bluuebunny/crossref_metadata_2025 huggingface dataset:
Learning NOTSS While Tying Knots: Integrating the Nontechnical Skills for Surgeons Course With Technical Surgical Skills Training, A Mixed Methods Study
Authors: Abahuje Egide , Bartuska Andrew , Dias Roger D. , Muneza Eugène , Sibomana Isaie , Williams Wendy , Koch Rachel , Robertson Jamie M. , Ntakiyiruta George , Evans Faye , Riviello Robert , Yule Steven
Published: February 2022

Objective:

The aims of this study were to describe the process of integrating 2 established training programs, Nontechnical skills for surgeons, and a traditional essential surgical skills course and to measure the impact of this integrated course on the behaviors of interprofessional surgical teams in Rwandan district hospitals.

Background:

Surgical errors and resulting adverse events are due to variability in both technical and nontechnical surgical skills. Providing technical and nontechnical skills training to the perioperative team may enhance the learning of both of these skills and promote safe intraoperative patient care.

Methods:

A quality improvement framework guided the process of integrating essential surgical skills and nontechnical skills into a single training program for surgical teams. The resulting 2-day training program was delivered to 68-person teams from 17 hospitals. Nontechnical skills for surgeons was taught through didactics and in the operating room, where preoperative briefing, intraoperative interactions, and postoperative debriefing were used as essential and nontechnical skills teaching moments. Postcourse surveys, follow-up interviews, focus groups, and direct observation of participants in the operating room were conducted to assess how participants implemented the knowledge and skills from the training into practice.

Results:

Ninety-seven percent of the participants reported that they were satisfied with the course. Follow-up participant interviews and focus groups reported that the course helped them to improve their preoperative planning, intraoperative communication, decision-making, and postoperative debriefing.

Conclusions:

It is possible to implement an integrated essential surgical skills and nontechnical skills training course. Integrating nontechnical skills into essential surgical skills courses may enhance learning of these skills.
A Prospective, 3-year Longitudinal Study of Modic Changes of the Lumbar Spine in a Population-based Cohort
Authors: Tamai Hidenobu , Teraguchi Masatoshi , Hashizume Hiroshi , Oka Hiroyuki , Cheung Jason P.Y. , Samartzis Dino , Muraki Shigeyuki , Akune Toru , Kawaguchi Hiroshi , Nakamura Kozo , Tanaka Sakae , Yoshida Munehito , Yoshimura Noriko , Yamada Hiroshi
Published: February 2022

Study Design.

Large-scale, prospective, population-based, longitudinal observational study.

Objective.

The aim of this study was to investigate the rate of incidence, transformation, and reverse transformation of Modic changes (MCs) using T1-weighted (T1W) and T2-weighted (T2W) lumbar magnetic resonance images (MRI) over a 3-year period.

Summary of Background Data.

Although MCs in populational study are considered significant, existing epidemiological evidence is based on cross-sectional studies only.

Methods.

Overall, 678 subjects (208 men, 470 women, mean age 62.1 ± 12.8 years in 2013) in both 2013 and 2016 surveys were included. The rate of change in Modic Type I (T1W: low-intensity, T2W: high-intensity), Type II (T1W: high, T2W: high), and Type III (T1W: low, T2W: low) at five endplates was analyzed over a 3-year period. An incidence of MC at each level and in the lumbar region was defined as no MC at baseline with signal changes at follow-up. Transformation was defined as Type I or II MC at baseline with conversion at follow-up Type II from Type I or Type III MC from Type I and II. Furthermore, reverse transformation was defined as Type I, II, or III MC at baseline, with at least one endplate showing a reversion in Modic type (no MC for baseline Type I; no MC and Type I for baseline Type II; no MC, Type I or Type II for baseline Type III) at follow-up.

Results.

Overall, 3390 endplates were included. For 3 years, the incidence, transformation, and reverse transformation of MCs were seen in 395 (11.7%), 84 (2.5%), and 11 (0.3%) endplates, respectively. The highest levels of incidence, transformation, and reverse transformation were at L2/3 (96 [14.2%] endplates), L5/S1 (32 [4.7%] endplates), and L2/3 (5 [0.7%] endplates), respectively.

Conclusion.

This study revealed a high incidence of MCs at the upper lumbar levels and transformation at the lower lumbar levels. Reverse transformation of MCs occurs but are rare.

Level of Evidence: 2
Hemostatic Management in Extracorporeal Membrane Oxygenation
Authors: Brokmeier Hannah M. , Wieruszewski Erin D. , Nei Scott D. , Loftsgard Theodore O. , Wieruszewski Patrick M.
Published: February 2022

The use of extracorporeal membrane oxygenation (ECMO) for acute cardiac and/or respiratory failure has grown exponentially in the past several decades. Systemic anticoagulation is a fundamental element of caring for ECMO patients. Hemostatic management during ECMO walks a fine line to balance the risk of safe and effective anticoagulant delivery to mitigate thromboembolic complications and minimizing hemorrhagic sequelae. This review discusses the pharmacology, monitoring parameters, and special considerations for anticoagulation in patients requiring ECMO.
Identifying Sensitive Windows of Exposure to NO2 and Fetal Growth Trajectories in a Spanish Birth Cohort
Authors: Whitworth Kristina W. , Rector Alison , Ish Jennifer , Chauhan Suneet P. J. , Ibarluzea Jesús , Guxens Mònica , Swartz Michael D. , Symanski Elaine , Iñiguez Carmen
Published: February 2022

Background:

We previously identified associations between trimester-specific NO2 exposures and reduced fetal growth in the Spanish INfancia y Medio Ambiente (INMA) project. Here, we use temporally refined exposure estimates to explore the impact of narrow (weekly) windows of exposure on fetal growth.

