92.1%) in the COVID-19 negative group. The baseline characteristics of patients in the 2 groups were similar. With a median follow-up of 331 days (range: 21–2226), we noticed a nonsignificant higher incidence of all-grade irAEs in the COVID-19 positive group (30.4% vs. 19.9%, P=0.18). The incidence of grade 3 and 4 irAEs was significantly higher in the COVID-19 positive group (10.9% vs. 3.2%, P=0.02). Multivariate analysis confirmed the association between COVID-19 infection and increased risk of severe irAE development (odds ratio: 1.08, 95% confidence interval: 1.02–1.14, P=0.01). Our study suggested that COVID-19 may pose a risk of severe irAEs in cancer patients receiving ICIs. Close monitoring and possibly delaying ICI administration could be considered when cancer patients are infected with COVID-19.
Value of Immunohistochemistry to Differentiate Digital Papillary Adenocarcinoma From Acral Hidradenoma With Papillary Structures
Authors: Xavier-Júnior José Cândido Caldeira , Camilo-Júnior Deolino João , Carneiro Dias André Luiz , Marques Ferreira Pedro Paulo , Abdalla Filho Antonio Roberto , Brenn Thomas
Published: September 2022

Digital papillary adenocarcinoma is a malignant adnexal tumor with a predilection for acral sites. Hidradenoma is a benign solid and cystic sweat gland neoplasm with focal ductal and glandular differentiation and good outcomes. Hidradenomas can occur at acral sites and show papillary structures; for this reason, they are included in the differential diagnosis of digital papillary adenocarcinoma, and immunohistochemistry is a valuable tool in this scenario. We described a case of a 43-year-old man with an epithelial tumor showing papillary structures in the intermediate phalanx of the fourth finger. There was diffuse positivity for p63 and negativity for S100 protein, suggesting that this tumor was an acral hidradenoma with papillary structures.
Vaspin Ameliorates Cardiac Remodeling by Suppressing Phosphoinositide 3-Kinase/Protein Kinase B Pathway to Improve Oxidative Stress in Heart Failure Rats
Authors: Ji Mingyue , Li Yong , Liu Yun , Ma Genshan
Published: September 2022

This study aimed to explore whether vaspin could alleviate cardiac remodeling through attenuating oxidative stress in heart failure rats and to determine the associated signaling pathway. Cardiac remodeling was induced by myocardial infarction, transverse aortic constriction, or angiotensin (Ang) II infusion in vivo, and the neonatal rat cardiomyocytes (NRCMs) and neonatal rat cardiac fibroblasts (NRCFs) were treated with Ang II. Vaspin treatment alleviated fibrosis in myocardial infarction, transverse aortic constriction, and Ang II-treated rats. The Ang II-induced increases of atrial natriuretic peptide and brain natriuretic peptide in NRCMs and Ang II-induced increases of collagen I and collagen III in NRCFs were reduced after vaspin treatment. Vaspin administration inhibited the Ang II-induced increases of phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) pathway, superoxide anions, malondialdehyde, and NADPH oxidases activity in NRCMs and NRCFs. The overexpression of PI3K, Akt, or NADPH oxidases 1 reversed the attenuating effects of vaspin on Ang II-induced elevation of atrial natriuretic peptide and brain natriuretic peptide in NRCMs, as well as Ang II-induced increases of collagen I and collagen III in NRCFs. The administration of wortmannin (PI3K inhibitor) or MK2206 (Akt inhibitor) inhibited the oxidative stress induced by Ang II in NRCMs and NRCFs. The above results suggest that vaspin can alleviate cardiac dysfunction and remodeling in heart failure rats. Vaspin attenuates Ang II-induced hypertrophy of NRCMs and fibrosis of NRCFs through suppressing PI3K/Akt pathway to alleviate oxidative stress.
Association between lower parity and low muscle mass in postmenopausal women: data from KNHANES (2010-2011)
Authors: Ahn So Hyun , Kim Heeyon , In Kim Hye , Yun Bo Hyon , Shin Hye Jung , Roh Yun Ho , Chon Seung Joo , Seo Seok Kyo
Published: September 2022

Objective

This study aimed to investigate whether parity is associated with the prevalence of low muscle mass in postmenopausal women.

