bluuebunny/crossref_metadata_2025 huggingface dataset:
IDENTIFYING QEEG EVOKED POTENTIAL VOLTAGE PATTERNS IN PEDIATRIC CASES WITH PERSISTENT POST-CONCUSSION SYMPTOMS (PPCS): A RETROSPECTIVE STUDY
Authors: Phu Nancy , Thirunagari Prem Kumar , Tramutolo David , Marx Tyler , Streeter Leslie , Minor Jon , Mortazavi Mo
Published: July 2021

Background:

Persistent post-concussion symptoms (PPCS) encompasses a broad spectrum of mood and cognitive impairments related to traumatic brain injury from sport activities. There has been limited studies conducted on determining the significance of quantitative EEG (qEEG) testing in the pediatric population. Hence, investigations on P300 evoked potential patterns may provide insight on PPCS course, prognosis, and management.

Purpose:

The purpose of this study is to identify possible P300 evoked potential voltage trends in PPCS pediatric patients.

Methods:

A retrospective study of pediatric patients with PPCS (defined as symptoms greater than one month) from 7/2018 to 12/2019 at a private concussion clinic in Tucson, AZ. Patients were excluded if they had a history of learning disorders, seizure disorder, or complex concussions with a skull fracture or intracranial hemorrhage, or no qEEG data. Patients were tested between 6-12 weeks post injury using the standard oddball audio P300 EEG protocol and measures extracted included P300 voltage. Patients were further classified into substages of PPCS (1: 1-3 months; 2: 3-6 months; 3: 6-12 months; 4: 12-36 months) to compare mean P300 voltage score among stages.

Results:

We identified 33 pediatric patients (age 8-21) with available qEEG data. 10 patients were in stage 1; 12 in stage 2; 8 in stage 3; and 3 in stage 4. Stage 1 group had an average P300 voltage of 17.4μV. Stage 2 group had an average of 10.9μV. Stage 3 group had an average of 13μV. Stage 4 group had an average of 10.3μV. There was a significant difference in the average P300 voltage seen in PPCS symptoms duration less than 3 months compared to 3 months or longer (p=0.018).

Conclusion:

There is a potential trend in declining P300 voltage with progressive PPCS stage. Our data suggests that chronic cognitive dysfunction represented by reduced P300 voltage may be most common in PPCS durations that are beyond 3 months. Future studies are needed to further validate this initial finding and to identify the significance of voltage patterns in concussion prognosis and management.
COMPLICATIONS OF ARTHROSCOPIC DRILLING IN THE TREATMENT OF OSTEOCHONDRITIS DISSECANS OF THE KNEE IN CHILDREN AND ADOLESCENTS
Authors: Baghdadi Soroush , Isaacs David , Chan Calvin , Wells Lawrence , Ganley Theodore J , Lawrence John Todd
Published: July 2021

Background:

Arthroscopic drilling is a well-established treatment for stable intact OCDs of the knee in children when non-operative treatment fails. The decision to proceed to operative treatment requires a discussion regarding the risks and benefits of surgical intervention. While there is abundant data suggesting that OCD drilling is a highly effective treatment strategy, there is little data specifically evaluating the risks and complications of this procedure.

Purpose:

The goal of this study was to assess the complications of drilling of stable OCDs of the knee, and the risk factors for developing complications.

Methods:

In a retrospective chart review from 2009-2017, data from patients <18 years old who underwent arthroscopic drilling for stable intact OCD lesions of knee were collected. Lesions treated with other techniques (fixation, chondroplasty, OATS), and those with <3 months of follow-up were excluded. Characteristics of the lesions, treatment approach, and post-operative course were recorded. For bilateral surgeries, each knee was considered a separate record.

Results:

139 knees in 131 patients were evaluated, of which 102 (73%) were male. The mean age was 12.7years. 108 knees (77%) had an open physis at the time of operation. Patients were managed conservatively for a mean of 6.76 months pre-operatively (SD=6.6). Average follow-up was 14.8 months after the initial surgery (SD=13.25). 53 patients (38%) were obese or overweight at the time of surgery. All patients regained full ROM within 5° of the contralateral knee at a mean 12.9 weeks post-op (SD=3.2), with all but 7 (5 %) returning to activities of daily living at the 3-month visit. No cases of infection, stiffness, arthrofibrosis, or other procedure-related complications were recorded. 6 knees (4.3%) underwent 7 additional surgeries during the follow-up period, all of which were for treatment failure in non-healing lesions (loose body removals, chondroplasty, or repeat drilling). In a multiple logistic regression model, age, gender, status of the physis at the time of surgery, BMI percentile, and OCD size were not predictive of the need for additional surgeries.

Discussion:

Our findings suggest that arthroscopic drilling for OCDs of the knee is a safe procedure with minimal risk of complications. The majority of patients return to their pre-operative daily activity level with full ROM by 3 months after surgery. Complications, including reoperation, were related to the progression of the OCD, rather than the surgical procedure.
Graft Failure in Adolescent Patients Undergoing Adult-Type ACL Reconstruction with Bone Patellar Tendon Bone or Hamstring Autograft
Authors: Mittal Ashish , Allahabadi Sachin , Coughlan Monica , Pandya Nirav
Published: July 2021

Introduction:

Anterior cruciate ligament (ACL) injuries represent a quarter of high school knee injuries. Adult-type ACL reconstruction (ACL-R) is the treatment of choice for skeletally mature adolescent patients with a complete ACL tear. Graft choice is individualized to the patient, taking into account the patient’s anatomy, activity level, and athletic participation. This subset of patients is at perhaps the highest risk of failure due to demands on the reconstruction after surgery.

