bluuebunny/crossref_metadata_2025 huggingface dataset:
The Resting State Central Auditory Network: a Potential Marker of HIV-Related Central Nervous System Alterations
Authors: Zhan Yi , Yu Qiurong , Cai Dan-Chao , Ford James C. , Shi Xiudong , Fellows Abigail M. , Clavier Odile H. , Soli Sigfrid D. , Fan Mingxia , Lu Hongzhou , Zhang Zhiyong , Buckey Jay C. , Shi Yuxin
Published: January 2022

Objective:

HIV positive (HIV+) individuals with otherwise normal hearing ability show central auditory processing deficits as evidenced by worse performance in speech-in-noise perception compared with HIV negative (HIV−) controls. HIV infection and treatment are also associated with lower neurocognitive screening test scores, suggesting underlying central nervous system damage. To determine how central auditory processing deficits in HIV+ individuals relate to brain alterations in the cortex involved with auditory processing, we compared auditory network (AN) functional connectivity between HIV+ adults with or without speech-in-noise perception difficulties and age-matched HIV− controls using resting-state fMRI.

Design:

Based on the speech recognition threshold of the hearing-in-noise test, twenty-seven HIV+ individuals were divided into a group with speech-in-noise perception abnormalities (HIV+SPabnl, 38.2 ± 6.8 years; 11 males and 2 females) and one without (HIV+SPnl 34.4 ± 8.8 years; 14 males). An HIV− group with normal speech-in-noise perception (HIV−, 31.3 ± 5.2 years; 9 males and 3 females) was also enrolled. All of these younger and middle-aged adults had normal peripheral hearing determined by audiometry. Participants were studied using resting-state fMRI. Independent component analysis was applied to identify the AN. Group differences in the AN were identified using statistical parametric mapping.

Results:

Both HIV+ groups had increased functional connectivity (FC) in parts of the AN including the superior temporal gyrus, middle temporal gyrus, supramarginal gyrus, and Rolandic operculum compared to the HIV− group. Compared with the HIV+SPnl group, the HIV+SPabnl group showed greater FC in parts of the AN including the middle frontal and inferior frontal gyri.

Conclusions:

The classical auditory areas in the temporal lobe are affected by HIV regardless of speech perception ability. Increased temporal FC in HIV+ individuals might reflect functional compensation to achieve normal primary auditory perception. Furthermore, increased frontal FC in the HIV+SPabnl group compared with the HIV+SPnl group suggest that speech-in-noise perception difficulties in HIV-infected adults also affect areas involved in higher-level cognition, providing imaging evidence consistent with the hypothesis that HIV-related neurocognitive deficits can include central auditory processing deficits.
Polyvinyl Alcohol Hydrogel Hemiarthroplasty of the First Metatarsophalangeal Joint Augmented With 3D-printed Baseplate
Authors: Madi Naji S. , Chopra Aman , Parekh Selene G.
Published: January 2022

Hallux rigidus is the most common arthritic pathology of the foot and is a debilitating disease that causes pain, swelling, and reduced range of motion. Although arthrodesis is the gold standard treatment option, a soft hemiarthroplasty implant, the polyvinyl alcohol (PVA) hydrogel, has been designed to preserve motion in the first metatarsophalangeal joint and alleviate pain. Made from synthetic PVA and saline, the index noninferiority trial showed satisfactory clinical outcomes. However, this result was not reproducible by others with implant subsidence being a common concern. In this surgical technique, we describe a novel modified approach which involves PVA hemiarthroplasty of the first metatarsophalangeal joint, 3-dimensional-printed baseplate and Akin osteotomy to ultimately prevent likely implant failure.
Characteristics and Outcomes of Patients With Frailty Admitted to ICU With Coronavirus Disease 2019: An Individual Patient Data Meta-Analysis
Authors: Subramaniam Ashwin , Anstey Christopher , Curtis J. Randall , Ashwin Sushma , Ponnapa Reddy Mallikarjuna , Aliberti Márlon Juliano Romero , Avelino-Silva Thiago Junqueira , Welch Carly , Koduri Gouri , Prowle John R. , Wan Yize I. , Laurent Michaël R. , Marengoni Alessandra , Lim Jun Pei , Pilcher David , Shekar Kiran
Published: January 2022

OBJECTIVES:

Frailty is often used in clinical decision-making for patients with coronavirus disease 2019, yet studies have found a variable influence of frailty on outcomes in those admitted to the ICU. In this individual patient data meta-analysis, we evaluated the characteristics and outcomes across the range of frailty in patients admitted to ICU with coronavirus disease 2019.

DATA SOURCES:

We contacted the corresponding authors of 16 eligible studies published between December 1, 2019, and February 28, 2021, reporting on patients with confirmed coronavirus disease 2019 admitted to ICU with a documented Clinical Frailty Scale.

STUDY SELECTION:

Individual patient data were obtained from seven studies with documented Clinical Frailty Scale were included. We classified patients as nonfrail (Clinical Frailty Scale = 1–4) or frail (Clinical Frailty Scale = 5–8).

DATA EXTRACTION:

We collected patient demographics, Clinical Frailty Scale score, ICU organ supports, and clinically relevant outcomes (ICU and hospital mortality, ICU and hospital length of stays, and discharge destination). The primary outcome was hospital mortality.

