bluuebunny/crossref_metadata_2025 huggingface dataset:
Multimodal Rehabilitation Following Gliosarcoma Resection: A Case Report
Authors: van Rij Stephen , Andrews A. Williams , Freund Jane , Bailey Stephen
Published: December 2020

Background and Purpose:

Gliosarcoma is a highly malignant brain cancer with an exceptionally poor medical prognosis. Despite poor prognostic indicators, rehabilitation may improve quality of life and restore independence. Little research is available to guide physical rehabilitation in this population. Medical and rehabilitation prognoses are interdependent, yet distinct in terms of objective and elements of consideration.

Case Description:

The patient was a female in her 70s who was diagnosed with a grade IV gliosarcoma of the left frontoparietal region. The tumor was surgically resected and severe postoperative complications resulted. Following medical stabilization, she spent 2 weeks in inpatient rehabilitation, followed by 4 months of hospice care. She was discharged to skilled nursing for rehabilitation including physical, occupational, and speech-language therapy.

Interventions:

Multimodal rehabilitation included functional tasks, neuromotor, resistance, and gait training over 6 weeks to maximize motor function and independence.

Outcomes:

The minimal detectable change was met or exceeded for fast gait speed, Berg Balance Scale, Timed Up and Go test, and Dynamic Gait Index. The minimal clinically important difference was exceeded for comfortable gait speed, Six-Minute Walk Test, and grip strength dynamometry. She was discharged to an assisted living facility.

Discussion:

Little research is available to guide intervention parameters for those with highly malignant gliomas receiving palliative care. Despite an exceptionally poor medical prognosis, skilled rehabilitation improved independence in an individual following gliosarcoma resection and should be considered for similar patients.
Physical Mobility and Balance Performance Differs in Older Cancer Survivors With Impaired Executive Function
Authors: Blackwood Jennifer , Rybicki Kateri
Published: December 2020

Background and Purpose:

Executive function (EF) is associated with falls and impaired gait in older adults. Performance on a measure of EF, the Trail Making Test Part B (TMT-B), may be able to differentiate between physical mobility and balance in older cancer survivors. The purpose of this study was to describe the demographic, disease-associated, and mobility differences in 2 groups of older cancer survivors based on the ability to complete TMT-B.

Methods:

Physical mobility and cognition was assessed in 50 older (aged 65+ years) cancer survivors. Group assignment was by TMT-B completion status (completers/noncompleters). Between-groups comparisons were performed on measures of physical mobility, balance, gait, and self-efficacy using nonparametric statistics.

Results:

Sixteen (32%) older cancer survivors were unable to complete TMT-B. Significant differences were found (P < .05) on all Timed Up and Go (TUG) measures in noncompleters versus completers: TUG (12.10 seconds vs 9.28 seconds), TUG-manual (12.81 seconds vs 10.88 seconds), TUG-cognitive (14.35 seconds vs 10.98 seconds). Noncompleters had significantly worse (P < .05) scores on the Short Physical Performance Battery, Fullerton Advanced Balance Scale, 30-second timed chair rise, balance confidence, falls self-efficacy, and all gait speed (usual, fast, dual-task) measures.

Discussion:

Older cancer survivors unable to complete TMT-B had worse performance in mobility, balance, strength, and dual-task activities that involve the increased demand of cognitive function. Executive function should be screened as a part of the falls risk management in older cancer survivors.

Conclusion:

Physical mobility, balance, and function are significantly more impaired in older cancers survivors who are unable to complete the TMT-B cognitive measure.
Position-related Change of Pelvic Incidence Depends on the Nonfused Sacroiliac Joint in Patients with Degenerative Spinal Diseases
Authors: Bao Hongda , Zhang Yuancheng , Shu Shibin , Zhang Tianyuan , Gu Qi , Jing Wenting , Liu Zhen , Sun Xu , Qiu Yong , Zhu Zezhang
Published: December 2020

Study Design.

A retrospective cross-sectional study.

Objective.

This study aims to determine whether the sacroiliac (SI) joint motion correlated to pelvic incidence (PI) change from standing to supine position in patients with degenerative spinal diseases.

Summary of Background Data.

PI was found an unstable parameter after adolescence as the fixed nature of PI was challenged by several studies. The SI joint has been shown to have some motion, age-related degenerative changes of cartilage and SI ligaments contribute to SI joint instability.

Methods.

The study contains both specimen study and radiographic study. One human specimen was acquired, on which PI was measured with different sacrum-ilium positions. In radiographic study, patients with old thoracolumbar fracture, lumbar disc herniation, stenosis, and spondylolisthesis were included. Ankylosing spondylitis (AS) patients were also included as control group. PI was measured on standing x-rays and scanogram of computed tomography images in supine position.

Results.

Specimen study result revealed that SI motion would lead to the change of PI with fixed pelvic thickness. In radiographic study, 101 patients with different etiology and 30 AS patients were included. After stratifying into different age groups, standing PI was significantly larger than supine PI in each age groups (P = 0.002, <0.001, and <0.001, respectively). In patients with degenerative diseases, PI was significantly larger on standing position than that on supine position. ΔPI showed no significant difference across etiologies. However, in AS patients, standing PI and supine PI revealed no significant difference (P = 0.528).

Conclusion.

Mobile SI joint may be the cause of increased PI in the aging spine. The dynamic change of PI is etiology-independent if the SI joint was not fused. Older patients have greater position-related change of PI.