Hypothesis/Purpose:

The purpose of this study was to evaluate outcomes including graft rupture between bone-patellar tendon-bone (BTB) versus hamstring autograft in adolescent patients undergoing adult-type ACL reconstruction.

Methods:

A retrospective review of patients under the age of 21 undergoing primary adult-type ACL-R by a single surgeon using BTB or hamstring autograft between 2011 and 2019 was performed. Patient demographics, athletic participation, concomitant injuries, graft utilized, graft size, femoral and tibial fixation devices, compliance with rehabilitation protocol, complications, and rates of revision surgery were evaluated. Factors associated with graft failure were compared using Fisher’s exact test with statistical significance < 0.05.

Results:

269 patients with an average age of 16.5 years (range 12.4-20.6) and an average follow-up of 2.1 years (range 0.4-6.6 years) were included. 52.5% of the patients were female. The overall graft rupture rate was 4.8%. There was no difference in average age, sex, compliance, and participation in high risk sports between graft type groups. Graft size was larger in patients with BTB autograft than patients with hamstring autograft (9.0 vs. 8.3; p<.001). There was no difference in the overall rate of re-operation between BTB and hamstring autografts (8.6% vs. 10.6%; p=0.81). There was no significant difference in rate of graft rupture with BTB and hamstring autograft (2.9% vs. 5.5%; p=0.26). Average time to revision surgery in those with ruptures was 1.7 years (range 0.7-4.7 years). 46% of patients had revision ACL-R with a different surgeon. There was no difference in age or participation in high risk sports between patients with and without graft tear. There was a higher percentage of documented compliance issues in patients with graft tear (46%) than without graft tear (29%), though not statistically significant (p=0.17).

Conclusion:

Rates of graft tear after ACL-R did not differ with BTB versus hamstring autograft. Rates of compliance and participation in high risk sports did not significantly differ in patients with and without graft tear. Many patients had a change in surgical provider for revision surgery.
AVOIDING POPLITEAL NEURO-VASCULAR INJURY DURING ILIOTIBIAL BAND ACL RECONSTRUCTION
Authors: Shea Kevin G , Tompkins Marc , Vuong Brian , VandenBerg Curtis , Shea Cooper , Wilson Phil , Green Dan , Ganley Ted , Ellis Henry
Published: July 2021

Background:

For patients with significant growth remaining, the Iliotibial Band ACL reconstruction technique has proven to be reliable procedure with minimal risk for growth disturbance. Recent dissection studies confirm the neuro-vascular bundle is within 1 cm of the ACL graft over the top position, confirming the importance of careful graft passage technique to avoid neurovascular injury.

Purpose:

The purpose of this study was to evaluate the over the top graft passage technique using pediatric 3-D knee models. Instrument placement for graft passage was assessed for its proximity to the posterior aspect of the femur, maintaining a safe distance from the neurovascular bundle.

Materials and Methods:

3D knee models (ages 7, 9, 11 years) were printed from high resolution knee CT scans, including a hinge/pivot mechanism to allow for simulation of knee position during flexion and extension. Various curved tip instruments were used to evaluate the path of the graft passage, with several goals: 1. Allow the instrument to create a graft path through the posterior capsule in the most anatomic femoral position. 2. Keep the tip of the instrument close to posterior and lateral cortex of the femur, to avoid neurovascular injury. The instruments varied in design, arc of curvature, overall length, diameters.

Results:

Clamp passage was performed using a retrograde approach, i.e. through the notch, passing outside the periosteum of the postero-lateral femur (Figure 1). For some clamps, the arc of the curvature allowed for passage of the instrument with minimal risk of neurovascular injury. For some clamp configurations, the clamps deviated significant from the posterior aspect of the femur during graft passage, which may increase the risk of neurovascular bundle injury. In each case, an instrument was identified that met the criteria for safe passage, but different instruments were required based upon the size of the knee joint.

Conclusions:

The ITB ACL reconstruction is one of the best options for ACL reconstruction in the skeletally immature. The neurovascular structures are very close to the path for over the top graft placement. Due to the wide range of knee dimensions in this group, different clamp designs may be necessary for optimal over the top graft passage. 3D knee models may guide surgeons for procedure technique and optimal instrument selection for safe graft passage.

[Figure: see text]
SELF-REPORTED SEVERITY OF MOOD SYMPTOMS IN PEDIATRIC PATIENTS WITH PERSISTENT POST-CONCUSSION SYMPTOMS (PPCS)
Authors: Spiegel Marshall , Minor Jon , Phu Nancy , Kliner Jared , Thirunagari Prem Kumar , Tramutolo David , Marx Tyler , Streeter Leslie , Mortazavi Mo
Published: July 2021

Background:

There are multiple subtypes identified in patients with Persistent Post Concussion symptoms (PPCS) in young athletes including mood subtype that is traditionally believed to be in higher incidence with PPCS. Although there may be an association of poor mood symptoms with worse PPCS outcomes, empirical analysis of patients’ mood symptoms and the duration of PPCS is scant. By better understanding the incidence of mood symptoms in pediatric PPCS, we may uncover other primary causes of ongoing brain dysfunction.

Purpose:

To explore the relationship between mood-symptom severity and the duration of PPCS.