DATA SYNTHESIS:

Of the 2,001 patients admitted to ICU, 388 (19.4%) were frail. Increasing age and Sequential Organ Failure Assessment score, Clinical Frailty Scale score greater than or equal to 4, use of mechanical ventilation, vasopressors, renal replacement therapy, and hyperlactatemia were risk factors for death in a multivariable analysis. Hospital mortality was higher in patients with frailty (65.2% vs 41.8%; p < 0.001), with adjusted mortality increasing with a rising Clinical Frailty Scale score beyond 3. Younger and nonfrail patients were more likely to receive mechanical ventilation. Patients with frailty spent less time on mechanical ventilation (median days [interquartile range], 9 [5–16] vs 11 d [6–18 d]; p = 0.012) and accounted for only 12.3% of total ICU bed days.

CONCLUSIONS:

Patients with frailty with coronavirus disease 2019 were commonly admitted to ICU and had greater hospital mortality but spent relatively fewer days in ICU when compared with nonfrail patients. Patients with frailty receiving mechanical ventilation were at greater risk of death than patients without frailty.
The Future of Uterus Transplantation: Cost, Regulations, and Outcomes
Authors: POLK HEATHER , JOHANNESSON LIZA , TESTA GIULIANO , WALL ANJI E.
Published: January 2022

Uterus transplantation (UTx) has evolved rapidly since technical success was first demonstrated, and is now practiced worldwide, using both living and deceased donors. As UTx transitions from an experimental to widely available standard clinical procedure, new challenges and questions are becoming more urgent. These include issues of cost and coverage, the establishment of guidelines and registries to ensure quality of care and monitor outcomes, regulatory oversight (including for the allocation organs from deceased donors), and the extent to which indications for UTx should be expanded.
Effects of high serum uric acid levels on oxidative stress levels and semen parameters in male infertile patients
Authors: Ma Jing , Han Ruiyu , Cui Tong , Yang Chaoju , Wang Shusong
Published: January 2022

This study is to investigate the effect of high serum uric acid (UA) level on oxidative stress and semen quality of male infertility patients.

A cohort of 654 male individuals aged between 20 and 45 years old were included in this study, and their semen and venous blood samples were collected. The serum UA, blood glucose, blood lipids, and hormone levels were determined by chemiluminescence method. The changes in inflammatory factors, oxidative stress, adipokines, and biochemical indices in seminal plasma were determined by ELISA. Organic acids in seminal plasma were detected with reversed-phase ultra high performance liquid chromatography.

Compared with the control group, the amount of semen and the total number of sperm in the hyperuricemia group significantly reduced (P < .05). Semen volume decreased with the increase of serum UA level, and the total number of sperm also decreased. The level of luteinizing hormone increased and the level of testosterone decreased in the hyperuricemia group. The concentration of superoxide dismutase decreased and the concentration of endothelin increased in the hyperuricemia group (P < .05). The concentration of seminal plasma α-glucosidase and alkaline phosphatase in the hyperuricemia group decreased significantly (P < .05). Compared with the control group, the contents of ascorbic acid, tartaric acid, lactic acid, and UA in the seminal plasma were significantly reduced in the hyperuricemia group (P < .05).

Blood UA level may become a new risk predictor of semen quality in infertile men.
The screening of diagnostic biomarker microRNA in first-trimester maternal plasma for Down syndrome
Authors: He Fengping , Yang Xiangkang
Published: January 2022

Background:

The trisomy of human chromosome 21 causes Down syndrome (DS), sometimes known as congenital folly's syndrome. The survivors show apparent mental impairment, unusual facial traits, growth and development abnormalities, and various deformities, with 60 percent of the infants having miscarriages in the early stages of the fetus. Plasma micRNA (miRNA) is a new diagnostic biomarker for DS; however, its significance in first-trimester maternal plasma is unknown. As a result, the purpose of this study is to assess the diagnostic significance of the biomarker miRNA in first-trimester maternal plasma for DS.

Materials and methods:

From January 2014 until the present, blood samples were obtained from pregnant women who visited our hospital. This study included 20 eligible DS pregnancies and 20 normal pregnant women. We looked at the differential miRNA expression profile in DS maternal plasma from the first and second trimesters using miRNA microarrays. Bioinformatics technology was used to compare the particular miRNA in DS maternal plasma from the first and second trimesters and screen the miRNA co-expressed in DS maternal plasma. Meanwhile, the expression level of chosen miRNAs was verified using quantitative real-time PCR (qRT-PCR).

Discussion:

This study aims to see how useful the diagnostic biomarker miRNA in first-trimester maternal plasma is for diagnosing DS. The findings of this investigation will provide clinical evidence for the discovery of a new diagnostic biomarker miRNA in first-trimester maternal plasma for DS diagnosis.

OSF regression number:

DOI 10.17605/OSF.IO/R49FT.
Acupuncture combined with SSRIs in the treatment of perimenopausal depressive disorder
Authors: Gao Zhan , Wang Jieqiong , Gao Mingzhou , Song Tingting , Gao Xiangju , Qiao Mingqi , Gao Jie
Published: January 2022

Background:

Perimenopausal depressive disorder (PDD) is an affective disorder involving endocrine, neurological, immune, which seriously endangers the physical and mental health of human. Selective serotonin reuptake inhibitors (SSRIs) are the current first-line clinical treatment, have limited efficacy and serious side effects. Acupuncture combined with SSRIs therapy has been widely used clinically because it increases efficacy and reduces side effects. There is a lack of high-quality evidence to assess its efficacy and safety. This study evaluated the effectiveness and safety of acupuncture combined with SSRIs in the treatment of PDD by meta-analysis.