Methods:

We included 1,685 women from INMA with serial ultrasounds at 12, 20, and 34 gestational weeks. We measured biparietal diameter (BPD), femur length, and abdominal circumference (AC) and from them calculated estimated fetal weight (EFW). We calculated z-scores describing trajectories of each parameter during early (0–12 weeks), mid (12–20 weeks), and late (20–34 weeks) pregnancy, based on longitudinal growth curves from mixed-effects models. We estimated weekly NO2 exposures at each woman’s residence using land-use regression models. We applied distributed lag nonlinear models to identify sensitive windows of exposure. We present effect estimates as the percentage change in fetal growth per 10 μg/m3 increase in NO2 exposure, and we calculated cumulative effect estimates by aggregating estimates across adjacent lags.

Results:

We identified weeks 5–12 as a sensitive window for NO2 exposure on late EFW (cumulative β = −3.0%; 95% CI = −4.1%, −1.9%). We identified weeks 6–19 as a sensitive window for late growth in BPD (cumulative β = −2.0%; 95% CI = −2.7%, −1.4%) and weeks 8–13 for AC (cumulative β = −0.68%; 95% CI = −0.97%, −0.40%). We found suggestive evidence that third trimester NO2 exposure is associated with increased AC, BPD, and EFW growth in late pregnancy.

Conclusions:

Our findings are consistent with the hypothesis that NO2 exposure is associated with alterations in growth of EFW, BPD, and AC dependent on the specific timing of exposure during gestation.
A Prospective Cohort Study of Seasonal Variation in Spontaneous Abortion
Authors: Wesselink Amelia K. , Wise Lauren A. , Hatch Elizabeth E. , Mikkelsen Ellen M. , Savitz David A. , Kirwa Kipruto , Rothman Kenneth J.
Published: February 2022

Background:

Up to 30% of pregnancies end in spontaneous abortion, yet few risk factors have been identified. Examining seasonal patterns in risk of spontaneous abortion can generate new hypotheses regarding environmental and lifestyle determinants.

Methods:

We used data from Pregnancy Study Online—a preconception cohort study of pregnancy planners from the United States and Canada—to examine seasonal variation in spontaneous abortion risk. We enrolled 12,197 women during 2013 to 2020, 6104 of whom reported a conception within 12 months of enrollment. On follow-up questionnaires, participants reported date of spontaneous abortion and weeks gestation at time of loss. We used periodic regression to estimate two aspects of seasonal occurrence: peak/low ratio—a measure of intensity of seasonal variation—and peak timing. We examined season at risk (from the date of each gestational week) in relation to spontaneous abortion; in a secondary analysis, we examined season of conception in relation to spontaneous abortion. We controlled for seasonal patterns in attempt initiation via month the pregnancy attempt began.

Results:

Almost 20% of women experienced spontaneous abortion. Risk was highest in late August, with a peak/low ratio of 1.3 (95% confidence interval [CI] = 1.1, 1.6). This seasonal pattern was evident almost exclusively for spontaneous abortion at <8 weeks since the last menstrual period date (peak/low ratio = 1.4; 95% CI = 1.2, 1.8), and associations were stronger among women living in the Southern and Midwestern United States.

Conclusions:

Environmental or lifestyle factors more prevalent in late summer may be associated with increased risk of early spontaneous abortion.
Impact of Social Disparities on Cardiovascular Disease and COVID-19 Outcomes
Authors: Khemraj Ryan R. , Solano Cristian , Patel Neesirg M. , Franklin Barry A.
Published: February 2022

The COVID-19 pandemic has exposed significant disparities within certain population subsets that manifest through greater disease burden and worse outcomes. In this commentary, we propose specific preventive interventions to address these disparities within the United States.
PHOTODYNAMIC THERAPY FOR THE TREATMENT OF CHOROIDAL METASTASES
Authors: Nguyen Minh T. , Stacey Andrew W.
Published: February 2022

Purpose:

To investigate the efficacy and safety of photodynamic therapy (PDT) in the treatment of choroidal metastasis.

Methods:

We conducted a systematic review of all reported cases of choroidal metastases treated with PDT in literature, and included the cases from our institution, for a comprehensive meta-analysis.

Results:

We identified 52 tumors in 40 eyes of 34 patients. The mean age was 60 years (range 28–77). The mean tumor thickness was 1.9 mm (range 0–4.8 mm), whereas the mean largest basal diameter was 8.2 mm (range 1.5–30 mm) on presentation. After an average of 1.4 treatment visit, PDT resulted in decreased tumor thickness (mean 1.9 mm before vs. 1.0 mm after PDT, P < 0.0001) and decreased central macular thickness (mean 454 µm before vs. 289 µm after PDT, P = 0.03). After PDT, 82% of tumors had reduced thickness, and subretinal fluid resolved in 75% of eyes. Photodynamic therapy also resulted in stable or improved vision in 78% of treated eyes (logMAR 0.50 before vs. 0.56 after PDT, P = 0.54). No adverse events were reported, and PDT was effective in treating the most common choroidal metastases (tumor control rate of 94% in 16 lung adenocarcinoma and 92% in 26 breast carcinoma metastasis cases).

