bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathogen-specific T Cells: Targeting Old Enemies and New Invaders in Transplantation and Beyond
Authors: Papadopoulou Anastasia , Alvanou Maria , Karavalakis George , Tzannou Ifigeneia , Yannaki Evangelia
Published: February 2023

Adoptive immunotherapy with virus-specific cytotoxic T cells (VSTs) has evolved over the last three decades as a strategy to rapidly restore virus-specific immunity to prevent or treat viral diseases after solid organ or allogeneic hematopoietic cell-transplantation (allo-HCT). Since the early proof-of-principle studies demonstrating that seropositive donor-derived T cells, specific for the commonest pathogens post transplantation, namely cytomegalovirus or Epstein-Barr virus (EBV) and generated by time- and labor-intensive protocols, could effectively control viral infections, major breakthroughs have then streamlined the manufacturing process of pathogen-specific T cells (pSTs), broadened the breadth of target recognition to even include novel emerging pathogens and enabled off-the-shelf administration or pathogen-naive donor pST production. We herein review the journey of evolution of adoptive immunotherapy with nonengineered, natural pSTs against infections and virus-associated malignancies in the transplant setting and briefly touch upon recent achievements using pSTs outside this context.
Outcome Prediction in Patients With Large B-cell Lymphoma Undergoing Chimeric Antigen Receptor T-cell Therapy
Authors: Voltin Conrad-Amadeus , Gödel Philipp , Beckmann Laura , Heger Jan-Michel , Kobe Carsten , Kutsch Nadine , Borchmann Peter , Dietlein Markus , Herrmann Ken , Stelljes Matthias , Rahbar Kambiz , Lenz Georg , Reinhardt H. Christian , Teichert Marcel , Noppeney Richard , Albring Jörn C. , Seifert Robert , von Tresckow Bastian , Flossdorf Sarah , Hanoun Christine
Published: February 2023

The introduction of chimeric antigen receptor (CAR) T-cell therapy has led to a fundamental shift in the management of relapsed and refractory large B-cell lymphoma. However, our understanding of risk factors associated with non-response is still insufficient and the search for predictive biomarkers continues. Some parameters measurable on 18F-fluorodeoxyglucose positron emission tomography (PET) may be of additional value in this context. A total of 47 individuals from three German university centers who underwent re-staging with PET prior to CAR T-cell therapy were enrolled into the present study. After multivariable analysis considering tumor characteristics and patient factors that might affect progression-free survival (PFS), we investigated whether metabolic tumor volume (MTV) or maximum standardized uptake value (SUVmax) further improve risk stratification. Their most suitable cut-offs were determined by Cox and logistic regression. Forward selection identified extra-nodal disease as the most predictive factor of those routinely available, and we found it to be associated with significantly inferior overall survival after CAR T-cell treatment (P = 0.012). Furthermore, patients with MTV and SUVmax higher than the optimal threshold of 11 mL and 16.7, respectively, experienced shorter PFS (P = 0.016 and 0.002, respectively). Hence, these risk factors might be useful for selection of individuals likely to benefit from CAR T-cell therapy and their management.
Intraocular Fibrin Glue to Lower the Risk of Postoperative Vitreous Hemorrhage After Diabetic Pars Plana Vitrectomy
Authors: Mansour Hana A. , Mahmoudzadeh Raziyeh , Hsu Jason
Published: February 2023

Purpose:

To investigate the use of intraocular fibrin glue to lower the risk of vitreous hemorrhage (VH) after pars plana vitrectomy (PPV) in eyes with diabetic VH or traction retinal detachment.

Methods:

A matched, case–control, single-surgeon, pilot study of patients undergoing PPV for diabetic VH or traction retinal detachment with versus without fibrin glue was performed.

Results:

Thirty-nine patients (13 glue and 26 control patients) were included. In the glue group, mean (SD) logarithm of the minimum angle of resolution visual acuity (Snellen) significantly improved from 1.53 (0.6) (20/678) to 0.99 (0.9) (20/195) at postoperative month 6 (P = 0.03). In the control group, mean logarithm of the minimum angle of resolution visual acuity also improved from 1.45 (0.8) (20/564) to 1.17 (0.9) (20/296) at postoperative Month 6 (P = 0.3). Persistent post-PPV VH was similar between the 2 groups (15.4% in both groups, P > 0.99). However, early recurrent VH (<3 months post-PPV) was seen in 34.6% in the control group and none in the glue group (P = 0.02). No intraocular inflammatory events were seen in the glue group.

Conclusion:

Intraocular fibrin glue may be a safe adjuvant in diabetic vitrectomy and may reduce the rate of early recurrent postoperative VH.
COVID-19 VACCINE–INDUCED ACUTE EXUDATIVE POLYMORPHOUS VITELLIFORM MACULOPATHY: CASE REPORTS
Authors: Baddar Dina , Fayed Alaa E. , Tawfik Caroline A. , Bassily Sherry , Gergess Maged M. , El-Agha Mohamed-Sameh H
Published: February 2023

Background:

Acute exudative polymorphous vitelliform maculopathy is a presumed retinal pigment epithelium abnormality that has been reported in patients with neoplasms and under certain classes of drugs. The pathophysiology remains unclear, despite the typical clinical features.

Purpose:

To report two cases of acute exudative polymorphous vitelliform maculopathy occurring after vaccination with a COVID-19 vaccine.