Methods

This study was performed using data from the 2010-2011 Korean National Health and Nutrition Examination Survey, which included 1,338 postmenopausal women aged 46 to 70 years. The association between parity and low muscle mass was analyzed after adjusting parity, multiparity, age, body mass index, diabetes mellitus, education level, and Homeostatic Model Assessment of Insulin Resistance and using weighted multiple logistic regression analysis. Modifiable risk factors were evaluated in a susceptible population. Low muscle mass was defined as an appendicular skeletal muscle mass index below 2 SDs with a cutoff value of 5.45 kg/m2.

Results

The low muscle mass group (n = 343) had lower parity, lower body mass index, more frequent previous history of diabetes mellitus, higher Homeostatic Model Assessment of Insulin Resistance, and higher education level compared with the non–low muscle mass group (n = 995). After adjusting for the confounding factors, parity with three births or more was associated with a significantly lower odds of postmenopausal low muscle mass than nulliparity (model 1: odds ratio, 0.32; 95% confidence interval, 0.12-0.87; P = 0.03; model 2: odds ratio, 0.27; 95% confidence interval, 0.11-0.67; P < 0.05). In the subgroup analysis of the lower parity group, moderate aerobic activity was associated with a lower low muscle mass prevalence.

Conclusions

A lower parity is associated with increasing the odds of low muscle mass in postmenopausal Korean women. Moderate aerobic activity may be effective in lowering the odds of low muscle mass in postmenopausal women with lower parity.
Behavioral interventions for improving sleep outcomes in menopausal women: a systematic review and meta-analysis
Authors: Lam Christine M. , Hernandez-Galan Leticia , Mbuagbaw Lawrence , Ewusie Joycelyne Efua , Thabane Lehana , Shea Alison K.
Published: September 2022

Importance

Perimenopausal and postmenopausal women commonly report sleep disruption and insomnia. Behavioral interventions may be safe alternatives for patients who are unwilling to begin pharmacological treatments because of adverse effects, contraindications, or personal preference.

Objective

The primary objective is to assess the efficacy of behavioral interventions on sleep outcomes among perimenopausal and postmenopausal women, as measured using standardized scales and objective methods (polysomnography, actigraphy). The secondary objective is to evaluate the safety of these methods through occurrence of adverse events.

Evidence Review

Searches were performed within MEDLINE (OVID interface, 1946 onward), Embase (OVID interface, 1974 onward), Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Web of Science (Core collection) using a search strategy developed in consultation with a health sciences librarian. Title/abstract and full-text screenings were performed in duplicate, and relevant studies were selected based on inclusion and exclusion criteria set to identify randomized controlled trials evaluating the effects of behavioral interventions on sleep quality. Risk of bias assessments were done using the Cochrane Risk of Bias 2 tool, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of the body of evidence. Data were pooled in a meta-analysis using a random-effects model.

Findings

Nineteen articles reporting results from 16 randomized controlled trials were included, representing a total of 2,108 perimenopausal and postmenopausal women. Overall, behavioral interventions showed a statistically significant effect on sleep outcomes (standardized mean difference [SMD], −0.62; 95% confidence interval [CI], −0.88 to −0.35; I
2 = 93.4%). Subgroup analyses revealed that cognitive behavioral therapy (SMD, −0.40; 95% CI, −0.70 to −0.11; I
2 = 72.7%), physical exercise (SMD, −0.57; 95% CI, −0.94 to −0.21; I
2 = 94.0%), and mindfulness/relaxation (SMD, −1.28; 95% CI, −2.20 to −0.37; I
2 = 96.0%) improved sleep, as measured using both subjective (eg, Pittsburg Sleep Quality Index) and objective measures. Low-intensity (SMD, −0.91; 95% CI, −1.59 to −0.24; I
2 = 96.8) and moderate-intensity exercise (SMD, −0.21; 95% CI, −0.34 to −0.08; I
2 = 0.0%) also improved sleep outcomes. No serious adverse events were reported. Overall risk of bias ranged from some concern to serious, and the certainty of the body of evidence was assessed to be of very low quality.