Conclusion:

Photodynamic therapy is effective at controlling tumors and preserving vision in patients with some choroidal metastases. Because of its minimal time commitment and good safety profile, PDT should be considered as a potential first-line treatment for small choroidal metastases.
A COMMON FINDING IN FOVEAL-SPARING EXTENSIVE MACULAR ATROPHY WITH PSEUDODRUSEN IMPLICATES BASAL LAMINAR DEPOSITS
Authors: Fragiotta Serena , Parravano Mariacristina , Sacconi Riccardo , Costanzo Eliana , Viggiano Pasquale , Prascina Francesco , Capuano Vittorio , Souied Eric H. , Querques Giuseppe
Published: February 2022

Purpose:

To characterize structural and clinical alterations preceding the diffuse macular atrophy in extensive macular atrophy with pseudodrusen (EMAP) and their evolution toward atrophic changes.

Methods:

A retrospective chart review was performed of patients with early-onset reticular pseudodrusen (i.e., pre-EMAP) younger than 55 years and EMAP with foveal sparing. Patients were included if they had complete medical records and multimodal imaging.

Results:

A total of 12 patients were reviewed, of whom 4 of 12 patients (7 eyes) presented a pre-EMAP stage, characterized by the presence of pseudodrusen-like deposits without atrophic changes, while the remaining 8 of 12 patients (10 eyes) exhibited EMAP with foveal sparing (60.1 ± 6.4 years). Subretinal deposits of various stages tended to fade, leaving subretinal pigment epithelium accumulation of hyperreflective material with a physical separation between the retinal pigment epithelium–basal lamina and the Bruch membrane, along with the persistence of hyperreflective material after retinal pigment epithelium loss. These findings preceded atrophy development in a pre-EMAP stage and the EMAP stage with foveal sparing.

Conclusion:

Our findings presented distinct multimodal imaging features in eyes with reticular pseudodrusen depicting a peculiar phenotype of rapidly progressing atrophy in midlife. The disease spectrum may include other forms of geographic atrophy allied by thickened basal laminar deposits.
The Impact of Electronic Handoff Tool on Sign-Out Practices in an Internal Medicine Residency Program
Authors: Huang Yuting , Alkhalfan Fahad , Kim Harim , Alzedaneen Yazan , Haleem Zarah , Zhou Meng , Sood Aseem , Chow Robert D.
Published: February 2022

High-quality and efficient sign-outs are essential to ensure patient safety. To evaluate the impact of a new handoff tool by objective measures of handoff quality and residents’ subjective experiences. Internal medicine residents working on a medical ward service completed a handoff clinical evaluation exercise (CEX) questionnaire and an anonymous survey on handoff quality and experiences prior to implementing a new handoff tool and at 2 and 6 weeks after implementation. CEX scores significantly improved from 5.3 ± 1.1 to 6.9 ± 0.7 in 6 weeks (P< 0.05). Residents reported that they were contacted less frequently after work, information needed by the receiving resident was more often found in the sign-out, and that tasks signed out to the oncoming team were more often executed. Before implementing the new handoff tool, 87% of residents reported that they were contacted after work hours 1–2 times per week with questions, while 75% of participants reported that they were almost never contacted after work hours after the new tool was implemented. A standardized handoff tool that utilizes smart phrases to provide residents with templates for sign-out significantly improved the quality and experience of sign-out in a short time period.
Electro-acupuncture for post-stroke cognitive impairment
Authors: Xie Guanli , Tang Xiaoxia , Luo Wen , Xu Yanfei , Li Deguang , Wang Zhe , Yuan Changfei , Xia Yibo , Zhou Xiaohan , Tian Miao , Yuan Zhifa , Wang Tao , Liao Jianglong
Published: February 2022

Background:

A considerable number of stroke survivors suffered from cognitive impairment, and more than one third of stroke survivors are affected at 3 and 12 months after the stroke. Although the published systematic reviews suggest that acupuncture can help improve post-stroke cognitive dysfunction, the power of the results is low due to study limitations. Therefore, this review is necessary to analyze the effect of acupuncture on cognitive impairment after stroke and to provide evidence for cognitive impairment in stroke.

Methods:

This study will be carried out in strict accordance with the Cochrane Handbook for Systematic Reviews of Interventions. According to the pre-established search strategy (PICOS framework), all the literature will be obtained from online databases including Cochrane Central Register of Controlled Trials in the Cochrane Library, Medline (via PubMed), EMBASE (via embase.com), CINAHL (via EBSCOhost), China National Knowledge Infrastructure database, WanFang Database, Chinese Science and Technology Periodical Database, and Sino-Med Database from inception until December 31, 2021 with no language limitations. Two reviewers will screen the records and include quality studies according to inclusion criteria independently. The data needed will be extracted independently by 2 authors according to a table of data extraction. Any inconsistencies in literature screening and data collection will be resolved to reach a consensus via discussion with a third author. Risk of bias for each study will be assessed using risk of bias tool. RevMan5.3 will be used to analyze the data. Heterogeneity will be identified and measured by Chi2. Subgroup analyses and sensitivity analysis will be carried out. Grading of Recommendations Assessment, Development and Evaluation will be used to evaluate the evidence for each outcome.

Conclusion:

The results of this study will provide a theoretical basis for the clinical use of electro-acupuncture to treat cognitive dysfunction after stroke.

Unique INPLASY number:

INPLASY202210038
A case report of intracardiac bone cement embolization after posterior decompression and cement-enhanced pedicle screw fixation for osteoporosis and lumbar degeneration
Authors: Sun Kui , Huang Fuli , Liang Biru
Published: February 2022

Rationale:

Bone cement leakage is a common complication of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) surgery and has also been reported in posterior decompression and cement-enhanced pedicle screw fixation. When bone cement leaks through the venous system, it will have serious consequences and even endanger the life of the patient, especially when the bone cement causes intracardiac embolism.

Patient concerns:

A 70-year-old woman developed chest tightness and decreased blood oxygen saturation following posterior decompression and cement-enhanced pedicle screw fixation.