Case Reports:

Two adult patients presented with visual disturbance after inoculation with a COVID-19 vaccine. The patients were otherwise healthy and have no family history of retinal dystrophies. Both cases exhibited the following features on multimodal imaging: multifocal hyporeflective lesions involving the macula, elongated photoreceptors, accumulated vitelliform material exhibiting autofluorescence, and lack of fluorescein dye leakage. Evidence of retinal pigment epithelium dysfunction was confirmed by electrooculography.

Conclusion:

Two cases of acute exudative polymorphous vitelliform maculopathy occurring after COVID-19 vaccination were reported. A relationship between the vaccine and the retinal pigment epithelial abnormality development that led to acute exudative polymorphous vitelliform maculopathy was postulate, possibly through autoantibodies against the severe acute respiratory syndrome coronavirus 2 virus structural surface glycoprotein antigens that cross react with the normal retinal pigment epithelial cells.
“An Unusual Case of Primary Vitreoretinal Lymphoma: A Transformed Lymphoma”
Authors: Ustaoglu Melih , Patel Rooshil , Wang Wei , Shah Sanket , Barr Charles
Published: February 2023

Purpose:

To report a case of primary vitreoretinal lymphoma (VRL) presenting as diffuse large b-cell lymphoma (DLBCL) 19 years after initial systemic follicular lymphoma.

Method:

A case report.

Results:

An 81-year-old male patient presented with a 1-month history of floaters and blurry vision in the left eye. He had a history of follicular non-Hodgkin lymphoma treated with systemic chemotherapy in 2002 and prostate cancer treated surgically in 2004. Ophthalmic examination revealed vitritis, retinal whitening, perivascular sheathing, and a vascularized cream-colored retinal mass in the superonasal periphery of the left eye. Diagnostic vitrectomy with retina and vitreous biopsies demonstrated DLBCL. Positron emission tomography/computed tomography confirmed the isolated lesion in the left eye without systemic involvement. Treatment with systemic and intraocular chemotherapy was planned.

Conclusion:

To the best of our knowledge, this is the first reported case of primary VRL of DLBCL transformed from follicular lymphoma. Intravitreal and systemic chemotherapy, including rituximab, should be consideered in the management of patients with transformed VRL.
OCCLUSIVE CYTOMEGALOVIRUS PANUVEITIS AFTER INTRAVITREAL DEXAMETHASONE IMPLANT
Authors: Kim Hyun Jun , Brill Daniel , Giuliari Gian Paolo
Published: February 2023

Purpose:

To report a case of unilateral cytomegalovirus (CMV) panuveitis with occlusive vasculitis after injection of intravitreal dexamethasone implant in a patient with type 2 diabetes mellitus.

Methods:

Observational case report.

Results:

A 60-year-old immunocompetent man with well-controlled type 2 diabetes mellitus was treated with intravitreal dexamethasone implant for recurrent uveitis that was responsive to steroids. Three months after implantation, the patient develops panuveitis with occlusive vasculitis. Anterior chamber tap confirms diagnosis of cytomegalovirus retinitis. Intravitreal foscarnet and oral valganciclovir led to quiescent disease.

Conclusions:

Patients treated with local immunosuppressants should be monitored carefully to assess treatment response and complications, even in the absence of frank immunodeficiency. Quantitative viral PCR can be an effective way to monitor treatment response to antiviral therapy.
Technique for the Management of Extensive Ocular Surface Lipodermoid Involving the Cornea of Children
Authors: Franco Elena , Gagrani Meghal , Lalgudi Vaitheeswaran G. , Shah Parth R. , Lenhart Phoebe , Bhola Rahul , Nischal Ken K.
Published: February 2023

Purpose:

Ocular surface lipodermoids with corneal involvement may require surgical intervention; if deep, ocular surface reconstruction with lamellar corneal tissue or amniotic membrane may be needed. We describe a staged technique using autologous ipsilateral simple limbal epithelial transplantation.

Methods:

After verifying sparing of Descemet membrane, the conjunctival portion of the lipodermoid was debulked in the first stage. Six weeks later, the corneal portion was excised, followed by autologous ipsilateral simple limbal epithelial transplantation to promote rapid reepithelialization of the residual stromal bed. Temporary tarsorrhaphy was used for patient comfort and to expedite ocular surface healing.

Results:

Three eyes of 3 children with grade III large ocular surface lipodermoids that encroached the visual axis and hindered proper eyelid closure underwent surgery without complications. In all cases, the visual axis was cleared and eyelid closure was improved. At the last follow-up (mean 35.7 months, median 36.0 months), the bed of the original dermoid showed minimal haze in 1 case, while 2 eyes developed small pseudopterygium; best spectacle–corrected visual acuity improved from 20/200 to 20/70 in the first case, from fix and follow to 20/50 in the second case, and remained fix and follow in the last case, but this child had congenital hydrocephalus with severe developmental delay.

Conclusions:

This surgical technique is a promising option for children with grade III large ocular surface lipodermoids given its effectiveness in clearing the visual axis and in improving eyelid closure. Moreover, it does not require lamellar corneal transplantation or intervention to the fellow eye.
Incidence of Blepharoptosis After Pars Plana Baerveldt 350 Glaucoma Implant Surgery by a Single Surgeon
Authors: Akai Ryota , Yunoki Tatsuya , Otsuka Mitsuya , Hayashi Atsushi
Published: February 2023

Purpose:

To investigate the incidence of postoperative blepharoptosis and clinical risk factors for blepharoptosis after pars plana Baerveldt 350 glaucoma implantation (BGI) by a single surgeon for refractory glaucoma.