Level of Evidence: 4
Coagulation, Vascular Morphology, and Vasculogenesis in Spinal Ligament Ossification Model Mice
Authors: Ichikawa Nana , Kumagai Gentaro , Wada Kanichiro , Kudo Hitoshi , Tanaka Sunao , Asari Toru , Liu Xizhe , Sasaki Ayako , Furukawa Ken-Ichi , Ishibashi Yasuyuki
Published: December 2020

Study Design.

In vivo studies of the vascular system in ossification of the posterior longitudinal ligament (OPLL) model mice.

Objective.

The aim of this study was to investigate blood coagulability, vascular morphology, and vasculogenesis capability, known as venous thromboembolism (VTE) risk factors in the ossification model, tiptoe walking (ttw) mice.

Summary of Background Data.

Patients with OPLL are more likely to develop VTE after spinal cord injury. Capillary mesh invasion of spinal ligaments precedes spinal ligament ossification in ttw mice. Investigation on vascular systems of ttw mice may contribute to clarifying its pathology.

Methods.

Coagulability of blood samples from ttw and C57BL/6 (WT) mice were evaluated at 8, 16, and 24 weeks of age. Vascular morphology was assessed from a Hematoxylin-Eosin stained section by measuring vessel area. A tube formation assay was performed with endothelial cells isolated from the aorta to assess vasculogenesis.

Results.

Prothrombin time was significantly shorter in ttw mice than in WT at 8 and 16 weeks. Fibrinogen had a greater increase in ttw mice than in WT at 16 weeks. The vascular area and vascular wall area were significantly smaller in ttw mice than in WT at all timepoints. The ratio of vascular wall area to vascular area was significantly smaller in ttw mice than in WT at 24 weeks. The endothelial cells from ttw mice formed significantly higher numbers of total branching points than WT cells.

Conclusion.

Ossification model mice had impaired blood coagulation and vascular morphology and high capacity for vasculogenesis. With regard to the pathogenesis of VTE, ttw mice harbor an environment that promotes the development of VTE.

Level of Evidence: N/A
Does the ACS NSQIP Surgical Risk Calculator Accurately Predict Complications Rates After Anterior Lumbar Interbody Fusion Procedures?
Authors: Narain Ankur S. , Kitto Alexander Z. , Braun Benjamin , Poorman Matthew J. , Curtin Patrick , Slavin Justin , Whalen Giles , DiPaola Christian P. , Connolly Patrick J. , Stauff Michael P.
Published: December 2020

Study Design.

Clinical case series.

Objective.

The aim of this study was to determine the effectiveness of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator in the prediction of complications after anterior lumbar interbody fusion (ALIF).

Summary of Background Data.

Identifying at-risk patients may aid in the prevention of complications after spine procedures. The ACS NSQIP surgical risk calculator was developed to predict 30-day postoperative complications for a variety of operative procedures.

Methods.

Medical records of patients undergoing ALIF at our institution from 2009 to 2019 were retrospectively reviewed. Demographic and comorbidity variables were entered into the ACS NSQIP surgical risk calculator to generate percentage predictions for complication incidence within 30 days postoperatively. The observed incidences of these complications were also abstracted from the medical record. The predictive ability of the ACS NSQIP surgical risk calculator was assessed in comparison to the observed incidence of complications using area under the curve (AUC) analyses.

Results.

Two hundred fifty-three (253) patients were analyzed. The ACS NSQIP surgical risk calculator was a fair predictor of discharge to non-home facility (AUC 0.71) and surgical site infection (AUC 0.70). The ACS NSQIP surgical risk calculator was a good predictor of acute kidney injury/progressive renal insufficiency (AUC 0.81). The ACS NSQIP surgical risk calculator was not an adequate predictive tool for any other category, including: pneumonia, urinary tract infections, venous thromboembolism, readmission, reoperations, and aggregate complications (AUC < 0.70).

Conclusion.

The ACS NSQIP surgical risk calculator is an adequate predictive tool for a subset of complications after ALIF including acute kidney injury/progressive renal insufficiency, surgical site infections, and discharge to non-home facilities. However, it is a poor predictor for all other complication groups. The reliability of the ACS NSQIP surgical risk calculator is limited, and further identification of models for risk stratification is necessary for patients undergoing ALIF.

Level of Evidence: 3
Sepsis-Associated Mortality, Resource Use, and Healthcare Costs: A Propensity-Matched Cohort Study*
Authors: Farrah Kelly , McIntyre Lauralyn , Doig Christopher J. , Talarico Robert , Taljaard Monica , Krahn Murray , Fergusson Dean , Forster Alan J. , Coyle Doug , Thavorn Kednapa
Published: December 2020

Objectives:

To examine long-term mortality, resource utilization, and healthcare costs in sepsis patients compared to hospitalized nonsepsis controls.

Design:

Propensity-matched population-based cohort study using administrative data.

Setting:

Ontario, Canada.

PATIENTS:

We identified a cohort of adults (≥ 18) admitted to hospitals in Ontario between April 1, 2012, and March 31, 2016, with follow-up to March 31, 2017. Sepsis patients were flagged using a validated International Classification of Diseases, 10th Revision-coded algorithm (Sepsis-2 definition), including cases with organ dysfunction (severe sepsis) and without (nonsevere). Remaining hospitalized patients were potential controls. Cases and controls were matched 1:1 on propensity score, age, sex, admission type, and admission date.

INTERVENTIONS:

None.

