bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal Reconstruction of Sagittal Alignment According to Global Alignment And Proportion Score Can Reduce Adjacent Segment Degeneration After Lumbar Fusion
Authors: Wang Muyi , Xu Liang , Chen Xi , Zhou Qingshuang , Du Changzhi , Yang Bo , Zhu Zezhang , Wang Bin , Qiu Yong , Sun Xu
Published: November 2020

Study Design.

A retrospective study

Objective.

The aim of this study was to investigate the ability of Global Alignment and Proportion (GAP) score to predict the occurrence of adjacent segment degeneration (ASD) after fusion surgery for lumbar degenerative diseases.

Summary of Background Data.

The recently developed GAP score was applied to predict postoperative complications for adult spinal deformity, as well as to facilitate future outcome-based research on optimal treatment for various spinal conditions. However, it remains unclear whether reconstruction of alignment according to GAP score can reduce the ASD rates.

Methods.

This study retrospectively reviewed 126 consecutive patients who had undergone lumbar fusion and had been followed over 2 years. Pre- and postoperative radiographs and MRI were analyzed for ASD. GAP scores were calculated based on the early postoperative spinopelvic parameters. Cochran-Armitage test of trend was performed to investigate the association between GAP score and the occurrence of ASD. Receiver-operating characteristic curves were used to analyze the predictive accuracy of the GAP score for ASD.

Results.

Radiographical ASD (R-ASD) and symptomatic ASD (S-ASD) were diagnosed in 44 (34.9%) patients and in 13 (10.3%) patients, respectively. The patients with a proportioned spinopelvic state according to the GAP score had significantly lower rates of ASD (R-ASD and S-ASD) or S-ASD than those with a moderately or severely disproportioned spinopelvic state. The area under curve for the GAP score predicting ASD and S-ASD was 0.691 (95% confidence interval [CI]: 0.596∼0.785, P < 0.01) and 0.865 (95% CI: 0.771∼0.958, P < 0.01), respectively.

Conclusion.

Our study revealed a significant association between postoperative GAP score and occurrence of ASD after lumbar fusion surgery. Setting surgical goals according to the GAP score may help reduce the occurrence of ASD, especially for S-ASD.

Level of Evidence: 4
Development and Validation of a Multidomain Surgical Complication Classification System for Adult Spinal Deformity
Authors: Klineberg Eric O. , Wick Joseph B. , Lafage Renaud , Lafage Virginie , Pellise Ferran , Haddad Sleiman , Yilgor Caglar , Núñez-Pereira Susana , Gupta Munish , Smith Justin S. , Shaffrey Christopher , Schwab Frank , Ames Christopher , Bess Shay , Lewis Stephen , Lenke Lawrence G. , Berven Sigurd
Published: November 2020

Study Design.

Prospective analysis of example cases

Objective.

The aim of this study was to analyze the accuracy and repeatability of a new comprehensive classification system for capturing complications data in adult spinal deformity.

Summary of Background Data.

Complications are common in adult spinal deformity surgery. However, no consensus exists on the definition or classification of complications in adult spinal deformity surgery. The lack of consensus significantly limits understanding of complications’ effects on outcomes in surgery for adult spinal deformity.

Methods.

Using a Delphi method, members of the International Spine Study Group, AO Spine, and the European Spine Study Group collaborated to develop an adult spinal deformity classification system. The multidomain classification system accounts for medical complications (cancer, cardiopulmonary, central nervous system, gastrointestinal, infectious, musculoskeletal, renal) and surgical complications (implant complications, radiographic complications, neurologic events, intraoperative events, and wound complications). Seventeen individuals (“event readers”), including spine surgeons, trainees, and research coordinators, used the new classification system two separate times to analyze complications in ten example cases. The accuracy and repeatability of the classification system were subsequently calculated based on the providers’ responses for the example cases.

Results.

The 10 example cases included 22 complications. Nearly 95% of complications were captured by >95% of the event readers. The system demonstrated good repeatability of 86.9% between the first and second set of responses provided by event readers.

Conclusion.

The ISSG-AO Multi-Domain Spinal Deformity Complication Classification System for Adult Spinal Deformity demonstrated good accuracy and repeatability among both surgeons and research coordinators in capturing complications in adult spinal deformity surgery. The ISSG-AO system may be applied to help better understand the impact of complications on outcomes and costs in adult spinal deformity surgery.

Level of Evidence: 5
A New Global Spinal Balance Classification Based on Individual Pelvic Anatomical Measurements in Patients With Adult Spinal Deformity
Authors: Nakashima Hiroaki , Kawakami Noriaki , Ohara Tetsuya , Saito Toshiki , Tauchi Ryoji , Imagama Shiro
Published: November 2020

Study Design.

A retrospective study.

Objective.

This study aims to establish a new, easy-to-implement global spinal balance (GSB) classification based on individual pelvic anatomical measurements in adult spinal deformity patients, and to validate this classification in terms of patients’ quality of life (QOL).

Summary of Background Data.

Coronal (central sacral vertical line) and sagittal (C7 sagittal vertical axis [C7 SVA]) lines are standard parameters to evaluate GSB. However, these parameters do not consider individual differences in height and physique. Therefore, a new classification to more simply evaluate GSB related to QOL would be a beneficial tool.

Methods.

This study included 279 patients with adult spinal deformity. The enrollment criteria included age >18 years and scoliosis >30°. GSB was evaluated based on C7 coronal vertical axis and C7 SVA, and was graded with our sagittal (Grades 1–3) and coronal classifications (Grades 1–3), where larger values represented worse GSB. In addition, total global balance classification (Grades 1–3) was also established based on both coronal and sagittal classifications. Patient self-assessment measures of health status were collected using the Scoliosis Research Society patient questionnaire (SRS-22). The relationships between responses to the SRS-22 and GSB were evaluated using partial correlation coefficients, adjusted by age.

