bluuebunny/crossref_metadata_2025 huggingface dataset:
Skin Necrosis Following Inadvertent Dermal Injection of Extended-release Buprenorphine
Authors: Crouse Ericka , Haught Justin , Tobarran Natasha , Nichols Cameron , Cumpston Kirk L. , Wills Brandon K.
Published: April 2021

Introduction:

Extended-release subcutaneous buprenorphine injection is a relatively new formulation and clinicians are still gaining experience with its use. There is sparse literature available on adverse events. We describe a case of skin necrosis associated with the injection site of extended-release buprenorphine.

Case Report:

A 35-year-old reported immediate swelling and eventual skin breakdown near his buprenorphine injection site. He was found to have ulceration down to the subcutis with no evidence of infection. The patient followed up with dermatology and underwent debridement of the site. The injection site healed with scar formation.

Discussion:

Although mild to moderate adverse events related to the injection site have been reported in Phase 3 studies of extended-release buprenorphine injection, this is a rare case of skin necrosis requiring surgical intervention and excision of the depot.

Conclusions:

This case highlights the potential complication of skin necrosis after inadvertent dermal of extended-release buprenorphine and reviews proper administration techniques.
Automated Near Real-Time Ventilator Data Feedback Reduces Incidence of Ventilator-Associated Events: A Retrospective Observational Study
Authors: Augustus Oglesby Harold Julius , Cataldo Steven H. , Pedro Michael J.
Published: April 2021

Objectives:

Critical care teams are encouraged to follow best practice protocols to help wean mechanically ventilated patients from the ventilator to reduce ventilator-associated events including ventilator-associated conditions, probable ventilator-associated pneumonias, and infection-related ventilator-associated conditions. Providers monitor for alerts suggestive of possible ventilator-associated events and advise when patients should undergo spontaneous breathing trials. Compliance with protocols in most units is suboptimal.

Design:

Retrospective review of clinical data over 24 months.

Setting:

St. Joseph Mercy Hospital Candler Hospital Medical-Surgical ICU.

Patients:

All mechanically ventilated patients.

Interventions:

The Respiratory Knowledge Portal was implemented in our ICU. For 13 months, Respiratory Knowledge Portal data were ported to ICU workstations (control). For the following 11 months, Respiratory Knowledge Portal data were also presented on tablet computers (intervention) for use during multidisciplinary rounds. We performed a retrospective review of Respiratory Knowledge Portal data from before and after the implementation of the tablet computers.

Measurements and Main Results:

Data were collected from 337 patients (187 control group, 150 intervention group). A decrease in the occurrence of ventilator-associated events was observed during the intervention group compared with the control group. Only 2.0% of patients in the intervention group experienced any category of ventilator-associated event, while 11.2% of patients in the control group experienced one event (p = 0.003). Intervention patients experienced less ventilator-associated conditions (p = 0.002), infection-related ventilator-associated conditions (p = 0.026), and probable ventilator-associated pneumonias (p = 0.036) than control patients. Twenty-one of the 24 patients with any ventilator-associated events were in the control group. There was no significant difference between the days spent on ventilation nor hospital length of stay in the control compared with intervention group patients.

Conclusions:

Fewer ventilator-associated events, ventilator-associated conditions, infection-related ventilator-associated conditions, and probable ventilator-associated pneumonias were seen during the period when Respiratory Knowledge Portal monitoring data was presented on tablet computers. There was no difference in time on ventilator nor overall length of stay.
Long-Term Cognitive Outcomes and Sleep in Adults After Extracorporeal Life Support
Authors: Daou Marietou , Lauzon Claire , Bullen E. Caroline , Telias Irene , Fan Eddy , Wilcox M. Elizabeth
Published: April 2021

Objectives:

To assess differences in cognitive outcomes and sleep in adult survivors of critical illness, managed with venovenous extracorporeal membrane oxygenation as compared to conventional mechanical ventilation only.

Design:

Retrospective cohort study linked with data from the COGnitive outcomes and WELLness study.

Setting:

A multisite study from five adult medical/surgical ICUs in Toronto.

Patients:

Thirty-three ICU survivors including adult patients who received venovenous extracorporeal membrane oxygenation (n = 11) matched with patients who received mechanical ventilation only (n = 22) using specified covariates (e.g., age).

Interventions:

None.

Measurements and Main Results:

Baseline demographics and admission diagnoses were collected at enrollment. Cognitive outcome was evaluated using the Repeatable Battery for the Assessment of Neuropsychologic Status (global cognitive function) and Trail Making Test B (executive function), and sleep variables were estimated using actigraphy. Assessments occurred at 7 days post ICU discharge and again at 6- and 12-month follow-up. No statistically significant difference was seen between patients treated with or without venovenous extracorporeal membrane oxygenation in the mean daily Riker Sedation Agitation Score; however, patients in the venovenous extracorporeal membrane oxygenation group received greater amounts of fentanyl over their ICU stay as compared to patients receiving conventional mechanical ventilation only (p < 0.001). No significant differences were found in performance on either of the cognitive assessment tools, between survivors treated or not with venovenous extracorporeal membrane oxygenation at any of the time points assessed. Total sleep time estimated by actigraphy increased from approximately 6.5 hours in hospital to 7.5 hours at 6-month follow-up in all patients, regardless of treatment type. Total sleep time remained consistent in both groups from 6 to 12 months post ICU discharge.