Methods:

A retrospective cohort study of pediatric PPCS patients (age < 18 years) treated at private concussion clinic in Tucson, AZ between 7/2018 to 7/2019. Based on written questionnaires completed by patients at office visits, patients were assigned a mood and anxiety score between 0 and 3, with 0 being the least severe and 1 being the most severe. Patients were also classified into stages 1 through 4 based on PPCS duration (see table). [Table: see text]

Results:

Data from 59 pediatric patients (ages ranged from 7 to 17 with a mean age of 13.9, 33:26 female to male) were included. ANOVA yielded p-value of 0.94. Average (mean) mood and anxiety scores for each PPCS substage were as follows: 0.9 for stage 1 (n=23); 0.8 for stage 2 (n=18); 0.8 for stage 3 (n=13); 0.6 for stage 4 (n=5).

Conclusion:

Our review data showed no significance between PPCS stages in regard to average self-reported mood symptoms. Contrary to traditional thinking this preliminary data in pediatric athletes illustrates that mood severity does not increase with increasing PPCS stage. This may suggest that other domains such as migraine or vestibulocular dysfunction may be the primary source of ongoing symptoms.
IDENTIFICATION OF FACTORS ASSOCIATED WITH DISEASE PROGRESSION IN THE CONTRALATERAL HIP OF PATIENTS WITH SYMPTOMATIC FEMOROACETABULAR IMPINGEMENT
Authors: Khan Adam , Louer Craig R. , Abu-Amer Wahid , Pashos Gail , Garrido Cecilia Pascual , Clohisy John C. , Nepple Jeffrey J.
Published: July 2021

Introduction:

Femoroacetabular Impingement (FAI) is one of the most common causes of hip osteoarthritis. Nevertheless, the factors contributing to symptom development and FAI disease progression are poorly understood.

Hypothesis/Purpose:

The purpose of this study was to (1) investigate rates of initial and subsequent symptom development in the contralateral hip of patients with FAI, and (2) identify predictors of disease progression (symptom development) in the contralateral hip.

Methods:

This prospective study included a minimum 5 year follow-up of the contralateral hip in 179 patients undergoing FAI surgery. Symptoms (moderate pain) were monitored over the study course. Univariate analysis compared patient and FAI imaging characteristics of patients developing symptoms to those who remained asymptomatic.

Results:

146 patients (146 hips, 81.5%) were included (min 5 year, mean 6.7 years). Thirty-nine (26%) presented with symptoms in the contralateral hip while 34 (23%) developed symptoms. Head-neck offset ratio (HNOR) on AP pelvis radiographs was significantly lower among hips that developed symptoms (0.164 vs. 0.153 p=0.025). Maximum alpha angle (p=0.413), lateral center edge angle (p=0.704), and crossover sign (p=0.115) were not predictive of symptoms. Patients with a UCLA activity score greater than 9 were less likely to develop symptoms (14% vs. 46%, p=0.081), but this was not statistically significant. The total arc of rotation in extension (35.740 vs 45.140, p=0.012) and 900 of flexion (40.00 vs 50.800, p=0.009) as well as external rotation at 900 of flexion (28.940 vs 36.590, p=0.020) were decreased in hips developing symptoms. Internal Rotation in flexion was not significantly decreased in symptomatic patients (11.060 vs 14.20, p=0.113).

Conclusions:

We identified unique radiographic and physical exam findings that are associated with symptom development in patients with FAI. Specifically, decreased hip rotation arc and decreased HNOR were strongly associated with disease progression and may represent important factors for future risk modeling in FAI patients.
NEURAL ACTIVITY AND LANDING BIOMECHANICS: EXPLORING THE RELATIONSHIPS BETWEEN THE BRAIN, BODY, AND ACL INJURY-RISK
Authors: Criss Cody R. , Grooms Dustin R. , Diekfuss Jed A. , Anand Manish , Slutsky-Ganesh Alexis B. , DiCesare Christopher A. , Myer Gregory D.
Published: July 2021

Background:

Anterior cruciate ligament (ACL) injuries predominantly occur via non-contact mechanisms, secondary to motor coordination errors resulting in aberrant frontal plane knee loads that exceed the thresholds of ligament integrity. However, central nervous system processing underlying high injury-risk motor coordination errors remain unknown, limiting the optimization of current injury reduction strategies.

Purpose:

To evaluate the relationships between brain activity during motor tasks with injury-risk loading during a drop vertical jump.

Methods:

Thirty female high school soccer players (16.10 ± 0.87 years, 165.10 ± 4.64 cm, 63.43 ± 8.80 kg) were evaluated with 3D biomechanics during a standardized drop vertical jump from a 30 cm box and peak knee abduction moment was extracted as the injury-risk variable of interest. A neuroimaging session to capture neural activity (via blood-oxygen-level-dependent signal) was then completed which consisted of 4 blocks of 30 seconds of repeated bilateral leg press action paced to a metronome beat of 1.2 Hz with 30 seconds rest between blocks. Knee abduction moment was evaluated relative to neural activity to identify potential neural contributors to injury-risk.

Results:

There was a direct relationship between increased landing knee abduction moment and increased neural activation within regions corresponding to the lingual gyrus, intracalcarine cortex, posterior cingulate cortex, and precuneus (r2= 0.68, p corrected < .05, z max > 3.1; Table 1 & Figure 1).