Methods:

All randomized controlled trials articles about acupuncture combined with SSRIs treatment of PDD will be searched in databases, such as PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang, Wei Pu from the construction of the library to December 16, 2021. According to Cochrane 5.1 Handbook criteria, two researchers independently screened the literature, extracted data, and evaluated the quality of included studies. Meta-analysis was performed by using RevMan 5.4 and STATA 16.0 software.

Results:

This study will summarize the current evidence to evaluate the effectiveness and safety of acupuncture combined with SSRIs for the treatment of PDD.

Conclusion:

The results of this study will provide clinicians with new treatment ideas and bring benefits to most patients.

Registration number:

INPLASY2021120080 (DOI number: 10.37766/inplasy2021.12.0080).
Risk factors for end-stage renal disease in patients with trauma and stage 3 acute kidney injury
Authors: Choi Kyunghak , Kim Min Soo , Keum Min Ae , Choi Seongho , Kyoung Kyu-Hyouck , Kim Jihoon T. , Kim Sungjeep , Noh Minsu
Published: January 2022

Research on long-term renal outcomes in patients with acute kidney injury (AKI) and trauma, especially those with traumatic brain injury (TBI), has been limited.

In this study, we enrolled patients with stage 3 AKI as per the Kidney Disease Improving Global Outcomes guidelines, who initiated renal replacement therapy (RRT). These patients were divided into 2 groups depending on the presence of TBI. Comparing the baseline characteristics and management strategies of each group, we analyzed whether TBI affects the progression of kidney disease.

Between January 1, 2014 and June 30, 2020, 51 patients who initiated RRT due to AKI after trauma were enrolled in this study. TBI was identified in 20 patients, and the clinical conditions were not related to TBI in the remaining 31. The study endpoint was set to determine whether the patients of each group needed RRT persistently at discharge and at the time of recent outpatient clinic. Six (30.0%) out of 20 patients with TBI and 2 (6.5%) out of 31 patients without TBI required conventional hemodialysis, as per the most recent data. No significant within-group differences were found in terms of the baseline characteristics and management strategies. In the logistic regression analysis, TBI was independently associated with disease progression to end-stage renal disease.

TBI is a risk factor for end-stage renal disease in patients with trauma and stage 3 AKI who initiate RRT.
Moxibustion for abdominal pain in COVID-19
Authors: Li Xuhao , Dong Tiantian , Hou Yi , Dong Zhibin , Yang Jiguo
Published: January 2022

Background:

Coronavirus disease 2019 (COVID-19) is an acute respiratory infectious disease that makes breathing difficult and is often accompanied by abdominal pain and distension. Moxibustion, a special external treatment of traditional Chinese medicine, has shown beneficial effects in the treatment of abdominal pain. Currently, there is a lack of systematic reviews on moxibustion for the treatment of abdominal pain. We conduct this study to evaluate the efficacy and safety of moxibustion in the treatment of abdominal pain. This study is designed to evaluate the effectiveness and safety of moxibustion for abdominal pain in COVID-19.

Methods:

Randomized controlled trials from December 2019 to December 2021 will be included, without restrictions on language or publication date. PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Databases, China National Knowledge Infrastructure, Wanfang Database, and VIP Database were searched. Two researchers will independently select studies, extract data, and evaluate study quality. The Cochrane risk of bias tool for randomized trials will be used to assess the risk of bias in the included studies. Statistical analyses will be conducted using the RevMan 5.3 software.

Results:

This study aimed to prove the efficacy and safety of moxibustion for abdominal pain in patients with COVID-19. Our study provides a more accurate treatment method for abdominal pain during COVID-19. We will publish our results in a peer-reviewed journal.

Conclusion:

This study will provide more convincing evidence for clinicians to treat these conditions and help them make appropriate decisions.

Ethics and dissemination:

This study did not include personal information. Ethical approval was not required for this study.

INPLASY registration number:

INPLASY2021120104.
Effect of methylene blue on hemodynamic and metabolic response in septic shock patients
Authors: Luis-Silva Fabio , Menegueti Mayra Gonçalves , Sepeda Corina dos Reis , Petroski-Moraes Bruno C. , Sato Lucas , Peres Leandro Moreira , Becari Christiane , Basile-Filho Anibal , Evora Paulo R.B. , Martins-Filho Olindo Assis , Auxiliadora-Martins Maria
Published: January 2022

Introduction:

Septic shock is a lethal disease responsible for a large proportion of deaths in the Intensive Care Unit (ICU), even with therapy centered on fluid resuscitation, use of vasopressors and empirical antibiotic therapy applied within the first hour of diagnosis. Considering the multifactorial pathophysiology of septic shock and the mechanism of action of vasopressors, some patients may not respond adequately, which can lead to the maintenance of vasodilatation, hypotension and increased morbidity, and mortality. This protocol aims to verify whether the use of methylene blue in septic patients with an early diagnosis can contribute to an earlier resolution of a shock compared to standard treatment.