Conclusions and Relevance

This meta-analysis provides evidence that behavioral interventions, specifically, cognitive behavioral therapy, physical exercise, and mindfulness/relaxation, are effective treatments for improving sleep outcomes among perimenopausal and postmenopausal women.
Trends in osteoporosis medication use in US postmenopausal women: analysis of the National Health and Nutrition Examination Survey 1999-2000 through 2017-2018
Authors: Orces Carlos H.
Published: September 2022

Objective

This study aimed to examine trends in the use of osteoporosis medications in postmenopausal women between 1999-2000 and 2017-2018.

Methods

National Health and Nutrition Examination Survey data were analyzed to describe trends in the use of osteoporosis medications in US women 50 years and older. Joinpoint regression software was used to detect points at which significant changes in the direction and magnitude of the trends occurred over time. Logistic regression models adjusted for potential confounders were assembled to determine the independent association between time period (2007-2008 vs 2017-2018) and osteoporosis medication use.

Results

Of 13,826 postmenopausal women, about 7% reported taking osteoporosis medications. Joinpoint regression demonstrated that the prevalence of women taking osteoporosis medications significantly decreased by −23.3% on average (95% confidence interval [CI], −23.3% to −37.7%) per survey cycle between 2007-2008 and 2017-2018. Similarly, bisphosphonate use decreased by −22.6% on average (95% CI, −38.8% to −2.1%) from 2007 to 2008 onward. Logistic regression demonstrated that, after adjustment for potential confounders including bone mineral density and self-reported hip or spine fractures, postmenopausal women were 61% and 56% less likely to use any osteoporosis medications and bisphosphonates in 2017 to 2018 compared with their counterparts in 2007 to 2008, respectively.

Conclusions

The use of osteoporosis medications in postmenopausal US women has significantly decreased since 2007 to 2008 onward. This finding was mostly attributed to a low prescription rate of bisphosphonate drugs. Moreover, the treatment of osteoporosis in postmenopausal women was suboptimal and decreased over time.
How a Faith-Based Healthcare Organization Is Turning the Tide of Environmental Impact
Authors: Cordola Craig
Published: September 2022

The healthcare sector's role in every community is inextricably linked to the health of those it serves. As research and media reports point to the significant impact of people on our planet's ecosystems, Ascension has responded by setting several environmental sustainability goals. Our work is defined by three pillars:

Net Zero Places focuses on carbon sources associated with Ascension's physical environments—carbon footprint, operational efficiency of facilities, and sustainable transportation.

Responsible Supply Chain focuses on the flow of goods from procurement to disposition—responsible purchasing, product usage management, recycling, and waste management.

Healthy Communities focuses on the relationship between sustainability and social determinants of health (SDOH)—linking determinants to Ascension's mission to sustain and improve the health of those we serve, especially the poor and vulnerable.

When we think about future generations, we realize that this work cannot wait. That is why we are reimagining today what environmental impact and sustainability could look like through the next decade and beyond. We are setting our corporate sights on net zero carbon and zero waste by 2040 and encourage other healthcare organizations to join us in these efforts. Working together, we can make a difference.
Climate Change and Healthcare: A Complicated Relationship
Authors: Gerwig Kathy
Published: September 2022

Climate change is a crisis with a devastating impact on health. The warming atmosphere is increasing the tolls of deaths and illnesses from heat waves, extreme weather, poor air quality, insect-borne diseases, and other conditions. Healthcare is connected to climate change in a way that is not fully appreciated by many healthcare leaders—in fact, the sector generates a significant share of greenhouse gas emissions that cause climate change. As additional costs, healthcare providers' margins are put at risk from treating more climate-related disease and illness, supply chain disruptions, and damage from severe storms and wildfires. These connections provide a compelling rationale for healthcare executives to create more resilience in operations, lead efforts toward decarbonization, and catalyze for climate action.
Australian cancer nurses’ experiences of burnout
Authors: Parkinson-Zarb Lauren , Duff Cameron , Wang Ying , Mills Jane
Published: September 2022

Background

Existing studies that seek to understand nurses’ experiences of burnout are dominated by cross-sectional, quantitative survey designs employing predetermined measures, often overlooking important job-related stressors that can be highly dependent on industry and professional contexts. Cancer nurses are a group of professionals who warrant special attention, as burnout in this profession is often attributed to high job demands and the challenge of caring for a vulnerable cohort of patients. A deeper understanding of the job demands associated with cancer nursing is required to provide insights about the work experiences of cancer nurses and identify aspects that mitigate burnout and stress.

