bluuebunny/crossref_metadata_2025 huggingface dataset:
Short-term radiographic outcome of varus osteotomy in the treatment of Legg-Calvé-Perthes disease: a retrospective case series study
Authors: Ghaznavi Alireza , Motaghi Paniz , Ghaderi Mohammad Taher , Sileymani Naseh , Saberi Saba , Mohammadpour Mehdi
Published: February 2022

Background:

Varus osteotomy is a popular method for the operative treatment of Legg-Calvé-Perthes disease (LCPD). In this study, the authors aimed to evaluate the radiographic outcomes of varus osteotomy and its association with the extent of hip involvement.

Methods:

Twenty-one patients in early stages of disease (stage I and II of LCPD, according to the modified Elizabethtown classification) who were treated with varus osteotomy were studied. The radiographic outcome measures were Caput Index and epiphyseal quotient (EQ) that were assessed before the surgery and 2 yr postoperatively. The level of hip involvement was determined by the modified lateral pillar classification.

Results:

The mean Caput index of the patients improved from 55.5±12.7 to 74±13.4 (P<0.001). The mean EQ of the patients improved from 47.2±12.9% to 67.8±17.1% (P<0.001). According to the EQs, the radiographic outcomes were found to be good, fair, and poor in 16 (76.1%) patients, 4 (19.1%) patients, and 1 (4.8%) patient, respectively. The mean change of Caput Index and EQ was significantly more in the B/C lateral pillar group than C lateral pillar group (P=0.04 and P=0.02, respectively).

Conclusions:

Varus osteotomy could be recommended as an effective surgical treatment for LCPD. The level of hip involvement at presentation could be used as independent factors of surgical prognosis.

Level of Evidence:

Level III.
Outpatient Opioid Prescribing Habits in Pediatric Patients With Bone Sarcomas After Undergoing Primary Tumor Resection
Authors: Ramos Omar , Mierke Alex , Filler Ryan , Williams Nadine L. , Femino Joseph D. , Zuckerman Lee M.
Published: February 2022

Background:

The majority of children with bone sarcomas experience pain. Opioids remain the mainstay treatment of cancer-related pain in children. The patterns of outpatient opioid prescription after surgery for primary bone sarcomas remains unknown. The purpose of this study is to evaluate the patterns of outpatient opioid prescription in patients with bone sarcomas after resection of the primary tumor, and to assess for factors that may lead to increased opioid dosing in these patients.

Methods:

A retrospective chart review of 28 patients with bone sarcomas undergoing primary tumor resection was performed. Demographic, medical, surgical, and pharmacological data was collected from all patients. The total morphine milligram equivalents (MMEs) prescribed after patient discharge were compared at 30-day intervals. The MMEs were then stratified by tumor location, presence of metastasis at time of surgery, and preoperative opioid use. Independent predictors of increased 30-day and total 120-day opioid utilization were evaluated.

Results:

Patients with preoperative opioid use were prescribed significantly more opioids in every 30-day postoperative interval and for the 120-day total. When stratified by tumor location, patients with primary tumors in the pelvis had significantly greater postoperative opioid utilization when compared with patients with tumors located in the lower and upper extremities during postoperative days 61 to 90 (5970 vs. 1060.4 and 0 MMEs, respectively, P=0.048) and during postoperative days 91 to 120 (6450 vs. 829.6 and 0 MMEs, respectively, P=0.015). Older age, diagnosis of osteosarcoma, increased length of stay postoperatively and presence of metastases were associated with a higher 30-day postoperative opioid utilization.

Conclusion:

Multiple factors were associated with increased opioid use including preoperative opioid use, longer postoperative stay in the hospital, metastatic disease, and primary sarcomas in the pelvis. The patient’s sex, body mass index, race, type of insurance, type of surgery performed, reoperation during the same admission and use of nonopioid adjuvants had no effect on opioid use. The results of this study can be used to stratify the average opioid requirement of pediatric patients undergoing primary bone sarcoma resection.

Level of Evidence:

Level IV.
Validation of a Novel Magnetic Resonance Imaging Classification for Osteochondritis Dissecans of the Knee
Authors: Feroe Aliya G. , Flaugh Rachel A. , Majumdar Aditi , Baxter Tara A. , Miller Patricia E. , Kocher Mininder S.
Published: February 2022

Background:

The novel Kocher classification is a 3-group magnetic resonance imaging (MRI) classification system for osteochondritis dissecans (OCD) of the knee that was shown to have comparable reliability to that of the established 5-group Hefti classification. The purpose of this study was to evaluate the validity and clinical utility of this simplified system as an alternative to the Hefti classification.

Methods:

Demographic data and arthroscopic findings were retrospectively collected from medical and surgical records of 144 consecutive knees in children with arthroscopically diagnosed knee OCD. OCD lesions on preoperative MRIs and surgical reports (serving as the reference standard) were assessed by independent raters and assigned both a Kocher and Hefti classification. Agreement between MRI classification and arthroscopic findings for both systems was assessed using weighted kappa (k

w
) coefficients. Validation, accuracy, sensitivity, and specificity were measured by comparing a dichotomized Kocher classification for MRI and arthroscopy, and by estimating Cohen kappa (k

c
) coefficients. Agreement between arthroscopic findings and treatment type was measured using the Spearman correlation coefficient.

