bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Fatty Acids on Brain Microglia Immune Responses
Authors: Lowry Jessica R. , Klegeris Andis
Published: February 2021

BACKGROUND

In 2018, the estimated global cost of health care for patients with dementia is expected to be over 1 trillion dollars (United States currency). Dementia in many cases is caused by Alzheimer's disease (AD), for which no viable treatment currently exists. Some significant risks in the development of AD are preventable, including diet‐related factors. One important diet‐related factor, dietary fats, is involved in key cellular processes. However, there is limited research on the role of dietary fats in the regulation of inflammation within the central nervous system (CNS). Non‐neuronal cells called microglia regulate the immune status of the CNS, and their dysregulated responses can lead to the enhanced release of cytotoxic mediators. These microglia‐released mediators can cause extensive neuron death, which is observed in AD. Metabolites of alpha‐linolenic acid (ALA) and linoleic acid (LA) are well‐known for modulating peripheral and CNS inflammation. However, the effects of ALA and LA on microglia are unknown.

OBJECTIVES

Assess whether ALA and LA affect microglial immune responses.

METHODS

BV‐2 microglia cells were treated with ALA or LA for 24 h, followed by pro‐inflammatory stimulation with bacterial lipopolysaccharide (LPS) for 24 h. Microglial supernatants and total protein from lysed BV‐2 cells were collected. The supernatants were used to quantify the secretion of reactive nitrogen species (RNS) by BV‐2 cells. Proteins were used to quantify the production of inducible nitric oxide synthase (iNOS) by western blotting.

RESULTS

Both ALA and LA significantly reduced RNS secretion by LPS‐stimulated BV‐2 microglia. LA, but not ALA, significantly reduced iNOS levels in LPS‐stimulated microglia. Data were analyzed using the randomized block design analysis of variance (ANOVA), followed by Dunnett's post‐hoc test.

CONCLUSIONS

Dietary fatty acids can modulate select microglial immune responses, and should be further investigated for their roles in CNS inflammation, which is involved in the progression of AD.

Support or Funding Information

Natural Sciences and Engineering Research Council, The Jack Brown and Family Alzheimer's Disease Research Foundation

This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
Interleukin‐10 in Type 1 Diabetes‐induced bone loss in mice
Authors: Rios‐Arce Naiomy Deliz , Mohr Susanne , Coughlin Brandon A. , Feenstra Derrick , Christian Barbara , McCabe Laura R. , Parameswaran Narayanan
Published: February 2021

The prevalence of diabetes is increasing worldwide. In addition to the commonly known complications of this disease, it is well known that Type 1 diabetes (T1D) can have a detrimental effect on bone health. Studies have shown that during the disease onset there is an increase in systemic and local cytokine production, suggesting that cytokines could play a regulatory role in bone loss during diabetes. Role of the anti‐inflammatory interleukin 10 (IL‐10) in bone physiology is well known. However, the role of IL‐10 in bone health during short‐ and long‐term diabetes has not been studied. We hypothesized that deficiency of IL‐10 in mice will lead to exacerbated bone loss in T1D. To test this, IL‐10 knockout and the corresponding C57BL/6J wild‐type mice (males, 7 weeks of age) were subjected to streptozotocin (STZ) injection (65 mg/g body weight) for 5 days to induce T1D. Diabetes was confirmed two weeks after the first injection by a blood glucose level of >300 mg/dL. Bones were collected at 4 weeks (short‐term) and 12 weeks (long‐term) post‐diabetes induction. Bone volume fractions (BVF) of femur and vertebrae were analyzed using microcomputed tomography (μCT) system. As expected T1D induced significant trabecular bone loss in WT mice at both 4 and 12 weeks after induction (BVF @ 4 weeks: WT control 29% VS WT STZ 15.9%; @12 weeks: WT control: 34.6% VS WT STZ: 9.6%; n=8–10). However, deficiency of IL‐10 exacerbated bone loss at the 4‐week time point (BVF @ 4 weeks WT STZ: 15.9% VS KO STZ: 8.7%; n=7), but by 12 weeks T1D BVF did not differ from WT mice. Vertebrae showed similar phenotype. We further found that cortical bone was affected in a comparable manner. Bone effects corresponded to changes in osteoblast RNA markers but not osteoclast RNA markers, suggesting that IL‐10 primarily affects anabolic events in the T1D bone. Taken together, these results suggest that IL‐10 is required for osteoblast regulation during early diabetes‐induced bone loss.

Support or Funding Information

R01 DK101050 03

R01 AT007695 04
Tinnitus and 3-Year Change in Audiometric Hearing Thresholds
Authors: Curhan Sharon G. , Halpin Christopher , Wang Molin , Eavey Roland D. , Curhan Gary C.
Published: February 2021

Objectives:

Tinnitus and hearing loss commonly coexist, however, the temporal relation between tinnitus and hearing loss is complex and not fully understood. Our objective was to examine the longitudinal association between persistent tinnitus, bothersome tinnitus, and 3-year elevation of audiometric hearing thresholds.

Design:

We conducted a longitudinal cohort study among 3106 women (mean age 59 years) who were participants in the Nurses’ Health Study II (2012–2018). Information on tinnitus was obtained from biennial questionnaires. Longitudinal changes in air conduction thresholds (0.5 to 8 kHz) were assessed by pure-tone audiometry conducted by licensed audiologists at 19 audiology testing sites across the United States. Logistic regression was used to estimate multivariable-adjusted odds ratios (MVORs, 95% confidence interval [CI]) and evaluate the relations of persistent tinnitus (several days per week or more), bothersome tinnitus (interferes with work, sleep, or daily activities), and risk of 3-year elevation of hearing thresholds.

