bluuebunny/crossref_metadata_2025 huggingface dataset:
PSXIII-29 Farm of origin has a major influence on the colonic microbiome but alterations due to selection for feed efficiency are also evident
Authors: Vigors Stafford , Sweeney Torres
Published: December 2019

While the intestinal microbiota is functionally important in nutrient digestibility and animal performance, the role of the microbiome in influencing feed efficiency is not well characterised. The objective of this experiment was to determine the relative influence of feed efficiency and farm of origin on the pig colonic microbiome. Animals were sourced from two geographically distinct locations in Ireland (farm A + B) and evaluated to identify pigs divergent in feed efficiency. The 8 most efficient (LRFI) & 8 least efficient (HRFI) pigs from farm A and 12 LRFI & 12 HRFI pigs from farm B were slaughtered. Colonic digesta was collected for sequencing of the V3-V4 hypervariable region of the bacterial 16S rRNA gene was performed on the Illumina MiSeq. Alpha diversity differed between the farms in this study with pigs from farm A having greater diversity based on Shannon and InvSimpson measures compared to pigs from farm B (P < 0.05). In agreement with this observation, pigs grouped by farm of origin rather than RFI in the beta diversity analysis. However, despite variation between farms, interesting taxonomic differences were identified between RFI groups. Within the phylum Bacteroidetes, the LRFI pigs had increased abundance of two families BS11 (P < 0.05) and a tendency towards increased Bacteroidaceae (P < 0.10) relative to the HRFI group. At genus level, the LRFI pigs had a tendency towards increased Bacteroides and CF231 (P < 0.10). In conclusion, while farm of origin has a substantial influence on microbial diversity in the pig colon, a microbial signature indicative of feed efficiency status was evident.
Shanks v Unilever: the sweet smell of success
Authors: Dunlop Hugh , Strath (Paralegal) Janet
Published: December 2019

Shanks v Unilever Plc & Ors [2019] UKSC 45 (23 October 2019)

The UK Supreme Court has allowed an appeal from a Court of Appeal ruling and found that Professor Ian Shanks was entitled to £2 million in employee compensation under sections 40(1) and 41 of the Patents Act 1977.
CMET-07. TUMOR RELATED IMPAIRMENTS OF NEUROCOGNITIVE FUNCTIONS IN PATIENTS WITH BRAIN METASTASES
Authors: Zhen Junjie , Li Shaoqun , Peng Zhangrui , Wen Lei , Lai Mingyao , Cai Linbo
Published: December 2019

OBJECTIVE

To study whether the neurocognitive functions were affected by brain metastases in patients, and what are the potential risk factors.

METHODS

A total of 172 patients with brain metastases were retrospectively analyzed. Prior to radiotherapy of brain metastases, the neurocognitive functions were evaluated by a wide range of tests including MOCA, VFT, HVLT-R, TMT-A, TMT-B and TOL. Kappa test was used to analyze the consistency of physical examination and neurocognitive assessment results. The related factors were analyzed with univariate and multivariate analysis.

RESULTS

53 out of 172 patients (30.8%) were identified with cognitive impairments by physical examination. The assessment with neurocognitive scales revealed that there were 148 cases of cognitive impairment (86.0%) and 24 cases of normal cognition (14.0%). Kappa=0.025, indicating that the difference between neurocognitive assessment results and physical examination was significant. The univariate analysis on the factors related to neurocognitive impairment revealed that the risk factors that may affect the neurocognitive functions included age, KPS, m-GPA score, RPA classification, whether the original tumor was under control, with or without brain metastases. After adjusting for education, the multivariate analysis showed that age≥45 years old, KPS≤70, RPA classification >2 and m-GPA score< 3 were independent risk factors for neurocognitive impairment.

CONCLUSION

Patients with brain metastases were found to have various degrees of neurocognitive impairment prior to radiotherapy. The neurocognitive functions of patients can be more precisely evaluated by a comprehensive scale assessment. Age, KPS, RPA classification and m-GPA score are the main factors associated with neurocognitive impairment.
GENE-01. THE MUTATIONAL LANDSCAPE OF PRIMARY CHORDOMAS AND THEIR SENSITIVE DETECTION IN PLASMA ctDNA BY MULTIPLE NEXT GENERATION SEQUENCING TECHNOLOGIES
Authors: Mattox Austin , Jiao Yuchen , Blair Cherie , Papadopoulos Nickolas , Bettegowda Chetan
Published: December 2019

CNS-associated tumors are notoriously difficult to detect in plasma. Chordomas are the most common primary spinal column malignancy, and extensive surgical procedures, along with chemotherapy and radiation are required to reduce recurrence. Currently CT, MRI, and PET are used to monitor for recurrence but are limited by surgical sequalae. In addition, needle biopsy risks tumor seeding along the biopsy track. In the largest cohort of chordomas described thus far, we characterize the mutational landscape of these tumors and show that liquid biopsy is a sensitive method for detecting cancers. 34 patients with a biopsy-confirmed diagnosis of chordoma had blood drawn before surgery, at the time of surgery, and/or at follow up appointments. Mutations in the primary tumor were identified by whole exome sequencing (WES) and droplet digital PCR (ddPCR) and/or Rapid Amplification of cDNA Ends Sequencing (RACE-Seq) was used to detect one or more of these mutations in plasma ctDNA at concurrent or later time points. The primary endpoint was detection of mutations in ctDNA in biopsy-confirmed chordoma samples. 87.9% of patients were ctDNA positive at the time of initial blood draw (p < 0.001). Follow up blood draws in twenty of the patients demonstrated that ctDNA levels reflected the clinical status of the disease. Patients with positive ctDNA levels were more likely to undergo radiotherapy (p = 0.004), and the presence of ctDNA may predict response to systemic chemotherapy and/or disease recurrence. Given the significant sequelae of biopsy and spinal surgery, liquid biopsy may be the best tool for detection and monitoring of chordomas.
PATH-33. GERMLINE PREDICTORS OF HEMATOLOGIC TOXICITY IN PATIENTS WITH GLIOMA TREATED WITH CHEMOTHERAPY
Authors: Sener Ugur , Bhatia Ankush , DeAngelis Lisa , Mandelker Diana , Yerram Prakirthi
Published: December 2019