Results:

Inter-rater reliability between the 2 MRI raters was substantial for the Kocher classification [k

a
=0.66; 95% confidence interval (CI)=0.56-0.75] and moderate for the Hefti classification (k

a
=0.57; 95% CI=0.47-0.67). There was no difference detected in the agreement statistics for Kocher versus Hefti classifications (P=0.89). Binary agreement using dichotomized Kocher classifications was worse than the 3-group category classification. When dichotomized, combining Kocher grades 1 and 2 demonstrated moderate agreement (k

c
=0.41; 95% CI=0.25-0.58), and combining grades 2 and 3 demonstrated fair agreement (k

c
=0.34; 95% CI=0.21-0.48). There was a strong correlation between arthroscopy-based finding and treatment category for both the Kocher classification (r=0.85; 95% CI=0.80-0.89) and the Hefti classification (r=0.82; 95% CI=0.75-0.86).

Conclusion:

The validity and clinical utility of the newer 3-group Kocher classification for knee OCD is comparable to that of the well-established 5-group Hefti classification. Both systems help determine lesion stability and characteristics on MRI, which correlate closely to arthroscopic findings. This simplified classification system, with less uncertainty, provides a foundation for further outcomes research to develop an evidence-based algorithm for effective surgical management of OCD lesions of the knee.

Level of Evidence:

Level II—diagnostic study.
Catabolism in Critical Illness: A Reanalysis of the REducing Deaths due to OXidative Stress (REDOXS) Trial*
Authors: Haines Ryan W. , Fowler Alexander J. , Wan Yize I. , Flower Luke , Heyland Daren K. , Day Andrew , Pearse Rupert M. , Prowle John R. , Puthucheary Zudin
Published: February 2022

OBJECTIVES:

Ongoing risk of death and poor functional outcomes are important consequences of prolonged critical illness. Characterizing the catabolic phenotype of prolonged critical illness could illuminate biological processes and inform strategies to attenuate catabolism. We aimed to examine if urea-to-creatinine ratio, a catabolic signature of prolonged critical illness, was associated with mortality after the first week of ICU stay.

DESIGN:

Reanalysis of multicenter randomized trial of glutamine supplementation in critical illness (REducing Deaths due to OXidative Stress [REDOXS]).

SETTING:

Multiple adult ICUs.

PATIENTS:

Adult patients admitted to ICU with two or more organ failures related to their acute illness and surviving to day 7.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The association between time-varying urea-to-creatinine ratio and 30-day mortality was tested using Bayesian joint models adjusted for prespecified-covariates (age, kidney replacement therapy, baseline Sequential Organ Failure Assessment, dietary protein [g/kg/d], kidney dysfunction, and glutamine-randomization). From 1,021 patients surviving to day 7, 166 (16.3%) died by day 30. After adjustment in a joint model, a higher time-varying urea-to-creatinine ratio was associated with increased mortality (hazard ratio [HR], 2.15; 95% credible interval, 1.66–2.82, for a two-fold greater urea-to-creatinine ratio). This association persisted throughout the 30-day follow-up. Mediation analysis was performed to explore urea-to-creatinine ratio as a mediator-variable for the increased risk of death reported in REDOXS when randomized to glutamine, an exogenous nitrogen load. Urea-to-creatinine ratio closest to day 7 was estimated to mediate the risk of death associated with randomization to glutamine supplementation (HR, 1.20; 95% CI, 1.04–1.38; p = 0.014), with no evidence of a direct effect of glutamine (HR, 0.90; 95% CI, 0.62–1.30; p = 0.566).

CONCLUSIONS:

The catabolic phenotype measured by increased urea-to-creatinine ratio is associated with increased risk of death during prolonged ICU stay and signals the deleterious effects of glutamine administration in the REDOXS study. Urea-to-creatinine ratio is a promising catabolic signature and potential interventional target.
The Relationship Between Nursing Informatics Competency and Clinical Decision-Making Among Nurses in West Bank, Palestine
Authors: Batran Ahmad , Al-Humran Saed Mohammad , Malak Malakeh Z. , Ayed Ahmad
Published: March 2022

This study aimed to examine the relationship between nursing informatics competencies and clinical decision-making by taking into account nurses' individual characteristics and job-related characteristics. A cross-sectional design was used. The cluster random sampling method was adopted to select 14 governmental hospitals in West Bank, Palestine, in which all nurses in these hospitals were invited to participate in this study. Results found that the total mean (SD) score for the nursing informatics competency scale was 2.6 (0.88), which indicates that the nurses had lower nursing informatics competency, and the informatics skills subscale had the lowest mean score (mean [SD], 2.4 [1.00]). Concerning clinical decision-making, the total mean (SD) score was 2.59 (0.38), which indicates that the nurses had lower clinical decision-making. Regarding clinical decision-making subscales, searching for information and unbiased assimilation of new information had the highest mean score (mean [SD], 2.64 [0.39]); on the contrary, the canvassing of objectives and values subscale had the lowest mean score (mean [SD], 2.53 [0.38]). Nursing informatics competency had a positive relationship with clinical decision-making. Thus, it is necessary to enhance nurses' informatics competency, especially informatics skills and clinical decision-making, by developing training programs about this technology directed to nurses.
Feasibility of cabazitaxel in octogenarian prostate cancer patients
Authors: Tralongo Paolo , Bordonaro Sebastiano , Di Lorenzo Giuseppe , De Giorgi Ugo , Borsellino Nicolò , Facchini Gaetano , Rossetti Sabrina , Fornarini Giuseppe , Longo Vito , Tralongo Antonino Carmelo , Caspani Francesca , Spada Massimiliano , Calvani Nicola , Carlini Paolo
Published: February 2022

Background

To evaluate the effectiveness and safety of cabazitaxel in castration-resistant prostate cancer patients aged ≥80 years, we performed a retrospective study on a sample of patients from 11 Italian cancer centers.