Purpose

This study describes the antecedents of burnout among Australian cancer nurses by focusing on the demands and resources inherent in their work. We aim to build on the existing literature by identifying job resources that may serve to mitigate the antecedents of burnout.

Methodology/Approach

An in-depth interview study of cancer nurses across a spectrum of age and experience in Australian metropolitan public health care services was conducted over a 2-year period that coincided with the COVID-19 pandemic. The job demands and resources model framed this study of job-related factors associated with burnout and conversely job resources that may foster work engagement.

Results

Patient aggression, workload, emotional demands, and abusive peers and managers were reported as distinct job demands, whereas job significance and supportive peers who demonstrated leadership, along with task variety, were identified as job resources.

Conclusion

Australian cancer nurses work in an environment where job demands are increasingly disproportionate to job resources, leading to significant risk of burnout.

Practice Implications

Our study identifies modifiable strategies for improving work conditions for this group who play a critical role in the health care system.
Assessment of Alpha Doses Received by Spa Workers Due to the Inhalation of 214Po and 218Po Radon Progeny
Authors: Misdaq M. A. , Ben el fakir M. , Ouguidi J.
Published: September 2022

In Morocco spas are more and more frequented by bathers for massages, body treatments, and aromatherapy and hair services, among others. Alpha-activities due to 222Rn, 220Rn and their progeny have been evaluated inside spa room atmospheres by means of a technique based on using two types of solid-state nuclear track detectors. 222Rn and 220Rn concentrations ranged between (67 ± 5 and 103 ± 7) Bq m−3 and (5.5 ± 0.4 and 9.8 ± 0.7) Bq m−3 for the studied spa rooms, respectively. The influence of ventilation rate in spa rooms on 222Rn and 220Rn concentrations has been studied. Alpha-activities due to the attached and unattached fractions of 214Po and 218Po radon progeny have been evaluated in various compartments of the respiratory system of spa working personnel. It has been shown that the majority of 214Po and 218Po radon progeny are attached to aerosols inside the considered spa rooms. Alpha-doses to the respiratory tract tissues of spa working personnel due to the energy loss of the emitted alpha-particles were evaluated. It has been shown that alpha-doses to the respiratory system of spa working personnel are influenced by exposure time of workers, mass of respiratory system target tissues, and radon concentration inside the studied spa rooms. The largest value of alpha-dose due to the 214Po and 218Po radon progeny from inhalation of air by female workers working 2,080 hours per year in the studied spa rooms was found equal to 5.16 mSv y−1.
Basic Cyber Security Considerations for Licensees of Radioactive Materials and Registrants of Radiation Producing Devices in an Era of Remote or Hybrid Compliance Inspections
Authors: Emery R. J. , Gillum M. D. , Gutierrez J. M.
Published: September 2022

The onset of the COVID pandemic impacted various regulatory agencies’ ability to safely fulfill their regulatory compliance inspection mandates via on-site inspections. Some agencies shifted to a remote or hybrid inspection process, which necessitates the electronic transmittal of a variety of records that may or may not have been transmitted in this fashion in the past, raising concerns about the records being sent and received securely. Considering this new environment, some basic cyber security diagnostic considerations are described for radiation source permit holders to consider prior to responding to an apparent legitimate regulatory inspection request, both in the current COVID cyber risk environment and the environment likely to exist into the future.
Adjuvanted recombinant zoster vaccine decreases herpes zoster-associated pain and the use of pain medication across 3 randomized, placebo-controlled trials
Authors: Kim Joon Hyung , Johnson Robert , Kovac Martina , Cunningham Anthony L. , Amakrane Mohamed , Sullivan Keith M. , Dagnew Alemnew F. , Curran Desmond , Schuind Anne
Published: September 2022

