bluuebunny/crossref_metadata_2025 huggingface dataset:
OPHTHALMOMYIASIS INTERNA WITH INVASION OF THE OPTIC NERVE
Authors: Durrani Asad F. , Johnson Mark W.
Published: October 2021

Purpose:

To report a case of ophthalmomyiasis interna with optic nerve invasion that was treated with oral ivermectin and prednisone.

Methods:

Case report with retrospective review of medical records and multimodal imaging studies.

Results:

A Christmas tree farmer in his sixties presented with expanding multicolored, spiraling photopsias in the left eye. The visual acuity measured 20/50, and examination and imaging findings showed subretinal tracks consistent with ophthalmomyiasis interna. After several weeks of spontaneous improvement, the visual acuity decreased to 20/150 and fundus examination showed new optic disc edema that was treated with ivermectin and prednisone. Despite the development of optic disc pallor, the visual acuity improved to 20/25.

Conclusion:

Subretinal fly larvae can occasionally exit the eye by invading the optic nerve. Treatment of optic nerve involvement with ivermectin and prednisone can result in an excellent visual outcome.
The Pain Course: a randomised controlled trial and economic evaluation of an internet-delivered pain management program
Authors: Dear Blake F. , Karin Eyal , Fogliati Rhiannon , Dudeney Joanne , Nielssen Olav , Gandy Milena , Staples Lauren , Scott Amelia J. , Heriseanu Andreea I. , Bisby Madelyne A. , Hathway Taylor , Titov Nickolai , Schroeder Liz
Published: October 2021

There is interest in the potential of Internet-delivered programs to cost-effectively increase access to pain management for people with chronic pain. However, few large-scale clinical and economic evaluations have been undertaken. Using a randomised controlled trial design, the current study (n = 659) examined the clinical efficacy, cost-effectiveness, and cost utility of an Internet-delivered pain management program for people with mixed chronic pain conditions when delivered with optional clinician support. The treatment group reported significant improvements in disability, depression, anxiety, average pain intensity, and quality-adjusted life years (QALYs), compared with control, and exhibited relatively high levels of treatment engagement and satisfaction. Each additional clinical improvement (defined as ≥ 30% improvement) produced by the intervention, over control, was associated with a cost of $48, $27, $38, and $83 for disability, depression, anxiety, and average pain intensity, respectively. Gaining one QALY was associated with a cost of $152 or $11,910 per QALY when an 80% probability criterion for cost utility was applied. The program itself was associated a relatively small, fixed, cost per patient but was not cost saving over the brief intervention period. The findings support the clinical efficacy and cost-effectiveness of Internet-delivered programs with “on demand” clinician support as a way to increase access to pain management. Key limitations of the current study include the use of a waitlist-control group, a short follow-up period, and the focus on governmental healthcare costs. Further evaluation of these programs is necessary if they are scaled up and offered as routine care.
Progression of
KCNQ4
related genetic hearing loss: a narrative review
Authors: Zhang Xiaolong , Wang Hongyang , Wang Qiuju
Published: October 2021

KCNQ4
gene mutation can lead to deafness non-syndromic autosomal dominant 2A, which is a type of autosomal dominant non-syndromic hearing loss. Deafness non-syndromic autosomal dominant 2A patients with
KCNQ4
gene mutation usually present with symmetrical, delayed, progressive high-frequency-affected hearing loss, which eventually can involve all frequencies. In this article, we comprehensively reviewed the research on the role and function of
KCNQ4
gene in genetic hearing loss. We discussed the pathological and physiological mechanisms of
KCNQ4
gene and the related clinical phenotypes of
KCNQ4
gene mutations. We also reviewed the latest developments in the treatment of
KCNQ4
gene mutation-related genetic hearing loss, including selective potassium channel activation drugs and gene therapy.
The current state of chemotherapy for the treatment of gastrointestinal stromal tumors with different genotypes: a narrative review
Authors: Xu Yingying , Hu Wenqing , Xiao Keyuan , Wang Feng , Guan Wenxian , Zong Liang
Published: October 2021

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the digestive system and are not sensitive to traditional chemotherapy. Therefore, historically, surgical resection was the only effective therapy. However, the emergence of tyrosine kinase inhibitors (TKIs) has revolutionized the treatment of GISTs, because they target c-Kit and PDGF receptor-α (PDGFRA), which are important in GIST development and progression. As research into c-Kit and PDGFRA continues, an increasing number of different TKIs are being used in the clinical setting. This review aims to discuss the current state of chemotherapy for the treatment of GISTs with different genotypes.
Exploring the Barriers Faced by Nephrology Nurses in Initiating Patients With Chronic Kidney Disease Into Advance Care Planning Using Focus-Group Interviews
Authors: CHEN Jui-O , LIN Chiu-Chu
Published: October 2021

Background

The prevalence of end-stage renal disease in Taiwan is the highest in the world. The rate of signing advance directives in Taiwan is lower than in Western countries, and most of the barriers that have been identified relate to initiating advance care planning (ACP).

Purpose

This study was designed to explore the barriers to discussing ACP with patients with chronic kidney disease faced by nephrology nurses.

