bluuebunny/crossref_metadata_2025 huggingface dataset:
An Inverted Acetabular Labrum Is Predictive of Pavlik Harness Treatment Failure in Children With Developmental Hip Dysplasia
Authors: Lin Adrian J. , Siddiqui Ali A. , Lai Lillian M. , Goldstein Rachel Y.
Published: July 2021

Introduction:

The failure rate of Pavlik harness treatment for developmental dysplasia of the hip (DDH) has been reported as high as 55%. The purpose of this study is to investigate the effect of an inverted acetabular labrum on outcomes of Pavlik harness treatment for DDH.

Methods:

A retrospective review was conducted on DDH patients at a tertiary care pediatric hospital from 2004 to 2016. DDH patients that underwent index treatment with Pavlik harness and had minimum 12 months follow-up were included. Medical charts were reviewed for demographics, treatment, and outcomes. Outcomes were compared between patients with an inverted labrum versus those without an inverted labrum.

Results:

A total of 156 patients with 229 dysplastic hips were included. The mean age at initiation of Pavlik harness treatment was 1.9±1.4 months and mean follow-up was 37.7±23.0 months. Bilateral DDH was diagnosed in 46% (73/156) of patients. In all, 37% (75/229) of hips failed Pavlik harness index treatment. Second-line treatment was rigid hip abduction bracing in 91% (68/75) of hips, closed reduction in 5% (4/75) of hips, and open reduction in 4% (3/75) of hips. An inverted labrum was present in 10% (22/229) of all hips. The incidence of Pavlik harness treatment failure was 91% (20/22) in the inverted labrum group compared with 27% (55/207) in the control group (P<0.001). Closed or open reduction was required in 86% (15/22) of the inverted labrum group compared with 3% (7/207) of hips in the control group (P<0.001). The incidence of avascular necrosis was 18% (4/22) in hips with an inverted labrum compared with 0.4% (1/207) in the control group (P<0.001).

Conclusions:

In children with DDH undergoing index treatment in a Pavlik harness, the presence of an inverted acetabular labrum is strongly predictive of treatment failure. Dysplastic hips with an inverted labrum also have a significantly higher risk of requiring closed or open reduction and developing avascular necrosis compared with those without an inverted labrum.

Level of Evidence:

Level III.
Identification of Anterior Cervical Spinal Instrumentation Using a Smartphone Application Powered by Machine Learning
Authors: Schwartz John T. , Valliani Aly A. , Arvind Varun , Cho Brian H. , Geng Eric , Henson Philip , Riew K. Daniel , Lehman Ronald A. , Lenke Lawrence G. , Cho Samuel K. , Kim Jun S.
Published: July 2021

Study Design.

Cross-sectional study.

Objective.

The purpose of this study is to develop and validate a machine learning algorithm for the automated identification of anterior cervical discectomy and fusion (ACDF) plates from smartphone images of anterior-posterior (AP) cervical spine radiographs.

Summary of Background Data.

Identification of existing instrumentation is a critical step in planning revision surgery for ACDF. Machine learning algorithms that are known to be adept at image classification may be applied to the problem of ACDF plate identification.

Methods.

A total of 402 smartphone images containing 15 different types of ACDF plates were gathered. Two hundred seventy-five images (∼70%) were used to train and validate a convolution neural network (CNN) for classification of images from radiographs. One hundred twenty-seven (∼30%) images were held out to test algorithm performance.

Results.

The algorithm performed with an overall accuracy of 94.4% and 85.8% for top-3 and top-1 accuracy, respectively. Overall positive predictive value, sensitivity, and f1-scores were 0.873, 0.858, and 0.855, respectively.

Conclusion.

This algorithm demonstrates strong performance in the classification of ACDF plates from smartphone images and will be deployed as an accessible smartphone application for further evaluation, improvement, and eventual widespread use.

Level of Evidence: 3
Suture-button Fixation and Arthroscopic Dorsal Ligamento-capsulodesis in Chronic Scapholunate Dissociation
Authors: Ozcelik Ismail B. , Cavit Ali
Published: July 2021

The treatment choice in scapholunate (SL) injury depends on the extent of the SL ligament tear, chronicity of injury, quality of the ligament remnants, reducibility of carpal malalignment, and cartilage status of the radiocarpal and midcarpal joints. In the absence of degenerative changes with chronic reducible dissociation, the optimal treatment would be the reconstruction of the SL interosseous ligament. Various SL reconstruction techniques via open or arthroscopic approaches have been described over the years; they include tendon reconstructions, volar/dorsal capsulodesis, SL allografts, bone-tissue-bone composite grafts, reduction and association of the scaphoid and lunate procedure, SL axis method, and SL internal brace technique. However, all of these techniques have their own shortcomings and disadvantages. The present study demonstrates a new technique using a suture-button device for the reduction and fixation of SL diastasis. The suture-button system is positioned between the scaphoid and the triquetrum, the direction of the system prevents scaphoid flexion and maintains continuity of the reduction. Arthroscopic dorsal ligamento-capsulodesis technique can be added to achieve biological healing during the stabilization process. The major advantages of this technique over others are a straightforward application with shorter operative time and lack of a need for harvesting a tendon graft. The technique is performed through mini-incisions, which enable a shorter postoperative recovery time and rehabilitation period and a quicker restoration of function which decreases the risk of joint stiffness. Furthermore, large bone tunnels which increase the risk of fracture are avoided.
Long-Term Acute Care Hospital Outcomes of Mechanically Ventilated Patients With Coronavirus Disease 2019*
Authors: Saad Marina , Laghi Franco A. , Brofman John , Undevia Nidhi S. , Shaikh Hameeda
Published: July 2021

OBJECTIVES:

To describe the clinical characteristics and outcomes of adult patients with coronavirus disease 2019 requiring weaning from prolonged mechanical ventilation.