Materials and methods

Fifty-seven patients aged ≥80 years were treated with cabazitaxel after previous failure with docetaxel; 39 completed a comprehensive geriatric assessment questionnaire (34 fit and 5 vulnerable) and 8 patients (14%) had an Eastern Cooperative Oncology Group performance status (PS) ≥2, while most had a PS of 0–1 (86%). Cabazitaxel was administered at a dose of 25 mg/m2 in 30 (52%) patients and 20 mg/m2 or adapted schedules in 27 (48%) patients. These schedules were adopted mainly in patients ≥85 years (75%), with a PS ≥2 (87.5%), and those classified as vulnerable (100%).

Results

The duration of treatment was 4.8 months and was comparable in all subgroups; disease control rate was reported in 36 patients (63%); prostate-specific antigen response was recorded in 18 patients (31.5%). Median overall survival was 13.1 months regardless of age (<85/≥85 years), but overall survival was reduced in vulnerable (7.2 months) and PS ≥ 2 patients (6.8 months). The most frequently documented grade 3–4 toxicities were neutropenia (14%) and diarrhea (10.5%). Six patients (10.5%) dropped out due to severe toxicity.

Conclusions

Octogenarian patients can be treated with cabazitaxel with reduced doses or alternative schedules that are associated with less toxicity and fewer treatment interruptions. Comprehensive geriatric assessment could facilitate more appropriate patient selection.
Silicone Granulomas at the Peripheral Intravenous Cannula Puncture Site
Authors: Gil-Pallares Pedro , Vázquez-Osorio Igor , Pérez-Feal Patricia , Suárez-Peñaranda José Manuel
Published: February 2022

Different adverse reactions to silicone present in cosmetic fillers, implants, or medical devices have been reported. The granulomatous reaction on the injection site due to catheters' silicone coating is an infrequent complication, which may be clinically difficult to suspect. Although the definitive diagnosis requires identification of the silicone with techniques such as X-ray spectroscopy, the possibility of involvement of silicone, as well as the histopathologic demonstration of granulomas with refractile, nonpolarizable, and nonstainable material strongly suggests this diagnosis. Moreover, the use of a low-diaphragm aperture or phase-contrast microscopy could be useful to demonstrate the presence of this, otherwise almost transparent, foreign body.
Clinical features of 162 fatal cases of COVID-19: a multi-center retrospective study
Authors: Zhou Xianlong , Ding Guoyong , Fang Qing , Guo Jun , Yang Luyu , Wang Ping , Fu Shou-Zhi , Li Ang , Xia Jian , Yu Jiangtao , Xia Jianyou , Ma Min , Hu Zhuanzhuan , Huang Lei , Liu Ruining , Jiang Cheng , Li Shaoping , Yu Mingxia , Xu Xizhu , Zhao Yan , Hu Quan , Xing Weijia , Zhao Zhigang
Published: February 2022

Background

The coronavirus disease 2019 (COVID-19) has affected approximately 2 million individuals worldwide; however, data regarding fatal cases have been limited.

Objective

To report the clinical features of 162 fatal cases of COVID-19 from 5 hospitals in Wuhan between December 30, 2019 and March 12, 2020.

Methods

The demographic data, signs and symptoms, clinical course, comorbidities, laboratory findings, computed tomographic (CT) scans, treatments, and complications of the patients with fatal cases were retrieved from electronic medical records.

Results

The median patient age was 69.5 (interquartile range: 63.0–77.25) years, and 80% of the patients were over 61 years. A total of 112 (69.1%) patients were men. Hypertension (45.1%) was the most common comorbidity, while 59 (36.4%) patients had no comorbidity. At admission, 131 (81.9%) patients had severe or critical COVID-19, whereas 39 (18.1%) patients with hypertension or chronic lung disease had moderate COVID-19. In total, 126 (77.8%) patients received antiviral treatment, while 132(81.5%) patients received glucocorticoid treatment. A total of 116 (71.6%) patients were admitted to the intensive care unit (ICU), and 137 (85.1%) patients received mechanical ventilation. Most patients received mechanical ventilation before ICU admission. Approximately 93.2% of the patients developed respiratory failure or acute respiratory distress syndrome. There were no significant differences in the inhospital survival time among the hospitals (P=0.14).

Conclusion

Young patients with moderate COVID-19 without comorbidity at admission could also develop fatal outcomes. The in-hospital survival time of the fatal cases was similar among the hospitals of different levels in Wuhan.
Changing Trends in Glaucoma Surgery Over the Past 5 Years in China
Authors: Qiao Chunyan , Zhang Hui , Cao Kai , Tian Jiaxin , Chung Tham Yih , Shan Jing , Han Ying , Wang Ningli ,   on Behalf of the Investigators for the Chinese Glaucoma Study Consortium
Published: February 2022

Purpose:

To analyze the trends of glaucoma surgery procedures over the past 5 years among hospitals across major provinces in China.

Materials and Methods:

This was a retrospective observational study based on medical records. We obtained the annual numbers of commonly performed glaucoma incisional surgeries from 57 hospitals of 30 provincial regions in the Chinese Glaucoma Study Consortium (CGSC) from January 2015 to September 2019. The trend of glaucoma surgery was analyzed by Cochrane-Armitage trend test.