Results.

A newly described coronal classification correlated with the preoperative function (P < 0.02), pain (P = 0.001), subtotal (P < 0.001) domains in the SRS-22, whereas a newly described sagittal classification was correlated with the preoperative subtotal domain (P < 0.001). There were also significant correlations between total global balance and the preoperative function (P = 0.03) and subtotal domains (P < 0.001) in the SRS-22.

Conclusion.

We present a simple new classification for GSB that strongly correlates with QOL in patients with adult spinal deformity, thereby translating clinical data into meaningful patient outcomes and livelihoods.

Level of Evidence: 4
Preoperative Halo-Gravity Traction for Patients with Severe Focal Kyphosis in the Upper Thoracic Spine
Authors: Li Yang , Shi Benlong , Zhu Zezhang , Liu Zhen , Liu Dun , Shi Bo , Sun Xu , Qiu Yong
Published: November 2020

Study Design.

Retrospective review.

Objective.

To evaluate the effect of preoperative Halo-gravity traction (HGT) in the treatment of severe focal kyphosis in the upper thoracic spine (UTS), and to propose the indications that HGT could serve as an alternative for three-column osteotomy (3CO) among these patients.

Summary of Background Data.

The HGT has been proven to be effective for severe kyphoscoliosis secondary to multiple etiologies. However, the safety and efficacy of HGT in severe focal kyphosis in UTS was still unclear.

Methods.

Patients with focal kyphosis in UTS undergoing HGT and without 3CO operation were reviewed. The sagittal focal kyphosis was measured at pre-, posttraction, and postoperation. The neurologic function at pretraction, posttraction, and postoperation were assessed according to the American Spinal Injury Association (ASIA) grading. The complications during HGT, operation, and follow-up were recorded. The comparison between pretraction and posttraction was performed using paired samples t test.

Results.

A total of 19 patients were included in this study, with a mean age of 13.2 ± 5.8 years. The average duration of HGT was 62.6 ± 8.4 days, during which the average kyphosis decreased from 95.3 ± 16.4° to 64.1 ± 19.2° (P < 0.001). After HGT, the ASIA grade improved from C to D in three patients and from C to E in three patients, from D to E in seven patients, from B to D in one patient. No deterioration in neurologic function was observed during HGT. The neurological status in one patient improved from ASIA C at pretraction to ASIA E at postoperation, but deteriorated to C at 4 years follow-up.

Conclusion.

Preoperative HGT could help to correct deformity and improve neurological deficit. 3CO procedure might be unnecessary in patients with severe focal kyphosis in UTS with the utilization of HGT.

Level of Evidence: 4
Age as a Predictor for Complications and Patient-reported Outcomes in Multilevel Transforaminal Lumbar Interbody Fusions
Authors: Claus Chad F. , Tong Doris , Lytle Evan , Bahoura Matthew , Garmo Lucas , Li Chenxi , Park Paul , Carr Daniel A. , Easton Richard , Abdulhak Muwaffak , Chang Victor , Houseman Clifford , Bono Peter , Richards Boyd , Soo Teck M.
Published: November 2020

Study Design.

Retrospective review of a multi-institutional data registry.

Objective.

The authors sought to determine the association between age and complications & patient-reported outcomes (PRO) in patients undergoing multilevel transforaminal interbody lumbar fusion (MTLIF).

Summary of Background Data.

Elderly patients undergoing MTLIF are considered high risk. However, data on complications and PRO are lacking. Additionally, safety of multilevel lumbar fusion in the elderly remains uncertain.

Methods.

Patients ≥50-year-old who underwent MTLIF for degenerative lumbar spine conditions were analyzed. Ninety-day complications and PROs (baseline, 90-d, 1-y, 2-y) were queried using the MSSIC database. PROs were measured by back & leg visual analog scale (VAS), Patient-reported Outcomes Measurement Information System (PROMIS), EuroQol-5D (EQ-5D), and North American Spine Society (NASS) Patient Satisfaction Index. Univariate analyses were used to compare among elderly and complication cohorts. Generalized estimating equation (GEE) was used to identify predictors of complications and PROs.

Results.

A total of 3120 patients analyzed with 961 (31%) ≥ 70-y-o and 2159 (69%) between 50–69. A higher proportion of elderly experienced postoperative complications (P = .003) including urinary retention (P = <.001) and urinary tract infection (P = .002). Multivariate analysis demonstrated that age was not independently associated with complications. Number of operative levels was associated with any (P = .001) and minor (P = .002) complication. Incurring a complication was independently associated with worse leg VAS and PROMIS scores (P = <.001). Preoperative independent ambulation was independently associated with improved PROMIS, and EQ5D (P = <.001). Within the elderly, preoperative independent ambulation and lower BMI were associated with improved PROMIS (P = <.001). Complications had no significant effect on PROs in the elderly.

Conclusions.

Age was not associated with complications nor predictive of functional outcomes in patients who underwent MTLIF. Age alone, therefore, may not be an appropriate surrogate for risk. Furthermore, baseline preoperative independent ambulation was associated with better clinical outcomes and should be considered during preoperative surgical counseling.