Conclusion:

Elevated activity in regions that integrate sensory, spatial, and attentional information may contribute to elevated frontal plane knee loads during landing. Interestingly, a similar activation pattern related to high-risk landing mechanics has been found in those following injury, indicating that predisposing factors to injury may be accentuated by injury or that modern rehabilitation does not recover prospective neural control deficits. These data uncover a potentially novel brain marker that could guide the discovery of neural-therapeutic targets that reduce injury risk beyond current prevention methods.

[Table: see text][Figure: see text]
MECHANISM OF INJURY IMPACTS CONCUSSION RECOVERY
Authors: Caze Todd J. , Ellis Christine , Knell Gregory ,   August Price PsyD, Abt John , Burkhart Scott
Published: July 2021

Background:

Approximately 2 million children sustain a concussion annually with the majority recovering within 28 days. However, some children take longer to recover suggesting more research is necessary to determine what factors prolonged return to activity/sport.

Hypothesis/Purpose:

The purpose of this study was to examine the relationship between mechanism of injury (MOI) and protracted recovery (>28 days). It was hypothesized that those who sustained a concussion via head-to-head or head-to-ground were at greater risk of recovery lasting longer than 28 days than other MOIs (head-to-body, head-to-object).

Methods:

Children aged 8-18 years who sustained a concussion were examined in an acute concussion clinic for diagnosis and treatment of injury. Patients were evaluated within seven days of injury and remained under clinical care until cleared to return to activity/sport. Average days of recovery along with crude hazard ratios were calculated based on MOI.

Results:

A total of 282 children (age: 13.9±2.2 years) were diagnosed with a concussion. Total recovery was 22.1±11.3 days overall, and by MOI was as follows: head-to-object (n=52, 22.1±12.7 days), head-to-body (n=36, 22.9±11.5 days), head-to-head (n=106, 21.3±10.9 days), head-to-ground (n=79, 22.7±11.0 days). Compared to a head-to-object MOI, the risk (95% CI) of delayed recovery by MOI was as follows: head-to-body (1.75, 0.65-4.70), head-to-head (1.66, 0.72-3.80), head-to-ground (1.70, 0.71-4.06).

Conclusion:

Contrary to our hypothesis, the head-to-head and head-to-ground MOIs were not associated with a greater risk of a protracted recovery in this sample of adolescents. These preliminary findings suggest that MOI may not be an important clinical indicator when being treated acutely in a specialty concussion clinic. Future research should consider angle and velocity of impact as a factor of recovery.
IDENTIFYING TRENDS IN MICROSACCADE RATE ON OCULOMOTOR TRACKER IN EARLY VS LATE STAGE PEDIATRIC CASES WITH PERSISTENT POST-CONCUSSION SYMPTOMS (PPCS)
Authors: Thirunagari Prem Kumar , Phu Nancy , Tramutolo David , Rieiro Hector , Polec Tanya , Marx Tyler , Streeter Leslie , Minor Jon , Mortazavi Mo
Published: July 2021

Background:

Oculomotor and visual processing deficits occur commonly after brain injury in young athletes. A subset of these concussed athletes do experience prolonged recoveries or PPCS with ongoing oculomotor deficits and visual symptoms. There have been limited studies conducted to determine the significance of oculomotor tracking (OMT) testing in the pediatric population, and even less investigating the role of microsaccades. Hence, investigations on microsaccades(MS), physiological adjustive micro eye movements critical in visual processing and central/peripheral visual integration, may provide insight on the role of visual dysfunction in PPCS course, prognosis, and management.

Purpose:

The purpose of this study is to identify possible MS rate trends and differences between early and late stage PPCS pediatric patients.

Methods:

A retrospective cohort study of 41 pediatric patients with PPCS or symptoms greater than one month from injury. Data was collected from 7/1/2018 to 12/1/2019 and the age group ranged from 8 to 21 years. For each participant, using the OMT device we measured the number of saccades generated, the size and speed of the microsaccades, the area covered and the ratio of vertical-to-horizontal direction component of the fixational eye movements, using a 250 Hz video-eye tracker mounted inside a HTC Vive VR headset. Participants were instructed to fixate on a central dot for 140 seconds, in 20-second intervals. Patients were classified into early or late stages of PPCS (early stage: 1-6 months; late stage: >6 months) to compare MS rate between stages. Exclusion criteria included history of visual disorders, learning disorders, seizure disorder, or intracranial hemorrhage.

Results:

27 patients were in the early stage while 14 patients were in the late stage. The early stage group had a mean MS rate of 125 beats/min while the late stage group had a mean MS rate of 116 beats/min. A two sample t-test assuming no difference between early and late stage patients resulted in a p value of 0.51.

Conclusion:

There is a potential trend in declining MS numbers with progressive PPCS stage. Although the t-test didn’t show statistical significance, this could be due to the small sample size of our study. Future studies are needed to validate this initial finding and to identify the significance of microsaccade patterns in concussion prognosis and management.

[Figure: see text]
ARTHROSCOPIC BANKART REPAIR FOR ADOLESCENT UNIDIRECTIONAL SHOULDER INSTABILITY: CLINICAL AND RADIOGRAPHIC PREDICTORS OF REVISION SURGERY AND INSTABILITY
Authors: Egger Anthony C. , Broida Sam , Willimon S. Clifton , Austin Thomas , Perkins Crystal A.
Published: July 2021

INTRODUCTION:

The treatment of adolescent shoulder instability can be a challenging problem, with multiple patient and radiographic risk factors for recurrent instability. Although glenoid bone loss has been well described, humeral bone loss has gained more recent attention. The purpose of this study is to evaluate the incidence and clinical outcomes of “off track” shoulder lesions and their association with clinical outcomes.