Measurements and Main Results:

Differences in mortality, rehospitalization, hospital length of stay, and healthcare costs were estimated, adjusting for remaining confounders using Cox regression and generalized estimating equations. Of 270,669 sepsis cases, 196,922 (73%) were successfully matched: 64,204 had severe and 132,718 nonsevere sepsis (infection without organ dysfunction). Over follow-up (median 2.0 yr), severe sepsis patients had higher mortality rates than controls (hazard ratio, 1.66; 95% CI, 1.63–1.68). Both severe and nonsevere sepsis patients had higher rehospitalization rates than controls (hazard ratio, 1.53; 95% CI, 1.50–1.55 and hazard ratio, 1.41; 95% CI, 1.40–1.43, respectively). Incremental costs (Canadian dollar 2018) in sepsis cases versus controls at 1-year were: $29,238 (95% CI, $28,568–$29,913) for severe and $9,475 (95% CI, $9,150–$9,727) for nonsevere sepsis.

Conclusions:

Severe sepsis was associated with substantially higher long-term risk of death, rehospitalization, and healthcare costs, highlighting the need for effective postdischarge care for sepsis survivors.
BAP1 deletion abrogates growth and metastasis of murine cutaneous melanoma
Authors: Luo Xin , Xu Yuyan , Li Yilei , Zhang Guiming , Huang Sisi , Liu Xiaolian , Ren Zhonglu , Liu Shuwen , Yu Le
Published: December 2020

Although germline mutations in BRCA-associated protein-1 (BAP1) predispose to cutaneous melanoma (CM), BAP1 is rarely mutated in primary CM outside the familial context. The role of BAP1 in the pathogenesis of CM remains obscure. Here, we discovered an unexpected role of BAP1 in suppressing CM growth and metastasis. BAP1 deletion by CRISPR-Cas9 system severely compromises colony-forming capability of murine CM cell line B16-F10 and human CM cell lines, SK-MEL-28 and A375. Furthermore, BAP1 loss abrogates tumor growth and lung metastasis in murine syngeneic tumor models. Deletion of BAP1 in B16-F10 cells leads to preferential downregulation of genes accompanied with increased H2A ubiquitination at lysine 119. Transcriptomic characterization of BAP1 deletion reveals multiple deregulated cellular functions including extracellular matrix-receptor interaction and MAPK signaling pathway which may contribute to BAP1’s effect on metastasis and proliferation. Our findings indicate that BAP1 could be a potential therapeutic target for CM.
Sebaceous Carcinoma of the Eyelid: A Systematic Review and Meta-Analysis
Authors: Desiato Vincent M. , Byun Young Jae , Nguyen Shaun A. , Thiers Bruce H. , Day Terry A.
Published: December 2020

BACKGROUND

Sebaceous carcinoma (SC) of the eyelid is a rare, aggressive malignancy associated with high rates of recurrence, metastasis, and tumor-related mortality.

OBJECTIVE

Provide a collective analysis of clinical presentations, management techniques, and outcomes, and compare outcomes of common treatment methods.

METHODS AND MATERIALS

Observational studies reporting management and outcomes of SC of the eyelid were included. Patient and clinical data were extracted, and meta-analysis of proportions was performed.

RESULTS

One thousand three hundred thirty-three subjects were included with a mean age of 65.2 years and 803 (60.2%) women. Of 647 initial diagnoses reported, 277 (42.8%) were correct, and the mean diagnostic delay was 14.7 months (range 8.5–34.8). The tumor location was reported in 1,246 subjects and involved the upper eyelid in 780 (62.6%), lower eyelid in 409 (32.8%), and 57 (4.8%) involved both. Overall rates of recurrence, metastasis, and tumor-related mortality were 15.9%, 12.1%, and 6.2%, respectively. There were no statistically significant differences in wide local excision (WLE) versus Mohs micrographic surgery (MMS) outcomes.

CONCLUSION

Sebaceous carcinoma of the eyelid is more common in women, on the upper eyelid, and is frequently misdiagnosed initially. Rate of recurrence, metastasis, and tumor-related mortality were similar in subjects managed with WLE versus MMS.
Prevalence, Clinical Factors, and Outcomes Associated With Myocardial Infarction With Nonobstructive Coronary Artery
Authors: Schmitz Katie , Groth Nicole , Mullvain Richard , Renier Colleen , Oluleye Oludamilola , Benziger Catherine
Published: December 2020

Background:

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an underrecognized clinical problem in patients presenting with acute coronary syndrome. Various clinical disorders lead to MINOCA thus making treatment and diagnosis a challenge. We aimed to compare the clinical factors and outcomes of patients with MINOCA versus obstructive disease [myocardial infarction due to coronary artery disease (MI-CAD)] in a largely rural health system.

Methods:

Between May 1, 2009 and June 24, 2019, all consecutive ST-segment elevation myocardial infarction patients at Essentia Health were prospectively examined. We categorized patients into MI-CAD (obstructive plaque ≥ 50% with revascularization) or MINOCA (obstructive plaque < 50% with exclusion of other alternative cause). Outcomes included 30-day and 1-year all-cause mortality, 30-day all-cause readmission and 30-day cardiac readmission.

Results:

There were 2170 patients included in the study; 2097 (96.6 %) had MI-CAD and 73 (3.4%) met the definition of MINOCA. Within the MINOCA group, the 3 most common presentations were supply–demand mismatch (28.8%), spontaneous coronary artery dissection (9.6%), and other etiology (60.3%). Only 10 (13 %) MINOCA patients had cardiac magnetic resonance imaging studies obtained within 6 months. MINOCA patients were younger 61.6 versus 63.4 years with higher left ventricular function 51.6% versus 50.4% with less likelihood of prior myocardial infarction 4.1% versus 15.5% or congestive heart failure 2.7% versus 6.3% (P < 0.05). Compared with MI-CAD patients, MINOCA patients had similar 30-day mortality (7.1% vs. 8.2%; P = 0.70), 1-year mortality (10.4% vs. 8.2 %; P = 0.55), and 30-day cardiac readmission (8.7% vs. 9.6%; P = 0.29). MINOCA patients were less likely to be discharged on aspirin, betablockers, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers, or statins (P < 0.05).