Methods:

Twenty-four patients (30 eyes) who underwent pars plana BGI for refractory glaucoma at Toyama University Hospital between November 2019 and February 2021 were included. Patients with a preoperative margin reflex distance-1 (MRD-1) of ≥2 mm were included in the study, and a decrease in MRD-1 of ≥2 mm at 6 months postoperatively was defined as blepharoptosis.

Results:

The mean MRD-1 decreased significantly from 3.2 ± 0.6 mm preoperatively to 2.4 ± 1.1 postoperatively (p < 0.01). Postoperative ptosis developed in 8 eyes (26.7%). A comparison of the ptosis (n = 8) and nonptosis (n = 22) groups showed a significant difference in the history and number of previous filtration surgeries (p = 0.02 and p = 0.03, respectively). Those with previous filtration surgery had a higher risk of blepharoptosis after pars plana BGI compared with those without previous filtration surgery (OR: 6.43; 95% confidence interval: 1.03–40.26; p = 0.04).

Conclusion:

Pars plana BGI is a risk factor for postoperative blepharoptosis. Particular attention should be paid to eyes that have undergone previous filtration surgery.
Subpalpebral Antibiotic Lavage for the Treatment of Refractory Infectious Scleritis
Authors: Maeng Michelle M. , Casella Alicia , Herrera Gissel , Amescua Guillermo , Karp Carol L. , Tse David T.
Published: February 2023

Abstract: Infectious scleritis is a potentially devastating condition that can result in severe vision loss. When traditional management fails, a subpalpebral antibiotic lavage system (SAL) can be considered to bathe the infected area with a high volume and concentration of antibiotics. Several reports show that this method can be curative for infectious scleritis, otherwise refractory to care. However, surgical approaches for this technique are either not well described, advocate for transecting the levator aponeurosis, or do not expose the entire width of the superior fornix, which can lead to postoperative ptosis. The authors describe a case where a novel approach was utilized, using a fenestrated angiocather in the superior lateral fornix, to maximize outcomes and minimize postoperative complications. In the setting of infectious scleritis refractory to traditional management, a SAL can be safely and effectively placed with the technique detailed in this report.
Trending Proinflammatory Markers to Prognosticate Mechanical Ventilation in COVID-19
Authors: Kozak Paul T. , Koziol Sophia M. , Mariano Andrew T. , Abraham Raju Z. , Phillips Martin T. , Anderson Michael J.
Published: February 2023

Background

Proinflammatory markers and clinical assessment have been used to help identify patients who need closer monitoring and possible mechanical ventilation (MV) in patients diagnosed with COVID-19. Retrospective analysis of proinflammatory markers before and after MV may aid in identifying proinflammatory markers that are most useful for predicting MV.

Methods

The study is a retrospective observational study at a single hospital in a community setting from May 2020 to June 2021. The population includes all adult patients hospitalized with COVID-19 with more than 1 measured value of white blood cell count (WBC), C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and d-dimer. If the patient did not require MV, admission proinflammatory markers were compared with the maximum proinflammatory marker during the hospital stay. If a patient did require MV, admission proinflammatory markers were compared with proinflammatory marker level on the day of intubation or the first available level after intubation.

Results

Among 242 hospitalized patients with polymerase chain reaction–confirmed COVID-19 diagnosis, an increase in LDH (P = 0.01458) and d-dimer (P = 0.00284) were associated with patients requiring MV. An increase in WBC (P = 0.19428), CRP (P = 0.58770), or ferritin (P = 0.09302) was not significantly associated with an increased need for MV during our study period.

Conclusions

Serial monitoring LDH and d-dimer can serve as biochemical markers in identifying patients at high risk for MV. WBC, ferritin, and CRP trends may not have utility in determining risk of MV. Cessation of indiscriminate trending of these markers may be an avenue for cost savings.
A Case Report
Authors: Khot Rajashree , Jafri Shahnawaz , Rathod Bharatsing , Joshi Prashant P.
Published: February 2023

Acute respiratory distress syndrome (ARDS) became synonymous with COVID-19 infection during the recent pandemic. We report this case who presented with fever and ARDS and had bilateral pneumonia on chest x-ray. After hospitalization, he deteriorated and required invasive ventilatory support. His real-time reverse transcription–polymerase chain reaction for COVID 19 was twice negative. Hence, he was screened for other infections causing ARDS. He had no eschar clinically but had other clues, such as leucocytosis, transaminitis, hypoalbuminemia, and thrombocytopenia. On investigations, his serology for scrub typhus was positive. He was given doxycycline to which he responded dramatically and was weaned off ventilator.