Methods and analysis:

This is a study protocol for a single-center randomized clinical trial design in an ICU of a tertiary university hospital. In this study, we intend to include 64 patients aged between 18 and 80 years with a diagnosis of septic shock, of any etiology, with up to 72 hours of evolution after volume restoration, using norepinephrine at a dose ≥0.2 μg/kg/min and vasopressin at a dose of 0.04 IU/min. After the initial approach, we will randomize patients into two groups, standard care, and standard care plus methylene blue. The sample size was calculated in order to show 30% differences in septic shock resolution between groups. The Research Ethics Committee approved the study, and all patients included will sign an informed consent form (Clinical registration: RBR-96584w4).
Efficacy and safety of SGLT2 inhibitors in patients with heart failure
Authors: Wang Li , Guo Xiaoning
Published: January 2022

Background:

Heart failure (HF) prognosis without therapy is poor, however introduction of a range of drugs has improved it. We aimed to perform a protocol for systematic review and meta-analysis on the effects and safety of Sodium-Glucose Transporter 2 inhibitors in HF patients.

Methods:

This protocol of systematic review and meta-analysis has been drafted under the guidance of the preferred reporting items for systematic reviews and meta-analyses protocols. This study will use the PubMed, Cochrane Library, Embase, Web of Science, and Medline databases. In addition, we will also collect 4 databases of China: China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wan-fang Database. The risk of bias of included studies is estimated by taking into consideration the characteristics including random sequence generation, allocation concealment, blinding of patients, blinding of outcome assessment, completeness of outcome data, selective reporting and other bias by Cochrane Collaboration's tool. All analyses were performed with Review Manager (RevMan) software, version 5.3 (Update Software Ltd, Oxford, Oxon, UK).

Results:

The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.

Conclusion:

Sodium-glucose transporter 2 inhibitors may improve critical outcomes in HF patients, and it is apparently safe.

Open Science Framework registration number:

https://doi.org/10.17605/OSF.IO/ZKE3Y 10.17605/OSF.IO/MP5SD
Can red cell distribution width in very low birth weight infants predict bronchopulmonary dysplasia?
Authors: Oh Seong Hee , Do Hyun-Jeong , Park Ji Sook , Cho Jae Young , Park Chan-Hoo
Published: January 2022

Red cell distribution width (RDW) is a useful marker for assessing the severity and prognosis of various diseases in adults. However, whether it is applicable to children, especially in newborns, has not been determined.

This study aimed to investigate the RDW values of preterm infants and evaluate whether RDW values in the early days of life can predict bronchopulmonary dysplasia (BPD) development.

One hundred and eight infants born at <30 weeks of gestation with a birth weight of <1500 g participated in this retrospective study. RDW values measured at birth, 7 days (D7), and 28 days (D28) after birth were reviewed. The changes in RDW values in the first month of life were analyzed, and we evaluated the relationship between RDW and BPD.

The mean RDW values at birth, D7, D28 and the change from birth to D7 were 16.2 ± 0.1%, 17.5 ± 0.2%, 17.6 ± 0.2% and 1.3 ± 1.8%, respectively. RDW at birth was lower in the infants born at <28 weeks’ gestational age than in those born at ≥28 weeks’ gestational age (15.7 ± 0.3 vs 16.4 ± 0.2, P = .024). RDW values of both groups increased during the first week after birth and did not differ significantly at D7. The levels remained similar at 1 month of age. RDW at birth, D7, and D28 and the changes in RDW from birth to D7 were not correlated with the development of BPD independent of its severity.

The usefulness of RDW as a predictor of BPD development remains questionable and requires further study.
Perception of cosmetic surgery and associated side effects
Authors: Cho Chung Hyang-In , Kim Young A.
Published: January 2022

This study explores the perception of female college students in South Korea regarding cosmetic surgery and its side effects.

Face-to-face interviews were conducted with 28 female college students over a period of 4 months, starting in October 2019. All participants were female college students who had not undergone cosmetic surgery. The collected data were analyzed qualitatively, using conventional content analysis.

Four categories and 13 subcategories were extracted from 112 meaningful codes reflecting perceptions related to cosmetic surgery and its associated side effects. The 4 categories that emerged in the study were: “reaction to the side effects of cosmetic surgery”, “reasons for cosmetic surgery”, “prospects of the participant's own cosmetic surgery”, and “prerequisites for decision-making regarding cosmetic surgery”.

The results of this study could be used as reference material by surgeons to ensure safer cosmetic surgeries. A sufficient consideration period and patient education prior to selective cosmetic surgery would minimize patient complaints and expand the base of safe cosmetic surgery.
Predictive value of microvascular density for response to anlotinib in advanced NSCLC
Authors: Liu Danqing , Ding Guozheng
Published: January 2022

Nonsmall cell lung cancer (NSCLC) is the most common type of lung cancer. This study aimed to categorize the microvessels in advanced NSCLC and determine the relationship between intratumoral microvascular density (MVD) and the efficacy of anlotinib for NSCLC.

The clinical data of 68 patients receiving anlotinib as third-line treatment or beyond for advanced NSCLC were retrospectively collected. Microvessels were stained for CD31 and CD34 by using immunohistochemical staining and were classified as undifferentiated (CD31+ CD34−) and differentiated vessels (CD31+ CD34+). The relationship between MVD and anlotinib efficacy and patient prognosis was analyzed.