Diagnosis:

After the patient was given symptomatic treatment, the symptoms were not relieved, the high-sensitivity troponin I level continued to rise, the electrocardiogram results were abnormal, and chest computed tomography (CT) revealed multiple flaky and strip-shaped dense shadows in the heart.

Intervention:

The patient underwent removal of foreign bodies from the heart under cardiopulmonary bypass and tricuspid valvuloplasty, removal of intracardiac bone cement, and repair of the tricuspid valve and chordae.

Outcome:

The patient recovered well postoperatively and was discharged from the hospital after 3 weeks. There were no intracardiac foreign bodies observed on chest CT after the operation.

Lessons:

For patients with cardiopulmonary discomfort after posterior decompression and bone cement-enhanced pedicle screw fixation, in view of the limitations of radiographic examination, we recommend performing chest CT examination to confirm the diagnosis. For patients with intravascular foreign body embolism, multidisciplinary team joint treatment saves lives.
Incidental adenocarcinoma of the gallbladder in a patient with Y insertion gallbladder duplication in the context of recurrent biliary colic
Authors: Jefferys Dustin , Roy Susmit , Majid Adeeb
Published: February 2022

Rationale:

Gallbladder cancer is the most common malignancy of the biliary tree. Despite this, the only curative therapy remains surgical resection of the lesion achieving microscopically clear margins before malignant spread has occurred. Gallbladder duplication is an uncommon anatomical variance which occurs globally. It can present in a range of ways dependent on the embryological origin of the variance.

Case:

A 52-year-old female presented for planned laparoscopic cholecystectomy in the context of cholelithiasis resulting in recurrent biliary colic. The patient had no personal history of malignancy or significant medical comorbidities.

Diagnosis:

Intraoperatively, the patient was found to have Y-insertion variation of gallbladder duplication. Histopathology of the resected gallbladders showed an incidental invasive gallbladder adenocarcinoma affecting one of the gallbladders.

Intervention:

Both gallbladders were laparoscopically resected en-bloc.

Outcomes:

The patient underwent oncology staging, which found no evidence of metastatic spread. Regular surveillance is attended with no recurrence of disease identified.

Conclusion:

There are few reported cases detailing the occurrence of gallbladder adenocarcinoma in the presence of duplication of the gallbladder. This case demonstrates the clinical benefit of R0 surgical resection of gallbladder cancer, whilst highlighting the difficulties of diagnosing duplication of the gallbladder or gallbladder adenocarcinoma.
Acupuncturing of myofascial pain trigger points for the treatment of knee osteoarthritis
Authors: Lin Xingzhen , Li Fei , Lu Hualong , Zhu Manhua , Peng Tian Zhong
Published: February 2022

Background:

Osteoarthritis of the knee is one of the major disorders leading to social dysfunction, economic loss and social development. This study was conducted to systematically evaluate the efficacy and safety effectiveness of acupuncture inactivation of myofascial pain trigger points in the treatment of osteoarthritis of the knee.

Methods:

Randomized Controlled Trials (RCTs) on the treatment of knee pain were searched by computer from PubMed, The Cochrane Library, China journal full-text database (CNKI), Chinese biomedical literature database (CBM), China academic journal database (Wanfang Data) databases from the date of creation to December 2021, and the data were analyzed by Reman 5.3 software for data analysis.

Results:

A total of 724 patients from 9 RCTs were finally included, and the results of meta-analysis showed that the acupuncture myofascial pain trigger point group was better than the control group in terms of total effective rate, cure rate, VAS score, Lysholm score, and WOMAC score.

Conclusion:

The efficacy and safety of acupuncturing myofascial pain trigger points in the treatment of knee osteoarthritis is positive, but due to the limited number of literature included in this study and the low quality of the included literature, there is still a need for high-quality and large sample size RCTs for the analysis of this treatment option.
The effect of music therapy on the anxiety, depression and sleep quality in intensive care unit patients
Authors: Li Dan , Yao Yunhua , Chen Jia , Xiong Gang
Published: February 2022

Background:

Music therapy serves as a non-pharmacological intervention for a variety of disorders with promising results. However, the effect of music therapy on improving anxiety, depression, and sleep quality in intensive care unit (ICU) patients remains unclear. This meta-analysis aims to evaluate the effect of music therapy on improving anxiety, depression, and sleep quality in ICU patients, thus providing evidences to support music therapy as a novel complementary alternative therapy.

Methods:

Randomized controlled trials (RCTs) reporting the efficacy of music therapy on improving anxiety, depression and sleep quality in ICU patients published before January 2022 will be searched in online databases, including the PubMed, the Cochrane Library, Web of Science, Embase, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Database, and WanFang Database. Literature screening, data extraction, and evaluation of risk of bias will be independently performed by two investigators. Meta-analysis will be performed using Stata 14.0 software.

Results:

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusion:

This study will provide reliable evidence-based evidence for the effect of music therapy on anxiety, depression, and sleep quality in ICU patients.

Ethics and dissemination:

Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms.

OSF Registration number:

DOI 10.17605/OSF.IO/EXAZ6.
Efficacy of levetiracetam in the treatment of pediatric epilepsy
Authors: Pang Qiming , Li Bangtao , Zhang Suli , Li Jiaoyang , Gu Shuo
Published: February 2022

Background:

To systematically collect, critically evaluate, and synthesize current evidence with respect to the efficacy, safety, and tolerability of levetiracetam as mono- or adjunctive therapy for children and adolescents with all types of epilepsy.