Level of Evidence: 3
Preoperative Hounsfield Units at the Planned Upper Instrumented Vertebrae May Predict Proximal Junctional Kyphosis in Adult Spinal Deformity
Authors: Yao Yu-Cheng , Elysee Jonathan , Lafage Renaud , McCarthy Michael , Louie Philip K. , Alshabab Basel Sheikh , Weissmann Karen , Lafage Virginie , Schwab Frank , Kim Han Jo
Published: November 2020

Study Design.

Retrospective cohort study.

Objective.

To investigate the association between Hounsfield units (HU) measured at the planned upper instrumented vertebra (UIV) and UIV+1 and proximal junctional kyphosis (PJK) in patients with adult spinal deformity (ASD).

Summary of Background Data.

PJK is a common complication following surgery for ASD and poor bone quality is noted to be one of the risk factors. HUs from standard computed tomography (CT) scans can be used for evaluating regional bone quality.

Methods.

Sixty-three patients were included from a single institution. The demographic characteristics and radiographic parameters were recorded. Local vertebral HUs at the planned UIV and UIV+ 1 were measured using preoperative CT scans. The patients were divided into three groups: no PJK, non-bony PJK, and bony PJK. The risk factors between the three groups and the correlation between the mean HU and increase in the PJK angle were analyzed.

Results.

The incidence of PJK was 36.5%. The mean HU was significantly lower in the bony PJK group (HU: 109.0) than in the no PJK group (HU: 168.7, P = 0.038), and the mean HU in the non-bony PJK group (HU: 141.7) was not different compared to the other two groups. There was a significant negative correlation between the mean HU values and the increase in the PJK angles (r = −0.475, P < 0.01). The cutoff value for the mean HU used to predict bony PJK was 120 and a HU value less than 120 was a significant risk factor for bony PJK (OR: 5.74, 95% CI [1.01–32.54], P = 0.04).

Conclusions.

We noted a significant inverse relationship between the mean HUs at the UIV and UIV+ 1 and increase in the PJK angles postoperatively. In ASD patients, the HUs may be used preoperatively to identify patients with a higher risk of bony PJK.

Level of Evidence: 3
Ventilator-Weaning Pathway Associated With Decreased Ventilator Days in Pediatric Acute Respiratory Distress Syndrome*
Authors: Mehta Sanjiv D. , Martin Kelly , McGowan Nancy , Dominick Cheryl L. , Madu Chinonyerem , Denkin Blair Kraus , Yehya Nadir
Published: November 2020

Objectives:

There is limited evidence on the impact of protocolized ventilator weaning in pediatric acute respiratory distress syndrome, despite utilization in clinical trials and clinical care. We aimed to determine whether protocolized ventilator weaning shortens mechanical ventilation duration and PICU length of stay in pediatric acute respiratory distress syndrome survivors.

Design:

Secondary analysis of a prospective pediatric acute respiratory distress syndrome (Berlin definition) cohort from July 2011 to June 2019 analyzed using interrupted time series analysis pre- and postimplementations of a ventilator-weaning pathway. We compared duration of invasive ventilation and PICU length of stay in survivors before and after implementation of a ventilator-weaning pathway. We excluded PICU nonsurvivors and subjects with greater than 100 ventilator days.

Setting:

Large academic tertiary-care PICU.

Patients:

Children with acute respiratory distress syndrome who survived to PICU discharge with less than or equal to 100 days of invasive mechanical ventilation.

Interventions:

Implementation of a ventilator-weaning pathway on May 2016.

Measurements and Main Results:

Of 723 children with acute respiratory distress syndrome, 132 subjects died and six subjects with ventilation greater than 100 days were excluded. Of the remaining 585 subjects, 375 subjects had acute respiratory distress syndrome prior to pathway intervention and 210 after. Patients in the preintervention epoch were younger, more likely to have infectious acute respiratory distress syndrome, and had increased use of alternative ventilator modes. Pathway adoption was rapid and sustained. Controlling for temporality, pathway implementation was associated with a decrease of a median 3.6 ventilator days (95% CI, –5.4 to –1.7; p < 0.001). There was no change in the reintubation rates. Results were robust to multiple sensitivity analyses adjusting for confounders.

Conclusions:

Ventilator-weaning pathway implementation shortened invasive ventilation duration in pediatric acute respiratory distress syndrome survivors with no change in reintubation. The effect size of this intervention was comparable with those targeted in acute respiratory distress syndrome trials.
Two-Step Imputation and AdaBoost-Based Classification for Early Prediction of Sepsis on Imbalanced Clinical Data
Authors: Baniasadi Atefeh , Rezaeirad Sepideh , Zare Habil , Ghassemi Mohammad M.
Published: November 2020

OBJECTIVES:

Sepsis is a life-threatening response to infection that causes tissue damage, organ failure, and death. Effective early prediction of sepsis would improve patients’ diagnosis and reduce the cost associated with late-stage sepsis infection by applying appropriate early intervention. However, effective early prediction is challenging because sepsis biomarkers are neither obvious nor definitive, and sepsis datasets are heavily imbalanced against positive diagnosis of sepsis while containing significant missing values. Early prediction of sepsis in ICUs using clinical data is the objective of the PhysioNet/Computing in Cardiology Challenge 2019.

DESIGN:

In this article, we proposed a machine learning algorithm to aid in the early detection of sepsis.

SETTING:

We applied linear interpolation and implemented a sample weighted AdaBoost model to predict sepsis 6 hours before clinical diagnosis.

PATIENTS:

Medical data contains more than 40,000 patients gathered from three geographically distinct U.S. hospital systems that consisted of a combination of hourly vital sign, lab values, and static patient descriptions.

INTERVENTIONS:

The challenge metric, however, did not directly reward models for their generalizability across institutions.