BACKGROUND

Temozolomide is an alkylating agent commonly used in treatment of gliomas. While this agent is generally well-tolerated, hematologic toxicity is a known complication with grade 3/4 thrombocytopenia in 4% and grade 3/4 neutropenia in 8% of adults. Recent data in several non-CNS malignancies suggested that patients with germline mutations may carry an increased risk of hematological toxicity in the setting of alkylator chemotherapy. We aimed to investigate if germline mutations in glioma patients are associated with myelotoxicity during alkylating chemotherapy.

METHODS

In this retrospective single-institution study, we reviewed patients with glioma treated at Memorial Sloan Kettering Cancer Center (MSKCC) who had confirmed germline mutations identified by the institution’s Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT) testing. MSK-IMPACT evaluates DNA for mutations in 76 genes known to be associated with hereditary cancer predisposition.

RESULTS

In 283 patients with glioma who underwent MSK-IMPACT testing, 16 distinct germline mutations were identified in 40 (14%) individuals. 27 had high-grade and 13 had low-grade glioma. Median age was 47 (range 1–79), 12 patients were women. 30 patients received temozolomide chemotherapy. Of the patients treated, four (13%) developed severe hematologic toxicity. Two cases of grade 3 neutropenia and four cases of grade 3/4 thrombocytopenia were identified. Temozolomide was stopped during radiation therapy for three patients with grade 4 thrombocytopenia or neutropenia, and dose-reduced in one patient with grade 3 thrombocytopenia. In patients who had hematologic toxicity, germline mutations were identified in genes NBN, ATM, EPCAM, and FANCC. NBN, ATM, and FANCC are involved in DNA repair. EPCAM is involved in cell adhesion.

CONCLUSIONS

Hematologic toxicity is a known complication with alkylator chemotherapy. Germline testing may identify patients at increased risk, leading to closer monitoring, modified dosing regimens to minimize myelosuppression, and quicker intervention to prevent interruptions in treatment.
QOLP-38. PATIENT REPORTED OUTCOMES IN GLIOMA: THE ROLE OF IDH MUTATION ON QUALITY OF LIFE AND MOOD
Authors: Parsons Michael , Bunevicius Adomas , Dietrich Jorg
Published: December 2019

Isocitrate dehydrogenase 1 (IDH) mutation has important clinical prognostic value in glioma patients conferring improved survival and better neurocognitive function (NCF) compared to IDH wild type (IDH-WT) patients. It is not known whether IDH mutation status has an impact on patient reported outcomes (PRO). The goal of this single institution retrospective study was to examine the impact of IDH-mutation status on PRO’s in patients who also completed neuropsychological evaluation.

METHODS

Out of 101 glioma patients referred for neuropsychological evaluation between 2018–2019, 73 completed the Functional Assessment of Cancer Therapy-Brain (FACT-Br; non-completion due to severe cognitive impairment, poor English). In addition to the total score, the FACT-Br includes 5 subscales of wellbeing (Physical, Social, Emotional, Functional, and Brain specific symptoms). 69 patients completed the Beck Depression Inventory (BDI) and 61 completed the Beck Anxiety Inventory (BAI). Self-reported symptoms were compared between those with IDH-Mut vs IDH-WT by ANOVA.

RESULTS

Diagnoses included glioblastoma (20), diffuse astrocytoma grade II/III (29) and oligodendroglioma grade II/III (24). 29/73 (40%) patients were IDH-mut. FACT-Br total scores did not differ between IDH-WT and IDH-Mut glioma patients (F=2.685; p=ns). Separate analyses of the 5 FACT-Br subscales showed that only the emotional functioning subscale differed significantly, with IDH-Mut patients reporting better emotional functioning than IDH-WT patients (F=7.4; p< 0.05). BDI and BAI scores did not differ by group (F= 2.2 and 1.9, respectively; p=NS).

CONCLUSIONS

IDH mutation was related to patient reported emotional status on the FACT-Br in this mixed clinical sample of glioma patients. Analysis is complicated by the heterogeneity of the sample and retrospective nature of the study. Routine inclusion of PRO’s as standard of care may allow a more comprehensive understanding of the impact of IDH throughout the natural history of glioma.
Ethnic Differences in the Association Between Pain and Social Support in Iraq and Afghanistan Veterans
Authors: Herbert Matthew S , Hernandez Jeffrey , Dochat Cara , Pittman James O E , Afari Niloofar
Published: December 2019

Objective

Although past research has identified differences in pain between non-Latino white (NLW) and Latino persons, few studies have focused on the influence of social support. The purpose of the present study was to determine if the association between the number of social support sources and ratings of pain intensity and pain interference differed as a function of ethnicity.

Design

Cross-sectional.

Setting

Veterans Affairs San Diego Healthcare System

Subjects

Participants were NLW (N = 389) and Latino (N = 207) Iraq and Afghanistan veterans.