Conclusions:

In this small retrospective case series, no significant differences were found in sleep or cognitive outcomes between extracorporeal life support and non–extracorporeal life support survivors. Further, in this hypothesis-generating study, differences in administered sedative doses during the ICU stay seen between the two groups did not impact 6- or 12-month cognitive performance or actigraphy-estimated sleep time.
Prolonged Anaphylaxis to Pfizer Coronavirus Disease 2019 Vaccine: A Case Report and Mechanism of Action
Authors: Frank Ashleigh , Radparvar Sara , Manasia Anthony , Bassily-Marcus Adel , Kohli-Seth Roopa
Published: April 2021

Background:

In response to the devastating effects of the coronavirus disease 2019 pandemic, several vaccine prototypes have been developed, with the Pfizer/BioNTech (BNT162b2) platform being the first to receive emergency use authorization. Although taken to market on an unprecedented timeline, the safety profile of the drug during clinical trials was shown to be favorable. Shortly after release, reports from the Centers for Disease Control and Prevention demonstrated a higher-than-average rate of anaphylaxis to the vaccine that has been the cause for concern for safety officials and the general public alike. Here, we present a unique case of protracted anaphylaxis in a recipient of the BNT162b2.

Case Summary:

The patient is a 55-year-old female with a history of multiple allergic reactions who presented with respiratory distress and hives after receiving the first dose of the BNT162b2, despite premedication with IV steroids and diphenhydramine. The refractory nature of her reaction was demonstrated by edema of her tongue (visualized on nasolaryngoscopy), requiring an epinephrine infusion for nearly 3 days. She was discharged from the hospital with instructions not to receive the second dose of the vaccine.

Conclusion:

Although the exact etiology of anaphylaxis secondary to this messenger RNA-based vaccine is not completely clear, our literature search and review of the patient’s course support either polyethylene glycol versus other excipient-related allergy as a possible cause. Based on the protracted nature to our patient’s anaphylaxis, critical care management for patients with a true anaphylactic reaction to BNT162b2 may require monitoring for an extended period of time.
The common region of lncRNAs UCA1 and UCA1α contributes to the bladder cancer tumorigenesis
Authors: Wang Yu , Li Xu , Chen Wei , Wu Wenjing
Published: April 2021

Accumulating evidence suggests that the long noncoding RNAs (lncRNAs) urothelial cancer associated 1 (UCA1) and urothelial cancer associated 1α (UCA1α) play a critical role in the development and progression of bladder cancer. However, the detailed mechanism, in particular the role of the common region of UCA1 and UCA1α, termed UCA1 same sequence (USS, approximately 1265 bp), remains unknown. To address this, the full length of 1265 bp USS was obtained initially, and then produced pcDNA3.1(+)-based overexpression vectors and designed siRNAs for UCA1, UCA1α, and USS, and assessed their effects on the human bladder cancer cell lines UMUC3 (which does not express UCA1 and UCA1α) and 5637 (which has high expression of UCA1 and UCA1α), respectively. Overexpression of UCA1, UCA1α, and USS significantly increased bladder cancer cell proliferation and the number of S-phase cells, but significantly decreased cell apoptosis and the number of G0/G1 phase cells. Consistently, silencing UCA1 and USS significantly decreased bladder cancer cell proliferation and the number of S phase cells, but significantly increased apoptosis and the number of G0/G1 phase cells. These results suggest that USS, the common region of UCA1 and UCA1α, can promote bladder cancer tumorigenesis by increasing cell proliferation and decreasing cell apoptosis in a similar way to UCA1 and UCA1α lncRNAs. This not only transforms our understanding of the role of UCA1, UCA1α, and their common region in tumorigenesis, but may also provide a new target for future clinical applications.
Mycosis Fungoides Preceding Pityriasis Lichenoides et Varioliformis Acuta by Twelve Years in a Pediatric Patient
Authors: Lowe Erin , Jacobsen Jeffrey R. , Taylor Steve , Miller Richard , Price Harper N. , Andrews Israel D.
Published: April 2021

A 15-year-old boy presented to the pediatric dermatology department with long-standing patch stage CD8+ mycosis fungoides and subsequent development of recurrent pityriasis lichenoides et varioliformis acuta eruptions. There have been rare reports of patients with chronic, recalcitrant pityriasis lichenoides developing mycosis fungoides, but we believe this to be the second case of mycosis fungoides preceding a diagnosis of pityriasis lichenoides, and the first case reported in the pediatric population.
Postoperative Pain After Mohs Micrographic Surgery is Well Tolerated Regardless of Psychological and Pain-Related Comorbidities
Authors: Brahe Catherine A. , Hardy Curtis Lamar , Miladi Anis
Published: April 2021

BACKGROUND

Preoperative patient screening has been evaluated in many surgical specialties as a way to improve the overall patient experience. Current data are limited regarding patient screening for dermatologic procedures. The goal of preoperative screening is to identify patients at risk for poor outcomes and tailor the treatment plan to ensure a greater overall patient experience.

OBJECTIVE

To investigate the association between psychological comorbidities and acute postoperative pain in patients treated with Mohs micrographic surgery (MMS).

MATERIALS AND METHODS

Subjects were recruited from a single center, single provider, uniformed service MMS practice, and asked to complete preoperative and postoperative questionnaires for scheduled MMS. Outcome variables included anticipated pain, actual pain after MMS, duration of pain, and medications used for pain.

RESULTS

Mohs micrographic surgery was well tolerated. There were no significant differences in anticipated or reported pain, or in medication use between cohorts. Significant differences in pain were noted with closure technique with complex surgical repairs generating the greatest pain across groups.

