bluuebunny/crossref_metadata_2025 huggingface dataset:
Drinking water contaminants in California and hypertensive disorders in pregnancy
Authors: Padula Amy M. , Ma Chen , Huang Hongtai , Morello-Frosch Rachel , Woodruff Tracey J. , Carmichael Suzan L.
Published: April 2021

Background:

Environmental pollutants have been associated with hypertensive disorders in pregnancy including gestational hypertension, preeclampsia, and eclampsia, though few have focused on drinking water contamination. Water pollution can be an important source of exposures that may contribute to adverse pregnancy outcomes.

Methods:

We linked water quality data on 13 contaminants and two violations from the California Communities Environmental Health Screening Tool to birth records from vital statistics and hospital discharge records (2007–2012) to examine the relationship between drinking water contamination and hypertensive disorders in pregnancy. We examined contaminants in single- and multipollutant models. Additionally, we examined if the relationship between water contamination and hypertensive disorders in pregnancy differed by neighborhood poverty, individual socioeconomic status, and race/ethnicity.

Results:

Arsenic, nitrate, trihalomethane, hexavalent chromium, and uranium were detected in a majority of water systems. Increased risk of hypertensive disorders in pregnancy was modestly associated with exposure to cadmium, lead, trihalomethane, and hexavalent chromium in drinking water after adjusting for covariates in single pollutant models with odds ratios ranging from 1.01 to 1.08. In multipollutant models, cadmium was consistent, lead and trihalomethane were stronger, and additional contaminants were associated with hypertensive disorders in pregnancy including trichloroethylene, 1,2-Dibromo-3-chloropropane, nitrate, and tetrachloroethylene. Other contaminants either showed null results or modest inverse associations. The relationship between water contaminants and hypertensive disorders in pregnancy did not differ by neighborhood poverty.

Conclusions:

We found increased risk of hypertensive disorders in pregnancy associated with exposure to several contaminants in drinking water in California. Results for cadmium, lead, trihalomethane, and hexavalent chromium were robust in multipollutant models.
Management of Hypertension in Pregnancy
Authors: Magee Laura A. , von Dadelszen Peter
Published: April 2021

Hypertension in pregnancy is currently defined as a systolic blood pressure (BP) of 140 mmHg or more, or a diastolic BP of 90 mmHg or more. This level of BP warrants antihypertensive therapy. Treating to a target BP of 135/85 mmHg halves the risk of severe hypertension that is itself associated with adverse maternal and perinatal outcomes, similar in magnitude to preeclampsia. While based on the results of the Control of Hypertension in Pregnancy Study (CHIPS) trial, this finding is consistent with all antihypertensive trials to date. Also, in the CHIPS trial, “tight” BP control also halved the risk of progression to thrombocytopenia and elevated liver enzymes for the mother, without adverse effects for the fetus or newborn. This was true regardless of the gestational age at which BP control was instituted. While methyldopa, labetalol, and nifedipine are the most commonly-recommended oral antihypertensives, it is not clear that one antihypertensive agent has advantages over the others for treatment of non-severe hypertension in pregnancy. No antihypertensives, including renin-angiotensin-aldosterone system (RAAS) inhibitors, have been shown to be teratogenic, although there may be an increase in malformations associated with the underlying condition of chronic hypertension. Atenolol and RAAS inhibitors should not be used once pregnancy is diagnosed, based on fetotoxicity. At present, BP treatment targets used in clinic are the same as those used at home as the differences are quite variable among hypertensive women. For treatment of acute severe hypertension, the most commonly-recommended antihypertensives are oral nifedipine, IV labetalol, and IV hydralazine, although oral agents have also been shown to be effective in the majority of women; while concerns raised about IV hydralazine-induced maternal hypotension and its consequences have not been confirmed, this medication may be an inferior antihypertensive to oral nifedipine. While treatment recommendations are based on evidence, women should be engaged in decision-making, as their values may alter target BP and antihypertensive choice. Future work will clarify the optimal target BP based on home BP measurements; whether BP targets should be lowered further if the definition of hypertension is based on a lower BP; which, if any, antihypertensive medication for non-severe hypertension is better with regards to maternal and perinatal outcomes; and whether factors beyond BP level (such as variability, race, and other physiological variables) should inform antihypertensive therapy in pregnancy.
Analysis of female demographics in the United States: life expectancy, education, employment, family building decisions, and fertility service utilization
Authors: Esencan Ecem , Simsek Burcin , Seli Emre
Published: April 2021

Purpose of review

To discuss changes in female demographic parameters in the US and associated increase in utilization of fertility services.

Recent findings

Fractions of women earning bachelor's, master's, and doctoral degrees increased from 1970 to 2018 (32.6 vs 64.8; 7.9 vs 27.3; 0.54 vs 5.7 per 10,000 women; P < .001; respectively). This was associated with decrease in percentage of married women (61.9% vs 50.8%) and increase in median age at first marriage (20.8 vs 27.8). In parallel, mean age of mothers at first birth increased (21.4 vs 26.8), and pregnancy rates of women aged 35–39 and 40–44 years doubled between 1980 and 2010 (0.036 vs 0.077; 0.009 vs 0.019 per 1,000 women). With later pregnancy attempts, female fertility rates decreased from 1970 to 2017 (87.9% vs 60.3%; P < .001). Women undergoing assisted reproductive technologies (ART) treatment with a DOR diagnosis increased (12% vs 31%), and ART cycles using donor eggs increased (16,161 vs 24,300), between 2005 and 2016.