Methods

Linear regression analyses were used to examine the interaction between ethnicity and number of social support sources on pain intensity and pain interference as measured by the Patient-Reported Outcomes Measurement Information System pain inventory.

Results

The association between number of social support sources and pain intensity and interference significantly differed by ethnicity (P < 0.01 and P = 0.01, respectively). Among NLW veterans, there was a significant negative association between number of social support sources and pain intensity. Among Latino veterans, there was a significant positive association between number of social support sources and pain intensity and interference.

Conclusions

These findings suggest important differences between NLW and Latino Iraq and Afghanistan veterans in the association between social support and pain. Future research should examine ethnic differences in pain-specific support received from the social environment.
TRANSBOUNDARY RADIOLOGICAL EFFECTS OF A HYPOTHETICAL NUCLEAR ACCIDENT IN NORTHEAST ASIA
Authors: Musauddin Ashraf , Kim Juyoul
Published: December 2019

Offsite radiological consequence investigation using computerized software has been considered as an important quantitative risk communication in order to recognize and discuss public concerns about nuclear safety and health risk in case of hypothetical nuclear accidents around specific nuclear power plants (NPPs), with guideline of lessons learned from previous nuclear disasters. In this study, Northeast Asia nuclear accident simulator (NANAS) developed by Nuclear Safety and Security Commission (NSSC) in Korea was used to quantify the offsite radiological consequences from Haiyang unit 1 NPP in China and to examine the emergency protective measures for the public around regions of Korea as NPPs operating in Northeast Asia countries contributed to about 25% of the industry. Broad simulations of radiological source term estimation, atmospheric dispersion analysis and radiation dose assessment to the public have been performed in case of hypothetical nuclear accident involving source term of radionuclides release taken from Fukushima accident.
Factors Related to Agreement Between Child and Caregiver Report of Child Functioning With Chronic Pain
Authors: Birnie Kathryn A. , Richardson Patricia A. , Rajagopalan Adithi V. , Bhandari Rashmi P.
Published: December 2019

Objectives:

Valid and efficient assessment of patient-reported outcomes remains a priority to guide pain treatment and research. PROMIS pediatric self-report and parent proxy measures offer feasible and rigorous evaluation of functioning in children with chronic conditions, including pain. A key challenge is determining the usefulness of multisource information from children and caregivers for understanding pain and function. Our primary aim examined child-caregiver agreement across child functioning domains. Our secondary aim examined child and caregiver factors associated with the child-caregiver agreement.

Materials and Methods:

A sample of 806 children with chronic pain (M
age=14.50 y; 72% female individuals) and a caregiver (M
age=45.82 y; 85% mothers) completed PROMIS pediatric self-report and parent proxy measures of anxiety, depression, fatigue, pain interference, and mobility before intake in an interdisciplinary outpatient pediatric chronic pain program.

Results:

The agreement was poor to good depending on the evaluation method (effect size, intraclass correlation, and clinical significance interpretation). Caregivers generally reported worse child symptoms across domains compared with child self-report. The greatest discrepancy was observed for child anxiety, pain interference, and peer relations, with the greatest agreement for child mobility. The greater caregiver-child discrepancy was found for younger children, girls, with a higher child or caregiver pain catastrophizing, and poorer caregiver physical or mental health.

Discussion:

Findings are discussed within the interpersonal context of pain and indicate the relevance of both child and caregiver perspectives to personalize chronic pain assessment and treatment. Findings can be used by clinicians and researchers to guide whether and how to integrate multi-informant reports about child chronic pain functioning.
Plate-Assisted Intramedullary Nailing of Proximal Third Tibia Fractures
Authors: Cinats David J. , Perey Bertrand , Moola Farhad , Boyer Dory , Lemke Helmut M. , Stone Trevor , Apostle Kelly , Viskontas Darius
Published: December 2019

Objectives:

To report on the safety of unicortical plate stabilization in conjunction with intramedullary nailing (IMN) of proximal third tibia fractures.

Design:

Retrospective cohort.

Setting:

A Level I trauma center.

Patients/Participants:

All Orthopaedic Trauma Association 41A and 42A/B/C proximal tibia fractures treated with IMN from January 2011 to May 2018 were reviewed. Fifty-three proximal tibia fractures in 50 patients were included in the study. Twenty-four patients were treated with plate-assisted reduction and IMN, and 29 were treated with IMN alone. The plate-assisted IMN cohort was subdivided into patients with plate retention and those that had the plate removed.

Intervention:

Plate-assisted IMN and IMN only.

Main Outcome Measurements:

Patients were followed up for evidence of nonunion, reduction quality, postoperative infection, and rate of implant removal.

Results:

There were no statistically significant differences between plate-assisted IMN and IMN only for age, fracture type, mechanism of injury, quality of reduction, or implant removal rate. Open fractures were treated more often with plate-assisted IMN (88%) compared with the number of open fractures treated with IMN only (12%). There were no differences in nonunion rate or rate of postoperative infection between the 2 groups.

Conclusions:

Plate-assisted IMN of proximal third tibia fractures can safely be performed even in open tibia fractures with similar rates of nonunion, infection, and implant removal rates to patients treated with IMN only.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Determinants of Direct Discharge Home From Critical Care Units: A Population-Based Cohort Analysis*
Authors: Martin Claudio M. , Lam Melody , Allen Britney , Richard Lucie , Lau Vincent , Ball Ian M. , Wunsch Hannah , Fowler Rob A. , Scales Damon C.
Published: December 2019

Objective:

To describe trends and patient and system factors associated with direct discharge from critical care to home in a large health system.