Results:

Persistent tinnitus was associated with higher risk of 3-year elevation of hearing thresholds across a broad range of frequencies. Compared with women without tinnitus, the MVORs (95% CI) for ≥5-dB threshold elevation among women with persistent tinnitus were 1.01 (0.81, 1.25) at 0.5 kHz, 1.45 (1.17, 1.81) at 1 kHz, 1.25 (1.00, 1.56) at 2 kHz, 1.34 (1.07, 1.69) at 3 kHz, 1.34 (1.06, 1.70) at 4 kHz, 1.49 (1.16, 1.91) at 6 kHz, and 1.63 (1.25, 2.12) at 8 kHz. The magnitudes of the associations for ≥10-dB threshold elevation were similar. The magnitudes of the associations were substantially greater among women with bothersome tinnitus. For example, compared with women without tinnitus, the MVORs (95% CI) for a ≥5- and ≥10-dB elevation of hearing thresholds at 4 kHz were 2.97 (1.50, 5.89) and 2.79 (1.38, 5.65), respectively. The risk was elevated even among women with tinnitus who had clinically normal hearing thresholds at baseline. In analyses that examined the association of tinnitus and elevation of low-, mid- and high-frequency pure-tone average (PTA) hearing thresholds, the results were similar. Compared with women without tinnitus, the MVORs (95% CI) for ≥5-dB PTA elevation among women with persistent tinnitus were 1.29 (0.99,1.67) for LPTA(0.5,1,2 kHz); 1.44 (1.16, 1.78) for MPTA(3,4 kHz); and 1.38 (1.11, 1.71) for HPTA(6,8 kHz). For ≥10-dB elevation, the MVORs were 2.85 (1.55, 5.23), 1.52 (1.10, 2.09), and 1.41 (1.10, 1.82), respectively.

Conclusion:

Persistent tinnitus was associated with substantially higher risk of 3-year hearing threshold elevation, even among women with clinically normal baseline hearing. The magnitudes of the associations were greater among those with bothersome tinnitus. Monitoring hearing sensitivities may be indicated in patients with tinnitus, including those without audiometric evidence of hearing impairment.
Evaluation of Radiation Protection Methods for Assistant Staff during CT Imaging in High-energy Trauma: Lens Dosimetry with a Phantom Study
Authors: Ota Joji , Yokota Hajime , Kawasaki Tatsuya , Taoka Junichi , Kato Hideyuki , Chida Koichi , Masuda Yoshitada , Uno Takashi
Published: February 2021

Staff are exposed to radiation in the scanning room when assisting with CT scans of patients requiring ventilatory support during procedures. We measured lens doses using a phantom during a high-energy trauma protocol. Dosimetry showed that the unprotected lens received 2.02 mGy on the right and 1.91 mGy on the left, which are not negligible doses. Respective exposures to the right and left lens were 53.6% and 55.1% when wearing 0.07 mm Pb protective glasses with side covers; 53.7% and 64.2% when wearing 0.7 mm Pb glasses without side covers when facing away from the patient couch; and 92.1% and 91.2% using protective shielding in the gantry. Since the face direction may change during assistance with CT imaging, it is desirable that the protective glasses have a shape with a side cover. The protective shielding had a major radiation reduction effect, although it is expensive to acquire, install, and maintain.
Real-time intraoperative OCT imaging of the vitreolenticular interface during pediatric cataract surgery
Authors: Sillen Hedwig , Van Looveren Jan , Plaeke Philip , Van Os Luc , Tassignon Marie-José
Published: February 2021

Purpose:

To report on the use of intraoperative optical coherence tomography (OCT) imaging of the vitreolenticular interface (VLI) during pediatric cataract surgery and to determine the incidence of VLI dysgenesis and surgical difficulties.

Setting:

Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.

Design:

Retrospective cohort study.

Methods:

This study included 51 pediatric patients who underwent cataract surgery between April 2016 and December 2018. Video recordings and OCT images of the VLI were analyzed and compared. VLI dysgenesis was considered present when intraoperative OCT images demonstrated partial or total adhesions between the posterior lens capsule and the anterior hyaloid membrane. Video recordings were analyzed to describe surgical difficulties, more specifically: inability to create a calibrated primary posterior continuous curvilinear capsulorhexis (PPCCC), occurrence of vitreous prolapse, need for anterior vitrectomy, and complicated IOL implantation.

Results:

Of the 51 patients included, VLI dysgenesis was demonstrated in 27 patients (52.9%). The incidence of VLI dysgenesis was greater in children with unilateral cataract (72.4%), and children with a posterior capsule plaque (90%). PPCCC was challenging in 20 patients. A defect of the anterior hyaloid membrane was found in 16 patients. Anterior vitrectomy or cutting vitreous strands with scissors was necessary in 10 patients.

Conclusions:

Intraoperative OCT images were an excellent tool to evaluate the VLI and to demonstrate the presence of VLI dysgenesis during pediatric cataract surgery. Performing a calibrated PPCCC was more challenging in the presence of VLI dysgenesis. This can subsequently expose a defect in the anterior hyaloid membrane, which may result in vitreous prolapse.
Surface ablation outcomes in high myopia with different epithelium removal techniques
Authors: D'Oria Francesco , Fernández-Buenaga Roberto , Casanova Laura , García-Corral María José , Vega Alfredo , Alio Jorge L.
Published: February 2021

Purpose:

To study the outcomes of alcohol-assisted photorefractive keratectomy (PRK) when compared with transepithelial PRK (TransPRK) using 2 software programs, with or without SmartPulse Technology (SmartSurfACE), in high myopia.