MEASUREMENTS AND MAIN RESULTS:

The article is evaluated using a new metric called Utility Score that is defined as Official scoring criteria. Our approach was among the top 10% of entries to the Challenge on a hidden test set.

CONCLUSIONS:

Herein, we demonstrate that our proposed approach was the most effective of the Challenge entrants when such generalizability is explicitly accounted for in model evaluation.
External Corroboration That Corticosteroids May Be Harmful to Septic Shock Endotype A Patients
Authors: Wong Hector R. , Hart Kimberly W. , Lindsell Christopher J. , Sweeney Timothy E.
Published: November 2020

OBJECTIVES:

We previously reported gene expression-based endotypes of pediatric septic shock, endotypes A and B, and that corticosteroid exposure was independently associated with increased mortality among pediatric endotype A patients. The Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial tested the efficacy of vasopressin as initial vasopressor therapy for septic shock among adult patients, when compared with norepinephrine. Patients who reached a prespecified dose of either vasopressor were further randomized to receive hydrocortisone or placebo. A proportion of patients in the Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial had transcriptomic data generated at baseline using whole blood-derived messenger RNA. We used the publicly available transcriptomic data from the Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial to assign the study subjects to pediatric septic shock endotype A or B, and tested the hypothesis that hydrocortisone treatment is associated with increased mortality among patients in endotype A.

DESIGN:

Secondary analysis of publicly available transcriptomic data.

SETTING:

Multiple adult ICUs.

PATIENTS:

Adults with septic shock randomized to hydrocortisone (n = 47) or placebo (n = 50).

INTERVENTIONS:

Randomization to the Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial experimental arms.

MEASUREMENTS AND MAIN RESULTS:

Endotype A patients receiving hydrocortisone had a mortality rate of 46%, whereas endotype A patients receiving placebo had a mortality rate of 22% (p = 0.105). In contrast, the mortality rates for endotype B patients receiving hydrocortisone or placebo were 19% and 22%, respectively. The odds of death were more than three times greater in endotype A patients receiving hydrocortisone than endotype A patients receiving placebo (p = 0.05).

CONCLUSIONS:

This exploratory analysis provides further evidence that corticosteroid exposure may be associated with increased mortality among septic shock endotype A patients.
Clinical features and treatment outcomes of human immunodeficiency virus-associated cryptococcal meningitis: a 2-year retrospective analysis
Authors: Song Wei , Shen Yin-Zhong , Wang Zhen-Yan , Qi Tang-Kai , Liu Li , Zhang Ren-Fang , Wang Jiang-Rong , Tang Yang , Chen Jun , Sun Jian-Jun , Lu Hong-Zhou
Published: November 2020

Background:

Cryptococcal meningitis (CM) is one of the most common opportunistic infections caused by Cryptococcus neoformans in human immunodeficiency virus (HIV)-infected patients, and is complicated with significant morbidity and mortality. This study retrospectively analyzed the clinical features, characteristics, treatment, and outcomes of first-diagnosed HIV-associated CM after 2-years of follow-up.

Methods:

Data from all patients (n = 101) of HIV-associated CM hospitalized in Shanghai Public Health Clinical Center from September 2013 to December 2016 were collected and analyzed using logistic regression to identify clinical and microbiological factors associated with mortality.

Results:

Of the 101 patients, 86/99 (86.9%) of patients had CD4 count <50 cells/mm3, 57/101 (56.4%) were diagnosed at ≥14 days from the onset to diagnosis, 42/99 (42.4%) had normal cerebrospinal fluid (CSF) cell counts and biochemical examination, 30/101 (29.7%) had concomitant Pneumocystis (carinii) jiroveci pneumonia (PCP) on admission and 37/92 (40.2%) were complicated with cryptococcal pneumonia, 50/74 (67.6%) had abnormalities shown on intracranial imaging, amongst whom 24/50 (48.0%) had more than one lesion. The median time to negative CSF Indian ink staining was 8.50 months (interquartile range, 3.25–12.00 months). Patients who initiated antiretroviral therapy (ART) before admission had a shorter time to negative CSF Indian ink compared with ART-naïve patients (7 vs. 12 months, χ
2 = 15.53, P < 0.001). All-cause mortality at 2 weeks, 8 weeks, and 2 years was 10.1% (10/99), 18.9% (18/95), and 20.7% (19/92), respectively. Coinfection with PCP on admission (adjusted odds ratio [AOR], 3.933; 95% confidence interval [CI], 1.166–13.269, P = 0.027) and altered mental status (AOR, 9.574; 95% CI, 2.548–35.974, P = 0.001) were associated with higher mortality at 8 weeks.

Conclusion:

This study described the clinical features and outcomes of first diagnosed HIV-associated CM with 2-year follow-up data. Altered mental status and coinfection with PCP predicted mortality in HIV-associated CM.
Medical Missions
Authors: Johanson Linda
Published: November 2020

Participating in medical mission work can have incomparable spiritual value. Experiencing a foreign culture via sounds, sights, tastes, smells, and textures is a unique avenue for caring for people's physical needs that opens opportunities for spiritually-focused interactions. Nurses can gain cultural competency and humility as they help envision future ministry possibilities with local residents and mission team members. Practical preparation suggestions and a reading list are provided.
Think Health Literacy to Improve the Patient Experience
Authors: Landis Philip
Published: November 2020

Nurses directly influence the experience that patients and their families have in their interactions with the health care system. This article addresses how nurses holistically influence the patient experience through the lens of health literacy, as nurses guide their patients and families through a confusing and complex system of care, replete with jargon and labyrinthine paths.
On the Horizon: Biologics and Nutrients for Neurotrophic Keratitis
Authors: Gumus Koray
Published: November 2020