If real-time reverse transcription–polymerase chain reaction for COVID-19 infection is negative, other rare but treatable respiratory infections leading to ARDS should be considered.
Contraceptive counseling for adolescents in the emergency department: A novel curriculum for nurse practitioners and physician assistants
Authors: Gabler Laurel S. , Shankar Michelle , Ketterer Tara , Molnar Jennifer , Adams Amber , Min Jungwon , Miller Elizabeth , Barral Romina L. , Akers Aletha , Miller Melissa K. , Mollen Cynthia
Published: February 2023

Many adolescents use the emergency department (ED) as their primary source of health care. As a result, the ED serves as a unique opportunity to reach adolescents. Although many adolescent visits to the ED are related to reproductive health, ED providers report barriers to providing this care, including lack of training. Nurse practitioners (NPs) and physician assistants (PAs) serve a vital role in the provision of consistent care to adolescents in the ED. The purpose of this study was to create a curriculum to train NPs and PAs at two pediatric institutions to provide patient-centered contraceptive counseling to adolescents in the pediatric ED regardless of their chief complaint. To do this, we created a four-part webinar followed by an in-person training session. Participants completed training and then conducted counseling sessions with adolescents in the ED. Counseling sessions were recorded and reviewed for fidelity to delineated counseling principles, and data from post-counseling surveys were collected. 27 NPs and PAs completed the training and conducted 99 counseling sessions. Nearly all sessions incorporated essential content and communication principles such as shared decision making (90%) and teach-back methods (75%). All NPs and PAs who participated reported satisfaction and subjective improvement in knowledge and competence from the training. This curriculum offers a novel and feasible approach to train NPs and PAs to deliver patient-centered contraception counseling to adolescents in the ED setting, and it can serve as a model for how to educate different providers to incorporate reproductive health education into the busy ED visit.
Hepatic steatosis after liver transplantation: a systematic review and meta-analysis
Authors: Silva Ana C. , Nogueira Paulo , Machado Mariana V.
Published: February 2023

NAFLD can occur after liver transplantation (LT), as recurrence or de novo hepatic steatosis (HS). We aimed to evaluate the literature on prevalence, risk factors, and prognosis of post-LT HS. Systematic review with meta-analysis through a search on: PUBMED, Scopus, and Web-of-Science, from inception until the September 30, 2021. Forty studies were included, representing 6979 patients. The post-LT HS prevalence was 39.76% (95% CI, 34.06–45.46), with a rising kinetics (11.06% increase per decade, p=0.04), and a geographical distribution (15.10% more prevalent in American continent compared with Europe and Asia). Recurrent HS was up to 5-fold more likely than de novo HS [OR: 5.38 (2.69–10.76)]. Metabolic disturbances were stronger risk factors in the post-LT recipient [obesity: OR: 4.62 (3.07–6.96); metabolic syndrome: OR: 3.26 (2.03–5.25)] as compared with pre-LT recipients, with the exception of diabetes mellitus, which doubled the risk at any set [pre-LT diabetes mellitus: OR: 2.06 (1.58–2.68); post-LT diabetes mellitus: OR: 2.12 (1.73–2.59)]. Donor factors were not the relevant risk factors for post-LT HS and the only immunosuppressive drug associated with increased risk was sirolimus [OR: 1.68 (1.07–2.64)]. The prevalence of post-LT steatohepatitis was 28.82% (19.62–38.03) and the strongest risk factor was pre-LT NAFLD. Limited outcomes data suggest that post-LT HS did not increase the risk for liver cirrhosis or mortality in these studies. Two out of 5 patients submitted to LT will develop post-LT HS, being recurrent HS more common than de novo HS. Diabetes mellitus and post-LT metabolic syndrome are the strongest risk factors for HS and baseline NAFLD for steatohepatitis. All transplanted patients should be enrolled in lifestyle interventions to prevent post-LT metabolic syndrome, and sirolimus should be avoided in high-risk patients.
Door-to-furosemide time and clinical outcomes in acute heart failure
Authors: Marques Pedro , Brito Maria T. , Vasques-Nóvoa Francisco , Ferreira João P. , Jardim Ana L. , Gouveia Rita , Besteiro Bruno , Vieira Joana T. , Gomes Filipa , Leite-Moreira Adelino , Bettencourt Paulo , Almeida Jorge , Friões Fernando
Published: February 2023

Background and importance

Acute heart failure (AHF) is one of the main causes of unplanned hospitalization in patients >65 years of age and is associated with adverse outcomes in this population. Observational studies suggest that intravenous diuretic therapy given in the first hour of presentation for AHF was associated with favorable outcomes.

Objectives

To study the short-term prognostic associations of the timing of intravenous diuretic therapy in patients admitted to the emergency department (ED) for acute AHF.

Design, settings and participants

Patients treated in the ED with intravenous diuretics were selected from the Estratificação de Doentes com InsuFIciência Cardíaca Aguda (EDIFICA) registry, a prospective study including AHF hospitalized patients. Early and non-early furosemide treatment groups were considered using the 1-h cutoff: door-to-furosemide ≤1 h and >1 h.

Outcomes measure and analysis

Primary outcomes were a composite of heart failure re-hospitalizations or cardiovascular death at 30- and 90-days.

Main results

Four-hundred ninety-three patients were included in the analysis. The median (interquartile range) door-to-furosemide time was 85 (41–220) min, and 210 (43%) patients had diuretics in the first hour. Patients in the ≤1 h group had higher evaluation priority according to the Manchester Triage System, presented more often with acute pulmonary edema, warm-wet clinical profile, higher blood pressure, and signs of left-side heart failure, while >1 h group had higher Get With the Guidelines-heart failure risk score, more frequent signs of right-side heart failure, higher circulating B-type natriuretic peptides and lower albumin. Door-to-furosemide ≤ 1 h was independently associated with lower 30-day heart failure hospitalizations and composite of heart failure hospitalizations or cardiovascular death (adjusted analysis Heart Failure Hospitalizations: odds ratios (OR) 3.65; 95% confidence interval (CI), 1.22–10.9; P = 0.020; heart failure hospitalizations or cardiovascular death: OR 3.15; 95% CI, 1.49–6.64; P < 0.001). These independent associations lost significance at 90 days.