Methods

A descriptive qualitative study design was adopted. The Consolidated Criteria for Reporting Qualitative Research was used to report the findings of this study. Data were collected using purposive sampling. A total of 34 nephrology nurses were recruited from hospitals in northern (2 groups, 10 participants), central (1 group, 4 participants), and southern (5 groups, 20 participants) Taiwan. A qualitative content analysis was conducted to analyze the transcripts of the eight focus groups.

Results

Five themes were identified, including (a) lacking the confidence to discuss ACP, (b) difficulty in finding an appropriate opportunity to initiate ACP discussion, (c) personally lacking the characteristics to discuss ACP, (d) conflicting perspectives between doctors and nurses over ACP, and (e) culture and belief-based barriers to discussing ACP.

Conclusions/Implications for Practice

The findings obtained from the interviews revealed that nurses must enhance their ACP-related knowledge and communication skills and foster personal confidence in initiating ACP discussions. Furthermore, nurses must be empowered to work with other healthcare professionals. To implement the initial process of discussing ACP in clinical settings, clinical guidelines should be developed for healthcare professionals on initiating ACP. These measures may facilitate improved collaboration in healthcare settings and further encourage patients and their families to participate in shared decision-making that may help patients complete advance directives and thereby achieve better care quality at the end of life.
Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula
Authors: Facciorusso Antonio , Ramai Daryl , Ichkhanian Yervant , Yadlapati Rena , Annese Vito , Wani Sachin , Khashab Mouen A.
Published: October 2021

Background:

There is limited evidence on the efficacy of peroral endoscopic myotomy (POEM) in patients with esophageal diverticula.

Aims:

This meta-analysis aimed to assess the efficacy and safety profile of POEM in patients with Zenker (ZD) and epiphrenic diverticula.

Methods:

With a literature search through August 2020, we identified 12 studies (300 patients) assessing POEM in patients with esophageal diverticula. The primary outcome was treatment success. Results were expressed as pooled rates and 95% confidence intervals.

Results:

Pooled rate of technical success was 95.9% (93.4%-98.3%) in ZD patients and 95.1% (88.8%-100%) in patients with epiphrenic diverticula. Pooled rate of treatment success was similar for ZD (90.6%, 87.1%-94.1%) and epiphrenic diverticula (94.2%, 87.3%-100%). Rates of treatment success were maintained at 1 year (90%, 86.4%-97.4%) and 2 years (89.6%, 82.2%-96.9%) in ZD patients. Pooled rate of symptom recurrence was 2.6% (0.9%-4.4%) in ZD patients and 0% in patients with epiphrenic diverticula. Pooled rates of adverse events and severe adverse events were 10.6% (4.6%-16.6%) and 3.5% (0%-7.4%) in ZD and 8.4% (0%-16.8%) and 8.4% (0%-16.8%) in epiphrenic diverticula, respectively.

Conclusion:

POEM represents an effective and safe therapy for the treatment of esophageal diverticula.
Manipulation of the gut microbiome in gluten-intolerance
Authors: Olivares Marta , Flor-Duro Alejandra , Sanz Yolanda
Published: October 2021

Purpose of review

Gluten is a complex mixture of highly immunogenic glutamine- and proline-rich proteins found in some cereals. In celiac disease (CeD), gluten triggers an autoimmune response due to its interaction with the human leukocyte antigen heterodimers that confer the genetic risk. The involvement of gluten in other disorders has also been investigated, but its role beyond CeD is still unclear. Here, we review the most recent evidence of the involvement of gluten in diseases and the opportunities of manipulating the gut microbiota to treat or prevent gluten-related conditions.

Recent findings

Most of the new studies have been conducted in the context of CeD, where important evidence has been gained on associations between the gut microbiota, genotype, and environmental factors such as breastfeeding and antibiotics. The role of the microbiota has been investigated in several prospective, observational and interventional studies with probiotics, which together showed that the gut microbiota could be targeted to ameliorate and aid in the prevention of CeD development.

Several studies have evidenced how genetic and environmental factors influence the gut microbiome with consequences in CeD. These findings could inspire the development of microbiota modulation strategies to support the prevention or treatment of CeD.
Aesthetics in Nursing Practice for Cancer Patients as Experienced by Nurses in Nepal
Authors: Dahal Pratiksha , Kongsuwan Waraporn
Published: October 2021

Background

Aesthetics in nursing practice address creating beautiful, meaningful, desirable, and satisfying experiences for both the nurse and the patient. However, little is known about aesthetics in nursing practice.

Objective

The aim of this study was to describe the lived experiences of nurses who provide aesthetically pleasant care in nursing practice for cancer patients.

Methods

The hermeneutic phenomenological approach grounded on Gadamer’s philosophy was used in this study. Sixteen Nepalese nurses who met the inclusion criteria were the participants. The data collection consisted of 2 methods of drawing graphic illustrations to reflect aesthetic nursing practices and in-depth interviews to explain them. The researchers analyzed and interpreted art-based graphic illustrations and interview transcriptions of 16 Nepalese nurses using van Manen’s approach.

Results

The 5 thematic categories covering these meanings comprised (1) knowing persons as whole, (2) creating a pleasant healing environment, (3) creative use of palliative care resources, (4) nurturing hope, and (5) rewarding the self.

Conclusion

This study provides the understanding of the nurses’ thoughts and actions of aesthetics in their nursing practice. The inductive knowledge from the experiences of the nurses informs the nursing discipline and profession to promote aesthetics in nursing.