Design:

Population-based cohort study of direct discharge to home rates annually over 10 years. We used a multivariable, multilevel random-effects regression model to analyze current factors associated with direct discharge home in a subcohort from the most recent 2 years.

Setting:

One hundred seventy-four ICUs in 101 hospitals in Ontario.

Patients:

All patients discharged from an ICU between April 1, 2007, and March 31, 2017.

Interventions:

None.

Measurements and Main Results:

Overall, 237,200 patients (21.1%) were discharged directly home from an ICU. The rate of direct discharge to home increased from 18.6% in 2007 to 23.1% in 2017 (annual increase of 1.02; 95% CI, 1.02–1.03). There were marked variations in rates of direct discharge to home across all critical care units. For medical and surgical units, the median odds ratio was 1.76 (95% CI, 1.59–1.92). In these units, direct discharge to home was associated with younger age (odds ratio, 0.36; 95% CI, 0.34–0.39 for age 80–105 vs age 18–39), fewer comorbidities (odds ratio, 1.74; 95% CI, 1.63–1.85 for Charlson comorbidity index of 0 vs 2), diagnoses of overdose/poisoning (odds ratio, 1.35; 95% CI, 1.23–1.47) and diabetic complications (odds ratio, 1.35; 95% CI, 1.2–1.51), and admission after a same-day procedure (odds ratio, 2.82; 95% CI, 2.46–3.23 compared with emergency department). ICU occupancy was inversely associated with direct discharge to home with an odds ratio of 0.88 (95% CI, 0.87–0.88) for each 10% increase.

Conclusions:

High rates of direct discharge to home with evidence of significant practice variation combined with identifiable patient characteristics suggest that further evaluation of this increasingly common transition in care is warranted.
Loss of the posteromedial support: a risk factor for implant failure after fixation of AO 31-A2 intertrochanteric fractures
Authors: Ye Kai-Feng , Xing Yong , Sun Chuan , Cui Zhi-Yong , Zhou Fang , Ji Hong-Quan , Guo Yan , Lyu Yang , Yang Zhong-Wei , Hou Guo-Jin , Tian Yun , Zhang Zhi-Shan
Published: December 2019

Background:

The purpose of this study was to analyze cases of AO31-A2 intertrochanteric fractures (ITFs) and to identify the relationship between the loss of the posteromedial support and implant failure.

Methods:

Three hundred ninety-four patients who underwent operative treatment for ITF from January 2003 to December 2017 were enrolled. Focusing on posteromedial support, the A2 ITFs were divided into two groups, namely, those with (Group A, n = 153) or without (Group B, n = 241) posteromedial support post-operatively, and the failure rates were compared. Based on the final outcomes (failed or not), we allocated all of the patients into two groups: failed (Group C, n = 66) and normal (Group D, n = 328). We separately analyzed each dataset to identify the factors that exhibited statistically significant differences between the groups. In addition, a logistic regression was conducted to identify whether the loss of posteromedial support of A2 ITFs was an independent risk factor for fixation failure. The basic factors were age, sex, American Society of Anesthesiologists (ASA) score, side of affected limb, fixation method (intramedullary or extramedullary), time from injury to operation, blood loss, operative time and length of stay.

Results:

The failure rate of group B (58, 24.07%) was significantly higher than that of group A (8, 5.23%) (χ
2 = 23.814, P < 0.001). Regarding Groups C and D, the comparisons of the fixation method (P = 0.005), operative time (P = 0.001), blood loss (P = 0.002) and length of stay (P = 0.033) showed that the differences were significant. The logistic regression revealed that the loss of posteromedial support was an independent risk factor for implant failure (OR = 5.986, 95% CI: 2.667–13.432) (P < 0.001).

Conclusions:

For AO31-A2 ITFs, the loss of posteromedial support was an independent risk factor for fixation failure. Therefore, posteromedial wall reconstruction might be necessary for the effective treatment of A2 fractures that lose posteromedial support.
New treatment standards for vulvar cancer 2020
Authors: Woelber Linn , Jaeger Anna , Prieske Katharina
Published: December 2019

Purpose of review

To highlight the recent advances regarding molecular mechanisms and therapeutic strategies in vulvar squamous cell carcinoma (VSCC), a rare but continuously rising disease.

Recent findings

Clinical research focuses on deescalation especially with regard to surgery. Recurrence patterns have been analyzed to further understand the course of disease showing a persistent risk for local recurrence even several years after the initial diagnosis. The main focuses of recent translational research are the distinct molecular mechanisms behind human papillomavirus (HPV)-positive and -negative VSCC. Next-generation sequencing analyses have highlighted TP53 as central driver mutation in HPV-negative disease. For HPV-independent VSCC, an impaired prognosis with limited disease-free and overall survival has been reported from a large multicenter analysis. Although no targeted agent has been granted approval, the impact of immunotherapy in vulvar cancer has been investigated in basket trials. Therapy response, however, was limited.