DESIGN:

Observational cohort study of patients admitted to two long-term acute care hospitals from April 1, 2020, to March 31, 2021.

SETTING:

Two long-term acute care hospitals specialized in weaning from prolonged mechanical ventilation in the Chicagoland area, Illinois, United States.

PATIENTS:

Adult (≥ 18 yr old) ICU survivors of respiratory failure caused by severe acute respiratory syndrome coronavirus 2 pneumonia receiving prolonged mechanical ventilation.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

During the study period, 158 consecutive patients were transferred to the long-term acute care hospitals for weaning from prolonged ventilation. Demographic, clinical, and laboratory data were collected and analyzed. Final date of follow-up was June 1, 2021. Prior to long-term acute care hospital transfer, median length of stay at the acute care hospital was 41.0 days and median number of ventilator days was 35. Median age was 60.0 years, 34.8% of patients were women, 91.8% had a least one comorbidity, most commonly hypertension (65.8%) and diabetes (53.2%). The percentage of weaning success was 70.9%. The median duration of successful weaning was 8 days. Mortality was 9.6%. As of June 1, 2021, 19.0% of patients had been discharged home, 70.3% had been discharged to other facilities, and 1.3% were still in the long-term acute care hospitals.

CONCLUSIONS:

Most patients with coronavirus disease 2019 transferred to two Chicago-area long-term acute care hospitals successfully weaned from prolonged mechanical ventilation.
Body Mass Index and Mortality in Coronavirus Disease 2019 and Other Diseases: A Cohort Study in 35,506 ICU Patients
Authors: Kooistra Emma J. , Brinkman Sylvia , van der Voort Peter H. J. , de Keizer Nicolette F. , Dongelmans Dave A. , Kox Matthijs , Pickkers Peter
Published: July 2021

OBJECTIVES:

Obesity is a risk factor for severe coronavirus disease 2019 and might play a role in its pathophysiology. It is unknown whether body mass index is related to clinical outcome following ICU admission, as observed in various other categories of critically ill patients. We investigated the relationship between body mass index and inhospital mortality in critically ill coronavirus disease 2019 patients and in cohorts of ICU patients with non-severe acute respiratory syndrome coronavirus 2 viral pneumonia, bacterial pneumonia, and multiple trauma.

DESIGN:

Multicenter observational cohort study.

SETTING:

Eighty-two Dutch ICUs participating in the Dutch National Intensive Care Evaluation quality registry.

PATIENTS:

Thirty-five–thousand five-hundred six critically ill patients.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Patient characteristics and clinical outcomes were compared between four cohorts (coronavirus disease 2019, nonsevere acute respiratory syndrome coronavirus 2 viral pneumonia, bacterial pneumonia, and multiple trauma patients) and between body mass index categories within cohorts. Adjusted analyses of the relationship between body mass index and inhospital mortality within each cohort were performed using multivariable logistic regression. Coronavirus disease 2019 patients were more likely male, had a higher body mass index, lower Pao
2/Fio
2 ratio, and were more likely mechanically ventilated during the first 24 hours in the ICU compared with the other cohorts. Coronavirus disease 2019 patients had longer ICU and hospital length of stay, and higher inhospital mortality. Odds ratios for inhospital mortality for patients with body mass index greater than or equal to 35 kg/m2 compared with normal weight in the coronavirus disease 2019, nonsevere acute respiratory syndrome coronavirus 2 viral pneumonia, bacterial pneumonia, and trauma cohorts were 1.15 (0.79–1.67), 0.64 (0.43–0.95), 0.73 (0.61–0.87), and 0.81 (0.57–1.15), respectively.

CONCLUSIONS:

The obesity paradox, which is the inverse association between body mass index and mortality in critically ill patients, is not present in ICU patients with coronavirus disease 2019–related respiratory failure, in contrast to nonsevere acute respiratory syndrome coronavirus 2 viral and bacterial respiratory infections.
Striving for Structure and Stability in Cincinnati's Family Homeless Shelters
Authors: Williams-Arya Pamela , Vaughn Lisa M. , Nidey Nichole , Sawyer Molly , Porter Kayla , Froehlich Tanya E.
Published: July 2021

Experiencing homelessness negatively impacts child health, development, and emotional-behavioral functioning, but there is limited knowledge regarding specific service priorities, as articulated by families themselves, to prevent or address these adverse sequelae. Thus, to elicit the service needs perspective of families in shelter and to translate these findings into real-world action, we undertook a community-based participatory research effort using Group-Level Assessment, a focus group methodology. An action-based participatory needs assessment called a Group-Level Assessment (GLA) was conducted in collaboration with parents currently experiencing homelessness. A total of 53 parents from 3 Cincinnati homeless shelters participated by responding to 17 to 20 open-ended prompts regarding their child's medical, developmental, learning, social, and behavioral needs. Using GLA methodology, we found that the needs expressed by families residing in shelters coalesced around the following themes: job and housing stability, education and skill development, emotional support, and improving shelter life. The GLA findings were then shared with shelter and community leaders, leading to a number of policy and practice enhancements in the shelters. This study demonstrates the power of the GLA approach to affect community action as a direct result of priorities generated by families experiencing homelessness.
Disparities in Technology and Broadband Internet Access Across Rurality
Authors: Graves Janessa M. , Abshire Demetrius A. , Amiri Solmaz , Mackelprang Jessica L.
Published: July 2021