Results:

Trabeculectomy, cataract extraction combined with goniosynechialysis, cataract extraction combined with trabeculectomy, and surgical peripheral iridotomy (SPI) were the top 4 surgical procedures percentages of which have the most substantial change over the course of 2015 to 2019 (all P
trend <0.001). Numbers of trabeculectomies decreased significantly from 47.59% in 2015 to 31.21% in 2019; cataract extraction combined with goniosynechialysis increased from 12.12% to 28.48%; cataract extraction combined with trabeculectomy increased from 13.11% to 15.97%; and SPI decreased from 9.03% to 6.34%. The proportion of internal drainage surgery increased from 24.31% in 2015 to 39.29% in 2019 while external drainage surgery decreased from 69.20% to 54.64% (All P
trend <0.001). The microinvasive glaucoma surgeries including AB-interno Canaloplasty, gonioscopy-assisted transluminal trabeculotomy, and Trabectome, increased from 0.62% to 1.40% (P
trend<0.001). Across all study hospitals, the trends were similar, except for the Tibet Autonomous Region Eye Center, where SPI and trabeculectomy remained the most common anti-glaucoma surgeries.

Conclusion:

In the past 5 years, we observed substantial reduction in trabeculectomy, and increase in combination cataract-glaucoma procedures across major hospitals in China. The proportion of internal drainage surgery increased, while external drainage surgery decreased significantly. Detailed understanding of shifting trends in glaucoma surgeries can facilitate better health care resource allocation and training of glaucoma subspecialists in China.
Efficacy, Feasibility, and Safety of Endoscopic Ultrasound-guided Fine-needle Biopsy for the Diagnosis of Gastrointestinal Subepithelial Lesions
Authors: Tan Yandi , Tang Xinyi , Huang Ju , Li Rui
Published: February 2022

Background:

Endoscopic ultrasound (EUS) fine-needle biopsy (FNB) has become an efficient method for diagnosing gastrointestinal (GI) subepithelial lesions (SELs). However, recent guidelines have not regarded FNB as the primary strategy for diagnosing GI SELs. We performed this study to systematically measure the efficacy, feasibility, and safety of EUS-FNB in diagnosing GI SELs.

Materials and Methods:

Relevant studies were searched in PubMed and EMBASE and published after January 2015 were included. The overall rates of diagnostic yield, technical success, and adverse events were calculated as outcome measures. The Jadad scale and the Newcastle-Ottawa scale were used to evaluate the quality of the trials, funnel plots and Egger’s test were used to measure publication bias, and sensitivity and subgroup analyses were performed to explore the variance of heterogeneity and sensitivity, respectively.

Results:

Sixteen studies analyzing 969 patients between 2015 and 2020 were included. Studies showed little change in sensitivity, and 13 were considered high quality. A certain degree of publication bias existed in the diagnostic accuracy rate. The overall rates of diagnostic yield, technical success, and adverse events were [85.69% (95% confidence interval (CI): 82.73-88.22, I
2=41.8%), 98.83% (95% CI: 96.73-99.97, I
2=54.3%), and 1.26% (95% CI: 0.35-2.54, I
2=0.0%)]. No clinical influencing factors were identified in the subgroup analysis.

Conclusions:

EUS-FNB is a promising technology with a relatively superior diagnostic yield, technical success, and security, which is an optimal option for the diagnosis of SELs.
Histologic Remission (NANCY Index) is Superior to Endoscopic Mucosal Healing in Predicting Relapse Free Survival in Patients With Ulcerative Colitis in Clinical and Endoscopic Remission
Authors: Wang Hunter , Fewings Ingrid , Bornman Lee , Shadbolt Bruce , Fadia Mitali , Subramaniam Kavitha
Published: February 2022

Background:

Histologic activity is recognized as an important predictor of relapse in ulcerative colitis (UC) patients. Current treatment targets aim at mucosal healing; however, many patients continue to have histologic activity.

Goals:

The aim was to assess histologic activity using the validated Nancy histologic index (NHI) score as a predictor of future relapse amongst UC patients in endoscopic and clinical remission.

Study:

In this retrospective cohort study, UC patients in clinical and endoscopic remission at a single tertiary center between 2015 and 2018, who underwent a surveillance colonoscopy were included. Clinical remission was defined by partial Mayo score (MSp) <2, and endoscopic remission was defined by Mayo endoscopic subscore (MES) ≤1. Histologic remission was defined by NHI <2. Predictive factors associated with the primary endpoint of clinical relapse were analyzed.

Results:

A total of 74 of 184 UC patients were included in the study. Amongst this cohort, 33 patients (45%) demonstrated histologic activity (NHI >1) at enrollment. The median follow-up time was 42 months (interquartile range: 26 to 63 mo) with median relapse free period of 30 months (interquartile range: 18 to 48 mo). Kaplan-Meier analysis demonstrated patients with MES 0 (P=0.02) and histologic remission (P<0.0001) had significantly longer relapse free survival. On multivariate analysis only histologic activity remained an independent risk factor of future clinical relapse (hazard ratio: 4.36, confidence interval: 1.68-11.27, P=0.002).

Conclusion:

Histologic remission using the NHI independently predicts significantly longer relapse free survival and may be a superior therapeutic target than endoscopic remission.
Drug-resistant tuberculosis: advances in diagnosis and management
Authors: Günther Gunar , Ruswa Nunurai , Keller Peter M.
Published: February 2022

Purpose of review

Diagnosis and treatment of drug-resistant tuberculosis (DR-TB) is undergoing substantial changes, owing availability of new diagnostic tools and drugs, coupled with global underdiagnosis and undertreatment. Recent developments are reviewed.