Methods:

The presentation of methods and results in this systematic review was performed according to the evaluation guidelines for health care interventions provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. Literature retrieval will use the Cochrane Library, Web of Science, PubMed, Embase, Allied and Complementary Medicine Database, China Biomedical Literature Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and Ongoing Clinical Trials 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. Data synthesis and analyses are performed using RevMan 5.4 software.

Results:

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

Conclusion:

Levetiracetam seems to be effective and safe for the treatment of pediatric epilepsy.
Effect of platelet-rich plasma injections for chronic nonspecific low back pain
Authors: Won Sun Jae , Kim Da-ye , Kim Jae Min
Published: February 2022

Background:

Patient with chronic nonspecific low back pain is weakened ligament, and prolotherapy is the effective treatment but their use remains controversial. These ligaments can be strengthened by platelet-rich plasma injection. We hypothesized that the effectiveness of platelet-rich plasma injection and prolotherapy may decrease pain and improved disability of patient with chronic low back pain

Methods:

This study was a prospective, double-blind, randomized controlled trial and was conducted for 3 years for patient enroll and follow-up. Thirty-four patients with chronic nonspecific low back pain (duration of at least 3 months) refectory to conventional management were randomized to platelet-rich plasma injection and lidocaine injection. Patients were treated with weekly platelet-rich plasma or lidocaine injections at the lumbopelvic ligaments for 2 weeks and then weekly prolotherapy with 15% glucose for 2 weeks and followed up 6 months. Visual analog scale, Oswestry Disability Index, and Roland–Morris Disability Questionnaire were evaluated at initial, 4 weeks, 3 months, and 6 months. Four patients did not complete this trial. Three were in the platelet-rich plasma injection and 1 was in the lidocaine injection.

Results:

The intensity of pain was significantly decreased in platelet-rich plasma injections at 6 months as compared lidocaine injections; between-group differences were 0.9 (95% confidence interval 0.10–1.75 [P = .027]). All participants were significantly decreased pain and disability index at 4 weeks, 3 months, and 6 months but there were no significant differences between groups except for visual analog scale at 6 months. The baseline parameters were no significant differences in both groups.

Conclusions:

In chronic nonspecific low back pain, the platelet-rich plasma injection in combination with prolotherapy is an effective intervention and either lidocaine or platelet-rich plasma injection significantly reduced disability. And injection at the lumbopelvic ligaments using the platelet-rich plasma and prolotherapy is also an effective treatment for pain.
Demographic and Clinical Factors Related to Severe COVID-19 Infection and Mortality in Patients With Schizophrenia
Authors: Ekinci Okan , Erkan Ekinci Asli
Published: February 2022

We aimed to explore the prevalence and determinants of severe COVID-19 disease and mortality in patients with schizophrenia in this study. We conducted a retrospective observational study of 1620 patients with schizophrenia. Of the 1620 patients, 52 (3.2%) tested positive for SARS-CoV-19. Among SARS-CoV-2–positive patients, 40 patients were hospitalized, and 17 patients required intensive care unit admission due to COVID-19 (76.9% and 32.7%, respectively). Severe COVID-19 disease was noted in 17 patients (32.7%) requiring intubation. In the logistic regression analysis, antipsychotic dose, and comorbidity score were independently associated with a greater risk of severe COVID-19 disease in patients with schizophrenia. Our study suggests that factors such as age, sex, comorbidities, and a daily antipsychotic dose may have effects on the poor outcome of SARS-CoV-2 disease in schizophrenia patients. In addition, the current findings propose that mortality may be associated with an older age, comorbidity score, and a longer duration of psychiatric disease among the SARS-CoV-2–positive patients with schizophrenia. However, the findings of our study should be verified in prospective and larger sample studies.
Effect of Combining 0.01% Atropine with Soft Multifocal Contact Lenses on Myopia Progression in Children
Authors: Jones Jenny Huang , Mutti Donald O. , Jones-Jordan Lisa A. , Walline Jeffrey J.
Published: February 2022

SIGNIFICANCE

Combining 0.01% atropine with soft multifocal contact lenses (SMCLs) failed to demonstrate better myopia control than SMCLs alone.

PURPOSE

The Bifocal & Atropine in Myopia (BAM) Study investigated whether combining 0.01% atropine and SMCLs with +2.50-D add power leads to greater slowing of myopia progression and axial elongation than SMCLs alone.

METHODS

Participants of the BAM Study wore SMCLs with +2.50-D add power daily and administered 0.01% atropine eye drops nightly (n = 46). The BAM subjects (bifocal-atropine) were age-matched to 46 participants in the Bifocal Lenses in Nearsighted Kids Study who wore SMCLs with +2.50-D add power (bifocal) and 46 Bifocal Lenses in Nearsighted Kids participants who wore single-vision contact lenses (single vision). The primary outcome was the 3-year change in spherical equivalent refractive error determined by cycloplegic autorefraction, and the 3-year change in axial elongation was also evaluated.

RESULTS

Of the total 138 subjects, the mean ± standard deviation age was 10.1 ± 1.2 years, and the mean ± standard deviation spherical equivalent was −2.28 ± 0.89 D. The 3-year adjusted mean myopia progression was −0.52 D for bifocal-atropine, −0.55 D for bifocal, and −1.09 D for single vision. The difference in myopia progression was 0.03 D (95% confidence interval [CI], −0.14 to 0.21 D) for bifocal-atropine versus bifocal and 0.57 D (95% CI, 0.38 to 0.77 D) for bifocal-atropine versus single vision. The 3-year adjusted axial elongation was 0.31 mm for bifocal-atropine, 0.39 mm for bifocal, and 0.68 mm for single vision. The difference in axial elongation was −0.08 mm (95% CI, −0.16 to 0.002 mm) for bifocal-atropine versus bifocal and −0.37 mm (95% CI, −0.46 to −0.28 mm) for bifocal-atropine versus single vision.