Herpes zoster (HZ) and HZ-associated pain greatly affect patients' quality of life, particularly in older and immunocompromised adults, for whom comorbidities and polypharmacy are often reported. Three phase III, randomized, placebo-controlled clinical trials have reported the adjuvanted recombinant zoster vaccine (RZV) as highly efficacious in preventing HZ and reducing pain severity in healthy adults ≥50 years old (Zoster Efficacy Study [ZOE]-50 study, NCT01165177) and ≥70 years old (ZOE-70; NCT01165229) and in immunocompromised adults ≥18 years old undergoing autologous hematopoietic stem cell transplantation (ZOE-HSCT; NCT01610414). Here, we investigated efficacy of RZV in reducing (i) the duration of clinically significant pain (Zoster Brief Pain Inventory pain score ≥3) and (ii) HZ-associated pain medication use and duration of use in participants with confirmed HZ (“breakthrough cases”) from the 3 studies. Recombinant zoster vaccine effectively reduced the duration of clinically significant HZ-associated pain during HZ episodes by 38.5% (P-value: 0.010) in the ZOE-HSCT study. Although a similar trend was observed in the ZOE-50 and ZOE-70 studies, the results were not statistically significant because of the high vaccine efficacy (VE) against HZ resulting in rare breakthrough cases. VE in reducing pain medication use (39.6%; P-value: 0.008) and duration of medication use (49.3%, P-value: 0.040) was reported in the ZOE-70 study; corresponding positive VE estimates were observed in the ZOE-50 and ZOE-HSCT studies but were not statistically significant. Data reported here demonstrate efficacy of RZV in reducing HZ-associated pain duration and pain medication use in breakthrough cases, thereby improving quality of life of those with HZ.
Microdosing psilocybin for chronic pain: a case series
Authors: Lyes Matthew , Yang Kevin H. , Castellanos Joel , Furnish Timothy
Published: September 2022

Psychedelic serotonergic agonists such as psilocybin have recently been shown to produce sustained benefit in refractory depression, end of life anxiety, and addiction when administered in hallucinogenic doses and coupled with psychotherapy. Although it has been suggested that similar high-dose protocols may help chronic pain conditions, there are few published clinical trials of psychedelics for pain. The use of these agents in subpsychedelic doses for chronic pain management has received even less attention. This case series details the experiences of 3 individuals who have used low-dose psilocybin to manage chronic neuropathic pain. Although the nature and etiology of each patient's pain vary, they share a common experience, including inefficacy of current therapeutics and decreased quality of life. Through self-administration of psilocybin, these patients have achieved robust pain relief with decreased reliance on traditional analgesic medications. Despite varying preparations and uncertain potencies, the analgesic effects for all 3 patients occurred at doses without a psychedelic experience and with minimal cognitive or somatic adverse effects. Furthermore, the efficacy of pain relief and, in some cases, the duration of the effect were magnified when coupled with functional exercise. In addition, in 1 case, repeated dosing seemed to produce increased relief, suggesting a possible long-term plasticity-mediated effect. These commonalities highlight psilocybin's therapeutic potential in the treatment of chronic pain that warrants further investigation.
O-arm CT for Confirmation of Successful Navigation During Robotic Assisted Bronchoscopy
Authors: Chambers Jefferson , Knox Daniel , Leclair Timothy
Published: September 2022

Background:

Robotic assisted bronchoscopy (RAB) is designed to increase bronchoscopic accessibility for difficult to reach pulmonary lesions. One limitation to success of RAB is computed tomography (CT) to body divergence. Real time imaging with cone beam CT is increasingly utilized for confirmation of correct navigation and tool-in-lesion during RAB. O-arm CT is a 3-dimensional imaging modality, which has not previously been described for use with RAB. Our purpose is to display the feasibility, ease of use, and high rate of confirmation of tool-in-lesion when using O-arm CT during RAB.

Methods:

Single center, retrospective review of 75 patients undergoing RAB with intraprocedural use of O-arm CT.

Results:

Median patient age was 65 years. Forty-nine percent of cases involved nodules ≤2 cm. Bronchus sign was absent in 44% of cases. Median procedure time was 80 minutes. Median number of O-arm CT runs per case was 2. The median effective dose of radiation was 7.2 millisieverts. Tool-in-lesion was confirmed in 97% (77 of 79) of cases. Definitive diagnosis was reached in 61 to 68 of 79 cases (77% to 86%). There were 2 cases of pneumothorax (2.5%), one of which needed intervention with tube thoracostomy.

Conclusions:

O-arm CT is an effective, and convenient alternative to other 3-dimensional imaging modalities for intraprocedural confirmation of tool-in-lesion during RAB.
The Quality of Care Delivered in a Simulation Center
Authors: Maguire Mary Beth R. , White Anne , Brown Austin
Published: September 2022

Background:

A standardized survey to describe the quality of care received from prelicensure nursing students during simulation can measure simulation program effectiveness.