Amidst the COVID-19 pandemic, interest in using telehealth to increase access to health and mental health care has grown, and school transitions to remote learning have heightened awareness of broadband inequities. The purpose of this study was to examine access and barriers to technology and broadband Internet service (“broadband”) among rural and urban youth. Washington State public school districts were surveyed about youth's access to technology (ie, a device adequate for online learning) and broadband availability in spring 2020. Availability of and barriers to broadband (ie, geography, affordability, and smartphone-only connectivity) were assessed across rurality. Among responding districts, 64.2% (n = 172) were rural and 35.8% (n = 96) were urban. Rural districts reported significantly fewer students with access to an Internet-enabled device adequate for online learning (80.0% vs 90.1%, P < .01). Access to reliable broadband varied significantly across geography (P < .01). Compared with their urban peers, rural youth face more challenges in accessing the technology and connectivity needed for remote learning and telehealth. Given that inadequate broadband infrastructure is a critical barrier to the provision of telehealth services and remote learning in rural areas, efforts to improve policies and advance technology must consider geographical disparities to ensure health and education equity.
Peptidoglycan Recognition Protein 1 Attenuates Atherosclerosis by Suppressing Endothelial Cell Adhesion
Authors: Jin Yao , Huang Hui , Shu Xinyi , Liu Zhuhui , Lu Lin , Dai Yang , Wu Zhijun
Published: July 2021

Peptidoglycan recognition protein 1 (PGLYRP1) has long been believed to play an important role in infectious and immune diseases. We hypothesized that it might be involved in the pathophysiology of atherosclerotic diseases, which are regarded as chronic inflammatory diseases. Serum PGLYRP1 concentrations were measured in 240 patients with coronary artery disease (CAD) and 209 age-matched and gender-matched individuals with normal coronary arteries using enzyme-linked immunosorbent assay. The expression of PGLYRP1 in atherosclerotic plaques was quantified using western blotting and immunostaining. ApoE

−/−
mice, fed a high-fat diet, were randomly given intraperitoneal injections of saline or recombinant PGLYRP1 protein for 12 weeks. The effects of PGLYRP1 on human umbilical vein endothelial cells were investigated by western blotting. Higher concentrations of PGLYRP1 were significantly associated with a higher risk of CAD. The odd ratio for upper quartile versus lower quartile was 2.24 (95% confidence interval: 1.21–4.13) after adjustment for sex, age, smoking, body mass index, lipid profile, blood pressure, fasting glucose, and estimated glomerular filtration rate. PGLYRP1 was highly expressed in murine atherosclerotic plaques. Recombinant PGLYRP1 protein alleviated the progress of atherosclerosis in vivo and reduced the expression of endothelial cells' adhesion molecules in vitro. In conclusion, our study suggested that PGLYRP1 is upregulated in patients with CAD and atherosclerotic plaques. PGLYRP1 may participate in the pathophysiological process of atherosclerosis.
Altered Vascular Reactivity to Circulating Angiotensin II in Familial Hypercholesterolemia
Authors: Ekholm Mikael , Wallén Håkan N. , Brinck Jonas , Jörneskog Gun , Kahan Thomas
Published: July 2021

We have previously shown increased vascular reactivity to angiotensin (Ang) II in familial combined hyperlipidemia. However, this has not been well studied in familial hypercholesterolemia (FH), a condition with incipient endothelial dysfunction. This study aimed to examine microvascular and macrovascular responses to Ang II in FH. Therefore, we investigated the effects of a 3-hour infusion of Ang II on blood pressure and forearm skin microvascular function in 16 otherwise healthy patients with FH and matched healthy controls. Skin microvascular hyperemia was studied by laser Doppler fluxmetry during local heating. Microvascular resistance was determined by the ratio of mean arterial pressure to microvascular hyperemia. Macrovascular reactivity was assessed by changes in brachial blood pressure. Compared with the controls, the FH group had increased baseline systolic blood pressure (127 ± 14 vs. 115 ± 12 mm Hg; P = 0.02), while systolic blood pressure responses were similar (+24 ± 9 vs. +21 ± 7 mm Hg; P = 0.26) after 3 hours of Ang II infusion. At baseline, there were no group differences in microvascular hyperemia or resistance. However, after 3 hours of Ang II infusion, heat-induced microvascular hyperemia was less pronounced in FH (126 ± 95 vs. 184 ± 102 arbitrary units; P = 0.01), while microvascular resistance during heat-induced hyperemia was increased (1.9 ± 0.9 vs. 0.9 ± 0.8, P = 0.01), as compared to controls. Both these responses were further pronounced 1 hour after stopping Ang II. In conclusion, despite similar blood pressure responses to Ang II in the FH group and controls, microvascular dilatation capacity was impaired in the FH group, indicating endothelial dysfunction. These findings and increased microvascular resistance may lead to hypertension and microvascular complications in FH.
COMPARATIVE EVALUATION OF OUTCOMES OF DRAINAGE TECHNIQUES IN VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Kumari Neha , Surve Abhidnya , Kumar Vinod , Azad Shorya V. , Chawla Rohan , Venkatesh Pradeep , Vohra Rajpal , Kumar Atul
Published: July 2021

Purpose:

To compare the anatomical and functional outcomes of drainage through posterior retinotomy versus perfluorocarbon liquid (PFCL)–assisted drainage in vitreoretinal surgery for rhegmatogenous retinal detachment and to study intraoperative and postoperative complications.