CONCLUSION

Mohs micrographic surgery is well tolerated by patients, both with and without psychological comorbidities. Our results show no statistically significant differences, suggesting a limited role for preoperative screening as a tool to guide pain management after MMS.
Does Double-Pass Pulsed-Dye Laser With Long and Short Pulse Duration Increase Treatment Efficacy of Port-Wine Stain? A Randomized Clinical Trial
Authors: Noormohammadpour Pedram , Ehsani Amir H. , Mahmoudi Hamidreza , Balighi Kamran , Razavi Zahra
Published: April 2021

BACKGROUND

Although pulsed-dye laser (PDL) 595 nm is known as the gold standard for treatment of port-wine stains (PWS), complete clearance of lesions occurs in a minority of cases.

OBJECTIVE

To compare the efficacy and safety of double-pass pulsed-dye laser (DPL), long pulse duration (20 m/s) followed by short pulse duration (1.5 m/s) within 20 minutes interval, with single-pass pulsed-dye laser (SPL) for (1.5 m/s) in the treatment of PWS.

METHODS

Twenty-four patients with PWS underwent 3 sessions of PDL. Each lesion was randomly divided into 2 portions to receive DPL or SPL. Colorimetric and dermoscopic evaluations were used to determine the response objectively. In addition, improvement was scored subjectively using the visual analog scale (VAS).

RESULTS

According to colorimetric analysis, the mean blanching rates for DPL and SPL treated sites were 48% (SD = 0.215) and 37% (SD = 0.213), respectively (p = .001). With VAS, 3.79 (SD = 0.93) and 3.33 (SD = 0.91) improvement scores were reported in the DPL and SPL treated areas, respectively (p = .008). Dermoscopic images showed that larger deep vessels were the most common remnant vessels in both treatment areas.

CONCLUSION

Compared with SPL, DPL with 20 minutes interval seems to be a more effective and safe method for the treatment of PWS.
Safety and Efficacy of Deoxycholic Acid Injection for Hypogastric Fat Reduction: A Pilot Study
Authors: Salvador Laura , Benito-Ruiz Jesús
Published: April 2021

BACKGROUND

Although deoxycholic acid (DCA) has been proposed for use in other areas, it is used primarily for treating moderate-to-severe fat in the submental area.

OBJECTIVE

To evaluate the safety and efficacy of DCA for fat reduction in the hypogastric region.

MATERIALS AND METHODS

A prospective, longitudinal, nonrandomized, open-label, interventional pilot study was performed. Deoxycholic acid was transcutaneously injected in upper right, upper left, lower right, and lower left hypogastric zones. Fat thickness was assessed using calipers, ultrasound, and 3-dimensional scanning. The primary end point safety was evaluated by laboratory tests and the incidence of adverse events.

RESULTS

Fourteen patients (54 treatment sessions) were included. The mean total volume administered was 26.6 mL. The main local adverse events were edema (94.4%), bruising (90.7%), and erythema (79.6%), all being self-limited (the mean duration 9.6, 7, and 2 days, respectively). A DCA dose was significantly associated with erythema duration (p = .0421) but not with edema duration (p = .1611) or bruising incidence (p = .1013). Measurement using calipers, ultrasound, and 3-dimensional scanning revealed significant fat thickness reduction. Patient-reported outcome measure scores revealed a significant improvement in patient satisfaction.

CONCLUSION

Deoxycholic acid may be a safe and effective option for reducing fat thickness in the hypogastric region, although given the cost/benefit ratio probably should be reserved for small deposits.
Laser Speckle Contrast Imaging for the Objective Assessment of Blood Perfusion in Keloids Treated With Dual-Wavelength Laser Therapy
Authors: Xu Chi , Ting Wenyun , Teng Yue , Long Xiao , Wang Xiaojun
Published: April 2021

BACKGROUND

Most of the widely used methods for the assessment of keloid treatment are subjective grading scales based on the opinion of an individual clinician or patient. There is a growing need for objective methods to evaluate keloid treatment.

OBJECTIVE

This study aimed to evaluate the value of laser speckle contrast imaging (LSCI) as an objective method for the assessment of dual-wavelength laser therapy for keloids.

METHODS

This prospective study included 21 patients with 54 keloids. All patients were treated with a combined 585-nm pulsed dye laser and 1,064 nm neodymium-doped yttrium aluminum garnet dual-wavelength laser at 4 weeks to 6 weeks intervals. Keloids were assessed using the Vancouver Scar Scale (VSS) and LSCI.

RESULTS

The total VSS score significantly decreased after 4 sessions of treatment (p < .05). Blood perfusion in keloids as measured by LSCI was significantly reduced after treatment (p < .05). The improvement of chest keloids in terms of the total VSS score and blood perfusion was significantly greater than that of scapular keloids (p < .05). There was a positive correlation between decreased perfusion and reduced total VSS score (R2 = 0.84).

CONCLUSION

Blood perfusion in keloids significantly decreased after dual-wavelength laser therapy. Laser speckle contrast imaging is a promising objective method for assessing the improvement of keloids treated with laser therapy.
Combined Treatment of Rolling Acne Scars in Ethnic Skin Using Extensive Subcision, Trichloracetic Acid Peel, and Fractional Ablative Erbium Laser
Authors: Taylor Mark B. , Koron Neža
Published: April 2021

BACKGROUND

Successful treatment of acne scars in ethnic skin requires procedures that are safe and effective with a low incidence of hyper or hypopigmentation postoperatively.

OBJECTIVE

In this study, the safety and efficacy of a combined treatment protocol including tumescent anesthesia, subcision, trichloracetic acid peel, and fractional erbium laser resurfacing was evaluated.

METHODS

This is a retrospective study of 56 patients (22 women and 34 men) with predominantly rolling acne scars and Fitzpatrick skin Types IV–VI who were treated using a combination of tumescent anesthesia, extensive subcision, fractional ablative erbium laser, and a blending 20% trichloracetic acid (TCA) peel.