Conclusion:

Though there was no difference in readmission and mortality between MINOCA and MI-CAD; use of secondary prevention medications and cardiac rehabilitation referral was low in MINOCA patients. Prospective studies will be relevant to assess effective medical therapy to improve outcomes in MINOCA patients.
Atrial Fibrillation Patients on Warfarin and Their Transition to Direct Oral Anticoagulants
Authors: Collins Peter , Lewin Andrea , Vincze Irving Nicole , Sylvester Katelyn , Fanikos John , Goldhaber Samuel Z. , Connors Jean M.
Published: December 2020

Background:

The standard of care for stroke prevention in nonvalvular atrial fibrillation (AF) is the use of direct oral anticoagulants (DOACs). However, many patients established on warfarin therapy have not been considered for a transition to a DOAC.

Objectives:

Assess the AF patient population of Brigham and Women’s Hospital (BWH) Anticoagulation Management Service (AMS) currently being treated with warfarin, transition eligible patients to a DOAC, and identify barriers to the transitional process.

Methods:

Patient characteristics were analyzed to describe the overall AF population and a systematic process was used to determine clinical candidacy for a transition from warfarin to a DOAC. After being deemed eligible by both the referring physician and the AMS pharmacist, each patient was contacted and offered the opportunity for DOAC transition. Endpoints included number of successful transitions and commonly encountered barriers.

Results:

Out of the 1407 total AF patients on warfarin managed by BWH AMS, there were 787 patients identified as candidates for DOAC transition and a successful transition was completed for 250 (31.8%) of them. Barriers to transition included patient preference for warfarin (n = 247, 31.4%), referring physician preference for warfarin (n = 112, 14.2%), cost (n = 88, 11.2%), AMS pharmacist preference for warfarin (n = 70, 8.9%), and previous DOAC intolerance (n = 20, 2.5%).

Conclusions:

Every institution or provider network that manages AF patients on warfarin should assess their population on a regular basis to identify candidates for DOAC therapy. Our initiative outlines a process for identifying and transitioning DOAC-eligible AF patients established on warfarin therapy and describes the most commonly encountered barriers to DOAC therapy.
The Challenge of Managing Bilateral Acute Angle-closure Glaucoma in the Presence of Active SARS-CoV-2 Infection
Authors: Krawitz Brian D. , Sirinek Portia , Doobin David , Nanda Tavish , Ghiassi Maryam , Horowitz Jason D. , Liebmann Jeffrey M. , De Moraes Carlos G.
Published: December 2020

Purpose:

To report a case of bilateral acute angle-closure glaucoma associated with hyponatremia in the setting of chlorthalidone use and SARS-CoV-2 infection, and to demonstrate the challenges of managing this patient given her infectious status.

Methods:

This was a case report.

Case:

A 65-year-old woman taking chlorthalidone for hypertension presented to the emergency room with headache, pain, and blurry vision in both eyes and was found to be in bilateral acute angle closure. On laboratory investigation, she was severely hyponatremic and also tested positive for SARS-CoV-2. B-scan ultrasound demonstrated an apparent supraciliary effusion in the right eye. Following stabilization of her intraocular pressures with medical management, she ultimately underwent cataract extraction with iridectomies and goniosynechiolysis in both eyes.

Conclusions:

We report a rare case of bilateral acute angle-closure glaucoma associated with hyponatremia. Chlorthalidone use and perhaps SARS-CoV-2 infection may have contributed to this electrolyte abnormality and unique clinical presentation. In addition, we discuss the challenges of managing this complex patient with active SARS-CoV-2 infection during the pandemic.
Ciguatera poisoning: the role of high-voltage-activated and store-operated calcium channels in ciguatoxin-induced sensory effects
Authors: L’Herondelle Killian , Misery Laurent , Le Gall-Ianotto Christelle , Philippe Reginald , Talagas Matthieu , Mignen Olivier , Lewis Richard J. , Le Garrec Raphaele
Published: December 2020

Introduction:

Ciguatera fish poisoning (CFP), the most common seafood poisoning worldwide, is caused by the consumption of seafood contaminated with ciguatoxins (CTXs). Pruritus is one of the most distressing symptoms, associated with other cutaneous sensory disorders, including paresthesia and cold dysesthesia. No specific treatment exists. CTXs are known to primarily activate voltage-gated sodium channels, but the downstream molecular events that lead to sensory disturbances remain poorly defined. Peptidergic sensory neurons were recently identified as major players in CFP sensory disturbances.

Methods:

In this study, we examined the role of molecular actors in 2 effects induced by Pacific CTX-2 (P-CTX-2): the increase in cytosolic calcium levels in rat primary sensory neurons; and the release of the neuropeptide substance P (SP) in sensory neurons co-cultured with keratinocytes.

Results:

Our results (i) rule out the involvement of the Na+/Ca2+ exchanger (NCX) and the transient receptor potential channels transient receptor potential ankyrin 1 and and transient receptor potential vanilloid 1; (ii) show that N-type voltage-gated calcium (Cav) channels contribute to the initiation of the calcium signal elicited by P-CTX-2 in rat sensory neurons, while N-type and L-type Cav channels play equal parts in the SP release in the co-culture; and (iii) identify store-operated calcium entry supported by Orai calcium release-activated calcium modulator 1 (ORAI1) as a critical effector of the late phase of the calcium signal and the subsequent SP release elicited by P-CTX-2.