METHODS:

A retrospective IRB approved study was performed to identify patients less than 19 years of age treated with isolated arthroscopic anterior labral repair for unidirectional shoulder instability. Radiographic measurements of glenoid diameter, % glenoid bone loss, glenoid track, hill-sachs interval (HIS), HS/glenoid track ratio, and intact anterior articular angle (IAAA) were performed for all patients with magnetic resonance imaging (MRI). All patients were contacted at final follow-up to collect outcome scores (PASS and SANE scores, activity level). A multivariable logistic regression analysis was performed to identify predictors of revision surgery or subjective instability (RI).

RESULTS:

86 patients were identified to meet inclusion criteria and 69 of these patients, 53 males and 16 females with a median age of 16 years [15, 17], had minimum 1-year clinical follow-up and were included in assessment of clinical outcomes and multivariable analysis. 12 patients (17%) had revision surgery and 10 patients had subjective instability without revision (14%) In univariate analysis (Table 1), patient height was the only patient factor which was significantly different between the revision/instability (RI) cohort and the non-revision/instability (NRI) cohort. All 86 patients were included in radiographic analysis. Intra- and inter-rater reliability (ICCs) for radiographic measurements are presented in table 2. Agreement was good and excellent for all measurements with the exception of inter-rater reliability of IAAA. Multivariable regression analysis demonstrated that HS/glenoid track ratio was not a predictor for RI. PASS and SANE scores at final follow-up were significantly lower in the RI cohort (79.5 and 70) respectively) as compared to the NRI cohort (94 and 90 respectively), p<0.001. 42 patients (69%) returned to the same or higher level of sports following surgery and this was no different between RI and NRI cohorts.

CONCLUSIONS:

31% of adolescent patients in our cohort experienced RI following arthroscopic bankart repair and this was associated with inferior PASS and SANE scores. Off-track lesions were not predictive of failure with primary repair.
Microlite-group minerals: tracers of complex post-magmatic evolution in beryl–columbite granitic pegmatites, Maršíkov District, Bohemian Massif, Czech Republic
Authors: Chládek Štěpán , Uher Pavel , Novák Milan , Bačík Peter , Opletal Tomáš
Published: July 2021

Microlite-group minerals occur as common replacement products after primary and secondary columbite-group minerals (CGM) in albitised blocky K-feldspar and in coarse-grained, muscovite-rich units of the Schinderhübel I, Scheibengraben and Bienergraben beryl–columbite pegmatites in the Maršíkov District (Silesian Unit, Bohemian Massif, Czech Republic). Textural and compositional variations of microlite-group minerals were examined using electron probe micro-analyses and microRaman spectroscopy (μRS). A complex post-magmatic evolution of the pegmatites and the following microlite populations (Mic) and related processes were found: (1) precipitation of U, Na-rich and F-poor Mic I on cracks in CGM; (2) alteration of Mic I to U-rich together with Na- and F-poor Mic II; and (3) partial replacement of Mic I and II by Mic III with a distinct Na, U and Ti loss and Ca and F gain. Stage (2) includes an extensive leaching of Na, without U loss. The final stage (3) produced euhedral-to-subhedral oscillatory zoned Ca and F enriched Mic III with distinctly different composition to the previous F-poor andA-site vacant Mic II. Aggregates of fersmite are associated commonly with Mic III. Distal Mic IIId occurs locally on cracks in K-feldspar or quartz, with compositions analogous to Mic III. Compositional variations and textural features of microlite-group minerals during dissolution–reprecipitation processes serve as sensitive tracers of post-magmatic evolution in granitic pegmatites recording complex interactions between magmatic pegmatite units and externally derived, hydrothermal metamorphic fluids.
Recent developments in the treatment of small cell lung cancer
Authors: Hiddinga Birgitta I. , Raskin Jo , Janssens Annelies , Pauwels Patrick , Van Meerbeeck Jan P.
Published: July 2021

Small cell lung cancer (SCLC) comprises about 15% of all lung cancers. It is an aggressive disease, with early metastasis and a poor prognosis. Until recently, SCLC treatment remained relatively unchanged, with chemotherapy remaining the cornerstone of treatment. In this overview we will highlight the recent advances in the field of staging, surgery, radiotherapy and systemic treatment. Nevertheless, the prognosis remains dismal and there is a pressing need for new treatment options. We describe the progress that has been made in systemic treatment by repurposing existing drugs and the addition of targeted treatment. In recent years, immunotherapy entered the clinic with high expectations of its role in the treatment of SCLC. Unravelling of the genomic sequence revealed new possible targets that may act as biomarkers in future treatment of patients with SCLC. Hopefully, in the near future, we will be able to identify patients who may benefit from targeted therapy or immunotherapy to improve prognoses.
Update on recent key publications in lung oncology: picking up speed
Authors: Rittmeyer Achim , Schiwitza Annett , Sahovic Lejla , Eul Bastian , Andreas Stefan
Published: July 2021

Introduction

As incidence rates for lung cancer are still very high and lung cancer remains the most deadly cancer since the turn of the millennium, efforts have been made to find new approaches in cancer research. This systematic review highlights how therapeutic options were extended and how the development of new drugs has picked up speed during the last 20 years.