Setting:

Vissum Miranza, University Miguel Hernandez, Alicante, Spain.

Design:

Retrospective, consecutive, case series.

Methods:

High myopic eyes undergoing surface ablation were included. The main inclusion criteria were preoperative spherical equivalent (SE) above −5.50 diopters (D) and no other ocular surgeries. Mitomycin-C was used in all the surgeries. The outcomes were analyzed using the 6-month follow-up visit data.

Results:

135 eyes were included. Alcohol-assisted PRK was performed in 65 eyes, transepithelial PRK (TransPRK1) in 32 eyes, and TransPRK2 in 38 eyes. The mean all groups preoperative sphere, cylinder, and SE were −6.00 ± 0.87 D, −1.13 ± 1.03 D, and −6.57 ± 0.69 D, respectively. The mean efficacy index in the alcohol-assisted PRK group was 0.91 ± 0.18 compared with 0.98 ± 0.1 and 0.98 ± 0.12 in the TransPRK1 and TransPRK2, respectively (P = .027). The mean safety index in alcohol-assisted PRK was 0.99 ± 0.05, whereas it was 1 ± 0.06 in the TransPRK1 and 0.99 ± 0.08 in the TransPRK2 (P = .780). A final SE of ± 0.50 D was achieved in 96.9% of eyes in the TransPRK1 group and in 100% eyes in the TransPRK2 group compared with 73.8% in the alcohol-assisted PRK group (P < .001).

Conclusions:

Surface ablation with the Amaris 500 excimer laser with flying spot pattern and mitomycin C use showed adequate refractive outcomes in high myopia correction in the 3 groups. TransPRK with or without SmartPulse Technology achieved statistically significant better outcomes than alcohol-assisted PRK in refractive predictability and efficacy.
Effects of Oral Administration of Alprazolam and Lorazepam as Hypnotics on Cardiovascular Parameters in Hypertensive Patients
Authors: Costa Alfredo , D'Angelo Angela , Ramusino Matteo Cotta , Perini Giulia , Bosone Daniele , Derosa Giuseppe , Fogari Roberto
Published: February 2021

Background

Previous studies have suggested that evening intake of benzodiazepine affects blood pressure (BP) and/or heart rate (HR) in healthy and hypertensive subjects. The aim of this study was to compare the effect of chronic oral administration of alprazolam and lorazepam as hypnotics on ambulatory BP and HR in patients with mild hypertension.

Methods

Consecutive outpatients of both sexes with newly diagnosed, never-treated mild hypertension were randomized, after a 4-week placebo run-in period, to receive alprazolam 0.5 mg plus placebo, lorazepam 1 mg plus placebo, or placebo plus placebo for 2 weeks in 3 crossover periods, each separated by a 1-week placebo wash-out period. At the end of the initial placebo run-in and of each treatment period, 24-hour ambulatory BP and HR monitoring was performed using a noninvasive device.

Results

In the 32 patients, no treatment had any effect on 24-hour and daytime systolic BP (SBP), diastolic BP (DBP), and HR, which remained unchanged. During the nighttime, SBP and DBP values were unaffected by alprazolam, as compared with placebo, whereas DBP was significantly higher after treatment with lorazepam (+3.7%, P < 0.05 vs placebo). Nocturnal HR mean values were significantly increased by lorazepam (+10.1%, P < 0.01 vs placebo), whereas they did not change after alprazolam.

Conclusions

In patients with mild hypertension, oral intake of alprazolam or lorazepam as hypnotics did not affect ambulatory BP or HR values. A slight increase in nighttime DBP was observed with lorazepam, whereas alprazolam showed no effect on nocturnal BP and HR, probably reflecting a stimulating effect of the drug on central α2-receptors.
Effects of Oxytocin on Emotion Recognition in Schizophrenia
Authors: Andari Elissar , Massa Nicholas M. , Fargotstein Molly D. , Taylor Nicholas B. , Halverson David M. , Owens Andrew V. , Currin Danielle L. , Bhattacharya Arpita , Gitman Dmitriy , Cuthbert Bruce C. , Young Larry J. , Duncan Erica J.
Published: February 2021

Background

Schizophrenia (SCZ) is a neurodevelopmental disorder that leads to poor social function. Oxytocin (OXT), a neuropeptide involved in social cognition, is a potential therapeutic agent for alleviating social dysfunction. Therefore, we investigated the effects of intranasal oxytocin (IN-OXT) on emotional processes in experimental interactive social contexts in individuals with SCZ.

Methods

In a male-only parallel randomized placebo-controlled double-blind trial, we investigated the effects of IN-OXT (24 IU) on visual fixation on pictures of faces and emotion recognition in an interactive ball-tossing game that probed processing of social and nonsocial stimuli.

Results

Intranasal oxytocin enhanced the recognition of emotions during an emotion-based ball-tossing game. This improvement was specific to the game that included social cue processing. Intranasal oxytocin did not affect eye gaze duration or gaze dwell time on faces in these patients.

Conclusions

An acute low dose of IN-OXT had a modest effect on social cue processing and was limited to emotion recognition. Higher doses and long-term trials targeting emotional processing in SCZ may lead to improved social function.
Understanding the Role of Work in Mortality
Authors: Hawkins Devan
Published: February 2021

Occupational disparities in mortality are a concern in public health. Understanding these disparities is important for identifying high-risk occupations for intervention and occupational factors that may be contributing to high risk for primary prevention. Using data from death certificates is a useful strategy for tracking occupational disparities in mortality. There are a number of challenges associated with working with this data. This paper describes how to access death certificate data, code occupational information from these death certificates, calculate mortality rates by occupation, and combine death certificate data with data from other sources. Limitations of existing death certificate occupation data are described along with recommendations about how to improve the collection of occupation information for death certificates. Finally, a proposal for the development of a national occupational mortality surveillance system is presented.
Bilateral Vestibulopathy in Neuroborreliosis
Authors: Malara Pasquale , Martellucci Salvatore , Castellucci Andrea , Belvisi Valeria , Del Torso Aleardo
Published: February 2021

Objective:

To describe a unique case of definite neuroborreliosis presenting with bilateral vestibulopathy (BV) due to simultaneous involvement of both vestibular systems highlighted by a complete assessment for all five vestibular receptors.