Conclusion

Door-to-furosemide ≤1 h was associated with a lower short-term risk of heart failure hospitalizations or cardiovascular death in AHF patients. Our findings add to the existing evidence that early identification and intravenous diuretic therapy of AHF patients may improve outcomes.
Use of a modified retrograde femoral rod as a custom length tibiotalocalcaneal nail
Authors: Waldron Jacob , Bandovic Ivan , Olson Adrian , Denisiuk Marek , Layson James , Afsari Alan , Best Benjamin J.
Published: February 2023

There has been increasing interest in the use of hindfoot tibiotalocalcaneal (TTC) nails to treat ankle and distal tibia fractures in select patient populations who are at increased risk for soft tissue complications after open reduction and internal fixation with traditional plate and screw constructs. We describe a technique which uses a retrograde femoral nail as a custom length TTC nail. By using a simple modification of the insertion jig, we are able to achieve safe screw trajectories that allow for robust distal interlocking fixation. Review of implantation in multiple cadaveric specimens demonstrates safe placement of distal screw fixation in the calcaneus without risking injury to important neurovascular structures. Because of the 2-cm incremental length options of this particular device, we are able to achieve supraisthmal fixation in the tibia which may lessen the risk for fracture that may be more likely to occur at the tip of a short TTC nail option. Furthermore, a custom length TTC nail is more costly and also requires advanced notice to acquire for the case; retrograde femoral nails are readily stocked and accessible at our level 1 trauma center. This TTC technique offers anatomic restoration while also offering convenience, instrument familiarity, cost savings, and increased patient safety.
A systematic review of patient-centered interventions for improving pain outcomes and reducing opioid-related risks in acute care settings
Authors: Seilern und Aspang Jesse , Schenker Mara L. , Port Ada , Leslie Sharon , Giordano Nicholas A.
Published: February 2023

Objectives:

This systematic review evaluates the literature for patient-oriented opioid and pain educational interventions that aim to optimize pain management using opioid-sparing approaches in the orthopaedic trauma population. The study protocol was registered with PROSPERO (CRD42021234006).

Data Sources:

A review of English-language publications in CINAHL (EBSCO), MEDLINE through PubMed, Embase.com, PsycInfo (EBSCO), and Web of Science Core Collection literature databases published between 1980 and February 2021 was conducted using PRISMA guidelines.

Study Selection:

Only studies implementing patient-oriented opioid and/or pain education in adult patients receiving acute orthopaedic care were eligible. Outcomes were required to include postinterventional opioid utilization, postoperative analgesia and amount, or patient-reported pain outcomes.

Data Extraction:

A total of 480 abstracts were reviewed, and 8 publications were included in the final analysis. Two reviewers independently extracted data from selected studies using a standardized data collection form. Disagreements were addressed by a third reviewer. Quality of studies was assessed using the Cochrane Risk of Bias Tool.

Data Synthesis:

Descriptive statistics characterized study findings, and content analysis was used to discern themes across studies.

Conclusion:

Our findings indicate the merit for patient-centered educational interventions including verbal/written/audio–visual trainings paired with multimodal approaches to target opioid-sparing pain management and reduce short-term pain scores in urgent and acute care settings after acute orthopaedic injuries. The scarcity of published literature warrants further rigorously designed studies to substantiate the benefit of patient-centric education in reducing prolonged opioid utilization and associated risks after orthopaedic trauma.

Level of Evidence:

Therapeutic level III.
A systematic review of kissing as a risk factor for oropharyngeal gonorrhoea or chlamydia
Authors: Charleson Finley , Tran Julien , Kolobaric Adam , Case Richard , Fairley Christopher K. , Hocking Jane S. , Chow Eric P.F.
Published: February 2023

Background

Tongue kissing is a poorly studied risk factor for sexually transmitted infections (STIs). We undertook the first systematic review to assess whether kissing is a risk factor for gonorrhoea or chlamydia of the oropharynx.

Methods

Online databases (MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane) and reference lists were searched until September 30th, 2022. The eligibility criteria for studies included: any peer-reviewed study design in the English language; gonorrhoea or chlamydia diagnosed by NAAT, or an infection self-reported by a patient; tongue kissing or its equivalent measured as an exposure. Studies were appraised using a quality scoring tool and qualitatively synthesised.

Results

Of 8248 studies screened, six were eligible for review. All were conducted among men who have sex with men (MSM) in Australia, including three prospective cohort studies, two cross-sectional studies, and one age-matched case-control study. In summary, all five studies examining gonorrhoea found an unadjusted association between kissing and oropharyngeal gonorrhoea. Two cross-sectional studies found that tongue kissing was an independent risk factor for oropharyngeal gonorrhoea after adjusting for other confounders such as participant demographic characteristics and other sexual practices. In contrast, a single eligible prospective cohort study found no association between kissing and oropharyngeal chlamydia.