Discussion:

Our in vitro findings indicate that Cav and ORAI1 channels may be promising pharmacological targets for specifically relieving the sensory effects of CTXs.
Comparison of an upgraded optical biometer with 2 validated optical biometers
Authors: Kanclerz Piotr , Hoffer Kenneth J. , Przewłócka Katarzyna , Savini Giacomo
Published: December 2020

Purpose:

The Revo NX is a new optical biometer, based on spectral-domain optical coherence tomography and able to obtain high-definition scans of both the anterior and posterior segment of the eye. A previous study found that its measurements of axial length (AL) were not interchangeable with those provided by a validated optical biometer; so, the manufacturer updated the instrument to improve agreement of AL values. This study aimed to prospectively compare the measurements by the updated Revo NX (version 9.5.0, biometry module) with those by 2 validated devices, the IOLMaster 700 and Lenstar LS-900.

Setting:

Optopol Technologies, Zawiercie, Poland.

Design:

Prospective evaluation of diagnostic test.

Methods:

Comparison between the devices was performed using repeated measures analysis of variance (ANOVA) with Bonferroni posttest, correlation coefficients, and the Bland-Altman method.

Results:

The investigation evaluated the results of 63 patients. For AL, anterior chamber depth (ACD), and lens thickness (LT), the differences were not clinically significant because they were less than 0.01 mm. Repeated measures ANOVA, however, detected a statistically significant difference for AL (P < .0001) and central corneal thickness (P < .0001) but not for ACD (P = .0630) or LT (P = .2667). The results obtained with all 3 biometers manifested a high level of agreement in the Bland-Altman analysis and very strong correlation.

Conclusions:

The measurements by the updated Revo NX had high agreement with the other optical biometers; a clear improvement was detected than the previous analysis between the original Revo NX (version 8.0.3) and the Lenstar LS-900.
Comparisons of intraocular lens power calculation methods for eyes with previous myopic laser refractive surgery: Bayesian network meta-analysis
Authors: Wei Ling , Meng Jiaqi , Qi Jiao , Lu Yi , Zhu Xiangjia
Published: December 2020

Purpose:

To compare the accuracy of the methods for calculation of intraocular lens (IOL) power in eyes with previous myopic laser refractive surgery.

Setting:

EENT Hospital of Fudan University, Shanghai, China.

Design:

Network meta-analysis.

Methods:

A literature search of MEDLINE and Cochrane Library from January 2000 to July 2019 was conducted for studies that evaluated methods of calculating IOL power in eyes with previous myopic laser refractive surgery. Outcomes measurements were the percentages of prediction error within ±0.50 diopters (D) and ±1.00 D of the target refraction (% ±0.50 D and % ±1.00 D). Traditional and network meta-analysis were conducted.

Results:

Nineteen prospective or retrospective clinical studies, including 1217 eyes and 13 calculation methods, were identified. A traditional meta-analysis showed that compared with the widely used Haigis-L method, the Barrett True-K formula, optical coherence tomography (OCT), and Masket methods showed significantly higher % ±0.50 D, whereas no difference was found in the % ±1.00 D. A network meta-analysis revealed that compared with the Haigis-L method, the OCT, Barrett True-K formula, and optiwave refractive analysis (ORA) methods performed better on the % ±0.50 D, whereas the Barrett True-K formula and ORA methods performed better on the % ±1.00 D. Based on the performances of both outcomes, the Barrett True-K formula, OCT, and ORA methods showed highest probability to rank the top 3 among the 13 methods.

Conclusions:

The Barrett True-K formula, OCT, and ORA methods seemed to offer greater accuracy than others in calculating the IOL power for postrefractive surgery eyes.
A Systematic Review on the Efficacy of Intravenous Racemic Ketamine for Bipolar Depression
Authors: Joseph Boney , Parsaik Ajay K. , Ahmed Ahmed T. , Erwin Patricia J. , Singh Balwinder
Published: December 2020

Background

Ketamine, a glutamate N-methyl-d-aspartate receptor antagonist, has shown rapid antidepressant effects in treatment-resistant depression. We conducted a systematic review of studies evaluating the efficacy of intravenous ketamine augmentation in treatment-resistant depression patients with bipolar disorder.

Methods

Major databases were searched for open-label and randomized controlled trials (RCT). Two independent reviewers screened and selected the studies that met the inclusion criteria. Studies were selected following the standard Cochrane methodology, and the findings are reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Methodological quality of the included studies was assessed using standardized measures.

Results

A total of 1442 articles were screened. Five studies were included in the systematic review (3 RCTs and 2 open-label studies) enrolling 110 subjects (mean age, 45.54 ± 12.65 years; 68.18% female). All the RCTs and open-label studies showed improvement in depressions symptoms after receiving a single infusion of ketamine. Included studies also suggested improvement in suicidal ideation and anhedonia after ketamine infusion. Dissociation and transient increase in blood pressure were the most common reported adverse effects with ketamine. Ketamine infusions did not increase mania symptoms.

Conclusions

Limited data show efficacy and feasibility of intravenous racemic ketamine in treatment-resistant bipolar depression. Further studies with larger sample size are required to strengthen the evidence.
Finding Early Improvement Threshold to Predict Response After 8 Weeks of Treatment Using Risperidone in First-Episode Psychosis
Authors: Subeesh Viswam , Maheswari Eswaran , Singh Hemendra , Neha Reddy , Mazhar Faizan
Published: December 2020

Purpose/Background

The study aims to assess whether the early response can predict the outcome at the endpoint for the treatment of first-episode psychosis with risperidone and identify the relationship between initial symptom reduction and late response.