Implications for Practice

These findings can be used to promote aesthetics in nursing practice to improve patients’ well-being holistically and increase nurses’ satisfaction from caring.
Stigma and Human Rights
Authors: Kelley Jennifer
Published: October 2021

Purpose/Objectives:

Transgender patients encounter barriers to accessing medical treatment. Although the medical field has made strides to improve transgender patients' health care experiences, programs that provide support in navigating existing obstacles are lacking. As integrated care becomes more prevalent, primary care settings have the potential to become medical havens for vulnerable patient populations. Enlisting support of professional case managers to connect transgender patients to services to meet their physical and behavioral health needs could increase health care utilization and decrease disparities.

Findings/Conclusions:

Because of their gender identities, transgender individuals experience high rates of discrimination within health care settings. There are also inequities that limit their access to quality treatment. These, combined with the fear of discrimination, contribute to an avoidance of medical care that negatively impacts the physical and mental health of transgender patients.

Implications for Case Management Practice:

Transgender discrimination in health care settings is pervasive and has detrimental effects on patients' well-being. Future research should foster collaboration between health care administrators, professional case managers, primary care providers, behavioral health consultants, and transgender patients to remove existing barriers and increase access to care. Until these changes occur, programs need to be designed for case managers to assist transgender patients in navigating the health care system and connecting to affirming providers.

Primary Practice Settings:

Health care systems and integrated primary care settings.
Defense Styles, Academic Procrastination, Psychological Wellbeing, and Approaches to Learning
Authors: Vlachopanou Patra , Karagiannopoulou Evangelia
Published: October 2021

This study investigates the relationships among defense styles, academic procrastination, psychological well-being, and approaches to learning. The questionnaires Defense Style Questionnaire-88, Procrastination Assessment Scale Questionnaire, Flourishing Scale, and HowULearn are used to measure the aforementioned variables, respectively. Social science students (N = 628) take part in the study. A hierarchical cluster analysis is used for clustering students into homogeneous groups. Three groups of students are identified: “psychologically stable and adaptive” (n = 285), “immature and unstable at risk” (n = 134), and “defensively dissonant” (n = 209) students. A decision tree model is used with the grade point average (GPA) score as an outcome variable to further examine interactions between the three clusters and the years of study on GPA. “Psychologically stable and adaptive” students report the highest GPA. Our findings bridge mental health variables with learning shedding light on our understanding of the use of defense styles when it comes to learning.
Robot-assisted fracture fixation in orthopaedic trauma surgery: a systematic review
Authors: Schuijt Henk Jan , Hundersmarck Dennis , Smeeing Diederik Pieter Johan , van der Velde Detlef , Weaver Michael John
Published: October 2021

Objective:

To investigate the applications of robot-assisted surgery and its effect on surgical outcomes in orthopaedic trauma patients.

Data Sources:

A search was performed in PubMed and Embase for articles in English, Dutch, German, or French, without restrictions on follow-up times, study size, or year of publication.

Study Selection:

Studies were included if they investigated patients undergoing robot-assisted fracture fixation surgery for orthopaedic trauma.

Data Extraction:

Outcomes studied were operating time, fluoroscopy time/frequency, complications, functional outcomes, intraoperative blood loss, fracture healing, and screw placement accuracy. Critical appraisal was done by using the Methodological Index for Non-Randomized Studies.

Data Synthesis:

Narrative review.

Conclusions:

A total of 3832 hits were identified with the search and 8 studies were included with a combined total of 437 included patients, 3 retrospective cohort studies, 2 prospective cohort studies, 1 cohort study not otherwise specified, 1 case series, and 1 randomized controlled trial. Four studies investigated pelvic ring fractures, 3 studies investigated femur fractures, and 1 study investigated scaphoid fractures. Seven investigated percutaneous screw fixation and 1 studied intramedullary nail fixation. One robotic system was used across all studies, the TiRobot, and all procedures were performed in China. The limited evidence suggests that that robot-assisted orthopaedic trauma surgery may reduce operating time, use of fluoroscopy, intraoperative blood loss, and improve screw placement accuracy, but the overall quality of evidence was low with a high risk of bias. Robot-assisted fracture fixation does not appear to lead to better functional outcomes for the patient.

Level of evidence: III
Age and socioeconomic status affect access to telemedicine at an urban level 1 trauma center
Authors: Braswell Matthew , Wally Meghan K. , Kempton Laurence B. , Seymour Rachel B. , Hsu Joseph R. , Karunakar Madhav , Afetse K. Eddie , Bailey Gisele , Bosse Michael , Brownrigg Maggie , Cuadra Mario , Dixon Amy , Girardi Cara , Grochowski Erica , Hysong Alexander , Jolissaint Josef , Macknet David , Mayberry R. Miles , Moody Patrick , Peterson Katheryn , Phelps Kevin D. , Pollock Hannah , Posey Samuel L. , Reid Risa , Roe Kris , Scannell Brian , Sims Stephen , Stanley Amber , Wohler Andrew D.
Published: October 2021

Objectives:

Despite clinical and economic advantages, routine utilization of telemedicine remains uncommon. The purpose of this study was to examine potential disparities in access and utilization of telehealth services during the rapid transition to virtual clinic during the coronavirus pandemic.

Design:

Retrospective chart review.

Setting:

Outpatient visits (in-person, telephone, virtual—Doxy.me) over a 7-week period at a Level I Trauma Center orthopaedic clinic.