Conclusions

This systematic review summarised the existing evidence, which suggests that tongue kissing may be a risk factor for oropharyngeal gonorrhoea but not chlamydia. Reinforcing the message that oropharyngeal gonorrhoea could be transmitted through kissing may inform the development of novel approaches to prevent gonorrhoea.
The Value of Hearing Aids for the Italian NHS: A Cost-utility Analysis
Authors: Fornaro Giulia , Armeni Patrizio , Albera Andrea , Barbara Michele
Published: February 2023

Objective:

Hearing loss (HL) prevalence in Italy is expected to increase due to population aging. Hearing aids (HAs) are the main tool for HL rehabilitation; however, cost-utility analyses of HAs are limited. Our objective was to estimate the cost-utility of HAs use.

Study Design:

Cost-utility analysis.

Setting:

Italian National Healthcare Service, societal perspective.

Patients, Intervention(s), and Main Outcome Measure(s):

A multistate Markov model was developed to model a cohort of 55-year-old individuals starting from normal hearing and moving across HL states to compare cost-utility and net monetary benefit of HA use accompanied by post-purchase service, HA use alone, and no treatment. Parameters were estimated using secondary data. Incremental cost-utility ratio (ICUR) and incremental net monetary benefit (INMB) were computed against a €16,625/quality-adjusted life year (QALY) willingness-to-pay (WTP) threshold. Deterministic and probabilistic sensitivity analysis (DSA, PSA) was implemented to assess how uncertainty affected results. Scenario analysis was performed on different assumptions on costs, dropout and compliance rates.

Results:

The model suggests HAs use is a cost-effective strategy compared to no treatment (in the base case: incremental costs €429–€476, incremental QALY gain 0.18 and 0.19, ICUR €2‚404/QALY–€2‚450/QALY, INMB €2‚476–€2‚682 for male and female cohort, respectively). By assuming no dropout, INMBs increase up to €10,643–€10,728. DSA highlights that utility weights contribute the most to model uncertainty, PSA shows that the treatment has 97.8%–97.3% probability of being cost-effective at the WTP threshold considered.

Conclusions:

We proposed an original model to assess the cost-utility of HAs use; the application to the Italian setting suggests the treatment is cost-effective, reinforcing the importance of early uptake.
Decision Making for Active Surveillance in Vestibular Schwannoma
Authors: Smith Harrison , Odeh Ahmad , Kallogjeri Dorina , Piccirillo Jay F.
Published: February 2023

Objective:

To describe the experiences of patients who elected for the active surveillance treatment option for their vestibular schwannoma (VS).

Study Design:

Twenty-two patients participated in semistructured patient interviews.

Setting:

Interviews were conducted between March and April 2021 via telephone with audio recordings and notes taken during each interview.

Patients:

Adults diagnosed with a VS and at any point after their diagnosis underwent a period of active surveillance were recruited based on the diagnosis made by MRI. Patients were excluded if they chose to undergo treatment immediately, had a diagnosis of neurofibromatosis type 2, or if they had a confirmed alternative diagnosis.

Intervention:

This intervention was a qualitative interview to assess patient experiences with their VS treatment decision.

Main Outcome Measures:

Identifying abstract categories that represent many of the stories told by the participants that produces a theory grounded in the data with explanatory power.

Results:

Factors that influenced patients’ treatment decisions were perceived physician bias, selfeducation, and personal accounts of VS patients through support groups, and side effects/complications of the various treatment options.

Conclusion:

Patients who opted for active surveillance as a treatment option reported high satisfaction with their decision and greater confidence in future treatments that would be necessary based on tumor growth. Future work should be done to increase shared decision making between the physician and patient to arrive at a treatment plan that aligns with their goals of care as well as potentially reducing overtreatment of VS.
Rates of Sensorineural Hearing Loss and Revision Surgery After Stapedotomy: A Single-institution Experience Using the Nitinol Prosthesis
Authors: Quimby Alexandra E. , Parekh Manan , Darwich Nabil F. , Hwa Tiffany P. , Eliades Steven J. , Brant Jason A. , Bigelow Douglas C. , Ruckenstein Michael J.
Published: February 2023

Background:

Historically, stapedectomy complication rates are quoted as 1% profound postoperative sensorineural hearing loss (SNHL), 5%–10% nonprofound SNHL, and 5%–10% revision surgery.

Objective:

We sought to reassess rates of post-stapedotomy complications based on our experience using contemporary surgical technique.

Methods:

A retrospective case series was carried out at an academic tertiary referral center. Adult patients undergoing stapedotomy from 2013 to 2020 were included. Primary outcomes were rates of hearing loss and revision surgery. Rates of dizziness, tinnitus, dysgeusia, and proportions of patients who achieved air-bone gap (ABG) closure at 8–12 weeks postoperatively were also assessed.

Results:

Four hundred sixty-eight stapedotomies in 399 patients with a median follow-up duration of 99 days (range, 11–5134) were reviewed. One patient (0.21%) suffered profound SHNL and 15 (3.20%) patients suffered nonprofound SNHL. The revision rate for stapedotomies from our institution was 4.49% (21 total revision surgeries). In 277 operations (59.19%), the patient had closure of the ABG within 10 dB. A further 132 (28.21%) had closure of the ABG between 10 and 20 dB. Air pure-tone audiometry scores improved by an average of 25.03 dB. Eighty-three (17.74%) patients complained of postoperative dizziness, which resolved by the time of the first follow-up appointment in all but 26 (5.56%). Seventeen patients (3.63%) complained of tinnitus, and 22 (4.70%) complained of dysgeusia.