Purpose:

The purpose of this study was to compare national Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data with data received from standardized patients (SPs) using a modified HCAHPS survey.

Methods:

SPs completed a modified HCAHPS survey immediately following each in-person simulated encounter. One year of SP responses (N = 385) from one baccalaureate nursing program was compared with the national HCAHPS survey data from the same time.

Results:

All SP responses were less than the national proportions. However, when the level of stringency was adjusted, the responses more similarly aligned to the national proportions.

Conclusions:

Findings suggest HCAHPS data can be used to model correlates of the quality of care SPs receive during simulation events.
Topical Review: Contact Lens Eye Health and Safety Considerations in Government Policy Development
Authors: Lakkis Carol , Lorenz Kathrine Osborn , Mayers Michael
Published: September 2022

SIGNIFICANCE

As new federal or state policies are introduced in the United States to shape the evolving contact lens market, it has never been more important to amplify the importance of patient health and safety during contact lens wear and promote the value of the eye care professional–patient relationship.

Within the United States, contact lenses are regulated by the Food and Drug Administration as class II or III medical devices that require additional regulatory and professional oversight to keep consumers safe. The contact lens market and broader eye health landscape are rapidly changing. Recently, the U.S. Federal Trade Commission finalized its 10-year review of the Contact Lens Rule, implementing new policies that will shape the contact lens market in the United States for years to come. The purpose of this clinical perspective was to compile and review key data regarding contact lens–related adverse events, including their economic impact on the health care system, to inform government policy development. Although contact lenses provide many benefits to the wearer, a variety of complications can occur ranging from asymptomatic events or mild discomfort to severe sight-threatening adverse events such as microbial keratitis. Patients who do not routinely visit their eye care professional or do not receive the lenses prescribed to them are at a greater risk of contact lens–related adverse events. Nearly 1 million people in the United States experience ocular infections or inflammation annually, resulting in significant health care costs. The economic burden of contact lens–related microbial keratitis in the United States has been estimated to be approximately $175 million annually. The importance of eye care professional oversight of contact lens wear cannot be emphasized enough to key stakeholders, including lawmakers, government regulators, contact lens manufacturers and distributors, and the broader eye health community.
The Value of Eccentric Infrared Photorefraction in Evaluating Keratoconus
Authors: Patel Avina M. , Kumar Preetam , Vaddavalli Pravin K. , Bharadwaj Shrikant R.
Published: September 2022

Significance

Non-linearity in the luminance profile of eccentric, infrared photorefraction may be used to differentiate corneal diseases like keratoconus that distort the cornea, relative to regular refractive errors.

Purpose

To determine the profile of eccentric, infrared, photorefraction in keratoconus as a prototypical disease model for distorted corneas and identify a parameter in this profile for differentiating such disease conditions from healthy controls.

Methods

Photorefraction reflex of 75 eyes with forme-fruste to advanced keratoconic cases and 75 eyes of controls with regular refractive errors (spherical equivalent: +0.50 to -11.75D; astigmatism: -0.50 to -4.50D across 0 to 180° axes) were obtained over their natural pupils under unaided viewing using a custom-designed photorefractor placed at 1 m from the subject. The test was repeated in 10 controls with 4D and 6D of trial-lens induced myopia and myopic astigmatism at 0°, 90°, 45° and 135°. Linear regression was performed on the luminance profile across the pupil and the departure of the data from linearity was estimated using the average residual error of the fit (Resavg).

Results

Photorefraction profiles varied linearly across the pupil in controls, with slopes increasing with refractive error (r = 0.87; P < .001) and Resavg remaining invariant of refractive error (r = -0.29; P > .4). Corresponding profiles in keratoconus significantly departed from linearity, with Resavg progressively increasing with disease severity (r = 0.66; P < .001). Resavg of 0.03 grayscale units/pixel distinguished keratoconus from controls with sensitivity increasing from 66.7% to 100% for mild to advanced keratoconus and specificity remaining ≥97.1% across disease severity. Induced myopia and myopic astigmatism produced predictable changes in luminance profile slopes, but with no change in Resavg values.