Recent findings

Molecular diagnostics, for Mycobacterium tuberculosis complex detection and prediction of drug resistance, implemented in the last decade, accelerated TB diagnosis with improved case detection. Nevertheless, access and coverage of drug-resistance testing remain insufficient. Genome sequencing-technologies, based on targeted next-generation sequencing show early potential to mitigate some of the challenges in the future. The recommendation to use an all oral, bedaquiline based regimen for treatment of multidrug-resistant/rifampicin-resistant TB is major advancement in DR-TB care. TB regimen using new and repurposed TB drugs demonstrate in recent clinical trials like, NIX-TB, ZeNIX and TB PRACTECAL considerable treatment success, shorten treatment duration and reduce toxicity. Their optimal use is threatened by the rapid occurrence and spread of strains, resistant to new drugs. Children benefit only very slowly from the progress.

There is notable progress in improved diagnosis and treatment of drug-resistant TB, but complicated by the COVID-19 pandemic the majority of TB patients worldwide don’t have (yet) access to the advances.
Small bowel Crohn's disease: optimal modality for diagnosis and monitoring
Authors: Carretero Cristina
Published: February 2022

Purpose of review

This paper reviews different imaging options for small bowel (SB) Crohn's disease (CD) patients.

Recent findings

In total, 80% of patients suffering from CD have SB involvement, being the exclusive manifestation in 30% of cases. As the proximal disease is related to poor response to treatment, a higher rate of stenosis and a greater need for surgical treatment, a SB assessment should be performed. This evaluation should be done not only once the disease has been diagnosed but periodically. The former to determine the extent of the disease, and the latter according to a treat-to-target strategy. Available techniques such as magnetic resonance imaging, intestinal ultrasound and capsule endoscopy (CE) have shown good accuracy parameters in CD patients. Cross-sectional studies are superior for penetrating and stricturing disease, whereas CE is excellent for proximal involvement and mucosal healing. Local expertise and availability may lead the election between techniques, nevertheless, they should not be considered as competitors but as complementary tools.

SB involvement in CD patients is frequent and related to poorer outcomes. Hence, SB evaluation should be screened after diagnosis and routinely during the follow-up.
Focal therapy: definition and rationale
Authors: Clark Roderick , Klotz Laurence
Published: February 2022

Purpose of review

The role of focal therapy for the treatment of prostate cancer is expanding in clinical practice. The aim of this review is to introduce readers to controversies in the use of focal therapy and its rationale.

Recent findings

There is a growing body of literature regarding the short-term and medium-term cancer control parameters and quality of life outcomes. These are mostly observational studies without a comparative arm. There is a need for high-quality randomize control trials comparing these treatments to definitive standard of care interventions (e.g. surgery or radiotherapy) in appropriate patient populations.

Focal therapy for prostate cancer has become an established therapeutic strategy. Evidence continues to accrue regarding its effectiveness. It is a useful treatment option for the appropriately selected patient, with the appeal of improved quality of life compared with standard therapies.
Implementing a Large-Scale Escape Room
Authors: Rossley Amanda , Loesche Amy , Glanert-Kempf Michelle
Published: February 2022

The purpose of this project was to evaluate an escape room’s impact on electronic health record downtime competence. Seventy-four nurses simultaneously completed a sequentially designed, tabletop escape room to escape a zombie invasion. Results showed 92% of participants were motivated by the escape room; 90% reported it significantly influenced their learning. Findings were reinforced when the institution had an unplanned electronic health record downtime 2 days after the event.
Pathologist-Patient Visits—Revisited
Authors: Gutmann Edward J.
Published: February 2022

Direct pathologist-patient encounters are infrequent, but there has been a modest movement toward such interactions in the past 2 decades. The present article places that movement in perspective. It includes a discussion of diverse factors—including congressional laws, the views of department chairs, and progress in artificial intelligence—that could promote pathologist-patient interactions and also reviews factors that might deter such encounters.
Primary NTRK-rearranged Spindle Cell Neoplasm of the Lung
Authors: Zhu Peipei , Wang Jian
Published: February 2022

Three cases of primary NTRK-rearranged spindle cell neoplasm of the lung with resemblance to those described in the somatic soft tissues are presented. The patients are 2 males and 1 female with age at presentation ranging from 31 to 45 years (mean, 36 y). All the 3 tumors were discovered incidentally during physical examinations. None of the patients had any prior history of mesenchymal neoplasms anywhere else. Computed tomography revealed intrapulmonary mass located in the right upper lobe, left upper lobe, and left lower lobe, respectively. All the patients underwent lobectomy. Grossly, the tumors were described as yellowish-white solid measuring in size between 1.2 and 1.8 cm (mean, 1.5 cm). Histologically, they were characterized by monomorphic spindle cells arranged in haphazard fascicles accompanied by variable stromal collagens. Nuclear atypia was mild and mitotic activity was scarce. By immunohistochemistry, the neoplastic cells in all 3 cases showed strong and diffuse staining of CD34, pan-TRK, and TrkA with variable expression of S100 protein, whereas they were negative for cytokeratin, SOX10, ALK, α-smooth muscle actin, desmin, and STAT6. Fluorescence in situ hybridization analysis revealed NTRK1 rearrangement in all 3 cases. Subsequent next-generation sequencing identified TPM3-NTRK1 fusion in 2 cases and LMNA-NTRK1 fusion in 1 case. All 3 patients are alive without the disease (median follow-up, 9 mo; range, 4 to 87 mo). The cases present herein demonstrate that NTRK-rearranged spindle cell neoplasms may occur primarily in the lung, albeit extremely rare, and should be included in the differential diagnosis of primary pulmonary spindle cell neoplasms.
Outcome of Extracorporeal Membrane Oxygenation for Pediatric Patients With Neoplasm: An Extracorporeal Life Support Organization Database Study (2000–2019)
Authors: Suzuki Yota , Cass Samuel H. , Kugelmann Andrew , Mobli Keyan , Taylor Williams P. , Radhakrishnan Ravi S.
Published: February 2022

OBJECTIVES:

This study update in usage and outcomes of pediatric extracorporeal membrane oxygenation (ECMO) for patients with neoplasm analyzed according to demographics, clinical variables, and complications.