Conclusions:

SNHL, complications, and revision rates for stapedotomy in the modern era may be substantially lower than those currently presented to patients based on classic techniques and historical data.
Expression of Polyadenylate-binding Protein Cytoplasmic 1 (PABPC1) in Combination With RAD51 as Prognostic Biomarker in Patients Who Underwent Postoperative Chemotherapy for Esophageal Squamous Cell Carcinoma
Authors: Pu Jiangtao , Teng Zhangyu , Zhang Tao , Wang Biao , Zhang Dengguo , Yang Qin , Yang Qiao , Sun Xingwang , Long Wenbo
Published: February 2023

Molecular markers in the prognosis of esophageal squamous cell carcinoma (ESCC) patients who received postoperative treatments are lacking. This research aims to evaluate the prognostic value of polyadenylate-binding protein cytoplasmic 1 (PABPC1) alone and in combination with RAD51 in ESCC patients who underwent postoperative chemotherapy (CT). A total of 103 ESCC patients who underwent postoperative CT and 103 matched ones who received surgery alone were analyzed in this study. PABPC1 and RAD51 expression was assessed in cancer samples by immunohistochemistry. PABPC1 high expression (PABPC1-HE) but not that of RAD51 was associated with poor patients’ survival, regardless of the postoperative treatment or node status. Patients with PABPC1 low expression and RAD51 negative expression [RAD51− (PABPC1-LE/RAD51−)] tumor had good overall survival (OS) in both the CT treated and untreated groups. Patients with PABPC1-LE/RAD51+ and PABPC1-HE/RAD51+ tumors had longer OS in the CT treated group than in the untreated group. However, PABPC1-HE/RAD51− was associated with a poor outcome in both groups and the patients with PABPC1-HE/RAD51− tumor had hardly any benefit from CT in N+ status. PABPC1 alone and in combination with RAD51 was a prognostic biomarker for OS in ESCC patients who received postoperative CT.
Improving Documentation of Postdischarge Issue Mitigation during Postdischarge Phone Calls
Authors: Vepraskas Sarah , Osorio Snezana Nena , Bauer Sarah Corey , Stephany Alyssa , Gage Sandra
Published: February 2023

Introduction:

Postdischarge phone calls (PDPCs) are recommended to identify and mitigate postdischarge issues such as missed follow-up appointments, medication errors, and failure to activate contingency plans. A current state assessment showed variability in documenting PDPC content and postdischarge issue mitigation. Therefore, the primary aim was to improve the postdischarge issue mitigation documentation rate from 65% to 100% over 16 months.

Methods:

An interdisciplinary quality improvement team used the Model for Improvement to perform planned sequential interventions over 16 months. The outcome measure was documentation of postdischarge issue mitigation. Process measures included PDPC template use and completion and postdischarge issue identification. Balancing measures included call attempts and caller perceptions of ease of documentation. Interventions included creating a flowsheet note template, creating caller template training sessions, and sharing team data and feedback. We gathered data via reports generated from the electronic medical record, chart review, and survey. Data were analyzed using statistical process control charts and established rules for detecting special cause variation.

Results:

The postdischarge issue mitigation documentation increased from 65% to 91% over 16 months. Template use and completion increased from 0% to 100% and 98%, respectively. The number of postdischarge issues identified remained unchanged. Call attempts increased from 40% to 59%. Caller perceptions remained unchanged.

Conclusions:

Documentation of postdischarge issues and issue mitigation promotes adequate communication with the patient’s care providers, improving the quality and safety of care. Data sharing to promote team engagement was the key factor in improving documentation of postdischarge issue mitigation.
“Three-Dimensional Assessment of Frontal Bossing and Temporal Pinching in Patients with Sagittal Craniosynostosis using Curvature Analysis.”
Authors: Harrison Lucas M. , Mathew Denzil P. , Cole Naomi A. , Sachdeva Sanchit , Hallac Rami R. , Derderian Christopher A.
Published: February 2023

Background:

Sagittal craniosynostosis results in variable degrees of frontal bossing and bilateral temporal pinching. This study assesses the three-dimensional (3D) changes in these regions utilizing curvature analysis and volumetric analysis before, and 1-year after, extended sagittal strip craniectomy with post-operative helmet therapy (ESC).

Methods:

A retrospective review of 3D photographs of 50 subjects treated with ESC and 50 age-matched controls was performed. Images were collected pre-operatively and 1-year post-operatively. The convexity of the forehead and concavity of the temples were quantified. CT scans of normal subjects and subjects with sagittal synostosis were analyzed to assess the percent of total intracranial volume in the anterior cranial fossa before and after ESC.

Results:

Forehead convexity in ESC pre-operatively (24.49±3.16 m -1) was significantly greater than controls (22.48±3.84 m -1; p=0.005). Forehead convexity significantly decreased after ESC (18.79±2.43 m -1; p<0.001) and did not differ from controls (19.67±3.08 m -1; p=0.115). The ESC group had more concave temples pre-operatively (-10.27±4.37 m -1) as compared to controls (-6.99±3.55 m -1; p<0.001). Temple concavity significantly decreased after ESC (-4.82±3.17 m -1; p<0.001) and did not differ from controls (-5.64±3.27 m -1; p=0.075). In the ESC group, the percent ICV in the anterior cranial fossa decreased from 22.03% to 18.99% after surgery while the anterior volume in controls was stable (17.74% to 16.81%).