Patients were divided into the high or low MVD groups according to the median MVD of differentiated (9.4 vessels/field) and undifferentiated microvessels (6.5 vessels/field). There were significantly more patients with high undifferentiated-vessel MVD in the disease control group than in the disease progression group (72.7% vs 16.7%, P < .001). Patients with high undifferentiated-vessel MVD had significantly longer median progression-free survival than those with low undifferentiated-vessel MVD (7.1 vs 3.7 months, P < .001).

Anlotinib as third- or beyond line therapy is safe and effective for advanced NSCLC. Patients with a higher density of undifferentiated microvessels have better response to anlotinib and longer progression-free survival.
Recurrence of a congenital diaphragmatic hernia 57 years postoperatively
Authors: Horiguchi Kohei , Lee Sang-Woong , Shimizu Tetsunosuke , Arima Jun , Taniguchi Kohei , Hagihara Seita , Komeda Koji , Uchiyama Kazuhisa
Published: January 2022

Rationale:

Postoperative recurrence of congenital diaphragmatic hernia (CDH) in adults is very rare. There is currently no precedent and no established treatment. We encountered a case of CDH which recurred 57 years, postoperatively.

Patient concerns:

A 57-year-old man with dyspnea on exertion was referred to our hospital. He had undergone surgery at the same hospital for CDH when he was 46 days old.

Diagnosis and interventions:

Laboratory studies, except diagnostic imaging and spirometry, were otherwise within normal limits. He was diagnosed with recurrent CDH based on computed tomography and underwent laparoscopic surgery.

Outcomes:

His postoperative course was uneventful, and there was no recurrence on follow-up.

Lessons:

We reported our encounter with a case of recurrent CDH, more than 50 years after the initial surgery. When managing diaphragmatic hernias, prompt surgical treatment, with consideration to prior surgical history for CDH, leads to satisfactory results.
Secondary glaucoma with anterior chamber cholesterolosis
Authors: Han Ruijuan , Tian Aijun , Fan Yaxin , Yin Juan , Ren Mingyu
Published: January 2022

Rationale:

The presence of cholesterol crystals in the anterior chamber is extremely rare, and secondary glaucoma with cholesterol crystals in the anterior chamber, reported in the literature, is even rarer. This paper reports 3 cases of secondary glaucoma with cholesterol crystals in the anterior chamber.

Patient concerns:

Three patients were admitted to the hospital because of ocular distension and blindness. Ocular examination on admission indicated high intraocular pressure, and crystalline gold substances were observed in the anterior chamber.

Diagnosis:

Based on clinical manifestations and an aqueous fluid smear, absolute glaucoma and anterior chamber cholesterol crystals were diagnosed.

Interventions:

In the first case, transscleral ciliary photocoagulation was performed; in the last 2 cases, trabeculectomy combined with extracapsular cataract extraction was performed.

Outcomes:

The follow-up period was 11 to 15 months. Intraocular pressure was stable in 2 patients treated with surgery, and no cholesterol crystals were observed in the anterior chamber. The intraocular pressure increased in 1 patient treated with laser, and a small amount of cholesterol crystals was still observed in the anterior chamber.

Lessons:

Anterior chamber cholesterol crystallization is extremely rare and cannot be treated if it does not cause other lesions. However, glaucoma occurred in all 3 cases in this study, and intraocular pressure increased in 1 case after laser treatment and remained stable in 2 cases after surgical treatment. Therefore, the treatment plan for anterior chamber cholesterol crystallization in glaucoma requires further discussion.
Successful treatment of locally advanced bulky cervical cancer complicated by irreducible complete uterine prolapse
Authors: Lee Dong Hyung , Joo Jong Kil , Suh Dong Soo , Shin Byung Sup , Hwang Seo Yoon , Kim Ki Hyung
Published: January 2022

Rationale:

Cervical cancer complicated by irreducible complete uterine prolapse in elderly patients is extremely rare. No standard treatment has been established for these conditions.

Patient concerns:

A 74-year-old woman with a 30-year history of pelvic organ prolapse presented with irreducible complete uterine prolapse and a large exophytic mass involving the cervix and vaginal wall.

Diagnosis:

Biopsy of the mass was performed at the referring institution and showed invasive verrucous-type squamous cell carcinoma.

Interventions:

A prolapsed uterus with a tumor mass could not be manually reduced. After completion of concurrent chemoradiotherapy, the tumor mass in the prolapsed uterus decreased and could be reduced manually. Subsequently, the patient underwent hysterectomy and intra-abdominal uterosacral ligament suspension.

Outcomes:

At 19 months of postoperative follow-up, the patient remained disease-free and had no evidence of vault prolapse.

Lessons:

This study has important clinical implications and may provide a therapeutic strategy to address unmet medical needs in combination with locally advanced cervical cancer complicated by irreducible complete uterine prolapse. These conditions were successfully treated using a multidisciplinary approach of chemoradiotherapy followed by radical hysterectomy and uterosacral ligament suspension.
In Patients With Functional Movement Disorders, Is Specialized Physical Therapy Effective in Improving Motor Symptoms?
Authors: Callister Marcus N. , Stonnington Cynthia B. , Cuc Andrea , Alcott Sally B. , Driver-Dunckley Erika D. , Mehta Shyamal H. , Hasan Shemonti , Marks Lisa A. , Wingerchuk Dean M. , O’Carroll Cumara B.
Published: January 2022

Background:

Functional movement disorders (FMD, aka psychogenic movement disorders) are very common and frequently chronic and disabling. Despite this, there is a paucity of evidence-based treatment to manage and alleviate these conditions. Specialized physical therapy (PT), involving sequential motor relearning and redirecting attention, has shown promise as a therapeutic intervention for motor symptoms.