Patient:

A 72-year-old woman presented with disabling disequilibrium arisen about 4 weeks earlier and history of erythema migrans developing about 45 days before.

Interventions:

Assessing all five vestibular receptors with the video-head impulse test (vHIT), the suppression head impulse paradigm (SHIMP) and vestibular evoked myogenic potentials (VEMPs), a severe bilateral vestibulopathy was diagnosed. IgG and IgM Borrelia-specific antibodies on patient serum and cerebrospinal fluid analysis confirmed the diagnosis of neuroborreliosis. Following diagnosis, a course of doxycycline was started and the patients received an individualized vestibular rehabilitation program.

Results:

The patient exhibited slowly progressive improvements for disabling symptoms and the improving function of all five vestibular receptors was monitored with vHIT, SHIMP, and VEMPs over time.

Conclusions:

This is the first case report of bilateral vestibulopathy likely caused by neuroborreliosis. Although neurotologic involvement is an uncommon complication in this condition, clinicians should consider a vestibular testing battery when addressed by patient's history and bedside vestibular findings.
Lateral Thoracotomy for Ventricular Assist Device Implantation: A Meta-Analysis of Literature
Authors: Mariani Silvia , Li Tong , Boethig Dietmar , Napp L. Christian , Chatterjee Anamika , Homann Katharina , Bounader Karl , Hanke Jasmin S. , Dogan Guenes , Lorusso Roberto , Bauersachs Johann , Haverich Axel , Schmitto Jan D.
Published: February 2021

The use of lateral thoracotomy (LT) for implanting left ventricular assist devices (LVADs) is worldwide increasing, although the available evidence for its positive effects compared with conventional sternotomy (CS) is limited. This systematic review and meta-analysis analyzes the outcomes of LT compared with CS in patients undergoing implantation of a centrifugal continuous-flow LVAD. Four databases and 1,053 publications were screened until December 2019. Articles including patients undergoing implantation of a centrifugal continuous-flow LVAD through LT were included. A meta-analysis to compare LT and CS was performed to summarize evidences from studies including both LT and CS patients extracted from the same population. Primary outcome measure was in-hospital or 30-day mortality. Eight studies reporting on 730 patients undergoing LVAD implantation through LT (n = 242) or CS (n = 488) were included in the meta-analysis. Left thoracotomy showed lower in-hospital/30-day mortality (odds ratio [OR]: 0.520, 95% confidence interval [CI]: 0.27–0.99, p = 0.050), shorter intensive care unit (ICU) stay (mean difference [MD]: 3.29, CI: 1.76–4.82, p < 0.001), lower incidence of severe right heart failure (OR: 0.41; CI: 0.19–0.87, p = 0.020) and postoperative right ventricular assist device (RVAD) implantation (OR: 0.27, CI: 0.10–0.76, p = 0.010), fewer perioperative transfusions (MD: 0.75, CI: 0.36–1.14, p < 0.001), and lower incidence of renal failure (OR: 0.45, CI: 0.20–1.01, p = 0.050) and device-related infections (OR: 0.45, CI: 0.20–1.01, p = 0.050), respectively. This meta-analysis demonstrates that implantation of a centrifugal continuous-flow LVAD system via LT benefits from higher short-term survival, less right heart failure, lower postoperative RVAD need, shorter ICU stay, less transfusions, lower risk of device-related infections and kidney failure. Prospective studies are needed for further proof.
Use of Hemoadsorption in Patients With Severe Intoxication Requiring Extracorporeal Cardiopulmonary Support—A Case Series
Authors: Zickler Daniel , Nee Jens , Arnold Tim , Schröder Tim , Slowinski Torsten , Eckardt Kai-Uwe , Körner Roland , Kruse Jan Matthias
Published: February 2021

Drugs intoxications often lead to severe vasoplegia and cardiogenic shock, and VA-ECMO represents a viable therapy option. However, as cardiopulmonary support is not contributing to the removal of the causal agent from the blood, detoxification by a new hemoadsorption device (CytoSorb) could represent a potential therapeutic tool due to its highly efficient elimination capacity of endogenous but also exogenous hydrophobic substances for which otherwise no effective antidote exist.

In this case series, four anecdotal cases of acute intoxications requiring VA-ECMO support used as extracorporeal cardiopulmonary resuscitation after intoxication-induced out-of-hospital cardiac arrest (OHCA) are presented, who were additionally treated with CytoSorb hemoadsorption in combination with renal replacement therapy. Combined treatment was associated with a considerable decrease in plasma levels of the overdosed drugs. Additionally, the combination of applied techniques was safe, practical, and technically feasible with no adverse or any device-related side effects documented during or after the treatment sessions.

Based on the reported dramatic decline in drug levels during treatment, that fits in the device’s characteristics, we strongly suggest to further investigate the potentially lifesaving role of CytoSorb therapy in patients with acute intoxications requiring multiple organ support techniques.
Esophageal Squamous Papilloma in Children: A Single-center Case Series
Authors: Tou Andrea M. , Al-Nimr Amer O.
Published: February 2021

Objectives:

Esophageal squamous papilloma (ESP) is a rare epithelial lesion most commonly seen in adults, with an unclear etiology and limited pediatric data available. The aim of this study was to provide an estimated prevalence of this lesion in our pediatric population, as well as to identify any demographic, clinical, or pathologic associations—including human papilloma virus (HPV) infection, which has been linked with ESP in adult literature.