Neurotrophic keratitis (NK), a potentially sight-threatening corneal disease, still does not have a specific treatment. The reduction or complete loss of corneal sensation, the most important factor in its pathogenesis, is one of the most important factors that complicate the treatment of corneal wound healing. In addition, the visual outcome may be adversely affected because of aggressive stromal fibrosis in severe NK cases. Basically, the current management of NK aims to accelerate wound healing and prevent the progression. However, new therapeutic agents, particularly developed depending on cell type-specific healing mechanisms are required for better visual outcomes. In recent years, several studies have started to use new promising areas of translational research, including gene therapy, stem cell therapy, miRNA, and bioengineering. Evidence has emerged that future treatment strategies for NK will be designed by the results of these studies. In this review, it is aimed to summarize scientific data of new treatment modalities for NK.
Successful Outcome of Simultaneous Allogeneic Simple Limbal Epithelial Transplantation With Therapeutic Penetrating Keratoplasty (PKP) for Limbal Stem Cell Deficiency and Sterile Keratolysis After Chemical Injury
Authors: Kunapuli Anuradha , Fernandes Merle
Published: November 2020

Purpose:

To describe the successful outcome of simultaneous allogeneic simple limbal epithelial transplantation (SLET) combined with therapeutic penetrating keratoplasty (PKP) for limbal stem cell deficiency (LSCD) with sterile keratolysis after bilateral chemical injury.

Methods:

A 37-year-old man presented with total LSCD and sterile keratolysis with perforation in the left eye after amniotic membrane transplantation for bilateral chemical injury before 3 months. The right eye had a stable ocular surface, absence of palisades of Vogt, and minimal anterior stromal scarring. To salvage the left eye, emergency therapeutic PKP combined with allogeneic SLET was performed. He was given oral steroids for 8 weeks and mycophenolate mofetil for 1 year to prevent allograft rejection.

Results:

At the last follow-up, 2 years later, with miniscleral contact lens, his best corrected visual acuity was 20/20 with a clear graft and an intact ocular surface.

Conclusions:

To the best of our knowledge, this is the first report of successful outcome of emergency PKP with simultaneous allogeneic SLET managed by systemic immunosuppression for corneal perforation with LSCD.
Posteriorly Displaced Orbital Implant Causing Intractable Anophthalmic Socket Pain
Authors: Hartford Juliet B. , Zehden Jason , Sweeney Adam R. , Yen Michael T.
Published: November 2020

Anophthalmic socket pain is a rare complication of enucleation. The authors present a patient presenting with intractable anophthalmic socket pain due to a posteriorly displaced orbital implant. The patient’s pain localized to the V1 and V2 orbitofacial dermatomes, and we suspect compression of the frontal and zygomatic branches of the ophthalmic and maxillary nerves, respectively, as the underlying etiology of the patient’s pain. Removal of the implant and placement of a dermis fat graft was effective at alleviating the patient’s symptoms.
Multicameral Steatocystoma Simplex of the Caruncle
Authors: Charles Norman C. , Jakobiec Frederick A. , Sherwood Pamela , Belinsky Irina
Published: November 2020

A yellow cyst of the caruncle in a 68-year-old man displayed the characteristic sebaceous glands and sebocytes of steatocystoma within the cyst wall, with a unique configuration of multiple branching compartments. The cyst lining was of trichilemmal character, lacking a keratohyalin granular layer, and replicated the immunohistochemical characteristics of a previously reported caruncular steatocystoma with the exception of a positive trichilemmal marker, calretinin, in the present case. Four previous cases of caruncular steatocystoma have been described, only one of which incorporated immunohistochemical analysis. Steatocystoma develops from a sebaceous gland duct, which displayed in this case multiple chambers subdividing what is usually a single round lumen.
Urethral Orifice Genital Herpes Caused by HSV-1 in a Female Patient: A Case Report
Authors: Yang Jia-Yi , Mo Xiao-Hui , Wang Xiu-Li
Published: November 2020

Introduction:

Genital herpes is one of the most common sexually transmitted infections worldwide. Most genital herpes occur on the genitalia, perineum, buttocks, upper thighs, or perianal areas. However, there were reports of rare cases of genital herpes on urethral orifice.

Herein, we report a case of a patient who was diagnosed with urethral orifice genital herpes, a place likely to be ignored.

Case presentation:

A 53-year-old woman presented with vagina pruritus at first, with subsequent burning sensation around urethra. Mycostatin and mycospor were administered for the treatment of the pruritus. Then levofloxacin was prescribed. Finally, the patient was given treatment with acyclovir. Different from other cases, the investigation showed herpes simplex virus type 1 DNA positive and herpes simplex virus type 2 DNA negative by PCR. The patient was therefore diagnosed with genital herpes.

Discussion:

Most genital herpes happen on the genitalia, perineum, buttocks, upper thighs, or perianal areas. Few cases have been reported that genital herpes occurred on urethral orifice till now.

Conclusion:

If there is no typical symptoms that patient present with herpes simplex virus type 1 or 2 positive, urethral orifice genital herpes should be considered.
Capsaicin Regulates Mitochondrial Fission to Promote Melanoma Cell Apoptosis
Authors: Ma Jing-Jing , Yang Yu-Qi , Guo Sen , Wang Hui-Na , Yi Xiu-Li , Zhao Tao , Liu Lin , Yue Qiao , Liu Yu , Shi Qiong , Gao Tian-Wen , Guo Wei-Nan , Li Chun-Ying
Published: November 2020

Objective:

Capsaicin (CPS) is a major component of the red pepper, and its anti-tumor property has been confirmed. However, the underlying mechanism of this anti-tumor effect has not been fully clarified, so we conducted this study to evaluate the role of mitochondrial fission and subsequent mitochondrial dysfunction in CPS-induced apoptosis of melanoma cells.