Conclusions

Unlike regular myopia and astigmatism, the photorefraction reflex is significantly non-linear in keratoconus owing to the distorted cornea. Measures of non-linearity in luminance profile may be incorporated in commercial photorefractors for differentiating such disease conditions from regular refractive errors.
Case Report: Asymptomatic Skew Deviation Secondary to Chronic Ischemic Infarction of the Cerebellum
Authors: Borgman Christopher J. , Krug Casey
Published: September 2022

SIGNIFICANCE

Skew deviation is likely encountered clinically more often than previously thought. Cerebellar causes of skew deviation appear to be the rarest cause and should be considered by clinicians when encountering patients with findings consistent with skew deviation.

PURPOSE

This case report describes an undiagnosed, asymptomatic skew deviation in an established glaucoma patient returning for routine follow-up. Appropriate diagnosis and subsequent neuroimaging identified a chronic ischemic cerebellar infarction.

CASE REPORT

A 72-year-old man presented for a routine glaucoma follow-up examination. Cover test revealed a 10–prism diopter left hypertropia, which worsened in right gaze and left head tilt. Double Maddox rod testing showed 5° excyclotorsion of the right eye and no torsion in the left eye. Upright-supine testing was positive. Given the patient's noticeable right head tilt, left hypertropia, increased excyclotorsion of his lower eye, and positive-upright test, the patient was diagnosed with a skew deviation. Brain MRI revealed a chronic, undiagnosed cerebellar ischemic infarction, a known cause of skew deviation and the associated ocular tilt reaction.

CONCLUSIONS

It can be challenging to identify skew deviations and their underlying causes. When clinically encountering a vertical deviation, appropriate tests (cover-uncover test, Parks-Bielschowsky three-step test, ocular torsion testing, and upright-supine test) are imperative to help make the correct diagnosis. Neuroimaging can then be pursued in hopes of identifying the underlying cause.
Case Report: Choriocapillaris Flow Voids in Acute Syphilitic Posterior Placoid Chorioretinitis
Authors: Crist Andrew J.
Published: September 2022

SIGNIFICANCE

Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a rare clinical presentation of ocular syphilis. The worldwide incidence of syphilis has recently increased. Clinicians should be familiar with the distinct appearance and imaging findings of ASPPC and promptly initiate antibiotic treatment to limit functional vision loss and systemic complications of neurosyphilis.

PURPOSE

This case demonstrates the utility of optical coherence tomography angiography (OCT-A) imaging to further understand the pathophysiology and visual prognosis of ASPPC.

CASE REPORT

A 75-year-old man presented with 7 days of decreased vision in his left eye. His visual acuity was 20/20 in the right eye and 20/200 in the left eye. Fundus examination revealed placoid lesions in the superior and inferotemporal aspects of the posterior pole in the right eye and a large placoid macular lesion in the left eye. Optical coherence tomography imaging revealed disruption and loss of the ellipsoid zone and external limiting membrane, nodular elevations on the retinal pigment epithelium, and choroidal hyperreflective punctate lesions in the left eye. Optical coherence tomography angiography displayed choriocapillaris perfusion flow voids greater in the left eye than in the right eye. Two months after penicillin treatment, the placoid lesions resolved in both eyes with an improvement in outer retinal structural abnormalities on optical coherence tomography imaging and visual acuity to 20/25 in the left eye. Eleven months after presentation, the OCT-A choriocapillaris flow voids had improved without complete restoration.

CONCLUSIONS

The flow voids seen on OCT-A imaging in this case of ASPPC suggest a possible inflammatory process with a primary location in the choriocapillaris.
Case Report: Optic Nerve Atrophy Secondary to Sjögren Syndrome
Authors: Remolí-Sargues Lidia , García-Villanueva Carolina , Monferrer-Adsuara Clara , Gracia-García Alicia , López-Salvador Belén , Cervera-Taulet Enrique
Published: September 2022

SIGNIFICANCE

Optic neuropathy associated with Sjögren syndrome is rare and usually has an acute onset.

PURPOSE

This study aimed to report a case of asymmetric optic nerve atrophy attributed to Sjögren syndrome.