Further clinical research should focus on deciphering the molecular mechanisms of tumor development further. Detailed understanding of the molecular landscape will help to find novel therapy targets, fight the disease in advanced stages and thereby improve the quality of life for affected patients.
Characterization of a TP53 Somatic Variant of Unknown Function From an Ovarian Cancer Patient Using Organoid Culture and Computational Modeling
Authors: BI JIANLING , THIEL KRISTINA W. , LITMAN JACOB M. , ZHANG YUPING , DEVOR ERIC J. , NEWTSON ANDREEA M. , SCHNIEDERS MICHAEL J. , GONZALEZ BOSQUET JESUS , LESLIE KIMBERLY K.
Published: December 2019

In our proof-of-concept study of 1 patient with stage IIIC carcinosarcoma of the ovary, we discovered a rare mutation in the tumor suppressor, TP53, that results in the deletion of N131. Immunofluorescence imaging of the organoid culture revealed hyperstaining of p53 protein. Computational modeling suggests this residue is important for maintaining protein conformation. Drug screening identified the combination of a proteasome inhibitor with a histone deacetylase inhibitor as the most effective treatment. These data provide evidence for the successful culture of a patient tumor and analysis of drug response ex vivo.
Finger-Prick Autologous Blood in the Treatment of Persistent Corneal Epithelial Defects
Authors: Balal Shafi , Nitiahpapand Rynda , Hassan Ali , Than Jonathan , Patel Amit , Kumar Bimal , Sharma Anant
Published: December 2019

Purpose:

Autologous hemoderivative eye drops have a role in the management of persistent epithelial defects (PEDs), but their use may be limited by cost and availability. Finger-prick autologous blood (FAB) treatment uses whole capillary blood, obtained from a sterilized fingertip, as an alternative form of hemoderivative eye drop therapy. To date, 1 report has described the safe and effective use of FAB for dry eye and PEDs. We report the results of 10 eyes (10 patients) treated with FAB for PEDs.

Methods:

Ten patients with PEDs in 1 eye for a mean of 259 ± 201 days due to diabetic neurotrophic keratopathy (n = 3), herpetic keratitis (n = 3), postpenetrating keratoplasty (n = 1), keratoconjunctivitis sicca (n = 1), postradiotherapy (n = 1), and neuropathic ulcer (n = 1) were treated with FAB 4 times a day for 28 days in addition to conventional therapies. All patients had been unsuccessfully treated with conventional therapy before commencing on FAB. None of the patients had received any surgical treatment for PED.

Results:

At day 28, the PED had healed in 60% (n = 6) of the eyes. In 1 eye, the PED reduced in size by half. Thirty percent (n = 3) of patients had incomplete follow-up data at the end of the study.

Conclusions:

FAB in combination with conventional treatment may be successfully used in the management of refractory PEDs. No adverse effects arising from FAB treatment were observed.
Morphological and Optical Determinants of Visual Disability in Fuchs Endothelial Corneal Dystrophy
Authors: Wacker Katrin , Grewing Viviane , Fritz Marianne , Böhringer Daniel , Reinhard Thomas
Published: December 2019

Purpose:

To identify determinants of visual disability in patients with advanced Fuchs endothelial corneal dystrophy.

Methods:

This prospectively sampled cross-sectional study at a tertiary referral center included participants with clinically advanced Fuchs dystrophy requiring endothelial keratoplasty and no other vision-limiting pathologies. We quantified visual disability using the Fuchs dystrophy-specific Visual Function and Corneal Health Status (V-FUCHS) visual disability instrument. We calculated Fuchs dystrophy-specific glare and diurnal variation (Glare Factor) scores and visual acuity-related disability (Visual Acuity Factor) scores. To assess corneal morphology and optics, all participants underwent standardized Scheimpflug imaging and tests for disability glare and best-corrected visual acuity on Early Treatment Diabetic Retinopathy Study charts after subjective refraction. Associations of morphological and optical parameters with V-FUCHS scores were assessed adjusting for age, sex, and lenticular status.

Results:

Participants with more posterior corneal backscatter had more visual disability (higher scores), with participants in the highest quartile of backscatter (median, 1409 scatter units) having 0.57 higher Glare Factor scores (95% confidence interval, 0.14–1.00) and 0.61 higher Visual Acuity Factor scores (95% confidence interval, 0.15–1.06) compared with participants in the lowest quartile of backscatter (median, 812 scatter units). Other morphological and optical factors such as anterior corneal backscatter, higher-order aberrations, or edematous surface changes were not empirical contributors to visual disability, especially when accounting for posterior corneal backscatter.

Conclusions:

Corneal backscatter is a driver of characteristic visual disability in Fuchs dystrophy. Comprehensive assessments of morphology and direct quantification of disease-related disability may help identify the best candidates for endothelial keratoplasty.
Cost–Benefit and Cost–Utility Analysis of Amphotericin B Supplementation of Corneal Storage Media With Endothelial Keratoplasty-Prepared Tissue
Authors: Chiang Trent Tsun-Kang , Shtein Roni M. , McCoy Kristen , Hurlbert Susan , Grossman Gregory H.
Published: December 2019

Purpose:

To determine the cost-effectiveness of amphotericin B supplementation, we analyzed both current costs to treat postendothelial keratoplasty (EK) fungal infections and potential costs associated with amphotericin B supplementation.

Methods:

We collected 19 US cases of post-EK fungal eye infections from the published literature and assessed the associated costs from the literature. A survey of surgeons was also conducted with questions regarding their experiences in managing these infections.

Results:

We estimated that the costs to diagnose, manage, and treat post-EK fungal keratitis and post-EK fungal endophthalmitis are USD $21,113 and $34,850, respectively. The largest portion of the costs can be attributed to the need for additional surgical management, which is required in 79% of the cases. We estimated the total cost of amphotericin B supplementation to be $44.39 per graft with use of conventional amphotericin B and conservative assumptions regarding supplementation processes. Cost-effectiveness analysis demonstrated that amphotericin B supplementation is cost-effective at $100,000 per quality-adjusted life-year level only if amphotericin B supplementation can prevent more than 69.62% of post-EK fungal infections, assuming the incidence of post-EK fungal infection remains at the level it was between 2012 and 2017.