Intervention:

Virtual visits utilizing the Doxy.me platform.

Main Outcome Measures:

Accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”).

Methods:

All outpatient visits (in-person, telephone, virtual) during a 7-week period were tracked. At the end of the 7-week period, the electronic medical record was queried for each of the 641 patients who had a visit during this period for the following variables: gender, ethnicity, race, age, payer source, home zip code. Data were analyzed for both the total number of visits (n = 785) and the total number of unique patients (n = 641). Patients were identified as accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”).

Results:

Weekly totals demonstrated a rapid increase from 0 to greater than 50% virtual visits by the third week of quarantine with sustained high rates of virtual visits throughout the study period. Hispanic and Black/African American patients were able to access virtual care at similar rates to White/Caucasian patients. Patients of ages 65 to 74 and 75+ accessed virtual care at lower rates than patients ≤64 (P = .003). No difference was found in rates of virtual care between payer sources. A statistically significant difference was found between patients from different zip codes (P = .028).

Conclusion:

A rapid transition to virtual clinic can be performed at a level 1 trauma center, and high rates of virtual visits can be maintained. However, disparities in access exist and need to be addressed.
Accuracy of Urea Nitrogen and Creatinine Measurements in Postmortem Serum and Pericardial Fluid Compared With Antemortem Data
Authors: Takasu Shojiro , Matsumoto Sari , Kodama Saki , Sakamoto Kana , Shimmura Suzuka , Iwadate Kimiharu
Published: October 2021

Although several studies have measured urea nitrogen (UN) and creatinine (Cr) concentrations in postmortem serum and pericardial fluid, no recent antemortem biochemical data have been available for forensic autopsy, thereby making the evaluation of the accuracy of postmortem data difficult. This study compared antemortem (from emergency room results before the declaration of death) and postmortem serum UN and Cr concentrations, as well as postmortem serum and pericardial fluid values, in 51 forensic autopsy cases (postmortem interval within 87 hours). Postmortem UN concentrations were strongly correlated with antemortem data. Moreover, no significant difference between pericardial fluid UN concentrations and antemortem data was observed. Postmortem serum and pericardial fluid Cr values were also correlated with antemortem data, although postmortem values were significantly higher than antemortem ones. Given our observation of early postmortem elevation in Cr concentrations, such an elevation was attributed to rigor mortis. In conclusion, the current study demonstrated the utility of postmortem UN and Cr concentrations, in particular of those measured in the pericardial fluid.
Thirteen Cases of Valeryl Fentanyl in Michigan
Authors: Ton Erinn , Stevens Christine , Moorman Paul , Markey Michael , Hunter Brian , Bush Russell , Jones Prentiss
Published: October 2021

In this report, we describe 13 cases of drug overdose in Michigan in which valeryl fentanyl was found in postmortem blood. Valeryl fentanyl is a schedule I opioid that is rarely found in drug overdoses in the United States. Although little data exist on the mortality and morbidity associated with valeryl fentanyl, its molecular structure indicates that it would be less potent than fentanyl.

When analyzing blood samples for valeryl fentanyl, samples from peripheral sites were sometimes negative for quantitative levels; however, samples from central sites in the same decedent were positive. This could indicate unique pharmacokinetics for valeryl fentanyl, which could have implications for other fentanyl analogs. Given the paucity of pharmacodynamic information, the prohibition of its use, the potential to buttress law enforcement efforts in monitoring drug trafficking trends, and to determine the efficacy of current regulations, laboratories should test for valeryl fentanyl. When testing for valeryl fentanyl, and likely other fentanyl analogs, the site of sample collection is important: central sources of blood are preferred to peripheral sources.
Point-of-Care Ultrasound Identification of Portal Vein Thrombosis in a Pediatric Patient
Authors: Ong Yoon Nee , James Vigil , Lau Kiew Siong , Chor Yek Kee , Ong Gene Yong-Kwang
Published: October 2021

Abdominal pain is one of the most common presenting complaints encountered in the pediatric emergency department. The use of point-of-care ultrasonography by emergency physicians has been shown to expedite the diagnosis of a large variety of conditions and can be used to accurately identify intra-abdominal pathology in children. We describe the case of a pediatric patient who presented to the pediatric emergency department with acute abdominal pain, in whom point-of-care ultrasonography helped expedite the diagnosis of acute portal vein thrombosis and liver abscess.
Factors Associated With Burnout in Physical Medicine and Rehabilitation Residents in the United States
Authors: Bean Allison C. , Schroeder Allison N. , McKernan Gina P. , Mesoros Matthew , Silver Julie K. , Verduzco-Gutierrez Monica , Cuccurullo Sara , Franzese Kevin
Published: October 2021

Objectives

The aims of the study were to determine the prevalence of burnout in physical medicine and rehabilitation residents in the United States and to identify the personal- and program-specific characteristics most strongly associated with residents reporting burnout.

Design

This was a cross-sectional survey of US physical medicine and rehabilitation residents. Emotional exhaustion, depersonalization, and burnout were assessed using two validated items from the Maslach Burnout Inventory. Associations of burnout with demographics and personal factors, residency program characteristics, perceived program support, and work/life balance were evaluated.