Methods:

The objective of this study was to critically assess current evidence regarding specialized PT compared with usual care in improving motor symptoms among patients with FMD. This was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a clinical question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, and content experts in the fields of physical medicine and rehabilitation, physical and occupational therapy, psychiatry, and psychology.

Results:

A randomized controlled feasibility trial was identified and selected for critical appraisal. This study randomized 60 patients with FMD to a 5-day specialized outpatient PT program or to general outpatient PT referral, and measured patient-reported and clinician-measured outcomes. At 6 months, 72% of patients in the intervention group had a good outcome compared with 18% of control group patients. Patients in the specialized outpatient PT program had significantly better outcomes in 3 Short-Form 36 (SF36) domains (d=0.46 to 0.79) and multiple other scales of physical and social function as well as clinician-measured outcomes. The intervention resulted in 0.08 additional quality-adjusted life years in a cost-effective manner.

Conclusions:

Current evidence suggests that in patients with FMD, specialized PT improves motor symptoms in a clinically significant, sustained, and cost-effective manner. This promising intervention warrants further investigation and replication.
Comparison of Logarithmic Reading Charts for Visual Assessment in Normally Sighted Participants
Authors: Maeni Yahya A. , Paterson Kevin B. , Maltby John , McGowan Victoria A. , Hutchinson Claire V.
Published: January 2022

SIGNIFICANCE

Logarithmic reading charts provide standardized measures of reading performance. Here we show that existing charts provide equivalent assessments of visual aspects of reading that are in good agreement with traditional measures of visual acuity and seem uninfluenced by cognitive (linguistic) factors.

PURPOSE

The aims of this study were to (1) determine the equivalence of logarithmic charts of sentence and word reading, (2) evaluate the relationship between reading chart performance and more traditional measures of visual assessment, and (3) establish the influence of linguistic factors on reading chart performance.

METHODS

In a sample of 82 normally sighted participants, we determined performance on the reading measures (e.g., reading acuity, reading speed, critical print size) of the following logarithmic charts of sentence and word reading: The Colenbrander English Continuous Text Near Vision Card, Radner Reading Chart, Minnesota Reading Acuity Chart, and Smith-Kettlewell Reading Chart. In doing so, we compared performance on reading measures between charts and with performance on more traditional measures of visual assessment (uncrowded and crowded letter acuity, stereoacuity, accommodation) and cognitive measures of word knowledge and ability (Wechsler Adult Intelligence Scale Vocabulary Subtest, National Adult Reading Test).

RESULTS

Factor analysis confirmed that performance on the reading measures (reading acuity, reading speed, critical print size) was equivalent across charts. Reading test performance was also related to more traditional measures of vision, the most consistent of which were significant associations between reading acuity and acuity for single-letter optotypes. There were no significant associations between reading chart performance and cognitive measures of word knowledge and ability.

CONCLUSIONS

The findings presented here suggest that logarithmic charts composed of sentences and words represent an alternative to traditional letter acuity testing. This is particularly the case for measures of reading acuity.
Skin and Soft Tissue Infection Treatment and Prevention Practices by Pediatric Emergency Medicine Providers
Authors: Mistry Rakesh D. , Hogan Patrick G. , Parrish Katelyn L. , Thompson Ryley M. , Fritz Stephanie A.
Published: January 2022

Objective

The aim of the study was to evaluate skin and soft tissue infection (SSTI) treatment and prevention practices among pediatric emergency medicine (PEM) clinicians in the context of current clinical practice guidelines and contemporary evidence.

Methods

This was a cross-sectional survey of PEM clinicians belonging to the American Academy of Pediatrics Section on Emergency Medicine Survey listserv. Four varying hypothetical clinical scenarios of children with SSTI were posed to respondents; subsequent items assessed SSTI treatment and prevention practices. Provider demographics were collected.

Results

Of 160 survey respondents, more than half stated that they would prescribe oral antibiotics for each clinical scenario, particularly for more complex presentations (small uncomplicated abscess, 51.8%; large uncomplicated abscess, 71.5%; recurrent abscess, 83.5%; febrile abscess, 90.3%; P < 0.001). Most commonly selected antibiotics were clindamycin and trimethoprim-sulfamethoxazole. Across scenarios, more than 80% selected a duration of treatment 7 days or more. Of the 121 respondents who prescribe preventive measures, 85.1% recommend hygiene measures; 52.5% would prescribe decolonization with topical antibiotic ointment and 77.5% would recommend antiseptic body washes. Half of the respondents reported that their institution has standard guidance for SSTI management.