Methods:

This was a prospective randomized study of 52 cases who underwent vitreoretinal surgery for rhegmatogenous retinal detachment. Group 1 underwent PFCL-assisted drainage through preexisting break, whereas Group 2 had posterior retinotomy to drain subretinal fluid. Cases were evaluated for retinal reattachment rates, visual outcomes, optical coherence tomography parameters, and postoperative metamorphopsia. The patients were followed up for minimum period of 3 months.

Results:

Two groups were comparable in terms of demographic and preoperative parameters. Both groups had single surgery success rate of 100% by the end of follow-up. Final best-corrected visual acuity in Group 1 was 0.61 ± 0.33 and 0.61 ± 0.32 in Group 2 (P = 0.77). Optical coherence tomography parameters (foveal contour, retinal layers, central macular thickness, and epiretinal membrane formation) were similar between the two groups. Subjective metamorphopsia was present in 30.77% (8 of 26) patients in Group-1 and 69.23% (18 of 26) patients in Group-2 (P = 0.034). One eye had retained subretinal PFCL away from the macula in Group 1.

Conclusion:

Anatomical and functional outcomes were similar in vitrectomy using PFCL-assisted drainage versus posterior retinotomy drainage. Postoperative metamorphopsia was lesser in patients who underwent PFCL-assisted drainage through the pre-existing break.
Lymphoma of the Lacrimal Sac: The Massachusetts Eye and Ear Experience With a Comparison to the Previously Reported Literature
Authors: Neerukonda Vamsee K. , Stagner Anna M. , Wolkow Natalie
Published: July 2021

Purpose:

To describe the frequency, clinical features, and histologic subtypes of biopsy proven lacrimal sac lymphomas, and to compare these results to the previously published literature.

Methods:

A retrospective chart review was performed at a single institution from 2004 to 2017. Pathology reports, operative notes, and patients’ medical charts were reviewed.

Results:

Of 566 lacrimal sacs submitted for routine histopathologic evaluation, 16 cases of lymphoma were identified. All were low-grade, non-Hodgkin B-cell lymphomas, biopsied at an average age of 71 years. Thirteen patients (81.25%) had a pre-existing lymphoma diagnosis; the average interval between the diagnosis of systemic or nonocular adnexal lymphoma and lacrimal sac lymphoma was 7.9 years (range 2–26 years; median 5.5 years). Three cases of primary lacrimal sac lymphoma were identified. Histopathology showed 3 cases (18.75%) of follicular lymphoma, 3 (18.75%) of extranodal marginal zone lymphoma, and 10 (62.5%) of chronic lymphocytic leukemia/small lymphocytic lymphoma. Primary cases presented with epiphora and nasolacrimal duct obstruction, while secondary cases predominantly manifested as dacryocystitis. All lacrimal sac neoplasms were locally responsive (without local recurrence) to chemotherapy, radiation, or both.

Conclusions:

Lacrimal sac lymphoma is uncommon but should be suspected among patients with known lymphoma who develop dacryocystitis. In this series, primary lacrimal sac lymphoma most often presented as a mass or nasolacrimal duct obstruction. Chronic lymphocytic leukemia/small lymphocytic lymphoma was the most commonly identified cause of secondary lacrimal sac lymphoma. Distinguishing primary from secondary lacrimal sac lymphomas is important, as the extent of disease and histopathologic subtypes differ, which may affect patient management.
Acquired Epiblepharon Alleviated With Teprotumumab Treatment in Active Thyroid Eye Disease Patient
Authors: Chen Kevin W. , Phelps Paul O.
Published: July 2021

A 46-year-old Asian female patient with thyroid eye disease reported ocular irritation, eyelid swelling, diplopia, and pain with eye movement. The patient was diagnosed with active thyroid eye disease and secondary thyroid eye disease–acquired epiblepharon, which was causing bilateral punctate epithelial erosion. Treatment was started with newly U.S. Food and Drug Administration approved teprotumumab, an insulin-like growth factor-1 receptor inhibitor. Four infusion treatments later, the patient’s epiblepharon was alleviated with minimal side effects. In this report, the authors present a case of thyroid eye disease–acquired epiblepharon resolving with teprotumumab treatment.
A prospective long-term follow-up of dorsal root ganglion stimulation for the management of chronic intractable pain
Authors: Eldabe Sam , Copley Sue , Gulve Ashish , Baranidharan Ganesan , Bretherton Beatrice , Kansal Anu , Madzinga Grace , Brookes Morag , Thomson Simon , Duarte Rui V.
Published: July 2021