Conclusions:

We found that amphotericin B supplementation can be cost-effective under conservative assumptions if it is moderately effective in preventing post-EK fungal infections.
Lacrimal Gland Ductal Cyst Complicated by Abscess Formation
Authors: Sadek Hadeel , Mirani Neena , Lee Huey-Jen , Langer Paul D.
Published: December 2019

A 52-year-old woman with a 7-month history of a left lateral upper eyelid nodule presented with an acute, 1-day history of left upper eyelid swelling and erythema associated with chemosis, epiphora, and pain. Magnetic resonance (MR) imaging revealed a well-circumscribed cystic mass indistinguishable from the left lacrimal gland containing a fluid–fluid level. Surgery confirmed an abscess within the lacrimal gland; histopathologic examination revealed a dilated lacrimal duct with an inflammatory exudate within the lumen. This report details one of the few reported cases of an acute lacrimal gland ductal cyst abscess and, to the authors’ knowledge, the first with MR images
Iterative Development of an mHealth Intervention to Support Antiretroviral Therapy Initiation and Adherence Among Female Sex Workers in Mombasa, Kenya
Authors: Aunon Frances M. , Okada Elena , Wanje George , Masese Linnet , Odeny Thomas A. , Kinuthia John , Mandaliya Kishorchandra , Jaoko Walter , Simoni Jane M. , McClelland R. Scott
Published: December 2019

Nurses have an integral role to play in achieving the 95-95-95 goals to stem the HIV epidemic. We used the Information–Motivation–Behavioral Skills (IMB) theoretical model to develop a nurse-delivered, mHealth intervention to support antiretroviral therapy adherence among female sex workers living with HIV in Mombasa, Kenya. Twenty-three purposively sampled female sex workers living with HIV participated in 5 focus group discussions to iteratively develop the message content as well as the format and structure of the nurse-delivered, text-based intervention. Focus group discussion interview guides were developed in accordance with the IMB model. Transcripts were analyzed according to IMB themes, and findings were used to develop the intervention. Information-oriented texts addressed concerns and misconceptions; motivation-oriented texts reinforced women's desires to feel healthy enough to engage in activities; and behavioral skills-oriented texts included strategies to remember medication doses. The nurse-delivered, theory-based, culturally tailored intervention to support medication adherence was evaluated.
Increasing nurse practitioner students' comfort levels in caring for veterans with post-traumatic stress disorder
Authors: Cannady Jolene , Adams Judith
Published: December 2019

Few nurse practitioner programs integrate education on care of veterans into their curriculum. Because more veterans are seeking health care outside of the Veteran Affairs system, all advanced practice nurses need to be prepared to meet the unique needs of veterans with post-traumatic stress disorder (PTSD). The authors developed an education session on military-to-civilian transition and screening and treatment of veterans with PTSD. The session was provided to a convenience sample of students. Case studies were included to allow student participation and active learning. Students completed pre-education and post-education surveys to measure their comfort level in caring for this specific population and their understanding of PTSD. The participant scores on comfort level with identifying and managing PTSD after the education session were significantly increased. Placing veteran-specific education into nurse practitioner programs enhances the comfort level with identifying and managing PTSD. Adding this veteran-specific education could enhance the overall care for veterans in the civilian sector.
Diagnostic Yield and Bleeding Complications Associated With Bronchoscopic Biopsy of Endobronchial Carcinoid Tumors
Authors: Gao Yang , Moua Teng , Midthun David E. , Mullon John J. , Decker Paul A. , Ryu Jay H.
Published: December 2019

Background:

Bronchial carcinoid often appears hypervascular on bronchoscopic visualization and may be associated with hemoptysis. The diagnostic yield and bleeding complications associated with bronchoscopic biopsy of bronchial carcinoid tumors remain unclear.

Materials and Methods:

Patients with bronchial carcinoid tumors that were bronchoscopically visualized and biopsied at our tertiary referral medical center, over an 8-year period from 2010 to 2017, were retrospectively identified and reviewed to assess diagnostic yield and bleeding complications. Correlations with patient characteristics and carcinoid tumor features were analyzed.

Results:

Forty-nine patients were included (57% female). Tumors were predominantly (71%) located in proximal airways (mainstem and lobar bronchi). Bronchoscopic biopsy was diagnostic in 45 patients (92%). Thirteen patients (27%) experienced moderate (n=12, 25%) or severe (n=1, 2%) bleeding. Among these, 6 tumors (46%) had a vascular appearance and 4 patients (31%) had experienced recent hemoptysis. However, neither vascularity nor hemoptysis was associated with bleeding at biopsy (P=0.68 and 0.73, respectively). Carcinoid tumors were classified as typical in 79% and atypical in 21% with no difference in diagnostic yield or bleeding risk (P=0.28 and 0.92, respectively). Tumor size was also not associated with increased diagnostic yield or bleeding risk (P=0.54 and 0.39, respectively).

Conclusion:

Bronchoscopic biopsy of endobronchial carcinoid is associated with a high diagnostic yield and severe bleeding is rarely encountered. Diagnostic yield and bleeding seemed independent of vascular tumor appearance or history of recent hemoptysis.
Balloon-occluded Retrograde Transvenous Obliteration Versus Transjugular Intrahepatic Portosystemic Shunt for Gastric Varices
Authors: Yu Qian , Liu Chenyu , Raissi Driss
Published: December 2019

Introduction:

Balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS) are well-validated techniques in the management of portal hypertensive gastric variceal bleeding when medical management alone is not sufficient. However, despite their effectiveness, the adverse effects from both procedures make each technique more suitable to different cohorts of patient’s depending on presence or lack of certain comorbidities. This study aims to compare clinical outcomes of patients who have undergone both procedures for portal hypertensive gastric variceal bleeding.