RESULTS

The mean improvement after a single treatment, assessed by 3 independent evaluators (2 dermatologist and 1 dermatology physician assistant), was 2.52 (SD = 1.04) on a scale of 1 to 4.

CONCLUSION

The combination of tumescent anesthesia, extensive subcision, fractional ablative erbium laser resurfacing, and a blending 20% TCA peel (combined procedure) is both safe and effective in the treatment of rolling acne scars in ethnic skin types with acceptable temporary adverse effects.
Prenatal metal mixtures and sex-specific infant negative affectivity
Authors: Cowell Whitney , Colicino Elena , Levin-Schwartz Yuri , Enlow Michelle Bosquet , Amarasiriwardena Chitra , Andra Syam S. , Gennings Chris , Wright Robert O. , Wright Rosalind J.
Published: April 2021

Background:

Prenatal exposure to metals has been associated with a range of adverse neurocognitive outcomes; however, associations with early behavioral development are less well understood. We examined joint exposure to multiple co-occurring metals in relation to infant negative affect, a stable temperamental trait linked to psychopathology among children and adults.

Methods:

Analyses included 308 mother-infant pairs enrolled in the PRISM pregnancy cohort. We measured As, Ba, Cd, Cs, Cr, Pb, and Sb in urine, collected on average during late pregnancy, by ICP-MS. At age 6 months, we assessed negative affect using the Infant Behavior Questionnaire—Revised. We used Weighted Quantile Sum (WQS) regression with repeated holdout validation to estimate the joint association between the metals and global negative affectivity, as well as four subdomains (Fear, Sadness, Distress to Limitations, and Falling Reactivity). We also tested for a sex interaction with estimated stratified weights.

Results:

In adjusted models, urinary metals were associated with higher scores on the Fear scale (βWQS = 0.20, 95% confidence interval [CI]: 0.09, 0.30), which captures behavioral inhibition, characterized by startle or distress to sudden changes in the environment and inhibited approach to novelty. We observed a significant sex interaction (95% CI for the cross-product term: −0.19, −0.01), and stratified weights showed girls (61.6%) contributed substantially more to the mixture effect compared with boys (38.4%). Overall, Ba contributed the greatest mixture weight (22.5%), followed by Cs (14.9%) and As (14.6%).

Conclusions:

Prenatal exposure to metals was associated with increased infant scores on the temperamental domain of fear, with girls showing particular sensitivity.

Key words: Prenatal; Metals; Mixtures; Temperament; Infancy; Negative affect
Predicting Perinatal Outcomes in Fetuses with Congenital Diaphragmatic Hernia Using Ultrasound and Magnetic Resonance Imaging
Authors: Huang Jun , Liu Hongli , Hu Haiyan , Zhang Li , Cai Ping , Li Yonggang , Li Junnan
Published: April 2021

Congenital diaphragmatic hernia is a congenital fetal disease, which mainly causes pulmonary hypoplasia and pulmonary hypertension. Effective early prenatal diagnosis can detect and predict the prognosis of congenital diaphragmatic hernia in infants, thus provide a reference for prenatal counseling, early intervention, and potential choices for the child's family. Ultrasound and magnetic resonance imaging are the most commonly used methods for non-invasive examination of the fetus. This paper discusses evaluation parameters based on these two imaging modalities.
Attenuated Risk of Pneumonia Due to Inflammation by Frequent Sauna Baths
Authors: Kunutsor Setor K. , Jae Sae Young , Laukkanen Jari A.
Published: April 2021

Purpose:

Inflammatory pathways are involved in the pathogenesis of pneumonia. Frequent sauna sessions may reduce the risk of respiratory tract infections including pneumonia independent of inflammation. We aimed to evaluate the independent and joint associations of high-sensitivity C-reactive protein (hsCRP) and frequency of sauna bathing (FSB) with risk of pneumonia in a prospective cohort study.

Methods:

Serum hsCRP as an inflammatory marker was measured using an immunometric assay and FSB was assessed by self-reported sauna bathing habits at baseline in 2264 men aged 42-61 yr. Serum hsCRP was categorized as normal and high (≤3 and >3 mg/L, respectively) and FSB as low and high (defined as ≤1 and 2-7 sessions/wk, respectively). Multivariable-adjusted HRs (CIs) were calculated for incident pneumonia.

Results:

A total of 528 cases of pneumonia occurred during a median follow-up of 26.6 yr. Comparing high versus normal hsCRP, the multivariable-adjusted risk for pneumonia was HR = 1.30 (95% CI, 1.04-1.62). The corresponding risk was HR = 0.79 (95% CI, 0.66-0.95) comparing high versus low FSB. Compared with men with normal hsCRP and low FSB, high hsCRP and low FSB was associated with an increased risk of pneumonia in multivariable analysis (HR = 1.67: 95% CI, 1.21-2.29), with no evidence of an association for high hsCRP and high FSB and pneumonia (HR = 0.94: 95% CI, 0.69-1.29).

Conclusions:

In a general middle-aged to older male Caucasian population, frequent sauna baths attenuated the increased risk of pneumonia due to inflammation.
A Novel Technique for Donor Insertion and Unfolding in Descemet Membrane Endothelial Keratoplasty
Authors: Fogla Rajesh , Thazethaeveetil Indumathy Ramachandran
Published: April 2021

Purpose:

To describe a novel technique for insertion and unfolding of donor Descemet membrane (DM) scroll during DM endothelial keratoplasty (DMEK).