Initial clinical studies have shown that the stimulation of the dorsal root ganglion (DRG) can significantly reduce chronic intractable pain. However, clinical data on long-term results and complications of these systems are limited. The aim of this prospective study is to report on a single center long-term follow-up of DRG stimulation for intractable chronic pain. Participants were implanted with DRG stimulation devices between 2013 and 2015 with an observation period of 24 months. Patients were contacted again in 2020 for a final follow-up (ie, between 5 and 7 years postimplantation). Forty-two participants were recruited, of whom 32 received the fully implantable pulse generator (IPG). At the final follow-up, 50% (16/32) of participants were still using DRG stimulation. Two participants still had the original IPG and 14 had received a replacement IPG. Pain scores were significantly reduced at 24 months, mean difference 1.7 (95% confidence interval: 0.2-3.3, P = 0.03), and at the last follow-up, mean difference 2.1 (95% confidence interval: 0.3-4, P = 0.03). Significant improvements were observed for health-related quality of life. The findings were generally robust to imputation methods of missing data. Implantable pulse generators of 8 patients were explanted because of dissatisfaction with pain relief. In conclusion, DRG stimulation can provide effective pain relief and improved quality of life in patients suffering with neuropathic pain, although this study had a revision rate of 42% within the first 24 months, and 56% of IPGs that were replaced because of battery depletion had a shorter than expected battery life.
Amygdala functional connectivity mediates the association between catastrophizing and threat-safety learning in youth with chronic pain
Authors: Timmers Inge , López-Solà Marina , Heathcote Lauren C. , Heirich Marissa , Rush Gillian Q. , Shear Deborah , Borsook David , Simons Laura E.
Published: July 2021

There is a need to identify brain connectivity alterations predictive of transdiagnostic processes that may confer vulnerability for affective symptomology. Here, we tested whether amygdala resting-state functional connectivity (rsFC) mediated the relationship between catastrophizing (negative threat appraisals and predicting poorer functioning) and altered threat-safety discrimination learning (critical to flexibly adapt to new and changing environments) in adolescents with persistent pain. We examined amygdala rsFC in 46 youth with chronic pain and 29 healthy peers (age M = 15.8, SD = 2.9; 64 females) and its relationship with catastrophizing and threat-safety learning. We used a developmentally appropriate threat-safety learning paradigm and performed amygdala seed–based rsFC and whole-brain mediation analyses. Patients exhibited enhanced connectivity between the left amygdala and right supramarginal gyrus (SMG) (cluster-level P-FDR < 0.05), whereas right amygdala rsFC showed no group differences. Only in patients, elevated catastrophizing was associated with facilitated threat-safety learning (CS+>CS−; r
p = 0.49, P = 0.001). Furthermore, in patients, elevated catastrophizing was associated with reduced left amygdala connectivity with SMG / parietal operculum, and increased left amygdala connectivity with hippocampus, dorsal striatum, paracingulate, and motor regions (P < 0.001). In addition, blunted left amygdala rsFC with right SMG/parietal operculum mediated the association between catastrophizing and threat-safety learning (P < 0.001). To conclude, rsFC between the left amygdala (a core emotion hub) and inferior parietal lobe (involved in appraisal and integration of bodily signals and attentional reorienting) explains associations between daily-life relevant catastrophizing and threat-safety learning. Findings provide a putative model for understanding pathophysiology involved in core psychological processes that cut across diagnoses, including disabling pain, and are relevant for their etiology.
Leprosy Update in China, 2019
Authors: Wang Le , Sun Pei-Wen , Yu Mei-Wen , Gu Heng , Wang Hong-Sheng , Chen Xiang-Sheng
Published: July 2021

Objective:

To study the epidemiology of leprosy in China in 2019 and give suggestions to improve future leprosy control activities.

Methods:

We collected leprosy data from the Leprosy Management Information System in China, which includes data from 31 Chinese provinces, autonomous regions, and municipalities, except for Hong Kong, Macao, and Taiwan. We then performed a descriptive analysis of these data.

Results:

A total of 464 new leprosy cases were reported nationwide in 2019, with a case detection rate of 0.033/100,000. The proportions of children younger than 15years, multibacillary cases, and cases with World Health Organization grade 2 disability were 1.3%, 90.3%, and 21.6%, respectively. A total of 2,219 leprosy cases were registered in China by the end of 2019, giving a prevalence rate of 0.158/100,000. Fifty-six counties had a prevalence rate of more than 1/100,000, and most of them were located in Southwest China. There were 31 reported relapse cases.

Conclusion:

The prevalence of leprosy has improved continuously throughout China, but the southwest region is still an area of concern.
Efficacy and Safety of 0.05% Halometasone/1% Triclosan Cream Versus 0.1% Mometasone Furoate Cream in the Treatment of truncal vitiligo: A Retrospective Study
Authors: Qi Shu-Zhen , Zeng Xue-Si , Hu Shu-Chang
Published: July 2021

Objective:

To retrospectively evaluate efficacy and safety of 0.05% halometasone/1% triclosan cream (Hal/TCS) in treating truncal vitiligo of children and adolescents.

Methods:

We retrospectively reviewed the records of children and adolescents with truncal vitiligo treated only with topical Hal/TCS twice daily or only with topical 0.1% mometasone furoate cream (mometasone) twice daily for at least 3 months, and collected relevant data. Efficacy outcomes included patients’ mean repigmentation score after 1- and 3-month treatment calculated based on patients’ repigmentation percentage, and effective rate (percentage of patients with ≥50% repigmentation). Subgroup analyses of patients’ mean repigmentation score based on their age, vitiligo stage, and duration were conducted. Rate of adverse events were calculated.

Results:

One hundred and twenty-two eligible patients were included, among them, 63 and 59 patients were in the Hal/TCS group and the mometasone group, respectively. After 3 months of treatment, the Hal/TCS group had significantly higher mean repigmentation score and effective rate than the mometasone group (53.49 ± 28.33 vs. 41.46 ± 27.16, P = 0.02; 53.97% vs. 35.59%, P = 0.04, respectively). Patients with shorter disease duration (≤12 months) and patients with progressive vitiligo responded significantly better to the Hal/TCS treatment than patients with longer disease duration and patients with stable vitiligo, respectively. Both treatments were well tolerated and the two treatment groups had comparable rates of adverse events.