CONCLUSIONS

Adding 0.01% atropine to SMCLs with +2.50-D add power failed to demonstrate better myopia control than SMCLs alone.
Comparison of Epithelial Thickness Mapping in Normal Corneas with Different Types of Astigmatism
Authors: Sedaghat Mohammad-Reza , Momeni-Moghaddam Hamed , Azimi Abbas , Saadati Omolbanin , Reinstein Dan Z. , Vida Ryan S.
Published: February 2022

SIGNIFICANCE

Corneal epithelial thickness mapping has a wide range of applications including screening for keratoconus, screening for anterior basement membrane dystrophy, and assessment of dry eye. It also plays an important role in corneal laser refractive surgery. These all require an understanding of the epithelial thickness profile in a normal cornea as a reference.

PURPOSE

This study aimed to compare corneal epithelial thickness along different meridians in normal eyes with different types of corneal astigmatism.

METHODS

In this cross-sectional study, corneal topography and epithelial thickness mapping by anterior segment optical coherence tomography was performed for 154 normal eyes. Corneal astigmatism was classified based on the orientation of the steepest corneal meridian (with-the-rule [WTR], against-the-rule [ATR], and oblique) and the amount (low, moderate, and high). On a 9-mm epithelial thickness map, the thickness along the horizontal (180°), vertical (90°), and diagonal (45 and 135°) meridians was calculated.

RESULT

With-the-rule, oblique, and ATR astigmatisms were observed in 40, 31, and 29% of the eyes, respectively. In all types of astigmatism, the mean epithelial thickness was greater along the 180° meridian and thinner along the 90° meridian. There was no statistically significant difference in mean thickness along different meridians for WTR (P = .24) and oblique (P = .46) astigmatism, whereas the difference along the 180 and 90° meridians (P = .003) for ATR astigmatism was statistically significant. Also, there was a statistically significant difference in thickness in different types of astigmatism separately for each meridian (P < .05) so that the highest and lowest thicknesses were seen for ATR and oblique astigmatisms, respectively. The epithelial thickness showed no statistical difference in various amounts of astigmatism along different meridians.

CONCLUSIONS

Thicker epithelium along the horizontal meridian in ATR may point to the surface regularizing functions of the epithelium to create a regular and smooth surface, but thickness assessment along the different meridians in oblique and WTR showed no curvature-dependent changes.
Assessment of Tear Film Parameters in Smokers and Subjects with a High Body Mass Index
Authors: Fagehi Raied , El-Hiti Gamal A. , Almojalli Abdullah , Alzuhairi Faisal S. , Alanazi Mana A. , Masmali Ali M. , Almubrad Turki
Published: February 2022

SIGNIFICANCE

The current study compares the ocular tear film parameters in three different groups using a single noninvasive, practical, and easy-to-use tool.

PURPOSE

This study aimed to assess the tear film in smokers, those with a high body mass index (BMI), and healthy subjects using the EASYTEAR view+.

METHODS

Thirty men with a high BMI (>25 kg/m2; 24.4 ± 6.4 years), 30 smokers (25.1 ± 6.1 years), and 30 healthy subjects (22.2 ± 3.5 years) were recruited. Each subject completed the Ocular Surface Disease Index, followed by the assessment of noninvasive tear breakup time, tear meniscus height (TMH), and lipid layer patterns (LLPs).

RESULTS

Significant differences were found in the median TMH scores between smokers and healthy subjects (P = .03) and between subjects with a high BMI and the healthy ones (P = .04). The median LLP score was significantly (P < .001) higher in normal subjects (4.0 [1.0]) than in smokers (2.4 [1.0]) and subjects with high BMI (2.0 [1.3]). For subjects with a high BMI, the noninvasive tear breakup time score was strongly correlated (Spearman rank correlation coefficient; r) with TMH (r = 0.552, P = .002) and LLP (r = 0.555, P = .001). The LLP showed that grade B (lipid layer thickness, 30 to 50 nm; more compact) was common in subjects with a high BMI, grade C (50 to 80 nm, gray waves) was predominant in smokers, and grade D (~80 nm, dense white-blue layer) represented the majority of normal eye subjects.

CONCLUSIONS

Smokers and individuals with a high BMI showed significantly lower lipid layer grades and tear meniscus height scores compared with the control group. The assessment of tear film parameters using the EASYTEAR view+ supports the findings of previous studies that implicate smoking and high BMI as risk factors for dry eye.
Comparison of Two Thermal Pulsation Systems in the Treatment of Meibomian Gland Dysfunction: A Randomized, Multicenter Study
Authors: Wesley Gina , Bickle Katherine , Downing Johnathon , Fisher Bret , Greene Brennan , Heinrich Colton , Kading David , Kannarr Shane , Miller Jason , Modi Satish , Ludwick David , Tauber Joseph , Srinivasan Sruthi , Manoj Venkiteshwar
Published: February 2022

SIGNIFICANCE

Given the significance of meibomian gland dysfunction subjects in evaporative dry eye, its chronic and progressive nature, limited promising treatment options, and novel treatment techniques are important. This randomized clinical study evaluated the noninferiority of SYSTANE iLux with LipiFlow in meibomian gland dysfunction treatment at 12 months.

PURPOSE

This study aimed to demonstrate noninferiority of SYSTANE iLux compared with LipiFlow at 12 months after single treatment in meibomian gland dysfunction subjects with evaporative dry eye.