Methods:

ESP cases at University Hospitals Rainbow Babies & Children's Hospital were identified by conducting a retrospective search through all esophagogastroduodenoscopies (EGDs) performed in children under 18 years old, from January 1, 2000 to December 31, 2014. Histopathology reports were analyzed including Fluorescence In Situ Hybridization (FISH) for HPV, and a comprehensive chart review was performed for demographic data.

Results:

Of 12,459 children who required an EGD, 10 children were identified with ESP on biopsy, with ages ranging from 2 to 17 years. This provides an estimated prevalence of 0.08% over the entire study period. Seventy percentage of patients underwent endoscopy for abdominal pain, and 40% presented with gastroesophageal reflux. Sixty percentage of lesions were in the proximal esophagus, and 80% of patients had isolated lesions. Notably, none of the lesions tested were positive for HPV on FISH analysis.

Conclusions:

ESP is a rare benign lesion found incidentally in the pediatric population. The prevalence at our institution was 0.08%. All samples tested for HPV via FISH analysis were negative. As a result, regular analysis for HPV may not be necessary in pediatric patients with ESP in the future.
Contracts and Contracting
Authors: Terra Sandra M. , Zimmerling John
Published: February 2021

Purpose/Objectives:

The underlying guiding principles of case management services and practices of the Case Management Body of Knowledge include the following: “Case managers must possess the education, skills, knowledge, competencies, and experiences needed to effectively render appropriate, safe, and quality services to clients/support systems” and “Case management services are offered according to the clients' benefits as stipulated in their health insurance plans (http://www.cmbodyofknowledge.com/content/case-management-knowledge-2). Fulfilling these principles requires that the case manager engage in negotiating and contract execution.

This article explores the concepts of negotiation and some of the many ways case managers contribute to the contracting process.

Primary Practice Setting:

Acute care hospitals, individual practice, managed care.

Findings and Conclusions:

Case managers can provide valuable information during the contracting process, in many settings. In the managed care arena, case management can help identify the types of services needed by the population the organization serves. The same understanding of data can assist during the payer contracting process in the acute care setting and ensure that the hospital is fairly reimbursed by third party payers. The independent practitioners will, undoubtedly, face the need to negotiate for themselves as well as their clients.

Implications for Case Management:

The case manager, regardless of the setting, benefits from an understanding of the principles and processes associated with negotiation and contracting.
Factors Associated With Repeat Emergency Department Visits in a State-wide Cohort of Pediatric Patients With Mild Traumatic Brain Injury
Authors: Seligman Eva , Aslam Usman , Psoter Kevin J. , Ryan Leticia Manning , Nasr Isam W.
Published: February 2021

Objective

To describe demographic, injury, and clinical characteristics of pediatric patients treated in the ED for mild traumatic brain injury (mTBI), and to evaluate characteristics associated with mTBI-related return emergency department (ED) visit within 1 month of initial presentation.

Methods

Retrospective cohort study from April 1, 2012, to September 30, 2017, of children 19 years or younger presenting to any Maryland ED for mTBI identified in the Maryland Health Services Cost Review Commission database using ICD-9/10 codes. Demographic, injury, and clinical characteristics of individuals were collected. The primary outcome was mTBI-related return ED visit within 4 weeks. Multiple logistic regression tested the associated of individual demographic, injury, and clinical characteristics with mTBI-related return ED visit.

Results

There were 25,582 individuals who had an ED visit for mTBI, of which 717 (2.8%) returned to the ED within 4 weeks and 468 (1.8%) within 1 week with a mTBI-related diagnosis. In multivariable logistic regression analyses, public insurance (adjusted odds ratio [aOR], 1.44; 95% confidence interval [CI], 1.21–1.72) and female sex (aOR, 1.34; 95% CI, 1.15–1.56) were associated with increased odds of return to the ED within 4 weeks. Age younger than 2 years (aOR, 0.39; 95% CI, 0.21–0.72) was associated with decreased odds of return visit. There was a trend toward decreased odds of return patients receiving computed tomography head imaging (aOR, 0.86; 95% CI, 0.74–1.01).

Conclusions

Although return to the ED for mTBI-related complaints is uncommon, girls, older children, and publicly insured individuals may be at increased risk. Future targeted study may identify areas to improve access to appropriate longitudinal care and justify ED programs to better coordinate follow-up for mTBI.
International Endocervical Adenocarcinoma Criteria and Classification (IECC): An Independent Cohort With Clinical and Molecular Findings
Authors: Ren Hezhen , Almadani Noorah , Pors Jennifer , Leung Samuel , Ho Julie , Chow Christine , Ta Monica , Park Kay J. , Stolnicu Simona , Soslow Robert , Huntsman David , Gilks Blake C. , Hoang Lynn
Published: February 2021