Conclusions:

Short-term Hal/TCS treatment was effective, well-tolerated, and safe in treating vitiligo in the trunk of children and adolescents.
Chinese Immigrant Women's Experiences as Community Health Workers in Korea: A Focus Group Study
Authors: KIM Jiyun , KIM Hyang , HAN Hae-Ra
Published: July 2021

Background

The number of immigrant women in Korea is rapidly increasing. Immigrant women in Korea experience a host of health problems associated with living in a new country. Community health workers (CHWs) may be effective at delivering health promotion programs to vulnerable groups such as recent immigrants.

Purpose

Qualitative analysis was performed to identify the main themes characterizing the experiences of CHWs in recommending and guiding preventive screening tests for immigrant women.

Methods

This focus-group study was designed to investigate the experiences and perceptions of CHWs. We conducted interviews with 15 Chinese immigrant women who served as CHWs in a cancer screening program. We asked questions about the attitudes and perceptions that CHWs had from their research experiences. Each interview was audio-recorded and transcribed verbatim.

Results

Three main themes emerged: (a) recognizing the need for preventive healthcare, (b) becoming the CHWs who help people to be healthy, and (c) challenges to overcome to make CHWs more active. The CHWs in this study were willing to help other Chinese immigrant women and to improve their competency to help more effectively. However, they recognized limitations on their ability to address problems when delivering a breast and cervical cancer screening program.

Conclusions

When training CHWs for immigrants in Korea, frequent opportunities for consultation should be provided during program delivery to facilitate troubleshooting and help CHWs overcome challenges. A program that utilizes CHWs for various minority groups is needed.
Development and Evaluation of a Transition Model for Adolescents With Inflammatory Bowel Disease Moving From Pediatric to Adult Surgical Care
Authors: Bergström Jenny , Dellenmark-Blom Michaela , Gatzinsky Vladimir , Abrahamsson Kate , Bräutigam Matilda , Gatzinsky Cathrine
Published: July 2021

Background

There is a need for a transition model for patients with inflammatory bowel disease (IBD) moving from pediatric to adult surgical care.

Aim

The aim of this study was to report the development and evaluation of a transition model for adolescents with IBD from pediatric to adult surgical care in a Swedish setting.

Methods

A multidisciplinary team conducted a literature search on the needs of patients with IBD moving from pediatric to adult surgical care. This was followed by a consensus discussion to aid the creation of a surgical transition model. Between 2018 and 2020, eight of 12 adolescents who had undergone IBD surgery and were transferred to adult care answered a 25-item questionnaire regarding their health and quality of care.

Results

The main components of the surgical transition model are as follows: The adolescents are given more responsibility for their IBD management; they meet staff without parents; they are given information about the transfer at the age of 14 years; if willing, they undergo a rectoscopy without anesthesia; and they complete a transition checklist and have a first meeting with the pediatric and adult surgical staff. After transfer, respondents rated their health positively but described some everyday life limitations. They reported sufficient preparation before transfer, positive attitudes by healthcare professionals, and parental support. They felt they had been given enough information before the stoma surgery and were satisfied with availability of the nurse and the stoma location.

Discussion

A surgical transition model from pediatric to adult care for patients with IBD is motivated from the adolescents' perspectives. More research is warranted.
Classroom-Based Simulation: Participants and Observers Perceive High Psychological Fidelity and Improved Clinical Preparedness
Authors: Miale Susan , Silberman Nicki , Kupczynski Lori
Published: July 2021

Introduction.

High-fidelity simulation-based learning experiences (SBLEs) can improve student confidence for clinical practice, but there are several barriers to incorporating these activities into physical therapy program curricula.

Review of Literature.

Studies have explored high-fidelity acute care SBLEs in simulation laboratories, but little is known about the effectiveness of low-cost classroom-based SBLES in physical therapy education. Additionally, there is a gap in the literature related to the role of the active observer during SBLEs in physical therapy education. The purpose of this study was to uncover student perspectives about participating as both participant and observer in classroom-based SBLEs and the impact of this experience on preparedness for acute care clinical practice.

Subjects.

Subjects included a convenience sample of first-year doctor of physical therapy (DPT) students.

Methods.

Students participated in a series of classroom-based SBLEs as part of a first-year DPT course. This mixed methods study included focus groups to qualitatively analyze student perspectives of classroom-based SBLEs and a pre–post quasi-experimental design to evaluate changes in perceived self-efficacy for acute care clinical practice before and after a series of classroom-based SBLEs using the Acute Care Confidence Survey (ACCS).

Results.

Quantitative data analysis (n = 60) revealed a statistically significant increase in perceived self-efficacy for the total ACCS (Z = −6.250, P < .000) and all 4 subscales from presimulation to postsimulation. Qualitative data analysis (n = 22) revealed 4 primary themes related to participating in classroom-based SBLEs: (1) psychological fidelity—it felt real; (2) promotes clinical reasoning for participants and observers; (3) stimulates self-reflection and observational learning; and (4) fosters self-efficacy for future clinical practice.

Conclusion.

Classroom-based SBLEs can provide a high-fidelity and cost-effective means of exposing students to a range of clinical situations that engage all participants in experiential learning through both direct participation and active observation.
Otologic Manifestations After COVID-19 Vaccination: The House Ear Clinic Experience
Authors: Wichova Helena , Miller Mia E. , Derebery M. Jennifer
Published: July 2021

Objective:

With the increasing numbers of COVID-19 vaccinations available there are some reports of new onset of otologic symptoms. We present our experience in recently vaccinated patients over a 30-day time frame.