Conclusions

Although current evidence supports adjuvant antibiotics for all drained SSTI and decolonization for the index patient and household contacts, PEM clinicians do not consistently adhere to these recommendations. In light of these findings, development and implementation of institutional guidelines are necessary to aid PEM clinicians' point-of-care decision making and improving evidence-based practice.
The Evolution of Research and Therapy With Hypomethylating Agents in Acute Myeloid Leukemia and Myelodysplastic Syndrome: New Directions for Old Drugs
Authors: Short Nicholas J. , Dombret Hervé , Adès Lionel , Kantarjian Hagop
Published: January 2022

Azacitidine and decitabine are cytosine analogs that function as DNA methyltransferase inhibitors. These agents, commonly referred to as “hypomethylating agents,” are widely used for the treatment of myelodysplastic syndrome and acute myeloid leukemia (AML). In this review, we discuss the clinical development of these drugs, including the early studies that led to the optimization of their doses and schedules, and the pivotal studies that led to their regulatory approval, both as monotherapy and in combination with venetoclax for older adults with AML who are unfit for intensive chemotherapy. We also review the more recent development of oral hypomethylating agent formulations and the novel oral strategies being developed in myelodysplastic syndrome and AML.
Evolution of Therapy for Older Patients With Acute Myeloid Leukemia
Authors: Kadia Tapan M. , Wei Andrew H.
Published: January 2022

Most patients with newly diagnosed acute myeloid leukemia (AML) are 65 years or older. The treatment of AML in older patients has been characterized by distinct patient- and disease-related challenges that have impeded the meaningful progress that has been observed in younger patients with AML. Higher rates of comorbidities and frailty contribute to higher rates of treatment-related complications, whereas adverse disease features such as poor-risk genomics and secondary AML are associated with therapeutic resistance and shortened survival. Intensive chemotherapy and allogeneic stem cell transplant, although still considered standard for many newly diagnosed patients with AML, may not be appropriate for a larger subset of older patients with AML. Lower-intensity approaches such as hypomethylating agents have been widely applied for newly diagnosed older and unfit patients with AML, improving tolerability among this subset, but providing more modest response rates. Numerous analyses have attempted to tackle the utility of higher- versus lower-intensity therapy in older AML and identify the factors that can help choose the approach that best optimizes tolerability and efficacy. Recently, a greater understanding of the genomic and biologic heterogeneity of AML has led to better risk stratification and has contributed to the development of specific targeted therapies that are starting to narrow the gap between safety and efficacy. Newly approved agents, such FLT3 (FMS-like tyrosine kinase 3) inhibitors, IDH1 and IDH2 inhibitors, and the BCL2 inhibitor venetoclax, as well postremission maintenance therapy with CC-486 (oral 5-azacitidine), are being systematically incorporated into the evolving treatment of older patients with newly diagnosed AML.
Multiparametric 18F-FDG and 68GA-DOTATOC PET Imaging in Bone Metastatic Meningioma Before Radionuclide Therapy
Authors: Mairal Elise , Chevalier Elodie , Imbert Laetitia , Boursier-Joppin Caroline , Verger Antoine
Published: January 2022

This report presents the case of a 61-year-old woman with assessment of fronto-temporo-sphenoidal refractory meningioma before radionuclide therapy with pretherapeutic 68Ga-DOTATOC PET/CT. Given the discovery of osteolytic lesions, 18F-FDG PET/CT is planned to search for the primitive origin. Meningioma bone metastasis is confirmed with spine biopsies. The presence of dedifferentiated meningioma lesions indicating that high somatostatin receptor expression does not necessarily coincide with areas of increased glucose metabolism. 18F-FDG and 68Ga-DOTATOC PET/CT allows optimal characterization of tumor heterogeneity and guide targeted therapeutic management before PPRT.
Bacteriological Investigation and Drug Resistance Analysis of Chronic Refractory Wound Secretions
Authors: Dong Xiang-Mei , Pei Li-Li , Lu Peng-Song , Ni Peng , Yu Bao-Fu , Fan Zhi-Qiang
Published: January 2022

Background:

Chronic refractory wounds were common and the treatments were complicated for burn and plastic surgeons. This study was to investigate the bacterial distribution characteristics and bacterial drug resistance of chronic refractory wound secretions.

Methods:

The authors retrospectively analyzed 425 patients with chronic refractory wound infection. The results of bacterial culture of wound secretions and drug sensitivity test were retrospectively analyzed. Further, the location area of the wound was divided into 4 regions, and the difference of the bacterial culture results between different regions was analyzed.

Results:

The wound secretions were cultured into 401 bacterial strains, including 206 gram-positive bacteria strains, accounting for 51.4%, with the highest detection rate of Staphylococcus aureus at 26.2% (105/401). There were 195 gram-negative bacteria strains, accounting for 48.6%, with the highest detection rate of Pseudomonas aeruginosa at 14.2% (57/401). There were 6 fungal strains. The proportion of gram-negative bacteria in the III region of the wound zone was significantly greater than that in the other 3 regions.

Conclusions:

The detection rate of gram-positive bacteria and gram-negative bacteria of chronic refractory wound secretions is not much different. However, in the area close to the perineum (III region), gram-negative bacteria is significantly higher, which has a certain reference value for the use of antibiotics in clinical practice.

Level of evidence:

Level 4.
Intraoperative Neurophysiological Monitoring Alerts During Three-Column Osteotomy: Incidence and Risk Factors
Authors: Liu Wanyou , Qiu Junyin , Zhu Zezhang , Shi Benlong , Li Yang , Liu Zhen , Sun Xu , Qiu Yong
Published: January 2022

Prupose:

To analyze the incidence and risk factors of intraoperative neurophysiological monitoring (IONM) alerts in patients undergoing three-column osteotomy.

Methods:

A total of 551 patients (340 males and 211 females) with an average age of 31.9 years undergoing posterior 3-column osteotomy were retrospectively reviewed. The coronal Cobb angle of main curve and sagittal global kyphosis were measured on preoperative standing whole spinal x-rays. The Frankel scores at preoperation, postoperation, and the last follow-up were recorded and applied for assessment of neurologic status. Surgical procedures and other factors associated with IONM alerts were analyzed.