Recently, the International Endocervical Adenocarcinoma Criteria and Classification (IECC) has reorganized the classification of endocervical adenocarcinomas (ECAs), separating them into human papilloma virus (HPV)-associated (HPVA) and HPVA independent (HPVI) categories. In this study, we sought to revalidate the IECC clinical findings in an independent cohort and assess the mutational differences between HPVA and HPVI ECAs using next generation sequencing. Consecutive cases of ECAs were reclassified under the IECC. Clinicopathologic information was collected and tissue was sent for targeted next-generation sequencing in 33 genes. Associations between HPV status, clinicopathologic parameters and mutation status, with survival were evaluated. The series comprised of 85/100 HPVA (63 HPVA-usual type, 4 villoglandular, 3 mucinous intestinal, 15 mucinous not otherwise specified) and 15/100 HPVI (9 gastric, 4 mesonephric, 1 clear cell, 1 not otherwise specified). HPVA ECAs presented at a lower age (P=0.001), smaller tumor sizes (P=0.011), less margin positivity (P=0.027), less Silva pattern C (P=0.002), and lower FIGO stages (P=0.020). HPVA had superior survival compared with HPVI ECA [overall survival (P=0.0026), disease-specific survival (P=0.0092), and progression-free survival (P=0.0041)]. Factors that correlated with worse prognosis irrespective of HPV status were FIGO stage, positive margins and lymphovascular invasion (P<0.05). TP53 mutations were detected in a significantly higher proportion of HPVIs than HPVAs (P<<0.001). The study revalidates the IECC system by reaffirming the clinical and prognostic differences between HPVA and HPVI ECAs in an independent dataset.
Müllerian Mucinous Cystadenomas of the Ovary: A Report of 25 Cases of an Unheralded Benign Ovarian Neoplasm Often Associated With Endometriosis and a Brief Consideration of Neoplasms Arising From the Latter
Authors: Watkins Jaclyn C. , Young Robert H.
Published: February 2021

A subset of ovarian mucinous tumors demonstrates müllerian-type epithelium, with such lesions variably designated “endocervical-like” and seromucinous since their popularization based on a report of borderline examples in 1989. While müllerian mucinous borderline tumors and carcinomas have been highlighted in the literature, there has been minimal attention given to benign müllerian mucinous tumors, particularly müllerian mucinous cystadenomas. Given the paucity of literature describing the features of müllerian mucinous cystadenomas/cystadenofibromas, diagnostic difficulties may arise when papillary features are present and in cases that show a subtle transition from endometriosis. We thus reviewed 25 cases of müllerian mucinous cystadenoma/cystadenofibroma to highlight the notable characteristics of this entity, including gross, cytologic, and architectural features that aid in the distinction from müllerian mucinous borderline tumors as well as, rarely, metastatic tumors. The patients ranged in age from 26 to 85 yr old. Bilateral ovarian involvement was frequent (40%). The ovaries ranged from 2.3 to 26 cm in greatest dimension. Most were multicystic (18 cases) and contained tenacious mucoid material (14 cases). All cases demonstrated predominantly columnar mucinous epithelium with abundant pale-pink cytoplasm. A minor component of ciliated and endometrioid epithelium was seen in 15 and 2 cases, respectively. Broad papillary formations were frequently encountered (9 cases) as was epithelial papillary tufting comprising <10% of the tumor (6 cases). Endometriosis was present in 9 cases, with a transition from endometriosis to mucinous epithelium noted in 8 cases. This series highlights the morphologic features of a relatively uncommon, benign, endometriosis-associated ovarian tumor that may be confused with a müllerian mucinous borderline tumor or bland metastatic mucinous tumors. It also provides an argument for the terminology “müllerian mucinous cystadenoma” or “cystadenofibroma” rather than “seromucinous cystadenoma” due to the frequent association with endometriosis as well as the dominant mucinous epithelium.
Quantity and Quality of Physical Medicine and Rehabilitation Clerkships in US Medical Schools
Authors: Benbassat Danny , Cervero Ronald M. , Miller Matthew E. , Hager Nelson , Konopasky Abigail
Published: February 2021

Objective

The purpose of this study was to address two underreported issues in undergraduate physical medicine and rehabilitation medical education: quantity and quality of physical medicine and rehabilitation clerkships in US medical schools.

Design

A multimethod sequential design was used to evaluate the curricula of US medical schools. Quantity (N = 154) of physical medicine and rehabilitation clerkships was assessed by counting the number of required, selective, and elective clerkships in each medical school. Quality (n = 13) was assessed by conducting a thematic analysis on physical medicine and rehabilitation clerkship curricula to identify learning objectives. These objectives were then compared with learning objectives in a model standard.

Results

Whereas few medical schools required a physical medicine and rehabilitation clerkship, most offered elective rotations in physical medicine and rehabilitation. Most medical schools only included 6 of the 12 model standard learning objectives. Medical schools also included 29 learning objectives not present in the model standard.

Conclusions

Physical medicine and rehabilitation clerkships are not underrepresented but are underemphasized, in undergraduate medical schools. Furthermore, these clerkships use inconsistent learning objectives. Thus, findings suggest the need to draw attention to physical medicine and rehabilitation clerkships by offering them as selectives and to develop a list of standardized learning objectives. This exploratory study developed such a groundbreaking list and invites the physical medicine and rehabilitation community to test it.
Implementation and Maintenance of a Pediatric Severe Burn Guidelines Quality Improvement Project
Authors: Dolan Kristin J. , Flint Jennifer L. , Benton Tara C. , Miller Mikaela , Miller Jenna O.
Published: February 2021

Introduction:

Critically injured pediatric burn patients require specialized management, yet few verified pediatric burn centers exist in the United States. Many pediatric hospitals have resources to care for severely burned patients but lack standardized care guidelines, which improve outcomes. To improve the morbidity and mortality of severely burned pediatric patients admitted to the pediatric intensive care unit, we created a specialized burn team. We implemented Pediatric Severe Burn Guidelines, focusing on improving fluid resuscitation accuracy and providing timely nutritional support.