Methods:

DMEK was performed in 20 eyes. The donor DM scroll was loaded into a glass injector, and the fluid column was manipulated to achieve a double scroll configuration. After performing DM stripping and inferior iridectomy, an anterior chamber (AC) maintainer was placed in position. The glass injector was inserted into the AC and the tip rotated to ensure correct orientation of the DM scroll. After disconnecting the IV tubing from the AC maintainer, the donor DM scroll was delivered into the AC. Donor unfolding was performed using surface tapping techniques. An air bubble was injected under the graft to obtain a complete AC air fill. The outcomes of this surgical technique were analyzed.

Results:

Donor DM insertion and unfolding were performed without any complications in all eyes. Double scroll configuration of donor DM in the injector could be achieved in 17 of 20 eyes (85%). A controlled delivery, maintaining correct scroll orientation, was possible in all eyes. Intraoperative duration from insertion to unfolding was 252.7 ± 45.4 seconds. A clear cornea was achieved in all eyes, with 75% of eyes (15/20) achieving corrected distance visual acuity of 20/20 or better, at average follow-up duration of 13.3 ± 1.3 months. Endothelial cell loss at 6 months follow-up was noted to be 16.7%. Partial donor detachment was noted in 2 eyes (10%), which resolved spontaneously.

Conclusions:

Our novel technique of donor DM insertion allows easy donor insertion and unfolding, thereby simplifying the DMEK procedure.
Visual outcomes and patient satisfaction after implantation of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and multifocal profiles
Authors: Ribeiro Filomena J. , Ferreira Tiago B. , Silva Diana , Matos Ana Cláudia , Gaspar Sylvia
Published: April 2021

Purpose:

To evaluate clinical outcomes delivered by a new hybrid presbyopia-correcting intraocular lens (IOL): TECNIS Synergy ZFR00V IOL model (Johnson & Johnson Vision).

Setting:

Hospital da Luz Lisboa, Lisbon, Portugal.

Design:

Prospective observational study.

Methods:

Patients undergoing bilateral IOL implantation were included. Visual acuity (VA) was measured for far distance, intermediate (66 cm), and near (40 cm) vision under both photopic and mesopic conditions. In addition, at the 3-month follow-up visit, the defocus curve was obtained for binocular vision, and questionnaires were administered to measure spectacle independence and level of satisfaction ( quality of vision and Catquest-SF9) with the surgical outcomes.

Results:

54 eyes of 27 patients were included. At the 3-month follow-up, under photopic conditions, VA values were as follows: corrected distance VA (CDVA) = −0.02 ± 0.07, distance-corrected intermediate VA = 0.03 ± 0.11, and distance-corrected near VA (DCNVA) = 0.00 ± 0.08, whereas under mesopic conditions, VA values were as follows: CDVA = −0.01 ± 0.05 and DCNVA = 0.07 ± 0.09. The binocular defocus curve revealed that mean VA was better than 0.30 logMAR within the +1.00 to −4.00 diopters (D) interval, and better than 0.10 logMAR between +0.50 and −3.00 D. All patients achieved distance vision spectacle freedom, whereas 3.7% of them said they used them in certain intermediate or near vision situations. As much as 88% of the patients reported being fairly satisfied or very satisfied.

Conclusions:

The TECNIS Synergy ZFR00V IOL model used for cataract surgery is capable of restoring visual function while providing very good intermediate and near vision, under both photopic and mesopic conditions, resulting in a high level of patient satisfaction.
Overview of Traumatic Brain Injury in American Football Athletes
Authors: Canseco Jose A. , Franks R. Robert , Karamian Brian A. , Divi Srikanth N. , Reyes Ariana A. , Mao Jennifer Z. , Al Saiegh Fadi , Donnally Chester J. , Schroeder Gregory D. , Harrop James S. , Pepe Matthew D. , Vaccaro Alexander R.
Published: April 2021

Objective:

The aim of this review is to provide a summary of the epidemiology, clinical presentation, pathophysiology, and treatment of traumatic brain injury in collision athletes, particularly those participating in American football.

Data Sources:

A literature search was conducted using the PubMed/MEDLINE and Google Scholar databases for publications between 1990 and 2019. The following search phrases were used: “concussion,” “professional athletes,” “collision athletes,” “mild traumatic brain injury,” “severe traumatic brain injury,” “management of concussion,” “management of severe traumatic brain injury,” and “chronic traumatic encephalopathy.” Publications that did not present epidemiology, clinical presentation, pathophysiology, radiological evaluation, or management were omitted. Classic articles as per senior author recommendations were retrieved through reference review.

Results:

The results of the literature review yielded 147 references: 21 articles discussing epidemiology, 16 discussing clinical presentation, 34 discussing etiology and pathophysiology, 10 discussing radiological evaluation, 34 articles for on-field management, and 32 articles for medical and surgical management.

Conclusion:

Traumatic brain injuries are frequent in professional collision athletes, and more severe injuries can have devastating and lasting consequences. Although sport-related concussions are well studied in professional American football, there is limited literature on the epidemiology and management of severe traumatic brain injuries. This article reviews the epidemiology, as well as the current practices in sideline evaluation, acute management, and surgical treatment of concussions and severe traumatic brain injury in professional collision athletes. Return-to-play decisions should be based on individual patient symptoms and recovery.
A Cross-sectional Study on the Prevalence of Cervical Dysplasia Among Women With Female Genital Mutilation/Cutting
Authors: Martinez Alicia Azuaga , Malinverno Manuela Undurraga , Manin Emily , Petignat Patrick , Abdulcadir Jasmine
Published: April 2021

Objective

The aim of the study was to assess the prevalence of cervical dysplasia among migrant women with female genital mutilation/cutting (FGM/C) at a specialized clinic in Switzerland.