Methods:

Two melanoma cell lines and melanocytes were treated with CPS alone or in combination with ruthenium red (a transient receptor potential vanilloid 1 [TRPV] antagonist), Z-VAD-FMK (a pan-caspase inhibitor), or N-acetyl-L-cysteine (an antioxidant). Cell vitality was tested using a cell counting kit-8 assay. The expression levels of related proteins were examined by Western blotting. Apoptosis, intracellular reactive oxygen species, mitochondrial membrane potential, adenosine triphosphate levels, and mitochondrial dynamics were analyzed by flow cytometry, luminometry, and confocal laser microscopy, respectively, and compared between groups.

Results:

CPS treatment significantly inhibited the vitality of melanoma cells (For A2058 cells: 0 vs. 120 μmol/L: [100.00% ± 0%] vs. [51.02% ± 6.40%], P < 0.05; For WM35 cells: 0 vs. 120 μmol/L: [100.00% ± 0%] vs. [51.80% ± 3.45%], P < 0.05) but exerted less impact on normal melanocytes. CPS promoted melanoma cell apoptosis through TRPV channels and the caspase cascade. CPS treatment then led to TRPV channel-dependent mitochondrial dysfunction with an increase in reactive oxygen species generation (For A2058 cells: CPS vs. CPS+RR: [2.34 ± 0.30] vs. [1.34 ± 0.12], P < 0.05; For WM35 cells: CPS vs. CPS+RR: [2.25 ± 0.25] vs. [1.65 ± 0.13], P < 0.05), dissipation of the mitochondrial membrane potential (Control vs. CPS: [1.00 ± 0] vs. [0.61 ± 0.08], P < 0.05), and adenosine triphosphate reduction (P < 0.05). In addition, reactive oxygen species generation contributed to CPS-induced melanoma cell apoptosis. Mitochondrial fission was subsequently proved to connect CPS treatment to mitochondrial dysfunction, which was also TRPV channel-dependent, thereby inducing melanoma cell apoptosis.

Conclusion:

Our study highlights the role of mitochondrial fission and its related mitochondrial dysfunction in mediating the pro-apoptotic effect of CPS in melanoma. These findings deepen our understanding of the mechanisms underlying the anti-tumor activity of CPS and indicate the clinical relevancy of extending the use of this agent for cancer therapy.
Mobilization of Melanocytes During NB-UVB Treatment of Vitiligo
Authors: Li Yue , Zhang Ru-Zhi
Published: November 2020

Vitiligo, a common skin depigmentation disorder, is the result of complex interactions of genetic, immunological, environmental, and biochemical events. Treatments for vitiligo include drugs, phototherapy, surgical transplantation, and so on. Among them, the efficacy of narrow band-ultraviolet B has been confirmed. By inducing keratinocyte-derived factors and signalings, narrow band-ultraviolet B can trigger and/or promote the mobilization of melanocytes which migrate to lesional epidermis ultimately, leads to the repigmentation of white patches. The mobilization of melanocytes includes stages of activation, migration, proliferation, and differentiation. Elucidating processes that enable the specific mobilization of melanocytes and the signaling pathways and factors involved, will help the development of new drugs and methods for the treatment of vitiligo.
Prospective Analysis of an Evidence-Based Symptom Set in Superior Canal Dehiscence Syndrome
Authors: Naert Laura , Ocak Ibrahim , Griet Mertens , Van de Berg Raymond , Stultiens Joost J.A. , Van de Heyning Paul , Bisdorff Alexandre , Sharon Jeffrey D. , Ward Bryan K. , Van Rompaey Vincent
Published: November 2020

Introduction:

Superior canal dehiscence syndrome (SCDS) is characterized by a defect in the bone overlying the superior semicircular canal. This third mobile window generates an abnormal low-impedance pathway for sound/pressure transmission into the inner ear resulting in the characteristic symptoms.

Objective:

To perform a prospective analysis of symptoms in patients with SCDS.

Methods:

An aggregated symptom set was studied prospectively and compared with a healthy control group. The 31 items inquired about the presence and severity of symptoms. Initial comparison between both groups was performed using the Kolmogorov–Smirnov test and nonparametric Mann–Whitney U test. For analysis of the internal consistency, the Cronbach's alpha coefficient was determined. Finally, the prevalence of symptoms obtained in the present study was compared to the prevalence of symptoms obtained as part of a recent retrospective systematic review.

Results:

Responses from the 29 patients with SCDS in the case group and the 58 healthy controls were not normally distributed. Those with SCDS had a higher prevalence and more severe symptoms for almost all items. The Cronbach's alpha coefficient of 0.969 indicates an excellent internal consistency. The prospective prevalence of most symptoms was higher than the retrospective prevalence reported earlier.

Conclusions:

SCDS causes a variety of vestibular and auditory symptoms. This prospective study demonstrates that their prevalence and severity are higher than reported previously. This symptom set demonstrates excellent internal consistency and will serve as a foundation toward developing a disease-specific patient-reported outcome measure for SCDS.