Results

The survey was completed by 296 residents (22.8%), with 35.8% of residents meeting the criteria for burnout. Residents’ perception of not having adequate time for personal/family life was the factor most strongly associated with burnout (χ2 = 93.769, P < 0.001). Residents who reported inappropriate clerical burden and working more than 50 hrs/wk on inpatient rotations were most likely to report that they did not have adequate time for personal/family life. Faculty support (χ2 = 41.599, P < 0.001) and performing activities that led residents to choose physical medicine and rehabilitation as a specialty (χ2 = 93.082, P < 0.001) were protective against burnout.

Conclusions

Residents reporting having inadequate time for their personal/family life was most strongly associated with physical medicine and rehabilitation resident burnout, although many personal and program characteristics were associated with burnout.
Comparison of Radial Extracorporeal Shock Wave Therapy and Local Corticosteroid Injection Effectiveness in Patients With Carpal Tunnel Syndrome
Authors: Öztürk Durmaz Havva , Tuncay Figen , Durmaz Himmet , Erdem Hatice Rana
Published: October 2021

Objective

The aim of the study was to compare the effectiveness of radial extracorporeal shock wave therapy and local corticosteroid injection on pain, function, and nerve conduction studies in the treatment of idiopathic carpal tunnel syndrome.

Design

A total of 72 patients who were diagnosed as having carpal tunnel syndrome were included in the study. The radial extracorporeal shock wave therapy group received radial extracorporeal shock wave therapy, the local corticosteroid injection group received local corticosteroid injection, and the control group only used a resting hand splint. The patients were evaluated using a Visual Analog Scale–pain, a Visual Analog Scale–numbness, the Boston Symptom Severity Scale, the Boston Functional Status Scale, and handgrip strength tests before treatment 1 and 12 wks after the treatment.

Results

Both clinical and nerve conduction study parameters improved with all three groups, and this effect continued at the 12th-week follow-up of the patients. The Visual Analog Scale–pain, Visual Analog Scale–numbness, Boston Symptom Severity Scale, and Boston Functional Status Scale scores in the first week after the treatment, as well as Visual Analog Scale–pain and Boston Functional Status Scale scores in the 12th week after the treatment, were significantly lower in the local corticosteroid injection group compared with the other two groups.

Conclusions

Our study revealed the success of radial extracorporeal shock wave therapy, splint, and local corticosteroid injection, but symptom relief was greater in the first week and 12th week with local corticosteroid injection.
Implementation of a Framework for Telerehabilitation in Clinical Care Across the Continuum During COVID-19 and Beyond
Authors: Kim Soo Yeon , Daley Kelly , Pruski April D. , AlFarra Tariq , Azola Alba , Gonzalez Fernandez Marlis , Keszler Mary S. , Friedel Stacey , Haaf Hayley , Segall Harrison , Lien Peiting , Cypher Jacklyn , Mazariegos Julia , Raghavan Preeti
Published: October 2021

The COVID-19 pandemic has propelled an unprecedented global implementation of telemedicine and telerehabilitation as well as its integration into the healthcare system. Here, we describe the clinical implementation of the A3E framework for the deployment of telerehabilitation in the inpatient and outpatient rehabilitation continuum by addressing accessibility, adaptability, accountability, and engagement during the COVID-19 pandemic. By using an organized, coordinated, and stratified approach, we increased our telerehabilitation practice from 0 to more than 39,000 visits since the pandemic began. Learning from both the successes and challenges can help address the need to increase access to rehabilitation services even beyond the COVID-19 pandemic.
Mortality in Systemic Sclerosis–Associated Interstitial Lung Disease in Brazil
Authors: de Oliveira Martins Lucas Victória , Oliveira Sandra Maximiano , Silvatti Juliana , de Amorim Fernanda Godinho , Agapito Tito Cecilia V. , Kayser Cristiane
Published: October 2021

Objectives

The aim of this study was to identify risk factors associated with mortality in patients with systemic sclerosis (SSc), particularly those with interstitial lung disease (ILD), over a long-term follow-up in a large Brazilian SSc cohort.

Methods

We conducted a medical records review study of 380 scleroderma patients from 1982 to 2019. Systemic sclerosis ILD was considered in those with evidence of ILD on chest high-resolution computed tomography (HRCT). Causes of death were determined.

Results

Among the 380 SSc patients, SSc-ILD on chest HRCT was observed in 227 patients (59.7%). Seventy-two patients (18.9%) died during a mean follow-up of 7.2 years since the SSc diagnosis; among them, 57 (79.2%) had SSc-ILD, compared with 15 (20.8%) without SSc-ILD (p < 0.001). Of the 72 deaths, 51.4% were considered related to SSc, and ILD was the leading cause of death. The overall survival rates at 5, 10, and 15 years were 87.9%, 81.5%, and 74.9%, respectively. Kaplan-Meier analysis showed a significantly worse prognosis among patients with SSc-ILD than among those without ILD (p < 0.001). Among patients with SSc-ILD, disease duration of less than 4 years (p < 0.001), forced vital capacity <80% at baseline (p = 0.017), and pulmonary systolic arterial pressure ≥40 mm Hg on echocardiography (p < 0.001) were significantly associated with mortality by multivariate analysis.