Materials and Methods

This is a descriptive retrospective cross-sectional study. We reviewed the electronic medical records of all women who attended a specialized FGM/C clinic at the Geneva University Hospitals between 2010 and 2016. We examined sociodemographic data, sexually transmitted infections, FGM/C types, Pap smear results, and follow-up in women diagnosed with cervical dysplasia.

Results

Three hundred sixty records were reviewed and 338 women were included. The average age was 33 years (SD = 7.47 years). Most women were from Eritrea and Somalia (n = 204, 60.4%) and had FGM/C type III (n = 188, 55.6%). A total of 12.4% (n = 42) of the patients had abnormal Pap smears: 1.5% (n = 5) with atypical squamous cells of undetermined significance (ASCUS) with high-risk human papillomavirus (HPV), 7.9% (n = 27) with low-grade squamous intraepithelial lesion (LSIL), and 2.9% (n = 10) with high-grade squamous intraepithelial lesion or higher (HSIL +). Of the 37 patients with dysplasia, 22 (59.4%) completed follow-up and 15 (40.5%) received incomplete follow-up.

Conclusions

The prevalence of high-grade squamous intraepithelial lesion+ among migrant women with FGM/C is high (2.95%) compared with the general Swiss population (0.58%). Follow-up for cervical dysplasia must be improved by increasing provider knowledge of this patient population and by addressing barriers to care.
The Natural History of Cervical Intraepithelial Neoplasia Grades 1, 2, and 3: A Systematic Review and Meta-analysis
Authors: Loopik Diede L. , Bentley Heidi A. , Eijgenraam Maria N. , IntHout Joanna , Bekkers Ruud L. M. , Bentley James R.
Published: April 2021

Objective

The aim of the study was to obtain an updated overview of regression, persistence, and progression rates of conservatively managed cervical intraepithelial neoplasia grade 1 (CIN 1)/CIN 2/CIN 3.

Methods

Data sources were MEDLINE, Embase, and Cochrane (January 1, 1973–April 14, 2020). Two reviewers extracted data and assessed risk of bias. To estimate outcome rates, we pooled proportions of the individual study results using random-effects meta-analysis, resulting in point estimates and corresponding 95% CIs. Heterogeneity was quantified by the I
2 and τ2 measures.

Results

Eighty-nine studies were included, 63 studies on CIN 1 (n = 6,080–8,767), 42 on CIN 2 (n = 2,909–3,830), and 7 on CIN 3 (n = 245–351). The overall regression, persistence, and progression to CIN 2 or worse and CIN 3 or worse rates for women with conservatively managed CIN 1 were 60% (95% CI = 55–65, I
2 = 92%), 25% (95% CI = 20–30, I
2 = 94%), 11% (95% CI = 8–13, I
2 = 89%), and 2% (95% CI = 1–3, I
2 = 82%), respectively. The overall regression, persistence, and progression rates for CIN 2 were 55% (95% CI = 50–60, I
2 = 85%), 23% (95% CI = 19–28, I
2 = 83%), and 19% (95% CI = 15–23, I
2 = 88%), respectively. Finally, for CIN 3, these were 28% (95% CI = 17–41, I
2 = 68%), 67% (95% CI = 36–91, I
2 = 84%), and 2% (95% CI = 0–25, I
2 = 95%), respectively. Cervical intraepithelial neoplasia grade 2 regression was significantly higher in women 30 years or younger and high-risk human papillomavirus–negative women (66%, 95% CI = 62–70, I
2 = 76%; 94%, 95% CI = 84–99, I
2 = 60%). Only 2/7,180 (0.03%) and 10/3,037 (0.3%) of the CIN 1 and CIN 2 cases progressed to cervical cancer.

Conclusions

Most CIN 1/CIN 2 will regress spontaneously in less than 24 months, with the highest rates in high-risk human papillomavirus–negative and young women, whereas progression to cancer is less than 0.5%. Conservative management should be considered, especially in fertile women and with expected high compliance. Given the heterogeneity in regression rates of high-grade histology, this should be classified as CIN 2 or CIN 3 to guide management.
Increases in Human Papillomavirus Testing Preceding Diagnosis of Cervical Precancer in 5 US States, 2008–2016
Authors: Cleveland Angela A. , Gargano Julia W. , Griffin Marie R. , Park Ina U. , Niccolai Linda M. , Bennett Nancy M. , Pemmaraju Manideepthi , Fink Deanna , Brackney Monica , Scahill Mary , Ehlers Sara J. , Unger Elizabeth R. , Markowitz Lauri E. ,   the HPV-IMPACT Working Group
Published: April 2021

Objective

The aim of the study was to describe trends in human papillomavirus (HPV) testing preceding diagnosis of cervical precancer during a time of changing screening recommendations.

Materials and Methods

We conducted a cross-sectional analysis of data from active, population-based, laboratory surveillance among 1.5 million residents of 5 areas in the United States. We included women aged 21–39 years diagnosed with cervical intraepithelial neoplasia grades 2, 2/3, or 3 or adenocarcinoma in situ (collectively, CIN2+) during 2008–2016, who had a cytology and/or HPV test before diagnosis (n = 16,359).

Results

The proportion of women with an HPV test preceding CIN2+ increased from 42.9% in 2008 to 73.3% in 2016 (p < .01); testing increased in all age groups (21–24 y: 35.3% to 47.6%, 25–29 y: 40.9% to 64.1%, 30–39 y: 51.7% to 85.9%, all p < .01). The HPV testing varied by cytology result and was highest among women with atypical squamous cells of unknown significance (n = 4,310/4,629, 93.1%), negative for intraepithelial lesion or malignancy (n = 446/517, 86.3%), and atypical glandular cells (n = 145/257, 56.4%). By 2016, at least half of all cases in every surveillance area had an HPV test before diagnosis.