Methods

A systematic search was performed in PubMed, Cochrane Library and the European Union Trial Register and 443 records were identified. Our inclusion criteria constituted completed phase I, II and III studies investigating drugs approved by the European Medicines Agency (EMA). Overall, 127 articles were analysed.

Results

During the 5 year interval from 2015 to 2020, significantly more drugs were approved after phase III, and occasionally after phase II, trials than between 2000 and 2005 (p=0.002). Furthermore, there was a significant time difference (p=0.00001) indicating an increasingly briefer time interval between the publication of phase I and phase III results in the last few years.

Discussion

Due to novel therapeutic approaches, numerous new drugs in lung oncology were approved. This has improved symptoms and prognoses in patients with advanced lung cancer. However, faster approval could make it difficult to scrutinise new options regarding safety and efficacy with sufficient diligence.
Comorbidities of primary headache disorders: a literature review with meta-analysis
Authors: Caponnetto Valeria , Deodato Manuela , Robotti Micaela , Koutsokera Maria , Pozzilli Valeria , Galati Cristina , Nocera Giovanna , De Matteis Eleonora , De Vanna Gioacchino , Fellini Emanuela , Halili Gleni , Martinelli Daniele , Nalli Gabriele , Serratore Serena , Tramacere Irene , Martelletti Paolo , Raggi Alberto ,   On behalf of the European Headache Federation School of Advanced Studies (EHF-SAS)
Published: July 2021

Background

Primary headache disorders are common and burdensome conditions. They are associated to several comorbidities, such as cardiovascular or psychiatric ones, which, in turn, contribute to the global burden of headache. The aim of this study is to provide a comprehensive description of the pooled prevalence of comorbidities of primary headache disorders using a meta-analytical approach based on studies published between 2000 and 2020.

Methods

Scopus was searched for primary research (clinical and population studies) in which medical comorbidities were described in adults with primary headache disorders. Comorbidities were extracted using a taxonomy derived from the Global Burden of Disease (GBD) study. We compared prevalence of comorbidities among headache sufferers against general population using GBD-2019 estimates, and compared comorbidities’ proportions in clinical vs. population studies, and by age and gender.

Results

A total of 139 studies reporting information on 4.19 million subjects with primary headaches were included: in total 2.75 million comorbidities were reported (median per subject 0.64, interquartile range 0.32–1.07). The most frequently addressed comorbidities were: depressive disorders, addressed in 51 studies (pooled proportion 23 %, 95 % CI 20–26 %); hypertension, addressed in 48 studies (pooled proportion 24 %, 95 % CI 22–26 %); anxiety disorders addressed in 40 studies (pooled proportion 25 %, 95 % CI 22–28 %). For conditions such as anxiety, depression and back pain, prevalence among headache sufferers was higher than in GBD-2109 estimates. Associations with average age and female prevalence within studies showed that hypertension was more frequent in studies with higher age and less females, whereas fibromyalgia, restless leg syndrome, and depressive disorders were more frequent in studies with younger age and more female.

Conclusions

Some of the most relevant comorbidities of primary headache disorders – back pain, anxiety and depression, diabetes, ischemic heart disease and stroke – are among the most burdensome conditions, together with headache themselves, according to the GBD study. A joint treatment of headaches and of these comorbidities may positively impact on headache sufferers’ health status and contribute to reduce the impact of a group of highly burdensome diseases.
Assessment of normalized cerebral blood flow and its connectivity with migraines without aura during interictal periods by arterial spin labeling
Authors: Zhang Di , Huang Xiaobin , Mao Cunnan , Chen Yuchen , Miao Zhengfei , Liu Chunmei , Xu Chenjie , Wu Xinying , Yin Xindao
Published: July 2021

Background

Migraine constitutes a global health burden, and its pathophysiology is not well-understood; research evaluating cerebral perfusion and altered blood flow between brain areas using non-invasive imaging techniques, such as arterial spin labeling, have been scarce. This study aimed to assess cerebral blood flow (CBF) and its connectivity of migraine.

Methods

This study enrolled 40 patients with episodic migraine without aura (MwoA), as well as 42 healthy patients as control (HC). Two groups of normalized CBF and CBF connectivity were compared, and the relationship between CBF variation and clinical scale assessment was further evaluated.

Results

In comparison to HC subjects, MwoA patients exhibited higher CBF in the right middle frontal orbital gyrus (ORBmid.R) and the right middle frontal gyrus, while that in Vermis_6 declined. The increased CBF of ORBmid.R was positively correlated with both the Visual Light Sensitivity Questionnaire-8 (VLSQ-8) and the monthly attack frequency score. In MwoA, significantly decreased CBF connectivity was detected between ORBmid.R and the left superior frontal gyrus, the right putamen, the right caudate, as well as the right angular gyrus. In addition, increased CBF connectivity was observed between the left calcarine cortex and ORBmid.R.