Level of evidence:

NA
The Potential Clinical and Economic Value of a Human Papillomavirus Primary Screening Test That Additionally Identifies Genotypes 31, 45, 51, and 52 Individually
Authors: Asti Lindsey , Hopley Colin , Avelis Cameron , Bartsch Sarah M. , Mueller Leslie E. , Domino Molly , Cox Sarah N. , Andrews Jeffrey C. , Randall Samuel L. , Stokes-Cawley Owen J. , Asjes Caitlin , Lee Bruce Y.
Published: November 2020

Background

Although current human papillomavirus (HPV) genotype screening tests identify genotypes 16 and 18 and do not specifically identify other high-risk types, a new extended genotyping test identifies additional individual (31, 45, 51, and 52) and groups (33/58, 35/39/68, and 56/59/66) of high-risk genotypes.

Methods

We developed a Markov model of the HPV disease course and evaluated the clinical and economic value of HPV primary screening with Onclarity (BD Diagnostics, Franklin Lakes, NJ) capable of extended genotyping in a cohort of women 30 years or older. Women with certain genotypes were later rescreened instead of undergoing immediate colposcopy and varied which genotypes were rescreened, disease progression rate, and test cost.

Results

Assuming 100% compliance with screening, HPV primary screening using current tests resulted in 25,194 invasive procedures and 48 invasive cervical cancer (ICC) cases per 100,000 women. Screening with extended genotyping (100% compliance) and later rescreening women with certain genotypes averted 903 to 3163 invasive procedures and resulted in 0 to 3 more ICC cases compared with current HPV primary screening tests. Extended genotyping was cost-effective ($2298–$7236/quality-adjusted life year) when costing $75 and cost saving (median, $0.3–$1.0 million) when costing $43. When the probabilities of disease progression increased (2–4 times), extended genotyping was not cost-effective because it resulted in more ICC cases and accrued fewer quality-adjusted life years.

Conclusions

Our study identified the conditions under which extended genotyping was cost-effective and even cost saving compared with current tests. A key driver of cost-effectiveness is the risk of disease progression, which emphasizes the need to better understand such risks in different populations.
Clinical and Ophthalmological Characteristics of Ocular Syphilis in a Retrospective Tertiary Hospital Cohort
Authors: Wagner Laura F. , Lanzl Ines , Rothe Kathrin , Schneider Jochen , Zink Alexander , Zapp Daniel , Schwerdtfeger Christiane , Lee Marcel , Weidlich Simon , Neuenhahn Michael , Loos Daria , Spinner Christoph D.
Published: November 2020

Background

Data on ocular syphilis (OS) and its clinical presentation are currently insufficient. This study aimed to investigate the characteristics of a cohort with a high OS incidence at a university hospital in Germany, focusing on the clinical presentation of OS.

Methods

This single-center cohort study retrospectively analyzed data on 90 patients with 109 episodes of syphilis between 2008 and 2018. Cases of OS were identified and additionally reevaluated through a study-specific secondary assessment by an ophthalmologist specializing in uveitis.

Results

Twenty-three patients (26%) were diagnosed with OS, 16 (70%) of whom were with binocular involvement. Uveitis, especially that of the posterior segment, showed a high prevalence. Lumbar puncture was performed in 20 OS patients (87%), of whom 17 (85% of those with lumbar puncture/74% in total) met the 2018 Centers for Disease Control and Prevention criteria for likely neurosyphilis. Five (22%) of 23 patients had HIV infection, of whom 2 did not receive antiretroviral therapy. The preferred syphilis treatment regimens were benzylpenicillin and ceftriaxone, which yielded favorable serological, clinical, and ophthalmological outcomes.

Conclusions

A high incidence of OS was identified, and physicians should be aware of uveitis as a manifestation of syphilis. Most patients presented with uveitis and syphilis in an early or late latent stage and showed central nervous system involvement.
Fear of cancer recurrence, distress, depressive symptoms, and quality of life in hematopoietic stem cell transplantation patients
Authors: McQuellon Richard P. , Duckworth Katharine E. , Campbell Cassie R. , Russell Gregory B. , Miskewicz Kelly R. , Alsobrooks Amber , Andrykowski Michael A. , Lamar Zanetta S. , Naik Seema G. , Zamkoff Kenneth W. , Hurd David D.
Published: November 2020

Background:

Symptoms of psychological distress, including fear of cancer recurrence (FCR) and quality of life (QOL) deficits are common along the hematopoietic stem cell transplantation (HCT) survivorship trajectory. Identifying patterns over time could contribute to timely interventions.

Materials and Methods:

HCT recipients completed the Distress Thermometer (DT), the Center for Epidemiologic Studies-Depression scale (CES-D), the Fear of Relapse and Recurrence Scale, and the Functional Assessment of Cancer Therapy (FACT-BMT) at hospital admission, discharge, 3, 6, 12, and 24 months post-HCT. Demographic data and performance status (PS) were collected at baseline. Mean scores (standard deviation) and frequencies were calculated. We utilized a linear mixed model approach on the repeated measures data (outcome of FCR, with predictors of distress, depressive symptoms and QOL). A multivariate repeated measures regression was constructed to assess what variables were associated with FCR.

Results:

A total of 198 patients completed questionnaires at admission. A total of 144 patients were deceased or lost to follow-up at 2 years. Both CES-D (P = .006) and DT (P = .0019) scores changed significantly over time and were higher at hospital discharge. FCR did not change significantly (P = .28). QOL was most impaired at hospital discharge. FCR did not correlate with actual recurrence. A significant percentage of recipients were afraid of cancer recurrence; however, a much greater percentage did not feel that fear of recurrence got in the way of enjoying life. QOL (P < .0001) and PS (P = .014) were significant predictors of FCR. A substantial percentage of patients reported significant (>16) depressive symptoms and distress levels (≥4) during the 2-year study period.