Materials and Methods:

We conducted a search of electronic databases from their establishment to April 2019. The goal was to compare the efficacy of BRTO and TIPS in preventing variceal rebleeding and the risk of adverse events such as ascites and hepatic encephalopathy. Predictors of overall survival and rebleeding were also analyzed. Meta-analysis was performed with STATA 15.1.

Results:

Five randomized controlled trials and retrospective cohort studies were included in our meta-analysis. The number of patients who underwent BRTO and TIPS were 308 and 127, respectively. BRTO and TIPS have similar technical success rates (91.4% vs. 89.7%, P=0.995) and immediate bleeding control rates (97.7% vs. 95.9%, P=0.836). However, compared with TIPS, BRTO has lower likelihood of future cumulative rebleeding (10.6% vs. 18.7%, P=0.027) and hepatic encephalopathy (0.00% vs. 23.1%, P<0.001) but is more likely to aggravate ascites (22.4% vs. 4.3%, P=0.009). Serum albumin level and presence of hepatocellular carcinoma are both independent predictors of increased likelihood of rebleeding and overall survival (P<0.001).

Conclusions:

Both BRTO and TIPS are safe and effective interventions in the management algorithm of portal hypertensive gastric variceal bleeding. Although BRTO may be more effective at the prevention of future variceal rebleeding, the choice of BRTO versus TIPS should be tailored according to patient’s comorbidities.
Brentuximab Vedotin as Consolidation Therapy After Autologous Stem Cell Transplantation in Children and Adolescents (<18 y) With Early Relapse Hodgkin Lymphoma
Authors: Fernández Karen S. , Mavers Melissa , Marks Lianna J. , Agarwal Rajni
Published: December 2019

We describe 6 pediatric patients (12 to 18 y) with relapsed or refractory Hodgkin lymphoma treated with consolidative Brentuximab vedotin (Bv) following reinduction chemotherapy and autologous stem cell transplantation. The progression-free survival after autologous stem cell transplantation was 12, 18, 22, 24, 30, and 30 months. Most patients tolerated Bv well although 2 patients developed grade 3 neuropathy that prevent them from completing the scheduled 16 doses of Bv. Consolidative Bv in children and adolescents, as currently recommended for adult patients with early relapsed or refractory Hodgkin lymphoma, is feasible but with some significant toxicities.
Round Robin Evaluation of MET Protein Expression in Lung Adenocarcinomas Improves Interobserver Concordance
Authors: Boyle Theresa A. , Khalil Farah K. , Mino-Kenudson Mari , Sica Gabriel L. , Moreira Andre L. , Sholl Lynette M. , Knight Mirna Z. , Zhang Liping , Saller James , Varella-Garcia Marileila , Berry Lynne D. , Chen Heidi , Ellison Kim E. , Rivard Christopher J. , Kugler Kelly , Wistuba Ignacio I. , Fujimoto Junya , Kwiatkowski David J. , Bunn Paul A. , Kris Mark G. , Haura Eric B. , Hirsch Fred R.
Published: December 2019

Introduction:

Overexpression of the mesenchymal-epithelial transition (MET) receptor, a receptor tyrosine kinase, can propel the growth of cancer cells and portends poor prognoses for patients with lung cancer. Evaluation of MET by immunohistochemistry is challenging, with MET protein overexpression varying from 20% to 80% between lung cancer cohorts. Clinical trials using MET protein expression to select patients have also reported a wide range of positivity rates and outcomes.

Materials and Methods:

To overcome this variability, the Lung Cancer Mutation Consortium Pathologist Panel endeavored to standardize the evaluation of MET protein expression with “Round Robin” conferences. This panel used randomly selected Aperio-scanned formalin-fixed paraffin-embedded lung cancer specimens stained by MET immunohistochemistry for the Lung Cancer Mutation Consortium 2.0 study (N=838). Seven pathologists in separate laboratories scored images of 5 initial cases and 2 subsequent rounds of 39 cases. The pathologists’ scores were compared for consistency using the intraclass correlation coefficient. Issues affecting reproducibility were discussed in Round Robin conferences between rounds, and steps were taken to improve scoring consistency, such as sharing reference materials and example images.

Results:

The overall group intraclass correlation coefficient comparing the consistency of scoring improved from 0.50 (95% confidence interval, 0.37-0.64) for the first scoring round to 0.74 (95% confidence interval, 0.64-0.83) for the second round.

Discussion:

We found that the consistency of MET immunohistochemistry scoring is improved by continuous training and communication between pathologists.
Should We Stick with Surgical Glues? The Incidence of Dermatitis after 2-Octyl Cyanoacrylate Exposure in 102 Consecutive Breast Cases
Authors: Nigro Lauren C. , Parkerson Jamie , Nunley Julia , Blanchet Nadia
Published: December 2019