Conclusions

In Brazilian SSc patients, the presence of ILD was associated with a worse prognosis. The higher mortality among SSc-ILD patients, especially those with a shorter disease duration and forced vital capacity <80%, highlights the need for early screening and closer monitoring before irreversible lung function deterioration occurs.
Transorbital Debulking of Sphenoid Wing Meningioma
Authors: Smith Claire S. , Karlin Justin N. , Cohen Liza M. , Rootman Daniel B.
Published: October 2021

Objective:

To describe the clinical features and outcomes of patients who underwent transorbital debulking of sphenoid wing meningioma.

Methods:

Patients with a diagnosis of sphenoid wing meningioma who underwent transorbital debulking were included in this series. Preoperative and postoperative symptoms and examination findings, including best corrected visual acuity (BCVA) and proptosis were extracted from patient charts. All imaging studies, records of additional surgical and medical management, and complications of surgery were collated.

Results:

Eight patients were included. The most common symptoms at presentation were blurred vision (6/8) and proptosis (6/8). The most common clinical findings at presentation were decreased visual acuity and proptosis. Mean BCVA preoperatively was 0.93 in logMARunits andmeanrelative proptosis preoperatively was 4.88 mm. All patients underwent orbitotomy with or without bone flap with decompression of hyperostotic bone and subtotal resection of soft tissue mass. Mean follow-up time was 14months. Five of eight patients experienced postoperative improvement in BCVA, for mean change of 0.32. All patients demonstrated reduction in proptosis postoperatively with a mean reduction of 3.63 mm.

Conclusions:

Sphenoid wing meningioma can present with decreased visual acuity and/or proptosis. It is possible to address both of these problems in selected patients with transorbital debulking, an approach that avoids the aesthetic and functional consequences of craniotomy. The aim of this technique is not surgical cure, but rather improvement in vision and disfigurement.
Clinical Study of Cranioplasty Combined With Ipsilateral Ventriculoperitoneal Shunt in the Treatment of Skull Defects With Hydrocephalus
Authors: Yan Zhengcun , Zhang Hengzhu , Zhang Zhen , Wang Xiaodong , Wei Min , Wang Xingdong
Published: October 2021

Objective:

To explore the clinical effect and safety of cranioplasty combined with ipsilateral ventriculoperitoneal shunts in the treatment of skull defects with hydrocephalus.

Methods:

The clinical data of 78 patients with skull defects with hydrocephalus were analyzed retrospectively. All patients were treated with cranioplasty and ventriculoperitoneal shunts in 1 stage, including 35 cases of cranioplasty combined with ipsilateral ventriculoperitoneal shunts (ipsilateral operation group) and 43 cases of contralateral operations (contralateral operation group).

Results:

The incision length (28.97 ± 4.55 cm), operation time (139.00 ± 42.27 minutes), and intraoperative hemorrhage (174.57 ± 79.35 mL) in the ipsilateral operation group were significantly better than those in the contralateral operation group (respectively they were 37.15 ± 5.83 cm, 214.07 ± 34.35 minutes, and 257.21 ± 72.02 mL), and the difference was statistically significant (t = 6.786, 8.656, and 4.815, all P < 0.05). The degree of postoperative hydrocephalus was significantly improved in both groups, but there was no statistically significant difference in the degree of hydrocephalus between the 2 groups (P > 0.05). Among the postoperative complications, there was no statistically significant difference in infection, epilepsy, subdural effusion, titanium plate effusion, or excessive cerebrospinal fluid drainage between the 2 groups (P > 0.05), but the incidence of intracranial hemorrhage in the ipsilateral operation group (2.86%) was significantly lower than that in the contralateral operation group (20.93%, χ
2 = 4.138, P = 0.042). The postoperative Glasgow Coma Scale scores of the 2 groups were improved compared with those before the operation (P < 0.05), and there was no statistically significant difference in the postoperative Glasgow Coma Scale scores (P > 0.05). At 6 months after surgery, there was no statistically significant difference in Glasgow Outcome Scale effectiveness between the 2 groups (χ
2 = 0.005, P = 0.944).

Conclusions:

Cranioplasty combined with ipsilateral ventriculoperitoneal shunt has the same therapeutic effect as a contralateral operation, but it has the advantage of a short operation time, less intraoperative trauma, less bleeding, and less risk of intracranial hemorrhage, which is suitable for clinical applications.
Application of One Piece Autologous Rib Cartilage Graft in Hollow Space of Complete Naso-Ethmoid Orbital Fracture
Authors: Kim Tae Wook , Kim Min Ji
Published: October 2021

Background:

Complete naso-orbital-ethmoid (NOE) complex fractures including hollow space defects are difficult to treat. A proper bone fragment should be maintained for bony rearrangement and reconstruction; however, no guidelines are available for the treatment of the NOE complex. In patients with empty bone fragment from NOE fractures, implantation of autologous rib grafts may be an option for recreating the orbital rim.

Methods:

A 57-year-old man with open complete NOE fracture. Computed tomography (CT) revealed complete loss of bone fragments within the NOE area, including the inferior orbital rim and maxillary wall. A bone was harvested from the right fifth rib. The grafted bone mimicked the inferomedial orbital rim and was stabilized with mid plates.

Results:

Follow-up CT and three-dimensional (3D) volumetry were performed at 1, 3, 6, and 12 months. A well-positioned rib graft and orbital wall were observed. In 3D volumetry analysis, we noted that the absorption rate of the rib cartilage was 7.84% at 6 months. The absorption rate of rib cartilage was evaluated using CT images, which were reconstructed with a 3D image reconstruction program (Α-VIEW, Coreline soft, Seoul, Korea).