CASE REPORT

A 37-year-old woman was referred to neuro-ophthalmology service because of right optic nerve atrophy of unknown etiology. The patient was asymptomatic. Best-corrected visual acuity was 20/200 Snellen equivalent in the right eye and 20/20 Snellen equivalent in the left eye. The right eye had a relative afferent pupillary defect. Visual field demonstrated dense temporal loss, superior arcuate involvement, and an inferior paracentral defect in the right eye. Slit-lamp examination showed mild fluorescein staining of the cornea, moderate lissamine green staining of the conjunctiva, and abnormal tear breakup time in both eyes. Fundus examination revealed diffuse pallor of the right optic disc and a normal left optic disc. Optical coherence tomography showed inferior and superior retinal nerve fiber layer atrophy in the right eye and inferior retinal nerve fiber layer atrophy in the left eye. A diagnosis of right optic nerve atrophy was made. Immunologic studies were significant for positive anti-Ro and anti-La antibodies. MRI of the brain and orbit ruled out any intracranial or white-matter pathology. A diagnosis of optic nerve atrophy secondary to Sjögren syndrome was suspected, so corticosteroid treatment was started.

CONCLUSIONS

Optic nerve atrophy may be the initial manifestation of Sjögren syndrome. Therefore, optic neuropathy associated with Sjögren syndrome remains a diagnostic challenge. In these cases, specific antibodies such as anti-Ro and anti-La facilitate early diagnosis and can prevent vision-threatening complications.
Surgeon gender-related differences in operative coding in plastic surgery
Authors: Kalliainen Loree K. , Chambers Alison B. , Crozier Joseph , Conrad Heidi , Iozzio Mary Jo , Lipa Joan E. , Johnson Debra , Hansen Juliana E.
Published: September 2022

Background:

Numerous studies in the medical and surgical literature have discussed the income gap between male and female physicians but none have adequately accounted for the disparity.

Methods:

This study was performed to determine whether gender-related billing and coding differences may be related to the income gap. A 10% minimum difference was set a priori as statistically significant. A cohort of 1036 candidates’ nine-month case lists for the American Board of Plastic Surgery (ABPS) over a five year span (2014-2018) was evaluated for relationships between surgeon gender and work RVUs, coding information, major and minor cases performed and work setting. Data was de-identified by the ABPS prior to evaluation. We hypothesized that wRVUS, average codes per case, major cases, and minor cases would be at least 10% higher for male than female physicians.

Results:

Significant differences were found between males and females in wRVUs billed, wRVUs billed per case, and the numbers of major cases performed. The average total wRVUs for male surgeons was 19.34% higher than female surgeons (3253.2 [3090.5, 3425.8] versus 2624.1 [2435.2, 2829.6]. Male surgeons performed 14.28% more major cases than females (77.6 [72.7, 82.7] vs 90.5 [86.3, 94.9], p = 0.0002).

Conclusions:

Our findings support the hypothesis that billing and coding practices can, in part, account for income differences between male and female plastic surgeons. Potential explanations include practices focusing on larger and more complex operative cases and differences in coding practices.
Revisiting the Role of Occipital Artery Resection in Greater Occipital Nerve Decompression
Authors: Janis Jeffrey E. , ElHawary Hassan , Schoenbrunner Anna , Salimi Ali , Packowski Kathryn , Kavanag Kaitlin , Gfrerer Lisa , Austen William G.
Published: September 2022

Introduction:

Greater occipital nerve (GON) surgery has been shown to improve headaches caused by nerve compression. There is a paucity in data, however, specifically regarding the efficacy of concomitant occipital artery resection. To that end, the goal of this study was to compare the efficacy of greater occipital nerve decompression with and without occipital artery resection.

Methods:

This multi-center retrospective cohort study consisted of two groups: the occipital artery resection group (the artery was identified and resected) and the control group (no occipital artery resection). Preoperative, 3 months’ and 12 months’ migraine frequency, duration, intensity, Migraine Headache Index (MHI), and complications were extracted and analyzed.

Results:

A total of 94 patients underwent GON decompression and met all inclusion criteria, with 78 in the occipital artery resection group and 16 in the control group. Both groups did not differ in any of the demographic factors or preoperative migraine frequency, duration, intensity or MHI. Postoperatively, both groups demonstrated a significant decrease in migraine frequency, duration, intensity, and MHI. The decrease in MHI was significantly greater amongst the occipital artery resection group than the control group (p=0.019). Both groups had no major complications and a very low rate of minor complications.

Conclusion:

Occipital artery resection during greater occipital nerve decompressions is safe and improves outcomes, therefore it should be performed routinely.