DESIGN:

Retrospective database review of the Extracorporeal Life Support Organization registry from the last 2 decades (2000–2019). The data were divided between two decades in order to compare patients’ backgrounds and outcomes over time.

SETTING:

ECMO centers reporting to Extracorporeal Life Support Organization.

PATIENTS:

Patients equal to or younger than 18 years old with International Classification of Diseases, 9th Revision and International Classification of Diseases, 10th Revision codes that referred to neoplasms who were managed with ECMO.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Demographics, cancer subtype, clinical variables, and ECMO complications were assessed in relation to the primary study outcome of survival to hospital discharge. Nine-hundred two patients met inclusion criteria; 699 patients were in the latest decade, which is more than three times the number from the previous decade (203 patients). On univariate analysis, compared with the previous decade, in the later decade, ECMO was more frequently applied in patients with pre-ECMO cardiac arrest (31.3% vs 17.1%; p < 0.001), and/or lower oxygenation index (38.0 vs 48.1; p < 0.001). We failed to identify a difference in survival between the 2 decades (42.8% vs 37.9%; p = 0.218). On multivariable analysis, diagnosis of hematologic malignancy, post-cardiopulmonary resuscitation support type, hematopoietic stem cell transplant, and age older than seven were each associated with greater odds of mortality.

CONCLUSIONS:

The use of ECMO in children with neoplasm has expanded over the latest decade with changes in patient selection. Mortality remains unchanged. Hence, although the clinician still should stay cautious in its application, ECMO can be considered as an option to rescue pediatric oncologic patients in the setting of worsening cardiopulmonary status in the PICU.
Differential patterns of postmigration HIV-1 infection acquisition among Portuguese immigrants of different geographical origins
Authors: Pimentel Victor Figueiredo , Pingarilho Marta , Sole Giordano , Alves Daniela , Miranda Mafalda , Diogo Isabel , Fernandes Sandra , Pineda-Pena Andrea , Martins M. Rosário O. , Camacho Ricardo , Gomes Perpétua , Abecasis Ana B.
Published: February 2022

Objective:

To investigate the dynamics of phylogenetic transmission clusters involving immigrants of Portuguese Speaking Countries living in Portugal.

Design/methods:

We included genomic sequences, sociodemographic and clinical data from 772 HIV migrants followed in Portugal between 2001 and 2017. To reconstruct HIV-1 transmission clusters, we applied phylogenetic inference from 16 454 patients: 772 migrants, 2973 Portuguese and 12 709 global controls linked to demographic and clinical data. Transmission clusters were defined using: clusters with SH greater than 90% (phylogenetic support), genetic distance less than 3.5% and clusters that included greater than 66% of patients from one specific geographic origin compared with the total of sequences within the cluster. Logistic regression was performed to assess factors associated with clustering.

Results:

Three hundred and six (39.6%) of migrants were included in transmission clusters. This proportion differed substantially by region of origin [Brazil 54% vs. Portuguese Speaking African Countries (PALOPs) 36%, P < 0.0001] and HIV-1 infecting subtype (B 52%, 43% subtype G and 32% CRF02_AG, P < 0.001). Belonging to a transmission cluster was independently associated with treatment-naive patients, CD4+ greater than 500, with recent calendar years of sampling, origin from PALOPs and with seroconversion. Among Brazilian migrants – mainly infected with subtype B – 40.6% were infected by Portuguese. Among migrants from PALOPs – mainly infected with subtypes G and CFR02_AG – the transmission occurred predominantly within the migrants’ community (53 and 80%, respectively).

Conclusion:

The acquisition of infection among immigrants living in Portugal differs according to the country of origin. These results can contribute to monitor the HIV epidemic and prevent new HIV infections among migrants.
Decreasing the Incidence of Hypoxia and Airway Maneuvers During GI Procedures
Authors: Jones John W. , Varga Jeffrey , Chasens Eileen R. , McGrath Kevin , Deslate Sarah , Henker Richard
Published: March 2022

Many outpatient gastrointestinal procedures are completed with propofol anesthesia. A side effect of propofol is airway obstruction and subsequent hypoxia. This study was designed to determine whether the use of a high-flow nasal cannula is associated with a decreased incidence of hypoxia or airway obstruction in patients undergoing propofol sedation in the gastrointestinal laboratory with a STOP-BANG score ≥5. High-flow nasal cannula was administered at 70 L/min on 27 patients with a STOP-BANG score ≥5 receiving monitored anesthesia care sedation for an esophagogastroduodenoscopy, endoscopic ultrasound, or colonoscopy procedure. Patients were compared to a group from a previous project without the use of high-flow nasal cannula assessing whether hypoxia, apnea, or the need for airway maneuvers occurred. The non-high-flow nasal cannula group required an airway maneuver 53.3% (n = 8) whereas the high-flow nasal cannula group required an airway maneuver 18.5% (n = 5) (p = .021). High-flow nasal cannula was associated with a reduced need for airway maneuvers in patients with a high risk of obstructive sleep apnea undergoing propofol-assisted procedures.
Vaginectomy in Transmasculine Patients: A Review of Techniques in an Emerging Field
Authors: Coulter Madeline , Diamond David A. , Estrada Carlos , Grimstad Frances , Yu Richard , Doyle Paula
Published: March 2022

Purpose

This report reviews the various techniques for vaginal obliterative surgery in the transmasculine patient population, including advantages and drawbacks with differing methods and reflects on the focus of future research and surgical efforts.