Methods/Procedures

A prospective observational study with 4 points follow-up (weeks 2, 3, 4, and 8) was conducted in 48 adult first-episode psychosis patients. Symptoms were quantified by the Positive and Negative Syndrome Scale (PANSS) score. The initial recommended dose was 2 mg of risperidone once daily before sleep. The PANSS score on day 1 (before initiation of drug therapy) was considered as the baseline score. Treatment responses were considered as a reduction of more than 20%, 25%, 30% and 50% from the baseline score on first, second, third, and final follow-up, respectively. Receiver operating characteristic curves were generated for predicting response at the endpoint.

Findings/Results

Thirty-one (65%) patients achieved more than 50% reduction (responders) in PANSS score. The mean total PANSS score of the study population after 8 weeks of therapy was found to be 49.77 (95% confidence interval, 46.10–53.43). The mean percentage reduction in PANSS score after 8 weeks of therapy was found to be 52.92% (95% confidence interval, 48.83–57.01). Week 2 response can be taken as the early response (area under the curve = 81.9, P < 0.001). However, the more accurate prediction was possible with week 4 response (area under the curve = 88.7%, P < 0.001).

Implications/Conclusions

Our study suggests that patients with an early response at week 2 are likely to achieve positive response after 8 weeks.
Cost of the Illness of Treatment-Resistant Schizophrenia
Authors: Verma Meha , Grover Sandeep , Chakrabarti Subho
Published: December 2020

Purpose/Background

This study aimed to evaluate and compare the cost of illness in patients with treatment-resistant schizophrenia (TRS) during 3 months before starting clozapine and for the initial 3 months of treatment with clozapine.

Methods/Procedures

Fifty-two patients with TRS were evaluated for the cost of illness (direct, indirect, and provider cost) by using a structured questionnaire for the period of 3 months before starting clozapine and then at the end of the 3 months of clozapine therapy.

Findings/Results

Total treatment cost for the period of 3 months before starting clozapine was Indian rupees (INR) 40,372 (560.72 US dollars), and the total treatment cost for the first 3 months of clozapine therapy was INR 40,553 (563.23 US dollars). At both the assessments, indirect cost formed the main bulk of the total cost, with no significant difference in the indirect cost. The total direct treatment cost reduced from INR 13,931.6 (193.49 US dollars) to INR 8756 (121.61 US dollars), and the difference between the 2 assessments was statistically significant, with an advantage for clozapine. Overall, after starting clozapine, the total direct cost reduced from 34.5% to 21.6%, and the total indirect cost reduced from 54.3% to 40.2%. After starting clozapine, total provider cost increased from 11.2% to 38.2% of the totalcost.

Implications/Conclusions

Treatment with clozapine is not associated with a significant increase in the overall treatment cost, in the short term. However, there is a significant reduction in direct treatment costs.
Clinical Utility of Intraoperative Electrocochleography (ECochG) During Cochlear Implantation: A Systematic Review and Quantitative Analysis
Authors: Yin Linda X. , Barnes Jason H. , Saoji Aniket A. , Carlson Matthew L.
Published: December 2020

Objective:

To evaluate the utility of intraoperative electrocochleography (ECochG) as a predictive tool for preservation of residual acoustic hearing after cochlear implantation.

Data Sources:

A systematic review employing a multi-database search strategy (Ovid MEDLINE, Embase, EBM Cochrane, and Scopus) was conducted from inception to August 1, 2019. English language studies in humans were included.

Study Selection:

All articles were independently reviewed by two authors according to Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies without intraoperative ECochG obtained during cochlear implantation were excluded.

Data Extraction:

Extracted variables included number of patients, ECochG recording technique, success rate of obtaining ECochG potentials, intraoperative changes in ECochG signal, and postoperative hearing preservation outcomes.

Data Synthesis:

Among 537 eligible articles, 22 met inclusion criteria encompassing 498 unique patients. Ten studies featured extracochlear measurements, eight featured intracochlear measurements, and four featured both. Extracochlear ECochG had an average (SD) recording success rate of 94.9% (12.7%) while intracochlear ECochG had an average (SD) recording success rate of 91.8% (9.8%). One hundred forty five unique patients from six studies had complete intraoperative ECochG data with postoperative behavioral audiometry. After accounting for study-specific definitions of ECochG signal disturbance, worsening changes in intraoperative ECochG signal predicted postoperative hearing loss with limited sensitivity and specificity and notable heterogeneity across studies.

Conclusions:

Intraoperative ECochG recordings can be obtained in over 90% of patients, but accuracy in predicting postoperative hearing loss remains limited. Standardization of intraoperative ECochG monitoring technique and data interpretation are necessary to more robustly investigate outcomes and refine technique.
The Knowledge About Celiac Disease Among Healthcare Professionals and Patients in Central Europe
Authors: Riznik Petra , De Leo Luigina , Dolinsek Jasmina , Gyimesi Judit , Klemenak Martina , Koletzko Berthold , Koletzko Sibylle , Koltai Tunde , Korponay‐Szabó Ilma Rita , Krencnik Tomaz , Milinovic Marina , Not Tarcisio , Palcevski Goran , Sblattero Daniele , Werkstetter Katharina Julia , Dolinsek Jernej
Published: December 2020

Objectives:

Celiac disease (CD) remains undiagnosed for a long time in many adult and pediatric patients. We assessed the knowledge about CD among healthcare professionals (HCPs) and CD patients in Central Europe (CE).