Study Design:

Retrospective chart review.

Setting:

Tertiary otology ambulatory practice.

Patients:

All patients with available diagnostic codes, COVID-19 questionnaires and clinical notes.

Interventions:

Observational recordings.

Main Outcome Measures:

Within the same 30-day time period in 2019, 2020, and 2021, 1.6, 2.4, and 3.8% respectively, of all office visits were for patients with the diagnosis of new onset idiopathic sensorineural hearing loss (SNHL) without other underlying otologic diagnoses. In this time frame in 2021, 30 patients out of the 1,325 clinical visits had new or significantly exacerbated otologic symptoms that began shortly after COVID-19 vaccination. Specifically, 18 patients received Moderna and 12 patients received Pfizer vaccine. Their mean age was 60.9±13.8 years old; 11 were women and 19 men. The mean onset of symptoms was 10.18 ± 9 days post-vaccination. Symptoms included 25 patients (83.3%) with hearing loss, 15 (50%) with tinnitus, eight (26.7%) with dizziness, and five (16.7%) with vertigo. Eleven patients had previous otologic diagnoses, including six patients with Menière's disease, two with autoimmune inner ear disease (AIED), and three having both.

Conclusions:

There are no definite correlations to the COVID-19 pandemic or vaccination and new or worsened otologic symptoms. Vaccinated patients with new or exacerbated otologic symptoms should be promptly referred for evaluation. Suspected cases of post-vaccination otologic symptoms should be reported to the Center for Disease Control (CDC) vaccine adverse event reporting system (VAERS).
The Effect of CPAP on Middle Ear Pressure: A Systematic Review and Meta-analysis
Authors: Ma Cheng , Yuen Erick , Nguyen Shaun A. , Meyer Ted A. , Lambert Paul R.
Published: July 2021

Objective:

To assess the effect of short-term and long-term continuous positive airway pressure (CPAP) use on middle ear pressure (MEP) in adult ears.

Databases Reviewed:

PubMed, Scopus, and Embase were searched through October 2020. Search strategies used a combination of subject headings (e.g., MeSH in PubMed) and keywords for CPAP and middle ear pressure.

Methods:

English-language articles studying changes in MEP as measured by tympanometry or tympanograms in patients using CPAP were selected for inclusion. Data extraction from included articles included demographics, baseline, and follow-up data.

Results:

A total of 7 articles representing 664 patients with weighted mean age of 42.5 years (range 34.9–57.8 yrs) were included. Meta-analysis of three qualifying studies demonstrated a positive correlation between higher CPAP pressures and degree of MEP rise during CPAP use compared to baseline with mean difference of 25.1 daPa (95% confidence interval [18.7, 31.4]) at 5 cm H2O and 81.9 daPa (95% confidence interval [60.2, 103.5]) at 10 cm H2O. Short-term effects of CPAP use were reviewed in four studies that showed a transient rise in MEP. Three separate studies examining the long-term effects of CPAP use showed resting MEP was higher in patients with severe obstructive sleep apnea (OSA), which might be related to progressive eustachian tube dysfunction as a complication of severe OSA.

Conclusion:

Short-term CPAP use is associated with transient elevations of MEP in adult ears. Long-term CPAP use might produce beneficial MEP changes, especially in patients with OSA and eustachian tube dysfunction.
Cannabinoid Receptor 2 Agonism is Capable of Preventing Lipopolysaccharide Induced Decreases of Cochlear Microcirculation – A Potential Approach for Inner Ear Pathologies
Authors: Weiss Bernhard G. , Freytag Saskia , Kloos Benedikt , Haubner Frank , Sharaf Kariem , Spiegel Jennifer Lee , Canis Martin , Ihler Friedrich , Bertlich Mattis
Published: July 2021

Hypothesis:

The ability of JWH-133, an agonist at the cannabinoid receptor 2, to abrogate the effects of lipopolysaccharide on cochlear microcirculation was investigated.

Background:

Cochlear inflammation and subsequent impairment of microcirculation is part of numerous pathologies affecting inner ear function, including suppurative labyrinthitis, noise trauma, and sudden sensorineural hearing loss. One way of causing cochlear inflammation is exposing the cochlea to lipopolysaccharide, a bacterial endotoxin.

Methods:

Twenty Dunkin-hartley guinea pigs were divided into four groups of five animals each. Two groups received topic treatment with JWH-133 and two received treatment with placebo. One group that had been treated with JWH-133 and one with placebo were then exposed to lipopolysaccharide or placebo, respectively. Cochlear microcirculation was quantified before, in between and after treatments by in vivo fluorescence microscopy.

Results:

Significantly different changes in cochlear blood flow were only seen in the group that was treated with placebo and subsequently lipopolysaccharide. Every other group showed no significant change in cochlear blood flow.

Conclusion:

JWH-133 is capable of abrogating the effects of lipopolysaccharide on cochlear microcirculation. It may therefore be clinical interest in treating numerous inflammation associated cochlear pathologies.
Could the systemic immune-inflammation index be a predictor to estimate cerebrovascular events in hypertensive patients?
Authors: Aydin Cihan , Alpsoy Şeref , Akyüz Aydin , Özkaramanli Gür Demet , Emlek Nadir , Şahin Ayhan , Gültekin Ahmet , Aykaç Hüseyin
Published: July 2021

Background and objectives

Hypertension is one of the most important risk factors for cardiovascular and cerebrovascular events. Inflammatory processes occupy an important place in the pathogenesis of hypertension. Many studies have studied inflammatory markers responsible for the onset of hypertension and organ damage. In this study, we investigated whether the systemic immune-inflammation index (SII) (platelet × neutrophil/lymphocyte), – one of the new inflammatory markers – can be used to predict cerebrovascular events in hypertensive patients.