Findings

Existing techniques for vaginal obliterative surgery by vaginectomy or colpocleisis vary without strong evidence to identify a superior approach.

The increasing number of transmasculine patients seeking vaginectomy as a part of gender-affirming surgery must be matched by evidence-based techniques that provide a safe, long-term outcome.
Pelvic Floor Support and Symptoms 1 Year Postpartum in Relation to Excess Body Habitus Before, During and After First Vaginal Birth
Authors: Sheng Xiaoming , Wang Jie , Shaw Janet M. , Murtaugh Maureen A. , Nygaard Ingrid E.
Published: March 2022

Importance

Obesity may be a modifiable risk factor for pelvic floor disorders.

Objectives

The objective of this study is to determine associations between weight, weight changes, and cumulative exposure to excess body mass index (BMI) from prepregnancy to 1 year postpartum on pelvic floor support and symptoms 1 year after first vaginal birth.

Study Design

In 645 primiparous women who gave birth vaginally, we assessed anatomic pelvic floor support, pelvic floor symptoms and BMI at the third trimester, 5 – 10 weeks, and 1 year postpartum; we also assessed BMI prepregnancy and predelivery. Using multivariable models, we determined associations between pelvic floor outcomes 1 year postpartum and BMI quartiles at different timepoints, gestational weight gain, and postpartum weight retention. We evaluated associations between stress urinary incontinence (SUI) and moderate/severe urinary incontinence (UI) 1 year postpartum and cumulative excess BMI from prepregnancy to 1-year postpartum (BMI1year).

Results

Body mass index was not associated with anatomic support, composite symptom burden, overactive bladder, anal incontinence, or constipation at any timepoint. Gestational weight gain and postpartum weight retention were not associated with any 1-year outcome. Body mass index at every timepoint was positively associated with SUI and moderate/severe UI; BMI1year was most predictive. Cumulative excess BMI was positively associated with SUI and moderate/severe UI but only slightly more predictive of these outcomes than BMI1year alone.

Conclusions

Body mass index over the pregnancy trajectory was not associated with outcomes other than UI. The small advantage of cumulative exposure to excess BMI over BMI1year in predicting SUI and moderate/severe UI suggests that BMI1year adequately captures risk of these 1-year outcomes.
Mix and Mesh: An Electronic Database of FPMRS Mesh Products Through 2020
Authors: Woodburn Katherine L. , Cardenas-Trowers Olivia O. , Fitzgerald Jocelyn J.
Published: March 2022

Importance

A sequelae of the removal of pelvic organ prolapse (POP) transvaginal mesh products from the U.S. market is that current and future women's health providers may be unfamiliar with mesh products historically used to treat pelvic floor disorders.

Objectives

Our goal was to create an easily accessible resource to address this knowledge gap.

Study Design

An online database of mesh products used to treat POP and urinary incontinence was created with information, photographs, and videos collated from internet searches; manufacturer materials; and other primary sources. The database was then linked to a free smartphone application.

Results

This smartphone application includes, to the best of our knowledge, all mesh products used in the United States for the treatment of POP and stress urinary incontinence through December 2020. Included in the application are product descriptions of mesh color, size, design, and attachment points. Photographs and videos, when available, are included. The application is organized by mesh product name, but it is also searchable by other categories, such as manufacturer name and color.

To download the application to a smart phone, go to vaginalmeshcatalogue.glideapp.io/ on a web browser or access via the QR code. Once the website is loaded, you can interact with the mesh catalog as a website or save it to the phone's home screen as an application.

Conclusions

Health care providers of all experience levels can use this free application for educational and clinical purposes to better understand patients' histories, improve preoperative planning, and enhance patient counseling.
Practice patterns after implementation of a selective spinal immobilization protocol in a regional trauma system
Authors: Etheridge James C. , Sinyard Robert D. , Atiyeh John , Zhou Guohai , Collins Jay N. , Havens Joaquim M.
Published: March 2022

BACKGROUND

Universal spinal immobilization has been the standard of prehospital trauma care since the 1960s. Selective immobilization has been shown to be safe and effective for emergency medical services use, but it is unclear whether such protocols reduce unnecessary and potentially harmful immobilization practices. This study evaluated the impact of a selective spinal immobilization protocol on practice patterns in a regional trauma system.

METHODS

All encounters for traumatic injury in the Tidewater Emergency Medical Services region from 2010 to 2016 were extracted from the Virginia Pre-Hospital Information Bridge. An interrupted time series analysis was used to assess practice change after system-wide protocol implementation in 2013. Intravenous access was used as a nonequivalent outcome measure in the absence of an appropriate control group.

RESULTS

A total of 63,981 encounters were analyzed. At baseline, 16.7% of patients underwent full immobilization. The preprotocol slope was slightly positive (0.2% per month; 95% confidence interval, 0.1–0.2%). Slope and level changes after protocol implementation did not differ from those observed for intravenous access (−0.4% vs. −0.4% per month [p = 0.4917] and −1.6% vs. −1.1% [p = 0.1202], respectively). Cervical spinal immobilization became more common over the postimplementation period (0.1% per month; 95% confidence interval, 0.1–0.1%). Rates of immobilization for isolated penetrating trauma remained unchanged.