Conclusions:

Depressive symptoms and distress were highest at discharge, whereas overall QOL was lowest. FCR was prominent; yet for the majority, it was not an impediment to enjoying life. A psychosocial intervention may be most useful if introduced at hospital discharge and initiated during the first 3 months following HCT when distress is high.
Caregivers’ perception of psychosocial issues of pediatric patients with osteosarcoma: an exploratory study
Authors: Shunmugasundaram Chindhu , Veeraiah Surendran
Published: November 2020

Background:

Survival of children treated for osteosarcoma across India has improved from just 44% in 2001 (Chennai only) to 88.6% in 2016. Advances in treatment (chemotherapy, limb salvage surgery, or limb amputation) impact patients’ ability to work, body image, functional abilities, and recreational activities. Despite this, only little attention has been given to the psychosocial issues of children with osteosarcoma or their caregivers.

Aim:

The present study aimed to explore caregivers’ perception of psychosocial issues of pediatric osteosarcoma patients.

Methods:

This qualitative study used a funnel approach with convenience sampling to interview primary caregivers (N = 8) of pediatric osteosarcoma patients (on follow-up at a regional cancer centre in Chennai). There were no exclusions based on gender, disease stage, treatment status, or socioeconomic status. In-depth interviews were carried out using four semi-structured questions, developed by the research team, to guide the discussion of psychosocial issues faced by patients. Interviews were audio-taped, transcribed verbatim, and analyzed using thematic analysis. Codes from transcripts were categorized into themes.

Results:

Participants were all parents (mostly mothers) with mean age 35.8 years, and the patients they cared for had a mean age of 14 years. Themes identified were: 1) medication and treatment effects; 2) uncertain prognosis; 3) fear of uncertainty; 4) effect on education and activities; 5) restricted functioning; 6) social stigma and isolation; and, 7) social relationships. The psychosocial issues in the present were stressful treatment, physical weakness, and reintegration with normal life and school functioning. Those issues for the future were fear of disease recurrence and death, anxiety about social stigma and isolation, and restricted functioning.

Conclusions:

Findings from this study suggest a need for future studies that explore psychosocial issues from patients themselves. Interventions can then be designed to lessen psychosocial problems and improve quality of life for osteosarcoma patients and their primary caregivers.
Shared experiences of diagnosis and treatment of young-onset colorectal cancer: a patient-oriented qualitative study
Authors: Araujo Louise , Breau Genevieve , George Manju , Dau Hallie , Gastonguay Louise , Brown Erika Hanson , De Vera Mary A.
Published: November 2020

Objective:

The aim of this study was to gain a better understanding of the lived experiences of young-onset colorectal cancer (yCRC) from the perspective of patients and/or caregivers.

Methods:

We conducted a qualitative study, in collaboration with COLONTOWN®, an online colorectal cancer community. Individuals who have been diagnosed with yCRC, that is below the age of 50 years, or care for an individual with yCRC were invited to complete an online survey primarily comprising of an open-ended question asking participants to share their yCRC experiences in a text box, similar with how they may post on a social media platform. We applied an inductive, qualitative approach to identify themes arising from participants’ experiences.

Results:

From May to June 2019, we gathered experiences from 109 patients with yCRC and 11 caregivers. The majority of patients with yCRC were female (86, 71.7%) and diagnosed between the ages of 30 and 39 (49, 40.9%) and 40 and 49 years (61, 50.8%). We identified 8 themes: symptoms experienced; being misdiagnosed; advocating for oneself; appreciation of the healthcare team; frustration with the healthcare team and healthcare system; lasting effects of yCRC and its treatment; connecting with others; and reflections on experiences with yCRC.

Conclusions:

Our study highlights challenges experienced by yCRC patients across diagnosis, during treatment, and after treatment, notably misdiagnosis and need for access to information and support. Our study raises awareness of yCRC and experiences of individuals impacted by this disease.
Influence of psychosocial distress on traumatic stress symptoms among oncology patients in clinical trials
Authors: Cunningham Schuyler C. , Wakim Paul , Hendricks Jennifer , Cassidy Qulnn , Telgen Erin , BrintzenhofeSzoc Karlynn
Published: November 2020

Background:

This study explored the relationships between distress, number of lifetime traumas, and cancer-related traumatic stress (TSS) in people with cancer. This was done to inquire about TSS and to inform mental health recommendations for survivors of cancer.

Methods:

This study was guided by the Transactional Model of Stress and Coping. It utilized a cross-sectional survey design and a convenience sample. Participants were enrolled in a clinical trial for leukemia, lymphoma, mesothelioma, or prostate cancer. Data were collected one time using standardized measures and from participants’ electronic medical records.

Results:

Key findings of the bivariate analysis was that the level of distress and TSS had a statistically significant positive relationship (F 
= 50.99, P 
< .0001) and the number of traumatic events across the lifespan and TSS also had a statistically significant positive relationship (F = 9.53, P = .0033). The multivariable regression analysis indicated that 1-point increase on the Brief Symptoms Inventory (BSI-18) was associated with a 0.67 points increase in the PCL-5 score (95% confidence interval: 0.47–0.87, P < .0001, effect size = .39).

Conclusions:

Findings suggest that distress and TSS may be more related and present in this population than previously thought. Given the occurrence of TSS in this population, the data also suggest screening for TSS. This may be done more efficiently by using the BSI-18 to screen for distress, given that these findings show a relationship between BSI-18 scores and TSS symptomatology. In this way, providers may be able to identify, treat, and/or refer out for trauma informed mental health care thereby contributing to high-value, human-centered cancer care delivery.