Methods

Ambulatory blood pressure monitoring results between January 2019 and June 2020 of approximately 379 patients followed up with hypertension were retrospectively analyzed. These patients were divided into two groups as with or without a previous cerebrovascular event in the analyzed database. In all patients, complete blood count and biochemistry test results just before the cerebrovascular event were found from the database. SII, atherogenic index, neutrophil-lymphocyte ratio were calculated from the complete blood count. Forty-nine patients with stroke (group 1: 12.9%; mean age: 64.3 ± 14.6) and 330 patients without stroke (group 2: 87.1%; mean age: 50.8 ± 14.4).

Results

Ambulatory blood pressure measurements were lower in group 1. Lipid parameters were also lower in this group. Receiver operating characteristic curve analysis showed that SII had a sensitivity of 85.7% and specificity of 84.8 % for stroke in individuals who participated in the study when the cutoff value of SII was 633.26 × 103 (P = 0.0001) area under curve (95%); 0.898 (0.856–0.941). In multivariate logistic regression analysis, age and SII were significantly associated with a higher risk of stroke. Age, (hazard ratio:1.067; 95% CI, 1.021–1.115), SII (hazard ratio:1.009; 95% CI, 1.000–1.009), respectively.

Conclusions

In conclusion, SII is a simple, useful new inflammatory parameter for predicting stroke from hypertension. We found that the high SII levels increase the risk of stroke in hypertensive patients.
The diagnostic value of metabolic, morphological and heterogeneous parameters of 18F-FDG PET/CT in mediastinal lymph node metastasis of non–small cell lung cancer
Authors: Hua Jun , Li Lan , Liu Lisheng , Liu Qi , Liu Ying , Chen Xiaoliang
Published: July 2021

Objectives

To investigate the value of PET/CT metabolic, morphological and heterogeneous parameters in the diagnosis of 18F-FDG positive mediastinal lymph node metastasis in non–small cell lung cancer (NSCLC).

Patients and methods

A total of 156 patients with pathologically diagnosed NSCLC and underwent 18F-FDG PET/CT scans were enrolled in this study. Mediastinal lymph nodes with 18F-FDG uptake greater than the mediastinum were analyzed. The metabolic parameters of maximum and mean standardized uptake value (SUVmax, SUVmean), SUVratio (node SUVmax/mediastinum SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), morphological parameters of maximum short diameter (Dmin), CT values and metabolic heterogeneity parameter of coefficient of variation (COV) were measured. The performance of each parameter and their combinations for diagnosis of lymph node metastasis was evaluated through receiver operating characteristic (ROC) curves and binary logistic regression analysis.

Results

There were 206 lymph nodes with pathological evidence included in the study, including 103 metastatic and 103 nonmetastatic nodes. The SUVmax, SUVmean, SUVratio, TLG, COV and Dmin of metastatic lymph nodes were significantly higher/greater than those in nonmetastatic ones (P < 0.05). ROC curve analysis revealed that the combination of SUVratio, Dmin and COV showed the highest diagnostic efficacy among all single and combined parameters, the area under the curve (AUC) was 0.907 (P = 0.000), these three parameters all increased the risk of lymph node metastasis, with odds ratios of 1.848, 1.293 and 1.258, respectively (all P < 0.05).

Conclusion

Heterogeneity parameter was helpful for the accurate distinction of mediastinal lymph node metastasis in NSCLC. The combination of the SUVratio, Dmin and COV could improve the diagnostic accuracy. Multiple-parameters analysis plays an important complementary role in the diagnosis of lymph node metastasis.
Psychometric properties of the Client Satisfaction with Device module of the Orthotics and Prosthetics Users’ Survey (OPUS): a scoping review
Authors: Sorrentino Gregorio , Vercelli Stefano , Salgovic Ludovit , Ronconi Gianpaolo , Bakhsh Hadeel R. , Ferriero Giorgio
Published: July 2021

Patient’s satisfaction with device is an important clinical outcome in prosthetics and orthotics. The Client Satisfaction with Device (CSD) – one of the five modules of the Orthotics and Prosthetics Users’ Survey (OPUS) – has been defined as the only outcome measure specifically developed to measure user satisfaction with a prosthesis or an orthosis. The aim of this study was to provide a comprehensive review of the psychometric properties of the CSD, summarizing the present evidence on this measure, and verifying if the scoring system is consistent in the literature. A systematic literature search was conducted utilizing PRISMA guidelines. Articles were searched in PubMed and Scopus databases using search terms relating to the psychometric properties of the CSD. Thirteen articles assessing the psychometric properties of the CSD met the inclusion criteria for this review. The CSD has been translated and validated in several languages. However, these versions are not consistent across the studies since they include different number of items, with different number of response options, and scoring systems. The CSD – where used in its eight-item version, rated with a four-point rating scale – can be judged as a tool with acceptable psychometric properties for assessing satisfaction with devices in prosthesis and orthosis users. This CSD version seems the best one for optimizing coverage and psychometric quality with the fewest number of items. Further studies are warranted to assess the degree of suitability of this scale in specific populations of users of prostheses or orthoses and to analyze its psychometric properties in further cultural contexts.