CONCLUSION

Implementation of a selective spinal immobilization protocol did not reduce prehospital immobilization rates in a regional trauma system. Given the entrenched nature of immobilization practices, more intensive education and training strategies are needed. Efforts should prioritize eliminating immobilization for isolated penetrating trauma given its association with increased mortality.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
Cardiovascular Effects of High-Frequency Magnetic Seizure Therapy Compared With Electroconvulsive Therapy
Authors: Zhang Jun-yan , Wu Han , Jia Li-na , Jiang Wei , Luo Jiong , Liu Yi , Gao Qi , Ren Yan-ping , Ma Xin , Tang Yi-lang , McDonald William M.
Published: February 2022

Background

Magnetic seizure therapy (MST) is a novel convulsive therapy that has been shown to have antidepressant efficacy comparable to electroconvulsive therapy (ECT) with fewer cognitive side effects. However, the cardiovascular (CVS) effects of high frequency MST in comparison to ECT have not been investigated.

Materials and Methods

Forty-five patients with depression received 6 treatment sessions of 100 Hz MST versus 6 bifrontal ECT treatments in a nonrandomized comparative clinical design. Data on CVS function including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and rate pressure product (RPP) were collected at baseline (T0), after the induction of anesthesia but before the electrical stimulation (T1), during convulsion (T2), 2 minutes after cessation of motor seizure (T3), 5 minutes after cessation of motor seizure (T4), and 10 minutes after cessation of motor seizure (T5). Comparisons were made with baseline data and between MST and ECT groups.

Results

There were statistically significant elevations in the maximum HR, SBP, DBP, and RPP in patients receiving ECT compared with MST both in the initial and sixth treatments (all P < 0.05). Particularly, at T2, the ECT group had significantly higher HR, SBP, DBP, and RPP than those in MST group both in initial and sixth treatment (all P < 0.001). At the sixth treatment, the ECT group had significantly higher SBP, DBP, and RPP during the treatment than in the MST group (all P < 0.001).

Limitations

The anesthetic choices for this study may limit the generalizability of our findings. The sample size was relatively small.

Conclusions

Compared with ECT, high-frequency MST has fewer CVS side effects and may be a safer option for depression patients with CVS disorders.
Dame Louise Napier Johnson. 26 September 1940—25 September 2012
Authors: Barford David , Blundell Thomas L.
Published: March 2022

Louise Johnson was a leading architect of protein crystallography and structural enzymology. She pioneered the application of the technique to understand how enzymes function at the molecular level. Much of our current knowledge of how enzymes catalyse chemical reactions with high specificity and how their activities are regulated, especially by cooperative allosteric transitions and reversible protein phosphorylation, has its origins in Louise's research on lysozyme, glycogen phosphorylase and protein kinases. Louise helped pioneer Laue protein crystallography as a method to elucidate dynamic structural changes in proteins. She was a strong advocate of synchrotron radiation as a tool for structural biology, working to establish third generation synchrotrons. Her delight in science and kindness toward her colleagues and students were an inspiration to those who knew her.
Studying metabolism with multi-organ chips: new tools for disease modelling, pharmacokinetics and pharmacodynamics
Authors: Shroff Tanvi , Aina Kehinde , Maass Christian , Cipriano Madalena , Lambrecht Joeri , Tacke Frank , Mosig Alexander , Loskill Peter
Published: March 2022

Non-clinical models to study metabolism including animal models and cell assays are often limited in terms of species translatability and predictability of human biology. This field urgently requires a push towards more physiologically accurate recapitulations of drug interactions and disease progression in the body. Organ-on-chip systems, specifically multi-organ chips (MOCs), are an emerging technology that is well suited to providing a species-specific platform to study the various types of metabolism (glucose, lipid, protein and drug) by recreating organ-level function. This review provides a resource for scientists aiming to study human metabolism by providing an overview of MOCs recapitulating aspects of metabolism, by addressing the technical aspects of MOC development and by providing guidelines for correlation with
in silico
models. The current state and challenges are presented for two application areas: (i) disease modelling and (ii) pharmacokinetics/pharmacodynamics. Additionally, the guidelines to integrate the MOC data into
in silico
models could strengthen the predictive power of the technology. Finally, the translational aspects of metabolizing MOCs are addressed, including adoption for personalized medicine and prospects for the clinic. Predictive MOCs could enable a significantly reduced dependence on animal models and open doors towards economical non-clinical testing and understanding of disease mechanisms.
Implication of synaptotagmins 4 and 7 in activity-dependent somatodendritic dopamine release in the ventral midbrain
Authors: Delignat-Lavaud Benoît , Ducrot Charles , Kouwenhoven Willemieke , Feller Nina , Trudeau Louis-Éric
Published: March 2022

Dopamine (DA) neurons can release DA not just from axon terminals, but also from their somatodendritic (STD) compartment through a mechanism that is still incompletely understood. Using voltammetry in mouse mesencephalic brain slices, we find that STD DA release has low capacity and shows a calcium sensitivity that is comparable to that of axonal release. We find that the molecular mechanism of STD DA release differs from axonal release with regard to the implication of synaptotagmin (Syt) calcium sensors. While individual constitutive knockout of Syt4 or Syt7 is not sufficient to reduce STD DA release, the removal of both isoforms reduces this release by approximately 50%, leaving axonal release unimpaired. Our work unveils clear differences in the mechanisms of STD and axonal DA release.