METHODS

In this prospective, randomized, multicenter, assessor-masked, parallel-group trial, subjects (N = 236; aged ≥18 years) with meibomian gland score (MGS) of ≤12 in lower eyelids, noninvasive tear breakup time (NITBUT; first breakup) of <10 seconds, and Impact of Dry Eye on Everyday Life—Symptom Bother (IDEEL-SB) module score of >16 were randomized (1:1) to receive SYSTANE iLux (n = 119) or LipiFlow (n = 117). Subjects attended a total of eight visits, including screening, treatment, and follow-up visits at 2 weeks and at 1, 3, 6, 9, and 12 months/exit, to evaluate change from baseline in MGS, NITBUT, IDEEL-SB module score, and safety outcomes.

RESULTS

A total of 227 subjects completed the study (mean ± standard deviation age, 57.3 ± 13.8 years). At 12 months, least squares mean change from baseline in MGS was similar between iLux and LipiFlow (17.4 ± 1.97 vs. 17.8 ± 1.98). Noninferiority of SYSTANE iLux compared with LipiFlow in change from baseline in MGS (95% lower confidence limit of least squares mean difference, >−5), NITBUT (>−2.5 seconds), and IDEEL-SB score (95% upper confidence limit, <12) was achieved at all post-treatment visits. No other serious ocular or device-related adverse events were reported.

CONCLUSIONS

The treatment outcomes with SYSTANE iLux were noninferior to LipiFlow during the 12-month follow-up in subjects with dry eye–associated meibomian gland dysfunction.
Lactate, Base Excess, and the Pediatric Index of Mortality: Exploratory Study of an International, Multicenter Dataset
Authors: Morris Kevin P. , Kapetanstrataki Melpo , Wilkins Barry , Slater Anthony J. , Ward Victoria , Parslow Roger C.
Published: February 2022

OBJECTIVES:

To investigate the relationship between ICU admission blood lactate, base excess, and ICU mortality and to explore the effect of incorporating blood lactate into the Pediatric Index of Mortality.

DESIGN

Retrospective cohort study based on data prospectively collected on every PICU admission submitted to the U.K. Pediatric Intensive Care Audit Network and to the Australia and New Zealand Pediatric Intensive Care Registry.

SETTING:

Thirty-three PICUs in the United Kingdom/Republic of Ireland and nine PICUs and 20 general ICUs in Australia and New Zealand.

PATIENTS:

All ICU admissions between January 1, 2012, and December 31, 2015.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

One hundred twenty-three thousand two hundred fifty-two admissions were recorded in both datasets; 81,576 (66.2%) in the United Kingdom/Republic of Ireland and 41,676 (33.8%) in Australia and New Zealand. Of these 75,070 (61%) had a base excess recorded, 63,316 (51%) had a lactate recorded, and 60,876 (49%) had both base excess and lactate recorded. Median lactate value was 1.5 mmol/L (interquartile range, 1–2.4 mmol/L) (United Kingdom/Republic of Ireland: 1.5 [1–2.5]; Australia and New Zealand: 1.4 [1–2.3]). Children with a lactate recorded had a higher illness severity, were more likely to be invasively ventilated, admitted after cardiac surgery, and had a higher mortality rate, compared with admissions with no lactate recorded (p < 0.001). The relationship between lactate and mortality was stronger (odds ratio, 1.32; 95% CI, 1.31–1.34) than between absolute base excess and mortality (odds ratio, 1.13; 95% CI, 1.12–1.14). Addition of lactate to the Pediatric Index of Mortality score led to a small improvement in performance over addition of absolute base excess, whereas adding both lactate and absolute base excess achieved the best performance.

CONCLUSIONS:

At PICU admission, blood lactate is more strongly associated with ICU mortality than absolute base excess. Adding lactate into the Pediatric Index of Mortality model may result in a small improvement in performance. Any improvement in Pediatric Index of Mortality performance must be balanced against the added burden of data capture when considering potential incorporation into the Pediatric Index of Mortality model.
Airway Characteristics of Patients With 22q11 Deletion Undergoing Pulmonary Artery Reconstruction Surgery: Retrospective Cohort Study
Authors: Sganga Danielle , Meister Kara , Sidell Douglas R. , Wise-Faberowski Lisa , Shek Jennifer , Ma Michael , Martin Elisabeth , Hanley Frank L. , McElhinney Doff , Asija Ritu
Published: February 2022

OBJECTIVES:

We have previously shown that patients with a chromosome 22q11 microdeletion are at risk for prolonged respiratory failure after pulmonary artery reconstruction surgery compared with those with normal genotype. We sought to describe preexisting airway abnormalities in this patient population and examine relationships between airway abnormalities and outcomes.

DESIGN:

Single-center retrospective chart review from Society of Thoracic Surgery and Pediatric Cardiac Critical Care Consortium databases and the electronic medical record.

SETTING:

Lucile Packard Children’s Hospital at Stanford from September 2017 to February 2019.

PATIENTS:

All patients undergoing pulmonary artery reconstruction surgery were considered for inclusion.

INTERVENTIONS:

We identified 127 patients meeting study inclusion criteria. Thirty-nine patients met specific criteria and underwent screening preoperative bronchoscopy including microdirect laryngoscopy and lower airway examination. Postoperative bronchoscopy was performed at the discretion of the intensive care team.

MEASUREMENTS AND MAIN RESULTS:

Airway abnormalities were detected in 25/26 of children (96%) with a chromosome 22q11 deletion who underwent preoperative bronchoscopy. Upper and lower airway pathologies were found in 19/25 (73%) and 21/25 (81%) patients, respectively, and it was common for patients to have more than one abnormality. Presence of 22q11 deletion was associated with longer duration of mechanical ventilation (9.1 vs 4.3 d; p = 0.001), use of noninvasive positive pressure support (13 vs 6 d; p = 0.001), and longer hospital stays (30 vs 14 d; p = 0.002). These outcomes were worse when compared with patients with known airway abnormalities who did not have 22q11 deletion.