Conclusions:

The ESC group had significantly greater forehead convexity, temple concavity and anterior cranial fossa volume compared to controls. One year after ESC, forehead convexity, temple concavity, and percent ICV in the anterior fossa were comparable to controls.
New Horizons in Vascular Imaging With Photon-Counting Detector CT
Authors: Wildberger Joachim E. , Alkadhi Hatem
Published: February 2023

Noninvasive vascular imaging with computed tomography (CT) has become the clinical mainstay for many indications and body regions. The recent introduction of photon-counting detector (PCD)-CT into clinical routine has further broadened the spectrum of vascular applications. Technical improvements of PCD-CT, such as the decreased noise levels, improved contrast-to-noise ratio, and full spectral multienergy data information from every acquisition, have the potential to further impact on clinical decision making and ultimately on outcome of vascular patients. Early experience with the new PCD-CT technology demonstrates these improvements in various aspects. This review summarizes the main advantages of PCD-CT for vascular imaging a discussion of the PureLumen and PureCalcium algorithms.
Effect of Sleep Position on Sleep-Disordered Breathing in Young Children With Unrepaired Incomplete Cleft Palates
Authors: Yu Wenwen , Zheng Tong , Yao Kan , Xia Liang , Wei Silong , Cai Ming , Wang Guomin , Yang Yusheng , Liang Yun , Lu Xiaofeng
Published: February 2023

Children with cleft lip/palate are usually faced with upper airway problems after surgical repair. The severity of upper airway obstruction is more likely associated with the age and preoperative diagnosis of obstructive sleep apnea (OSA). This study aimed to investigate the severity of OSA in toddlers before palatoplasty from the perspective of polysomnography. In this retrospective cohort study, 97 children with unrepaired cleft palate and habitual prone sleeping were identified with a mean age of 1.6 years (SD 0.6) and divided into 2 age groups (1.5 year or younger and older than 1.5 year). Detailed information was collected including demographics, sleep parameters, and respiratory disturbances. Polysomnography results showed these children were at high risks of OSA with averagely moderate severity at night during their early childhood [apnea-hypopnea index 7.2±3.2 events/hour; obstructive apnea index (OAI) 6.5±2.8 events/hour]. Positional OAI was greatly lower in prone than that in laterals or in supine. Far more sleep time was spent in prone than in supine (42.9%±42.2% versus 8.5%±15.7%), which were consistent with parental reporting of prone sleeping habits. There were no significant differences found between the 2 age groups in respiratory disturbances such as apnea-hypopnea index, OAI, mean oxygen saturation, and nadir oxygen saturation (P=0.097–0.988). Thus, prone sleeping with a history of snoring might be indicators for early screening for OSA in the cleft population. Adequate attention should be paid to their upper airway and, if available, overnight polysomnography should be performed to ascertain their potential respiratory problems before repair surgery.
Watching Food Videos Leads to Postparotidectomy Salivary Fistula
Authors: Sheng Yue , Ye Yu-xun , Jiang Er-hui , Deng Wei-wei , Xiong Xue-peng
Published: February 2023

Salivary fistula is a common postparotidectomy complication, and eating sour or spicy food ranks among the leading causes. Here we report a rare postparotidectomy salivary fistula case, a 31-year-old female patient who affirmed that she did not eat any irritating foods but admitted that she had been watching food videos for up to 4 hours every day since she left hospital. This case offers a cautionary tale about postparotidectomy precautions.
IMMUNOSUPPRESSION CORRELATES WITH THE DETERIORATION OF SEPSIS-INDUCED DISSEMINATED INTRAVASCULAR COAGULATION
Authors: Sun Yini , Sun Hao , Feng Jianshuang , Wang Chaoyang , Zheng Jiayin , Ma Xiaochun
Published: February 2023

Background: The dysregulated host responses play a crucial role in the pathophysiology process of sepsis-induced disseminated intravascular coagulation (DIC). The study aimed to characterize the dynamic alternation of immune-related biomarkers and their relationship with the progression of DIC during sepsis. Methods: A prospective, observational study was conducted in a tertiary care academic hospital. Six hundred forty patients with sepsis were classified into three groups according to the International Society on Thrombosis and Hemostasis (ISTH) score: 383 involved patients without DIC (ISTH = 0), 168 sepsis with nonovert DIC (ISTH = 1–4), and 89 sepsis with overt DIC (ISTH ≥5). Eighteen immune-related biomarkers and six routine coagulation variables were examined at D1, D3, and D7 upon enrollment. The association between the immune parameters and the DIC deterioration was assessed during sepsis. Results: The study showed a 40% coagulation disorder and a 14% incidence of overt DIC in patients with sepsis. The patients with overt DIC displayed pronounced immune disorders from D1 to D7 upon sepsis, which was characterized by the decreased percentage of monocyte HLA-DR (mHLA-DR), increased percentage of regulatory T cells, the levels of procalcitonin, neutrophil CD64 index, and systemic inflammatory cytokines relative to nonovert DIC or non-DIC patients. In multivariate analysis, the combination of anti-inflammatory cytokine IL-10 and mHLA-DR at D1 upon enrollment had a superior predictive value for predicting DIC deterioration in sepsis (area under the curve = 0.87, P < 0.0001). Conclusion: These data illustrate that immunosuppression can crosstalk with coagulation disorder during sepsis and present an additional evaluation tool to predict DIC deterioration.