Methods:

HCPs and CD patients from 5 CE countries were asked to complete the web‐based questionnaire about CD. The questions were divided into subsections on epidemiology, clinical presentation, diagnostics, treatment, and follow‐up. Achieved scores of different specialists managing patients with CD were compared and regional differences in patients’ knowledge were analyzed.

Results:

Questionnaire was completed by 1381 HCPs and 2262 CD patients or their caregivers from Croatia, Hungary, Germany, Italy, and Slovenia. Mean score achieved by HCPs was 50.9%, and by CD patients 56.4%. Pediatric gastroenterologists scored the highest (69.4%; P < 0.001). There were significant differences in knowledge of patients from different CE regions with German participants scoring the highest (58.3%). Members of CD societies scored higher compared with nonmembers (mean score 58% vs 53.2%; P < 0.001) and patients diagnosed less than 5 years ago scored higher compared with those diagnosed more than 10 years ago (mean score 57.3% vs 54.6%; P < 0.001).

Conclusions:

The knowledge about CD among HCPs and CD patients is not satisfactory. Further awareness‐raising and learning activities are needed to improve HCPs‘ knowledge and to minimize the number of unrecognized patients and unnecessary diagnostic delays. Patients should be better informed about their disease to reach higher compliance with the gluten‐free diet.
Early Motor Repertoire in Infants With Biliary Atresia
Authors: Rodijk Lyan H. , Bos Arend F. , Verkade Henkjan J. , de Kleine Ruben H. , Hulscher Jan B.F. , Bruggink Janneke L.M.
Published: December 2020

Objectives:

The aim of the study was to assess the neurological status in infants with biliary atresia (BA) at time of diagnosis, using Prechtl's validated General Movement Assessment.

Methods:

Infants diagnosed with BA were prospectively included in a nationwide cohort study. From birth to approximately 46 weeks of postmenstrual age (PMA), general movements (GMs) are defined as “writhing movements.” At 46 to 49 weeks PMA, “‘fidgety movements” emerge. The infant's early motor repertoire was recorded on video before Kasai portoenterostomy. We scored GM optimality scores (min–max 5–42) or motor optimality scores (MOS, min–max 5–28) as appropriate. We defined GM optimality scores <36 and MOS <26 as atypical, and compared the results with 2 reference groups of healthy peers.

Results:

We assessed GMs in 35 infants with BA (11/35 boys, gestational age 40 weeks [36–42], birth weight 3370 g [2015–4285]). At time of diagnosis (PMA 47 weeks [42–60]), 16 infants (46%) showed atypical GMs. The proportion of infants with atypical GMs was significantly higher in BA (46%) than in 2 reference groups of healthy infants (vs 10%, P < 0.001; vs 18%, P < 0.001). Total and direct bilirubin levels were 165 μmol/L (87–364) and 134 μmol/L (72–334), respectively, height z score was 0.05 (–2.90, 1.75), weight z score −0.52 ([−2.50, −0.20) and mean upper arm circumference z score −1.80 (−2.50, −0.20). We found no statistically significant relation between atypical GMs and clinical variables.

Conclusions:

Almost half of the infants with BA showed atypical GMs at time of diagnosis, suggesting neurological impairment. Close monitoring of these infants is warranted to determine their individual neurodevelopmental trajectories.
Evaluation of Nonalcoholic Fatty Liver Disease in Pediatric Patients With Inflammatory Bowel Disease
Authors: Cohen Mallory E. , Deepak Parakkal , Khanna Geetika , Samson Charles M.
Published: December 2020

Adult studies demonstrate the co‐existence of nonalcoholic fatty liver disease (NAFLD) and inflammatory bowel disease (IBD) without traditional risk factors. Data in children with IBD are lacking. Here, we sought to establish the prevalence of NAFLD in a single‐center pediatric IBD cohort, and identify potential risk factors. After institutional review board approval, we enrolled children with IBD who underwent routine abdominal magnetic resonance enterography. Proton density fat fraction (PDFF) was then estimated on magnetic resonance enterography. A total of 83 patients with IBD were identified and PDFF maps completed. Five (6%) were found to have PDFF >5%, meeting criteria for NAFLD. Compared to the patients with IBD without NAFLD, none of the evaluated risk factors including age, sex, diagnosis, time since diagnosis, medication, median alanine aminotransferase, and weight status were statistically significant. Our findings demonstrate the occult nature of NAFLD in pediatric IBD. The prevalence is not at variance with what is expected in general teenage populations.
Mycoplasma genitalium Infection in Young Women Without Urogenital Symptoms Presenting to a Community-Based Emergency Department in Birmingham, Alabama
Authors: Gragg Stephen D. , Gupta Kanupriya A. , Olson Kristin M. , Van Der Pol Barbara , Xiao Li , Waites Ken B. , Geisler William M.
Published: December 2020

We used the Food and Drug Administration–cleared Aptima Mycoplasma genitalium assay to evaluate for M. genitalium infection among young women without urogenital symptoms presenting to a community-based emergency department in Birmingham, Alabama, between August 2016 to August 2019 for evaluation of nongynecological concerns. M. genitalium was detected in 23 (14.8%) of 155 women.
Vaginal Bacteria and Risk of Incident and Persistent Infection With High-Risk Subtypes of Human Papillomavirus: A Cohort Study Among Kenyan Women
Authors: Carter Kayla A. , Srinivasan Sujatha , Fiedler Tina L. , Anzala Omu , Kimani Joshua , Mochache Vernon , Wallis Jacqueline M. , Fredricks David N. , McClelland R. Scott , Balkus Jennifer E.
Published: December 2020

Background

Bacterial vaginosis (BV) is associated with an increased risk of high-risk human papillomavirus (hrHPV), whereas Lactobacillus-dominated vaginal microbiotas are associated with reduced burden of hrHPV. Few epidemiologic studies have prospectively investigated the relationships between vaginal bacteria and hrHPV, particularly among women from countries in Africa.