CONCLUSIONS:

Preexisting upper and lower airway pathologies are common in patients with a chromosome 22q11 deletion who undergo pulmonary artery reconstruction surgery. Despite similar postoperative hemodynamics and outcomes as their counterparts without 22q11 deletion, 22q11 deletion is associated with more postoperative respiratory complications not entirely explained by preexisting airway abnormalities.
Real World Experience With Dupilumab in Eosinophilic Esophagitis in Children and Young Adults at a Tertiary Care Pediatric Medical Center
Authors: Syverson Erin Phillips , Rubinstein Eitan
Published: February 2022

Dupilumab is one of a number of biologics currently under investigation for the treatment of eosinophilic esophagitis (EoE). We report on a group of 7 pediatric and young adult patients with EoE who were treated with dupilumab for a primary indication of asthma or atopic dermatitis, all of whom previously failed swallowed topical corticosteroid therapy dietary for management of their EoE. All 7 patients demonstrated histologic improvement in their EoE while on dupilumab, with a drop in median peak esophageal eosinophil count from 50 eosinophils per high-powered field (eos/hpf) (IQR 48–95 eos/hpf) to 2 eos/hpf (IQR 0–5 eos/hpf) off swallowed topical corticosteroid. Additionally, improvements in EoE symptoms and endoscopic findings were noted. This report highlights the effectiveness of dupilumab in a group of multiply atopic pediatric and young adult patients with difficult-to-treat EoE in real world practice.
Higher epicardial fat in older adults living with HIV with viral suppression and relationship with liver steatosis, coronary calcium and cardiometabolic risks
Authors: Tumkosit Monravee , Han Win Min , Tankittiwat Kumpol , Chattranukulchai Pairoj , Siwamogsatham Sarawut , Apornpong Tanakorn , Ureaphongsukkit Thornthun , Kerr Stephen J. , Boonyaratavej Smonporn , Avihingsanon Anchalee ,   the HIV-NAT 006/207 study team
Published: February 2022

Objectives:

HIV infection is associated with ectopic fat deposition, which leads to chronic inflammation and cardiometabolic dysregulation. We assessed the epicardial adipose tissue (EAT) volume and its associated factors among people with HIV (PWH).

Design:

A cross-sectional study.

Methods:

We conducted a cross-sectional study among PWH aged at least 50 years and age-matched and sex-matched HIV-negative older individuals in Bangkok, Thailand. Participants underwent a noncontrast, cardiac computed tomography (CT) scan to assess coronary artery calcium (CAC) score and EAT between March 2016 and June 2017. Multivariate linear regression analyses were used to investigate HIV-related factors, cardiac and metabolic markers associated with EAT volume.

Results:

Median age was 55 years [interquartile range (IQR) 52–60] and 63% were men. Median duration of antiretroviral therapy (ART) was 16 years with 97% had HIV-1 RNA less than 50 copies/ml and median CD4+ cell count of 617 cells/μl. Median EAT volume was significantly higher in PWH [99 (IQR 75–122) cm3] than HIV-negative individuals [93 (IQR 69–117) cm3], P = 0.022. In adjusted model, factors associated with EAT volume included male sex (P = 0.045), older age (P < 0.001), abnormal waist circumference (P < 0.001) and HOMA-IR (P = 0.01). In addition, higher CAC score was independently associated with EAT volume. Higher mean EAT volume was seen in PWH with severe liver steatosis than those without steatosis (P = 0.018). In adjusted PWH-only model, duration of HIV was significantly associated with higher EAT volume (P = 0.028).

Conclusion:

In an aging cohort, PWH had higher EAT volume than HIV-negative controls. EAT was also independently associated with central fat accumulation, insulin resistance, liver steatosis and CAC score.
Durability of tetanus seroprotection in people living with HIV
Authors: Dauby Nicolas , Gobert Cathy , Benslimane Asma , Nagant Carole , Necsoi Coca , van den Wijngaert Sigi , Corazza Francis , Delforge Marc , De Wit Stéphane
Published: February 2022

Objectives:

The aim of this study was to estimate the durability of tetanus toxoid specific seroprotection in a cohort of people with HIV (PWH).

Design:

A cross-sectional study.

Methods:

PWH with a last date of tetanus toxoid booster available were identified. Tetanus toxoid specific IgG were detected using commercial ELISA kit. Durability of seroprotection was estimated using a linear regression model and analyzed according to the country of birth. The impact of baseline parameters at the time of vaccination (CD4+ T cell count, viral load, and antiretroviral therapy) was also assessed.

Results:

One hundred three individuals were included. The median duration between last tetanus toxoid booster and sampling was 5.6years (IQR 2.6-8.9). Using a linear regression model, half-life of tetanus toxoid specific antibody was estimated at 9.9 years [95% confidence interval (95% CI: 5.5–50)] in the whole cohort. Half-life was reduced in individuals born outside Europe: 4.4 years (95% CI: 2.9–8.5). PWH born outside Europe had lower CD4+ T cell count at the time of immunization and more frequently a CD4+ T cell count nadir less than 200 cells/μl before vaccination.

Conclusion:

PWH born outside Europe have lower half-life of tetanus toxoid specific antibody as compared to previous study performed in the general population. Possible causes include lower nadir or current CD4+ T cell count or under-immunization status in country of origin before migration. Longer interval of booster vaccination, as recommended in the general population, might not be appropriate in this subgroup of PWH. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.