Skin adhesives have become standard in wound closure as alternatives to traditional sutures or as sterile occlusive dressings after surgery of all types. The literature is replete with case reports of contact dermatitis following exposure to cyanoacrylate-based adhesives, such as 2-octyl cyanoacrylate. Nonetheless, it has been the impression of the senior author and others that the incidence of allergic and/or contact dermatitis is much higher than commonly considered. The authors prospectively studied 102 consecutive patients who underwent breast surgery performed by the senior author with 2-octyl cyanoacrylate placed over incisions as an occlusive dressing. Two patients with a known glue allergy did not receive cyanoacrylate at surgery but were scratch tested to confirm the diagnosis. All patients were followed postoperatively. Twelve patients went on to develop significant dermatitis postoperatively after glue placement. Cyanoacrylate was confirmed as the cause of all rashes by allergy scratch testing for a total incidence of 14 percent (14 patients). Given the popularity of cyanoacrylate products across emergency rooms, clinics, and operating rooms, awareness of the true incidence of these reactions may caution against their use in the future.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today
Authors: Pathak Abraham , Mohan Raja , Rohrich Rod. J.
Published: December 2019

The practice of chemical peeling remains an important aspect of the nonsurgical techniques available to the aesthetic surgeon when approaching skin rejuvenation. Despite past predictions of their disappearance in favor of lasers, the overall use of chemical peels by plastic surgeons continues to grow. In the past two decades, the techniques available to the clinician have evolved in safety and efficacy based on the dermatologic investigations of various individuals, including Obagi, Hetter, and Stone. The versatility, clinical endpoint–directed predictability, and favorable risk profile of chemical peels proffered by these latest advancements affirm that this modality is essential to the practice of the plastic surgeon treating patients with rhytides and dyschromias. This review presents the current role of chemical peels in skin rejuvenation, emphasizing the significant clinical advancements and their modern day applications and practice.
Results of XPAND II: A Multicenter, Prospective, Continued-Access Clinical Trial Using the AeroForm Tissue Expander for Two-Stage Breast Reconstruction
Authors: Ascherman Jeffrey A. , Zeidler Kamakshi , Morrison Kerry A. , Appel James , Castle John , Chun Yoon , Colwell Amy , Mohebali Khashayar , Stokes Tracey , Sudarsky Laura
Published: December 2019

Background:

XPAND II was a prospective, multicenter, single-arm, open-label, continued-access study designed to confirm the results from the XPAND study, a multicenter, prospective, randomized study for breast reconstruction. The AeroForm device received clearance from the U.S. Food and Drug Administration in December 2016 based on the results of the pivotal XPAND trial, which compared the AeroForm to saline expanders.

Methods:

Fifty women were treated in the XPAND II study and implanted with the AeroForm device (86 devices). The study endpoint was successful completion of the second-stage surgery, and secondary endpoints were days to complete expansion and reconstruction, and patient/physician satisfaction. Following implantation, women were administered 10-cc doses of carbon dioxide at home up to three times daily. When adequate expansion was achieved, the expanders were exchanged for standard breast implants.

Results:

The primary endpoint (successful exchange to standard breast implant, precluding non–device-related failures) is 100 percent. All-cause interim success is 95 percent, with three subjects (four breasts) failing primary exchange because of non–device-related reasons. Median time to complete expansion was 21 days (range, 5 to 117 days). Median time to complete the reconstruction was 112 days (range, 55 to 329 days). Ninety-six percent of the subjects were very or moderately satisfied with the AeroForm expansion process.

Conclusions:

Results of the XPAND II continued access study confirm and improve on previous results from the randomized trial (XPAND). These results validate that the AeroForm patient-controlled, needle-free carbon dioxide tissue expander is safe and effective for two-stage breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Facial Nerve Danger Zones
Authors: Stuzin James M. , Rohrich Rod J.
Published: December 2019

Facial nerve injury is one of the most feared complications in surgical rejuvenation of the aging face. Understanding the three-dimensional architecture of the facial soft tissue, the fascial planes that exist within this architectural arrangement, and the danger zones where the facial nerve is situated superficial and adjacent to the planes of dissection commonly used in face-lift techniques, are the keys to safety in preventing motor branch injury. The two-dimensional branching patterns of the marginal and cervical branches of the facial nerve are variable, making it difficult to ascertain exact nerve location when dissecting within the cheek and neck. On a three-dimensional basis, the position and depth of the marginal and cervical branches are constant and predictable. Understanding the three-dimensional anatomy in terms of planes of dissection, and the danger zones where these nerve branches are vulnerable to injury, provides protection against iatrogenic injury when performing surgical rejuvenation of the aging face. These video vignettes provide an overview of the fascial anatomy of the cheek in relation to the facial nerve branches and delineate the regions of the face in which nerve branches are most likely to be injured. Methods to prevent injury are discussed. Furthermore, the vignette defines these danger zones and delineates methods to protect the nerve branches.
Solitary Cerebellar Metastasis of Ovarian Cancer Detected by FDG PET/CT
Authors: Hou Guozhu , Jiang Yuanyuan , Cheng Xin
Published: December 2019

Ovarian cancer with solitary metastasis to the cerebellum is very rare. We presented a 58-year-old woman complaining of headaches 9 months after debulking surgery and chemotherapy due to ovarian cancer. The serum CA125 level was elevated. FDG PET/CT was then recommended to identify potential malignancy and showed a hypermetabolic mass in the right cerebellum. The cerebellar mass was surgically removed, and the pathology confirmed metastasis from ovarian cancer.
Corpus Cavernosum Abscess Diagnosed on FDG PET/CT
Authors: Vermeulen Sim , Walgraeve Natascha , De Geeter Frank
Published: December 2019

The utility of PET in septicemia for showing its source and possible metastatic infection has been demonstrated. We describe the diagnosis on PET/CT of a spontaneous corpus cavernosum abscess in a 64-year-old man presenting with Streptococcus constellatus septicemia, in whom the clinical diagnosis had been elusive for 10 days.