Results:

A total of 98 (17.8%) IONM alerts were reported during surgery, including 82 somatosensory evoked potential alerts and 91 motor evoked potential alerts. Positive wake-up test was revealed in 57 patients (10.3%) even after prompt managements, and new neurologic deficits were observed in 50 patients (9.1%) at immediate postoperation. Of the 50 patients with new neurologic deficits at postoperation, the Frankel scores were A in 5 patients, B in 4, C in 9, and D in 32. The χ2 test showed that patients with congenital deformities, global kyphosis >90°, vertebral column resection procedure, cervicothoracic/thoracic osteotomy, blood loss >3,000 mL, and preoperative neurologic deficit were at a higher risk of IONM alerts.

Conclusions:

The incidence of IONM alerts in patients undergoing 3-column osteotomy was 17.8%. Congenital deformities, global kyphosis >90°, vertebral column resection, cervicothoracic/thoracic osteotomy, blood loss >3,000 mL, and preoperative neurologic deficit indicated high risk of IONM alerts.
Surveillance of carbapenem-resistant Klebsiella pneumoniae in a paediatric hospital in China revealed the dynamics of carbapenemase and the prevalence of ST2735 K. pneumoniae
Authors: Zhou Yan , Zhao Zeqing , Zeng Lulu , Peng Jun , Zhou Shuping , Min Liang , Ke Jiangwei , Liu Jinhui
Published: January 2022

Background. Carbapenem-resistant

Klebsiella pneumoniae

(CRKP) is increasingly isolated in paediatric wards, posing a severe threat to these vulnerable populations. This study investigated the clinical features, determinants of carbapenem resistance and clonal relatedness among CRKP in our hospital.

Hypothesis. The prevalence of carbapenem-resistant

K. pneumoniae

in paediatric patients differs from the strains isolated from adult patients in carbapenemase and predominant clones.

Aim. To investigate the pattern of carbapenemase and the clonal relationships between carbapenem-resistant

Klebsiella pneumoniae

in a paediatric hospital in Jiangxi Province.

Methodology. Forty-five CRKP isolates were consecutively collected from October 2016 to October 2020. Medical records were reviewed to analyse clinical features. Detection of carbapenemase genes was used to determine CRKP resistance mechanisms and clonal relatedness among CRKP was identified through multi-locus sequence typing (MLST).

Results. Forty-three (95.6 %) patients developed CRKP infection, and two (4.4 %) were colonized by CRKP in the urinary tract. The overall mortality rate was 13.3 %. In total, 42 (93.3 %) strains were positive for carbapenemase genes, and bla
NDM (62.2 %) was the predominant gene. The MLST identified 24 different sequence types (STs) of CRKP, in which ST11 (n=8, 17.8 %) and ST2735 (n=8, 17.8 %) were the most common STs.

Conclusion. The pattern of CRKP in paediatric patients reflects evolving changes. The ST2735

K. pneumoniae

may present as a dangerous CRKP clone circulating in paediatric patients.
Detection and upsurge of SARS-CoV-2 Omicron variant in Islamabad Pakistan
Authors: Umair Massab , Ikram Aamer , Rehman Zaira , Haider Syed Adnan , Badar Nazish , Ammar Muhammad , Ali Qasim , Ahad Abdul , Suleman Rana , Khalid Ayesha , Tariq Amna , Jamal Zunera , Salman Muhammad
Published: January 2022

The SARS-CoV-2 omicron variant was first detected in South Africa in November, 2021 and has rapidly spread to more than 90 countries. The emergence of Omicron variant demands for enhanced genomic surveillance to track the mutation profile and spread of virus. In the current study, we have sequenced 15 whole-genome sequences of SARS-CoV-2 Omicron variant from Islamabad region of Pakistan. Among the 15 isolates, 66% were from Islamabad whereas 33% of cases had international travel history of United Kingdom, Maldives, South Africa, and Oman. The detection of Omicron in local community and in travelers highlights the need for rigorous screening at national level and at entry points in order to contain the spread of variant.
A family of C. elegans VASA homologs control Argonaute pathway specificity and promote transgenerational silencing
Authors: Dai Siyuan , Tang Xiaoyin , Li Lili , Ishidate Takao , Ozturk Ahmet R , Chen Hao , Yan Yonghong , Dong Mengqiu , Shen Enzhi , Mello Craig C
Published: January 2022

Germline Argonautes direct transcriptome surveillance within peri-nuclear membraneless organelles called nuage. In C. elegans, a family of Vasa-related Germ Line Helicase (GLH) proteins localize in, and promote the formation of nuage called P granules. Previous studies have implicated GLH proteins in inherited silencing but direct roles in amplification of small RNAs, or in target mRNA or Argonatue binding have not been identified. Here we show that GLH proteins compete with each other to control Argonaute pathway specificity, bind directly to Argonaute-target mRNAs and act to promote the amplification of small RNAs required for transgenerational inheritance. We show that the ATPase cycle of GLH-1 regulates its direct binding to the Argonaute WAGO-1 which engages amplified small RNAs. Our findings support a dynamic and direct role for GLH proteins in inherited silencing beyond their role as structural components of nuage.