Conclusions:

Complete NOE fractures, especially fractures involving loss of the buttress for plating, may pose a burden to surgeons. In such cases, implantation of an autologous rib cartilage graft is a good option for bony frame reconstruction, without any concerns of bony resorption.
Fecal Putative Uropathogen Abundance and Antibiotic Resistance Gene Carriage in Women With Refractory Recurrent Urinary Tract Infection Treated With Fecal Microbiota Transplantation
Authors: Jeney Sarah E. S. , Avelar-Barragan Julio , Whiteson Katrine , Chang Jenny , Dutta Sonia , Lane Felicia
Published: October 2021

Objective

The aims of this study were to describe the fecal relative abundance of potentially uropathogenic bacteria and to analyze antibiotic resistance genes before and after fecal microbiota transplantation in women with recurrent urinary tract infection (UTI).

Methods

Shotgun sequencing was performed on fecal samples from 3 donors and 4 women with recurrent UTI who underwent transplantation. Recipient samples were sequenced at baseline and at 4 time points through 6 months postintervention. Relative fecal uropathogen abundance was analyzed by species and participant using descriptive statistics. Antibiotic resistance gene abundance was assigned, normalized, and compared between donors and recipients at baseline and postintervention using an abundance bar plot, nonmetric multidimensional scaling, and pairwise permutational multivariate analysis of variance.

Results

The median (range) relative abundance of Escherichia coli in all fecal samples from women with recurrent UTI was 0% (0%–5.10%); Enterococcus faecalis, 0% (0%–0.20%); Enterococcus faecium, 0% (0%–1.90%); Klebsiella pneumoniae, 0% (0%–0.10%); and Pseudomonas aeruginosa, 0% (0%–0.10%). Gut microbes carried genes conferring resistance to antibiotics used for UTI. No significant difference was seen in antibiotic resistance gene carriage after transplantation compared with baseline (P=0.22, R
2=0.08 at 3 months). Antibiotic gene composition and abundance were significantly associated with the individual from whom the sample came (P=0.004, R
2=0.78 at 3 months).

Conclusions

Exploratory analysis of gut microbiomes in women with recurrent UTI identifies no or low relative putative uropathogen abundance for all species examined. Antibiotic resistance gene carriage persisted after fecal microbiota transplantation, although conclusions are limited by small sample size.
Evidence for Early Cyclosporine Treatment for Hunner Lesion Interstitial Cystitis
Authors: Vollstedt Annah , Tennyson Lauren , Turner Katherine , Hasenau Deborah , Saon Md , McCartney Teresa , Beck Dana , Gilleran Jason , Peters Kenneth
Published: October 2021

Objectives

The objective of this study was to evaluate our experience using cyclosporine A (CyA) in the treatment of Hunner lesion interstitial cystitis (HLIC).

Methods

Retrospective chart review was performed on patients with HLIC treated with CyA from August 2012 to September 2019. Demographic and clinical variables, number of interstitial cystitis therapies, frequency, nocturia, and bladder pain visual analog scores before and after CyA treatment were collected, as well as the Global Response Assessment (GRA) and the Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index. CyA responders were defined as those with moderately or markedly improved GRA scores.

Results

A total of 51 patients with HLIC treated with CyA were identified. Mean follow-up was 3 years (0.36–6.8 years). Seventy-six percent (28 of 37) were female; mean age was 68 years (51–84 years). Before CyA treatment, an average of 8 previous therapies were tried and patients reported an average of 8 of 10 bladder pain. Daytime frequency was 11–20 times per day, and nocturia was 7 times per night. Per the GRA, 84% (31 of 37) were considered CyA responders. Posttherapy Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index scores were lower in responders compared with nonresponders (8.9 ± 5.7 vs 21.3 ± 7.0, P = 0.001). Bladder pain, number of hydrodistentions/fulgurations, nocturia, and daytime frequency improved significantly after CyA treatment.

Conclusions

The cyclosporine A response rate was 84%, with most of these patients reporting marked improvement. Bladder pain, daytime frequency, and nocturia were significantly improved after CyA treatment, and the number of interventions after CyA treatment decreased. Cyclosporine A should be considered earlier than fifth-line therapy in HLIC.
Increased room temperature ferromagnetism in Co-doped tetrahedral perovskite niobates
Authors: Zhou Yi , He Qing , Zhou Fei , Liao Xingqi , Liu Yong , Lai Zhonghong , Liao Mingqing , Han Tianyi , Huang Yudong , Zhu Jingchuan
Published: October 2021

Dilute magnetic semiconductors (DMSs), such as (In, Mn)As and (Ga, Mn)As prototypes, are limited to III–V semiconductors with Curie temperatures (
T
c
) far from room temperature, thereby hindering their wide application. Here, one kind of DMS based on perovskite niobates is reported. BaM

x

Nb

(1−
x
)

O

3−
δ

(
M
= Fe, Co) powders are prepared by the composite-hydroxide-mediated method. The addition of
M
elements endows BaM

x

Nb

(1−
x
)

O

3−
δ

with local ferromagnetism. The tetragonal BaCo

x

Nb

(1−
x
)