Methods:

This investigation is of a 9-year (2010–2019) retrospective preintervention and postintervention study of the effect of the formation of a multidisciplinary burn leadership committee and development and implementation of Pediatric Severe Burn Guidelines. The primary outcome measures are increasing the accuracy of fluid resuscitation and improving the timely administration of nutritional support. The process measure is the percentage of time the electronic health record power plan was used for burn admissions with burn leadership review of the cases. Balancing measures are pediatric intensive care unit and hospital length of stay.

Results:

Preprotocol patients received acceptable fluid resuscitation 25% (5/20) of the time compared to 61.5% (8/13) of the time in postprotocol patients (P = 0.04). In postprotocol patients, there is an improvement in the timely placement of postpyloric feeding tube and initiation of feeds 48 hours after admission.

Conclusions:

Extensive guidelines for standardized care require careful implementation and monitoring of adherence gaps. Creating a specialized burn team and implementing clinical guidelines standardize care leading to improvement in critical patient outcomes.
Posttraumatic Stress Disorder and the Associated Risk of Autoimmune Skin Diseases: A Nationwide Population-Based Cohort Study
Authors: Dai Ying-Xiu , Tai Ying-Hsuan , Chang Yun-Ting , Chen Tzeng-Ji , Chen Mu-Hong
Published: February 2021

Objective

Posttraumatic stress disorder (PTSD) is known as a risk factor for various immune-related disorders; however, the association between PTSD and related autoimmune skin diseases (ASDs) remains unclear. This study aimed to investigate the association of PTSD with the risk of related ASDs.

Methods

Participants were recruited from the National Health Insurance Research Database in Taiwan. We included 9801 patients with PTSD and 39,204 matched controls to assess the risk of developing ASDs. Cox regression model was used for analyses.

Results

After adjusting for confounders, we found an increased risk of ASDs among the patients with PTSD (adjusted hazard ratio [aHR] = 3.00, 95% confidence interval [CI] = 2.21–4.07) compared with that among matched controls. Statistically significant associations were found between PTSD and five individual ASDs, including psoriasis (aHR = 3.81, 95% CI = 1.90–7.67), lichen planus (aHR = 31.63, 95% CI = 4.00–249.91), alopecia areata (aHR = 4.77, 95% CI = 2.47–9.20), autoimmune bullous diseases (aHR = 9.55, 95% CI = 1.98–45.99), and vitiligo (aHR = 16.06, 95% CI = 4.48–57.54).

Conclusions

Patients with PTSD had an increased risk of developing ASDs compared with the matched controls. Further studies are needed for better understanding of the underlying mechanisms.
Brief Report: Hospitalization Rates Among Persons With HIV Who Gained Medicaid or Private Insurance After the Affordable Care Act in 2014
Authors: Chow Jeremy Y. , Nijhawan Ank E. , Mathews W. Christopher , Raifman Julia , Fleming Julia , Gebo Kelly A. , Moore Richard D. , Berry Stephen A.
Published: February 2021

Background:

It is unknown whether gaining inpatient health care coverage had an effect on hospitalization rates among persons with HIV (PWH) after implementation of the Affordable Care Act in 2014.

Methods:

Hospitalization data from 2015 were obtained for 1634 adults receiving longitudinal HIV care at 3 US HIV clinics within the HIV Research Network. All patients were engaged in care and previously uninsured and supported by the Ryan White HIV/AIDS Program in 2013. We evaluated whether PWH who transitioned to either Medicaid or private insurance in 2014 tended to have a change in hospitalization rate compared with PWH who remained uncovered and Ryan White HIV/AIDS Program supported. Analyses were performed by negative binomial regression with robust standard errors, adjusting for gender, race/ethnicity, age, HIV risk factor, CD4 count, viral load, clinic site, and 2013 hospitalization rate.

Results:

Among PWH without inpatient health care coverage in 2013, transitioning to Medicaid [adjusted incidence rate ratio 1.26, (0.71, 2.23)] or to private insurance [0.48 (0.18, 1.28)] in 2014 was not associated with 2015 hospitalization rates, after accounting for demographics, HIV characteristics, and prior hospitalization rates. The factors significantly associated with higher hospitalization rates include age 55–64, CD4 <200 cells/µL, viral load >400 copies/mL, and 2013 hospitalization rate.

Conclusions:

Acquiring inpatient coverage was not associated with a change in hospitalization rates. These results provide some evidence to allay the concern that acquiring inpatient coverage would lead to increased inpatient utilization.
Brief Report: Improvement in Metabolic Health Parameters at Week 48 After Switching From a Tenofovir Alafenamide–Based 3- or 4-Drug Regimen to the 2-Drug Regimen of Dolutegravir/Lamivudine: The TANGO Study
Authors: van Wyk Jean , Ait-Khaled Mounir , Santos Jesus , Scholten Stefan , Wohlfeiler Michael , Ajana Faïza , Jones Bryn , Nascimento Maria-Claudia , Tenorio Allan R. , Smith Don E. , Wright Jonathan , Wynne Brian
Published: February 2021

Background:

In TANGO, switching to dolutegravir/lamivudine was noninferior at 48 weeks to continuing 3-/4-drug tenofovir alafenamide–based regimens in virologically suppressed individuals with HIV-1. Antiretroviral agents have been associated with weight gain and metabolic complications.

Setting:

One hundred thirty-four centers; 10 countries.

Methods:

We assessed weight; fasting lipids, glucose, and insulin; and prevalence of insulin resistance and metabolic syndrome at baseline and week 48 in TANGO participant subgroups by boosting agent use in baseline regimens (boosted and unboosted).