Conclusions

Our results indicate that migraine patients exhibit abnormalities in regional CBF and feature CBF connection defects at the resting state. The affected areas involve information perception, information integration, and emotional, pain and visual processing. Our findings might provide important clues for the pathophysiology of migraine.
Review of applications of CRISPR-Cas9 gene-editing technology in cancer research
Authors: Zhao Ziyi , Li Chenxi , Tong Fei , Deng Jingkuang , Huang Guofu , Sang Yi
Published: July 2021

Characterized by multiple complex mutations, including activation by oncogenes and inhibition by tumor suppressors, cancer is one of the leading causes of death. Application of CRISPR-Cas9 gene-editing technology in cancer research has aroused great interest, promoting the exploration of the molecular mechanism of cancer progression and development of precise therapy. CRISPR-Cas9 gene-editing technology provides a solid basis for identifying driver and passenger mutations in cancer genomes, which is of great value in genetic screening and for developing cancer models and treatments. This article reviews the current applications of CRISPR-Cas9 gene-editing technology in various cancer studies, the challenges faced, and the existing solutions, highlighting the potential of this technology for cancer treatment.
Incidence and risk factors of post-operative cognitive decline after ablation for atrial fibrillation
Authors: Zhang Jing , Xia Shi-Jun , Du Xin , Jiang Chao , Lai Yi-Wei , Wang Yu-Feng , Jia Zhao-Xu , He Liu , Tang Ri-Bo , Dong Jian-Zeng , Ma Chang-Sheng
Published: July 2021

Background

Catheter ablation is widely used in atrial fibrillation (AF) management. In this study, we are aimed to investigate the incidence of postprocedural cognitive decline in a larger population undergoing AF ablation under local anesthesia, and to evaluate the associated risk factors.

Methods

This study included 287 patients with normal cognitive functions, with 190 ablated AF patients (study group) and 97 AF patients who are awaiting ablation (practice group). We assessed the neuropsychological function of each patient for twice (study group: 24 h prior to ablation and 48 h post ablation; practice group: on the day of inclusion and 72 h later but before ablation). The reliable change index was used to analyze the neuropsychological testing scores and to identify postoperative cognitive dysfunction (POCD) at 48 h post procedure. Patients in the study group accepting a 6-month follow up were given an extra cognitive assessment.

Results

Among the ablated AF patients, 13.7% (26/190) had POCD at 48 h after the ablation procedure. Multivariable analysis revealed that, a minimum intraoperative activated clotting time (ACT) < 300 s (OR 3.82, 95% CI 1.48–9.96, P = 0.006) and not taking oral anticoagulants within one month prior to ablation(OR 10.35, 95% CI 3.54–30.27, P < 0.001) were significantly related to POCD at 48 h post-ablation. In 172 patients of the study group accepting a 6-month follow up, there were 23 patients with POCD at 48 h post-ablation and 149 patients without POCD. The global cognitive scores were decreased in 48 h post-operation tests (0 ± 1 vs − 0.15 ± 1.10, P < 0.001) and improved significantly at 6 months post-operation (0 ± 1 vs 0.43 ± 0.92, P < 0.001). In the 23 patients with POCD at 48 h after the procedure, global cognitive performance at 6 months was not significantly different compared with that at baseline (− 0.05 ± 1.25 vs − 0.19 ± 1.33, P = 0.32), while 13 of them had higher scores than baseline level.

Conclusions

Incident of POCD after ablation procedures is high in the short term. Inadequate periprocedural anticoagulation are possible risk factors. However, most POCD are reversible at 6 months, and a general improvement was observed in cognitive function at 6 months after ablation.
The evolution of IBD perceived engagement and care needs across the life-cycle: a scoping review
Authors: Volpato E. , Bosio C. , Previtali E. , Leone S. , Armuzzi A. , Pagnini F. , Graffigna G.
Published: July 2021

Background

The chronic and progressive evolution of Inflammatory Bowel Diseases (IBD), with its prototypical fluctuating trend, creates a condition of psycho-social discomfort, impacting the quality of life in terms of personal, working, and interpersonal.

Aims

In this article, we want to identify the nature and extent of the research evidence on the life experiences, the perceived engagement, the psychological, social care and welfare needs of people affected by IBD across the lifecycle.

Methods

Following the approach set out by Arksey and O’Malley and the PRISMA extension for scoping reviews, we conducted a scoping review in March 2019 and closed the review with an update in October 2019. It was performed using electronic databases covering Health and Life Sciences, Social Sciences and Medical Sciences, such as PubMed, Medline, Embase, Scopus, Cochrane, Web of Science, PsycInfo.

Results

We identified 95 peer-reviewed articles published from 2009 to 2019, that allowed to detection the main needs in children (psychological, need to be accepted, physical activity, feeding, parent style, support, social needs), adolescents (to understand, physical and psychological needs, protection, relational, gratitude, respect, and engagement) and adults (information, medical, psychological, social, work-related, practical, future-related, engagement). Although the literature confirms that the majority of the IBD units have planned provision for the different types of transitions, the quality and appropriateness of these services have not been assessed or audited for all the kinds of challenges across the life cycle.

Conclusions

The literature shows the relevance of organizing a flexible, personalized health care process across all the critical phases of the life cycle, providing adequate benchmarks for comparison in a multidisciplinary perspective and ensuring continuity between hospital and territory.
Molecular epidemiology and genetic diversity of norovirus among hospitalized children with acute gastroenteritis in Tianjin, China, 2018–2020
Authors: Fang Yulian , Dong Zhaoying , Liu Yan , Wang Wei , Hou Mengzhu , Wu Jinying , Wang Lu , Zhao Yu
Published: July 2021

Background

Norovirus (NoV) is a major cause of viral acute gastroenteritis (AGE) in children worldwide. Epidemiological analysis with respect to the virus strains is limited in China. This study aimed to investigate the prevalence, patterns, and molecular characteristics of NoV infection among children with AGE in China.