Conclusions

During 2008–2016, the proportion of women with an HPV test preceding CIN2+ increased significantly for all age groups, cytology results, and surveillance areas. By 2016, most (85.9%) women aged 30–39 years had an HPV test, consistent with recommendations. Increasing utilization of HPV tests, which have demonstrated improved sensitivity for detecting cervical disease, may in part explain increasing rates of cervical precancer among women 30 years and older.
Gut microbiota in nonalcoholic fatty liver diseases with and without type-2 diabetes mellitus
Authors: Ebrahimzadeh Leylabadlo Hamed , Samadi Kafil Hossein , Farajnia Safar , Shanehbandi Dariush , Yaghoub Moaddab Seyed , Feizabadi Mohammad Mehdi , Ghotaslou Reza
Published: April 2021

Background and aims

The association between nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) is not very well described but gut microbiota composition is mentioned as a risk factor. The present study aimed to characterize the differences of dominant gut microbiota phyla among people with NAFLD as compared to T2DM and control groups.

Patients and methods

The major bacterial phylum of gut microbiota including Bacteroidetes, Firmicutes, Actinobacteria, Proteobacteria, and total bacteria of 15 NAFLD patients with T2DM, 15 NAFLD patients without T2DM, 15 patients with T2DM, and 20 healthy control subjects were assessed by a quantitative PCR (qPCR).

Results

NAFLD patients with T2DM had significantly higher BMI, triglyceride level, and total cholesterol level were compared with controls (Pv < 0.05). Bacteroidetes and Firmicutes phyla were significantly low in NAFLD patients with T2DM (Firmicutes, 2.55 ± 2.25, Pv 0/0002 and Bacteroidetes, 1.55 ± 2.29, Pv 0/0007), while the content of Proteobacteria and Actinobacteria was high in NAFLD patients with T2DM group and there were no significant differences between phyla with NAFLD patients with T2DM group (Pv > 0.05). Furthermore, Firmicutes copy number was lower in the separate groups of NAFLD and T2DM as compared to the healthy controls (Pv < 0.05).

Conclusions

This study performed gut microbiota for the first time among NAFLD and TDM patients separately and together. This investigation indicated that NAFLD patients with T2DM have a different gut composition in comparison to NAFLD, T2DM alone, which could be associated with disease development.
Gastrointestinal endoscopy can be safely performed during pandemic SARS-CoV-2 infection in Central Italy
Authors: Dilaghi Emanuele , Marcolongo Adriano , Anibaldi Paolo , Simmaco Maurizio , Prestigiacomo Claudio , Angeletti Stefano , Corleto Vito D. , D’Ambra Giancarlo , Ruggeri Maurizio , Di Giulio Emilio , Annibale Bruno , Lahner Edith
Published: April 2021

Objectives

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly contagious; gastrointestinal endoscopies are considered risky procedures for the endoscopy staff. Data on the SARS-CoV-2-exposure/infection rate of gastrointestinal endoscopy staff is scarce. This study aimed to assess the SARS-CoV-2-exposure/infection rate among gastrointestinal endoscopists/nurses performing gastrointestinal endoscopies before and after the adoption of specific prevention measures.

Patients and methods

Cross-sectional study in a teaching hospital (Rome, Central Italy) on retrospective data (9 March–15 April 2020) of consecutive gastrointestinal endoscopies, characteristics of procedures, patients and endoscopy staff, SARS-CoV-2-exposure/positivity of patients and staff before and after adoption of prevention measures. Exposed staff tested for SARS-CoV-2 by nasopharyngeal swabs(RNA-PCR) and serology.

Results

A total of 130 gastrointestinal endoscopies were performed in 130 patients (age 66 ± 14 years, 51% women, 51% inpatients, 56.9% lower). A total of 12 (9.2%) patients were SARS-CoV-2-positive and 14(10.8%) had a high risk of potential infection. Of the endoscopy staff (n = 16, 5 endoscopists, 8 nurses and 3 residents), 14 (87.5%) were exposed to SARS-CoV-2-infected and 16 (100%) to potentially infected patients. 3/5 and 5/5 endoscopists were exposed to actual and potential, 1/3 and 3/3 residents to actual and potential and 8/8 nurses to actual and potential infection, respectively. None of the staff was found to be infected with SARS-CoV-2. None experienced fever or any other suspicious symptoms of coronavirus disease 2019. Before the adoption of prevention measures, more endoscopists/nurses were in the endoscopy room than after (3.5 ± 0.6 vs. 2.1 ± 0.3, P < 0.0001).

Conclusions

Despite supposed high infection risk, gastrointestinal endoscopies may be safe for the endoscopy staff during the SARS-CoV-2 pandemic.
Patterns of Mental Health Care Before Initiation of Telemental Health Services
Authors: McDowell Alex , Huskamp Haiden A. , Busch Alisa B. , Mehrotra Ateev , Rose Sherri
Published: April 2021

Background:

Use of telemental health has increased among rural Medicare beneficiaries, particularly among individuals with serious mental illness (SMI). Little is known about what leads to the initiation of telemental health.

Objective:

To categorize the different patterns of mental health care use before initiation of telemental health services among individuals with SMI.

Methods:

A cohort of rural beneficiaries with SMI (defined as schizophrenia/related psychotic disorders or bipolar disorder) with an index telemental health visit in 2010–2017 was built using claims for a 20% random sample of fee-for-service Medicare beneficiaries. The authors used latent class analysis to identify classes of mental health care use in the 6 months before the index telemental health visits. Across the classes, the authors also described characteristics of index and subsequent mental health visits.