Methods

We conducted a prospective cohort study nested within the Preventing Vaginal Infections trial to evaluate associations between vaginal bacteria and hrHPV incidence and persistence. Sexually active, HIV-seronegative women aged 18 to 45 years who had a vaginal infection at screening were eligible to enroll. Analyses were restricted to participants enrolled in Kenya and randomized to placebo. At enrollment and months 2, 4, 6, 8, 10, and 12, hrHPV testing, quantitative polymerase chain reaction (measuring taxon quantity per swab), and 16S rRNA gene amplicon sequencing of the vaginal microbiota were performed. Generalized estimating equations multinomial logistic regression models were fit to evaluate associations between vaginal bacteria and incident and persistent hrHPV.

Results

Eighty-four participants were included in this analysis. Higher concentrations of Lactobacillus crispatus were inversely associated with persistent hrHPV detection. Specifically, 1 tertile higher L. crispatus concentration was associated with 50% reduced odds of persistent hrHPV detection (odds ratio, 0.50; 95% confidence interval, 0.29–0.85).

Conclusions

This study is consistent with reports that vaginal L. crispatus is associated with reduced susceptibility to hrHPV persistence. Evidence from in vitro studies provides insight into potential mechanisms by which L. crispatus may mediate hrHPV risk. Future studies should further explore in vivo mechanisms that may drive this relationship and opportunities for intervention.
A Computed Tomographic Analysis of Spheno-Occipital Synchondrosis Ossification for Age Estimation in a Sample of Egyptians
Authors: Sobh Zahraa Khalifa , Mohamed Ahmed Samir
Published: December 2020

The aim of the present work was to create statistically quantified age estimation standards based on spheno-occipital synchondrosis (SOS) fusion state as visualized in computed tomography in Egyptians. The study included 208 Egyptians between the ages of 5 and 30 years (117 male and 90 female participants). Spheno-occipital synchondrosis was visualized in a midsagittal view in a neutral head position. Degree of ossification of SOS was assessed using a 4-stage system. Interobserver agreement and intraobserver agreement were almost perfect with Cohen κ values of 0.863 and 0.983, respectively. The mean ages of complete fusion (stage 3) were 20.36 ± 3.11 and 20.94 ± 4.06 years in male and female participants, respectively. Nonfusion (stage 0) was observed up to 15 and 13 years in male and female participants, respectively. Complete fusion occurred as early as 15 and 13 years in male and female participants, respectively. All subjects with nonfused SOS were minors (<18 years). A total of 87.9% of male participants and 85.3% of female participants with completely fused SOS were legally adults (≥18 years). Significant regression models were formulated to predict age from SOS fusion stage (adjusted R
2 = 0.779 for male participants and 0.780 for female participants). Regression models predicted that male and female participants 18 years or older with 96.30% and 95.59% accuracy, respectively.
Left Carotid Artery Thrombosis Due to Thromboangiitis Obliterans
Authors: Bourgeau Melanie E. , Key Phillip G. , Chou Jesse , Prahlow Joseph A.
Published: December 2020

Thromboangiitis obliterans (TAO, Buerger disease) is a segmental, non-atherosclerotic vasculitis that causes occlusion of the small and medium sized vessels of the distal extremities. In rare cases, it can affect vessels in the gastrointestinal, cerebrovascular, coronary, and renal systems. The etiology of thromboangiitis obliterans is unknown, but there is a strong association with smoking in the development and the progression of the disease. We present the case of a 42-year-old homeless female smoker, who was found dead outdoors. Although originally suspected to be a possible trauma-related death, autopsy revealed a thrombus in her left carotid artery, which caused an acute cerebral infarction. It was concluded that thromboangiitis obliterans, likely precipitated by smoking, was the cause of the thrombosis and subsequent death.
Postmortem Diagnosis of Clostridium Without Culture Confirmation
Authors: Jackson McKenzie , Kemp Walter L.
Published: December 2020

We report 3 individuals with clostridial sepsis, 2 culture-confirmed and 1 assumed based on historical information and autopsy findings. Case 1: a 46-year-old man with history of colon cancer status postcolectomy was found unresponsive and rapidly developed decompositional changes. At autopsy, within 1 day of his death, he had marked gaseous distention of the scrotum and palpable crepitance from the eyes to the feet, with bullae formation in the suprapubic region and left thigh. Postmortem culture of bullae fluid grew Clostridium septicum. Case 2: a 63-year-old woman with history of non-Hodgkin's lymphoma who was identified to have Clostridium perfringens by hospital cultures. Autopsy was performed the day after death. The skin had a generalized red-tan discoloration. The liver had large gas pockets in the parenchyma. Microscopic examination revealed bacterial rods. Other than diverticulosis and mild coronary artery atherosclerosis, no other disease process was identified. Case 3: a 34-year-old man was found dead in his apartment, which was 68°F, just under 1 day after having last been known alive. He was cooled before autopsy and autopsied less than 24 hours after being found. He had fixed anterior lividity, an abdomen that was distended by gas formation, and a scrotum that was distended by gas formation. There was no green discoloration of the abdomen. Glomerular capillaries contained bacterial rods with terminal spores. Because no other cause was identified, the cause of death was certified as probable clostridial sepsis.