O

3−
δ

nanocrystals can be obtained by Co doping, which shows strong saturation magnetization (
M
sat
) of 2.22 emu g
−1
, a remnant magnetization (
M
r
) of 0.084 emu g
−1
and a small coercive field (
H
c
) of 167.02 Oe at room temperature. The
ab initio
calculations indicate that Co doping could lead to a 64% local spin polarization at the Fermi level (
E
F
) with net spin DOS of 0.89 electrons eV
−1
, this result shows the possibility of maintaining strong ferromagnetism at room temperature. In addition, the trade-off effect between the defect band absorption and ferromagnetic properties of BaM

x

Nb

(1−
x
)

O

3−
δ

is verified experimentally and theoretically.
Outcome uncertainty influences probability perception and risk attitudes
Authors: Elston Thomas Ward , Mackenzie Ian Grant , Mittelstädt Victor
Published: October 2021

Subjective inferences of probability play a critical role in decision-making. How we learn about choice options, through description or experience, influences how we perceive their likelihoods, an effect known as the description–experience (DE) gap. Classically, the DE gap details how low probability described options are perceptually inflated as compared to equiprobable experience ones. However, these studies assessed probability perception relative to a ‘sure-bet’ option, and it remained unclear whether the DE gap occurs when humans directly trade-off equiprobable description and experience options and whether choice patterns are influenced by the prospects of gain and loss. We addressed these questions through two experiments where humans chose between description and experience options with equal probabilities of either winning or losing points. Contrary to early studies, we found that gain-seeking participants preferred experience options across all probability levels and, by contrast, loss-mitigating participants avoided the experience options across all probability levels, with a maximal effect at 50%. Our results suggest that the experience options were perceived as riskier than descriptive options due to the greater uncertainty associated with their outcomes. We conclude by outlining a novel theory of probabilistic inference where outcome uncertainty modulates probability perception and risk attitudes.
Ascertaining the initiation of epidemic resurgences: an application to the COVID-19 second surges in Europe and the Northeast United States
Authors: Vilar Jose M. G. , Saiz Leonor
Published: October 2021

Assessing a potential resurgence of an epidemic outbreak with certainty is as important as it is challenging. The low number of infectious individuals after a long regression, and the randomness associated with it, makes it difficult to ascertain whether the infectious population is growing or just fluctuating. We have developed an approach to compute confidence intervals for the switching time from decay to growth and to compute the corresponding multiple-location aggregated quantities over a region to increase the precision of the determination. We estimated the aggregate prevalence over time for Europe and the northeast United States to characterize the COVID-19 second surge in these regions during year 2020. We find a starting date as early as 3 July (95% confidence interval (CI): 1–6 July) for Europe and 19 August (95% CI: 16–23 August) for the northeast United States; subsequent infectious populations that, as of 31 December, have always increased or remained stagnant; and the resurgences being the collective effect of each overall region with no location, either country or state, dominating the regional dynamics by itself.
Automated exploration of DNA-based structure self-assembly networks
Authors: Cazenille L. , Baccouche A. , Aubert-Kato N.
Published: October 2021

Finding DNA sequences capable of folding into specific nanostructures is a hard problem, as it involves very large search spaces and complex nonlinear dynamics. Typical methods to solve it aim to reduce the search space by minimizing unwanted interactions through restrictions on the design (e.g. staples in DNA origami or voxel-based designs in DNA Bricks). Here, we present a novel methodology that aims to reduce this search space by identifying the relevant properties of a given assembly system to the emergence of various families of structures (e.g. simple structures, polymers, branched structures). For a given set of DNA strands, our approach automatically finds chemical reaction networks (CRNs) that generate sets of structures exhibiting ranges of specific user-specified properties, such as length and type of structures or their frequency of occurrence. For each set, we enumerate the possible DNA structures that can be generated through domain-level interactions, identify the most prevalent structures, find the best-performing sequence sets to the emergence of target structures, and assess CRNs' robustness to the removal of reaction pathways. Our results suggest a connection between the characteristics of DNA strands and the distribution of generated structure families.
Preen gland microbiota covary with major histocompatibility complex genotype in a songbird
Authors: Grieves L. A. , Gloor G. B. , Bernards M. A. , MacDougall-Shackleton E. A.
Published: October 2021

Pathogen-mediated selection at the major histocompatibility complex (MHC) is thought to promote MHC-based mate choice in vertebrates. Mounting evidence implicates odour in conveying MHC genotype, but the underlying mechanisms remain uncertain. MHC effects on odour may be mediated by odour-producing symbiotic microbes whose community structure is shaped by MHC genotype. In birds, preen oil is a primary source of body odour and similarity at MHC predicts similarity in preen oil composition. Hypothesizing that this relationship is mediated by symbiotic microbes, we characterized MHC genotype, preen gland microbial communities and preen oil chemistry of song sparrows (Melospiza melodia). Consistent with the microbial mediation hypothesis, pairwise similarity at MHC predicted similarity in preen gland microbiota. Counter to this hypothesis, overall microbial similarity did not predict chemical similarity of preen oil. However, permutation testing identified a maximally predictive set of microbial taxa that best reflect MHC genotype, and another set of taxa that best predict preen oil chemical composition. The relative strengths of relationships between MHC and microbes, microbes and preen oil, and MHC and preen oil suggest that MHC may affect host odour both directly and indirectly. Thus, birds may assess MHC genotypes based on both host-associated and microbially mediated odours.