Results:

In each treatment group, 74% of participants used boosted regimens at baseline. In boosted and unboosted subgroups, weight and fasting glucose changes at week 48 were small and similar between treatment groups. Overall and in the boosted subgroup, greater decreases from baseline were observed with dolutegravir/lamivudine in fasting total cholesterol (P < 0.001), low-density lipoprotein cholesterol (P < 0.001), triglycerides (P < 0.001), total cholesterol/high-density lipoprotein cholesterol ratio (overall, P = 0.017; boosted, P = 0.007), and insulin (boosted, P = 0.005). Prevalence of HOMA-IR ≥2 was significantly lower at week 48 with dolutegravir/lamivudine overall [adjusted odds ratio (aOR), 0.59; 95% confidence interval (CI), 0.40 to 0.87; P = 0.008] and in the boosted subgroup [aOR, 0.56; 95% CI, 0.36 to 0.88; P = 0.012] but not in the unboosted subgroup [aOR, 0.70; 95% CI, 0.31 to 1.58; P = 0.396]. Prevalence of metabolic syndrome at week 48 was low and consistent between treatment groups overall, with differences trending to favor dolutegravir/lamivudine in the unboosted subgroup [aOR, 0.41; 95% CI, 0.15 to 1.09; P = 0.075].

Conclusion:

Generally, switching from 3-/4-drug tenofovir alafenamide–based regimens to dolutegravir/lamivudine improved metabolic parameters, particularly when switching from boosted regimens. Because of smaller sample size in the unboosted subgroup, results warrant further investigation.
HIV Prevention Responsibility Beliefs Among Men Who Have Sex With Men in the PrEP Era
Authors: Truong Hong-Ha M. , Fatch Robin , McFarland Willi , Raymond Henry F.
Published: February 2021

Background:

Beliefs regarding responsibility for preventing HIV transmission may differ between individuals and their sexual partners. We assessed HIV prevention responsibility beliefs among men who have sex with men (MSM) participating in the 2017 National HIV Behavioral Surveillance survey.

Methods:

MSM were recruited using time-location sampling at clubs, bars, and street locations in San Francisco. HIV prevention responsibility beliefs were assessed on a four-point scale (1 = strongly disagree to 4 = strongly agree). Associations were assessed using generalizing estimating equations to adjust for behaviors within multiple partnerships.

Results:

A total of 316 HIV-negative men and 76 HIV-positive men reported on 1336 partnerships. HIV-negative compared with HIV-positive men had higher endorsement of mutual responsibility (mean 3.7 vs. 3.5; P < 0.01). Both groups had similar levels of endorsing responsibility on the HIV-negative or HIV-positive partner. HIV-positive men endorsing equal responsibility were more likely to know their partner's HIV status (P < 0.01) and less likely to have serodiscordant condomless anal intercourse (CAI) (P < 0.01) than men who did not endorse equal responsibility. HIV-negative men in partnerships with pre-exposure prophylaxis (PrEP) use were more likely to know their partner's HIV status (P = 0.02) and have serodiscordant CAI (P = 0.04) than men not in partnerships with PrEP use.

Conclusions:

HIV-negative and HIV-positive men accept responsibility for preventing HIV. The finding that HIV-negative men in partnerships with PrEP use who engage in serodiscordant CAI is concerning because they are still at risk for other sexually transmitted infections, which are presently at elevated levels in San Francisco and other US cities.
Posttraumatic Scab on 131I Whole-Body Scan—A False-Positive Finding
Authors: Chowdhary Abdul Waheed , Kavanal Anwin Joseph , Sood Ashwani , Prashar Sarika , Upadhyay Ritesh , Bhattacharya Anish , Mittal Bhagwant Rai
Published: February 2021

131I scan plays a crucial role in the management of patients with differentiated thyroid cancer for the evaluation of remnant thyroid tissue, residual/recurrent metastatic disease, posttherapy tracer distribution, and response assessment to high-dose 131I therapy. Different causes secondary to physiological, pathological, and anatomical variations have been described for false-positive findings in the whole-body planar images. This case report of a patient of differentiated thyroid cancer with undocumented trauma to the left knee region a day before receiving the high-dose radioiodine therapy showed an interesting image finding of tracer uptake at unusual site in the posttherapy whole-body 131I scan.
Seasonal and Temperature-associated Effect on Infection in Implant-based Breast Reconstruction
Authors: Min Kyunghyun , Jeong Seong Su , Han Hyun Ho , Kim Eun Key , Eom Jin Sup
Published: February 2021

Background and Objectives

Despite advances in medicine, infection at the surgical site is an impregnation problem that most surgeons confront. Although studies on the seasonality of infection have been conducted in various areas, no study has confirmed the relationship between seasonal temperature and infection after breast reconstruction.

Methods

From 2008 to 2018, a retrospective study was conducted on patients who underwent implant-based breast reconstruction. Patient demographics, intraoperative data, postoperative data, and temperature information were collected. Temperature differences between cases with and without infection were examined. The differences in the incidence and risk of infection by season were estimated according to the hot season (July to August) and the nonhot season (September to June).

Results

Of the 460 cases enrolled, 42 cases developed an infection. Among them, 15 (35.71%) cases developed infection during the hot season (P = 0.003). According to the logistic regression model, the risk of infection was 2.639 times higher in the hot season than in the nonhot season (95% confidence interval, 1.282–5.434; P = 0.008). When the temperature was higher than 25°C, the risk of infection increased by 45.2% for every 1°C increase, which was statistically significant (odds ratio, 1.452; 95% confidence interval, 1.198–1.76; P < 0.001).

Conclusion

In conclusion, the hot season or average temperatures higher than 25°C increase the risk of infection in patients undergoing implant-based breast reconstruction. It is essential to focus on skin hygiene during the healing of the incision site.