Methods

A total 4848 stool samples were collected from children who were admitted with AGE in Tianjin Children’s Hospital from August 2018 to July 2020. NoV was preliminarily detected using real-time reverse transcription polymerase chain reaction (RT-PCR). Partial sequences of the RNA-dependent RNA polymerase (RdRp) and capsid genes of positive samples were amplified by conventional RT-PCR and then sequenced. The NoV genotype was determined by online Norovirus Typing Tool Version 2.0, and phylogenetic analysis was conducted using MEGA 6.0.

Results

The prevalence of NoV was 26.4% (1280/4848). NoV was detected in all age groups, with the 7–12 months group having the highest detection rate (655/2014, 32.5%). NoV was detected during most part of the year with higher frequency in winter than other seasons. Based on the genetic analysis of RdRp, GII. Pe was the most predominant genotype detected at 70.7% (381/539) followed by GII.P12 at 25.4% (137/539). GII.4 was the most predominant capsid genotype detected at 65.3% (338/518) followed by GII.3 at 26.8% (139/518). Based on the genetic analysis of RdRp and capsid sequences, the strains were clustered into 10 RdRp–capsid genotypes: GII.Pe-GII.4 Sydney 2012 (65.5%), GII.P12-GII.3 (27.2%), GII.P16-GII.2 (1.8%), GII.P12-GII.2 (0.2%), GII.P17-GII.17 (1.1%), GII.Pe-GII.3 (1.8%), GII.Pe-GII.2 (1.1%), GII.Pe-GII.1 (0.4%), GII.16-GII.4 Sydney 2012 (0.7%), and GII.P7-GII.6 (0.2%). The predominant NoV genotypes changed from GII.Pe-GII.4 Sydney 2012 and GII.P12-GII.3 between August 2018 and July 2019 to GII.Pe-GII.4 Sydney 2012 and GII.P16-GII.2 between August 2019 and July 2020. The patients with GII.Pe-GII.4 Sydney 2012 genotype were more likely to suffer from vomiting symptom than those with GII.P12-GII.3.

Conclusions

NoV is an important pathogen responsible for viral AGE among children in China. GII.Pe-GII.4 Sydney 2012 and GII.P12-GII.3 were major recombinant genotypes. Knowledge of circulating genotypes and seasonal trends is of great importance for disease prevention and surveillance.
Development of a structure-validated hypersexuality scale in Chinese university students
Authors: Jia Yanli , Shao Xu , Shen Chanchan , Wang Wei
Published: July 2021

Background

Hypersexuality is associated with many psychiatric disorders and creates enormous burden for the affected individual, family and society. There are numerous inventories measuring behavioral, emotional or stressful features of hypersexuality, we still need a structure-validated questionnaire to measure hypersexuality in a comprehensive way.

Methods

Based on previous inventories and related clinical descriptions of hypersexuality, we designed a matrix of 72 items related to hypersexual experience, and we invited 282 heterosexual university students who experienced hypersexuality at least once life-long to answer the matrix.

Results

Through exploratory factor analyses and exploratory structural equation modeling, we constructed a Hypersexuality Scale, with a satisfactory model structure of five factors (or scales, 4 items for each scale) of hypersexuality, and named them as the Negative Impact, Emotional Coping, Uncontrolled Behavior, Post-sex Regret, and Increased Interest. Most inter-correlations of these factors were significant but in low or medium levels in all participants. Male students scored significantly higher on Negative Impact and Increased Interest than females did.

Conclusions

The five scales described in this study might help to understand hypersexuality, and the Hypersexuality Scale might be applied to the clinical conditions related to hypersexuality.
Priorities and opportunities for palliative and end of life care in United Kingdom health policies: a national documentary analysis
Authors: Sleeman Katherine E. , Timms Anna , Gillam Juliet , Anderson Janet E. , Harding Richard , Sampson Elizabeth L. , Evans Catherine J.
Published: July 2021

Background

Access to high-quality palliative care is inadequate for most people living and dying with serious illness. Policies aimed at optimising delivery of palliative and end of life care are an important mechanism to improve quality of care for the dying. The extent to which palliative care is included in national health policies is unknown. We aimed to identify priorities and opportunities for palliative and end of life care in national health policies in the UK.

Methods

Documentary analysis consisting of 1) summative content analysis to describe the extent to which palliative and end of life care is referred to and/or prioritised in national health and social care policies, and 2) thematic analysis to explore health policy priorities that are opportunities to widen access to palliative and end of life care for people with serious illness. Relevant national policy documents were identified through web searches of key government and other organisations, and through expert consultation. Documents included were UK-wide or devolved (i.e. England, Scotland, Northern Ireland, Wales), health and social care government strategies published from 2010 onwards.

Results

Fifteen policy documents were included in the final analysis. Twelve referred to palliative or end of life care, but details about what should improve, or mechanisms to achieve this, were sparse. Policy priorities that are opportunities to widen palliative and end of life care access comprised three inter-related themes: (1) integrated care – conceptualised as reorganisation of services as a way to enable improvement; (2) personalised care – conceptualised as allowing people to shape and manage their own care; and (3) support for unpaid carers – conceptualised as enabling unpaid carers to live a more independent lifestyle and balance caring with their own needs.

Conclusions

Although information on palliative and end of life care in UK health and social care policies was sparse, improving palliative care may provide an evidence-based approach to achieve the stated policy priorities of integrated care, personalised care, and support for unpaid carers. Aligning existing evidence of the benefits of palliative care with the three priorities identified may be an effective mechanism to both strengthen policy and improve care for people who are dying.