Results:

The cohort included 4930 rural Medicare beneficiaries with SMI. Three classes of mental health care use before initiation of telemental health were identified. The largest class (n=3066) had minimal use of primary care provider mental health care and the second largest class (n=1537) had minimal specialty mental health care. The smallest class (n=327) was characterized by recent hospitalization or emergency department care. In the overall cohort, index visits were frequently established visits and were often with specialty prescribers.

Conclusions:

Our findings highlight 3 distinct patterns of care before telemental health initiation, providing insight into the role that telemedicine may play in mental health care for rural Medicare beneficiaries with SMI. Overall, telemental health was most often used to maintain care with existing providers.
The prediction of spread through air spaces with preoperative 18F-FDG PET/CT in cases with primary lung adenocarcinoma, its effect on the decision for an adjuvant treatment and its prognostic role
Authors: Falay Okan , Selçukbiricik Fatih , Tanju Serhan , Erus Suat , Kapdağli Murat , Cesur Ezgi , Yavuz Ömer , Bulutay Pinar , Firat Pinar , Mandel Nil Molinas , Dilege Şükrü
Published: April 2021

Purpose

In lung adenocarcinoma cases, ‘spread through air spaces’ (STAS) is a new indicator of invasion and directly related to disease survival. The aim of our study is to establish whether a preoperatively performed 18F-Fluorodeoxyglucose (FDG) PET/computed tomography (CT) imaging data can predict the presence of STAS in cases with lung adenocarcinoma and thus predict the decision for the type of surgery and adjuvant chemotherapy.

Materials and methods

Between 2000 and 2019, we retrospectively analyzed 63 patients with lung adenocarcinoma cases that had undergone lobectomy or pneumonectomy. Semiquantitative parameters were calculated and metabolic tumor volume (MTV)/CT volume (CTV) ratio was recorded from FDG PET/CT data. The pathological samples from these patients were evaluated for STAS. All these values were evaluated for their correlation with the alveolar spread.

Results

There was no statistically significant correlation to be found between CTV, MTV, total lesion glycolysis (TLG), standardized uptake value (SUV)max, SUVmean and STAS (P > 0.05). However, MTV/CTV ratio above 1 had statistically more alveolar spread. In the group with an MTV ratio above 1, STAS positivity was 27 (75%), and 9 (25%) did not have STAS, whereas these were 6 (22.2%) patients who had STAS, and 21 (77.8%) did not have STAS in the group with below 1 (P < 0.001).

Conclusions

In the preoperative PET study inoperable lung adenocarcinoma cases, MTV/CTV ratio higher than 1 was found to predict STAS positivity. As a result, it was found that it provided significant clinical additional information regarding the need for a surgical approach (lobar resection instead of sublobar) and adjuvant chemotherapy.
Addressing long-acting reversible contraception access, bias, and coercion: supporting adolescent and young adult reproductive autonomy
Authors: Bryson Amanda , Koyama Atsuko , Hassan Areej
Published: April 2021

Purpose of review

Long-acting reversible contraception (LARC) is comprised of highly effective methods (the subdermal implant and intrauterine devices) available to adolescents and young adults (AYAs). Professional medical societies endorse LARC use in AYAs and, more recently, have emphasized the importance of using a reproductive justice framework when providing LARC. This article reviews reproductive justice, discusses contraceptive coercion, examines bias, and highlights interventions that promote equitable reproductive healthcare.

Recent findings

Research indicates that both bias and patient characteristics influence provider LARC practices. AYA access to comprehensive LARC services is limited, as counseling, provision, management, and removal are not offered at all sites providing reproductive healthcare to AYAs. Interventions aimed at addressing provider bias and knowledge, clinic policies, confidentiality concerns, insurance reimbursement, and systems of oppression can improve AYA access to equitable, comprehensive contraceptive care. Additionally, the COVID-19 pandemic has exacerbated inequities in reproductive healthcare, as well as provided unique innovations to decrease barriers, including telemedicine LARC services.

Clinicians who care for AYAs should honor reproductive autonomy by approaching contraceptive services with a reproductive justice lens. This includes implementing patient-centered contraceptive counseling, increasing access to LARC, eliminating barriers to LARC removal, and committing to systemic changes to address healthcare inequities.
Primary graft dysfunction
Authors: Criner Rachel N. , Clausen Emily , Cantu Edward
Published: April 2021

Purpose of review

Primary graft dysfunction (PGD) is a devastating complication in the acute postoperative lung transplant period, associated with high short-term mortality and chronic rejection. We review its definition, pathophysiology, risk factors, prevention, treatment strategies, and future research directions.

Recent findings

New analyses suggest donation after circulatory death and donation after brain death donors have similar PGD rates, whereas donors >55 years are not associated with increased PGD risk. Recipient pretransplant diastolic dysfunction and overweight or obese recipients with predominant abdominal subcutaneous adipose tissue have increased PGD risk. Newly identified recipient biomarkers and donor and recipient genes increase PGD risk, but their clinical utility remains unclear. Mixed data still exists regarding cold ischemic time and PGD risk, and increased PGD risk with cardiopulmonary bypass remains confounded by transfusions. Portable ex vivo lung perfusion (EVLP) may prevent PGD, but its use is limited to a handful of centers. Although updates to current PGD treatment are lacking, future therapies are promising with targeted therapy and the use of EVLP to pharmacologically recondition donor lungs.

There is significant progress in defining PGD and identifying its several risk factors, but effective prevention and treatment strategies are needed.