Participation of women in education is paralleled by increased female employment, later occurrence of marriage, increased age of childbearing, decreased fertility rates, and increased DOR diagnosis.
Foot Orthoses Enhance the Effectiveness of Exercise, Shockwave, and Ice Therapy in the Management of Medial Tibial Stress Syndrome
Authors: Naderi Aynollah , Bagheri Shahabeddin , Ramazanian Ahoor Fatemeh , Moen Maarten H. , Degens Hans
Published: April 2021

Objective:

Our aim was to assess the effects of adding arch-support foot-orthoses (ASFO) to a multimodal therapeutic intervention on the perception of pain and improvement of recovery from medial tibial stress syndrome (MTSS) in recreational runners.

Design:

A prospective randomized controlled trial.

Setting:

Sport training and medical centers.

Participants:

Fifty female recreational runners with MTSS were randomized into 2 groups.

Interventions:

Runners either received ASFO or sham flat noncontoured orthoses. Both groups received a multimodal therapeutic intervention, including ice massage, ankle muscle exercises, and extracorporeal shockwave therapy.

Main Outcome Measures:

Pain during bone pressure using a numerical Likert scale (0-10), MTSS severity using an MTSS scale, perceived treatment effect using the global rating of change scale, and quality of life using the short Form-36 questionnaire were determined at week 6, 12, and 18.

Results:

Pain intensity and MTSS severity were lower, and the perceived treatment effect and physical function were better in the ASFO than in the sham flat noncontoured orthoses group at week 6 and week 12. Cohen's dz effect size for between-group differences showed a medium difference. However, arch-support foot-orthoses did not add to the benefits of multimodal therapeutic intervention on pain, MTSS severity and perceived treatment effect at week 18.

Conclusions:

Adding ASFO to a therapeutic intervention leads to an earlier diminishment of pain and MTSS severity, and improved PF and perceived therapeutic effects.
Feasibility and Effectiveness of an Interprofessional Mindfulness-Informed Group-Based Intervention for Treatment of Overactive Bladder: A Pilot Study
Authors: Reisch Rebecca , Zúñiga Ruth , Das Rebekah
Published: April 2021

Background:

Overactive bladder (OAB) is a common condition that negatively affects quality of life. Urinary urgency is the dominant symptom and behavioral therapy is the first-line approach. Mindfulness practices have been proposed for urgency management, but studies on mindfulness for OAB have not included components of behavioral therapy commonly used in clinical practice.

Objectives:

The primary objective was to examine the feasibility of implementing a novel mindfulness-informed group-based behavioral therapy intervention for OAB, using behavioral therapy specific to OAB. The secondary purpose was to examine the potential clinical utility of the program.

Study Design:

Pilot feasibility study.

Methods:

This was a single-arm pilot study using a convenience sample. The intervention was developed by 2 physical therapists and 1 licensed psychologist. Women with OAB symptoms were recruited from the community for a 6-week, 2 h/wk group-based program that included information on bladder health, urinary tract function, and mindfulness-informed practices. Participants were asked to engage in mindfulness activities between sessions.

Results:

Five women fit the inclusion criteria and 4 completed the study, attending all 6 sessions (retention rate: 80%). Time and resources required to deliver the intervention were deemed feasible. All participants showed improvements on some or all self-reported symptoms questionnaires.

Conclusions:

This novel program appears to be feasible and shows the potential for clinical utility. Future studies should include a longer recruitment period to achieve a larger sample size and should compare this intervention with other established interventions for OAB.
Genomics of aging: Glycosylation
Authors: Wysocki Kenneth , Seibert Diane
Published: April 2021

This third article in the Genomics of Aging series explores the process of glycosylation and how abnormal glycosylation contributes to aging and disease (i.e., diabetes, cardiovascular disease [CVD], neurological disorder, and cancer). Glycosylation is an important posttranslational process that contributes to normal protein folding, cell adhesion, protein stability, and motility. Gradual accumulation of molecular errors contributes to the aging process, and specific genetic variants in this pathway have been identified in cancer, CVD, aging, and vulnerability to disease progression. Manipulating glycosylation pathways may be beneficial in reducing disease risk in the future. Smoking cessation has been shown to reverse epigenetic changes in glycosylation pathways that increase cancer, CVD, and all-cause mortality risk, and CVD risk may be reduced if a dimeric glycosylated fusion protein pathway can be regulated. Selective food sources and synthetic vitamins and antioxidants have been shown to support normal glycosylation and help in the cell repair process.
Weaning patients with obesity from ventilatory support
Authors: Kacmarek Robert M. , Wanderley Hatus V. , Villar Jesús , Berra Lorenzo
Published: April 2021

Purpose of review

Obesity prevalence is increasing in most countries in the world. In the United States, 42% of the population is obese (body mass index (BMI) > 30) and 9.2% is obese class III (BMI > 40). One of the greatest challenges in critically ill patients with obesity is the optimization of mechanical ventilation. The goal of this review is to describe respiratory physiologic changes in patients with obesity and discuss possible mechanical ventilation strategies to improve respiratory function.

Recent findings

Individualized mechanical ventilation based on respiratory physiology after a decremental positive end-expiratory pressure (PEEP) trial improves oxygenation and respiratory mechanics. In a recent study, mortality of patients with respiratory failure and obesity was reduced by about 50% when mechanical ventilation was associated with the use of esophageal manometry and electrical impedance tomography (EIT).

Obesity greatly alters the respiratory system mechanics causing atelectasis and prolonged duration of mechanical ventilation. At present, novel strategies to ventilate patients with obesity based on individual respiratory physiology showed to be superior to those based on standard universal tables of mechanical ventilation. Esophageal manometry and EIT are essential tools to systematically assess respiratory system mechanics, safely adjust relatively high levels of PEEP, and improve chances for successful weaning.
Veterans’ Reported Comfort in Disclosing Sexual Orientation and Gender Identity
Authors: Ruben Mollie A. , Kauth Michael R. , Meterko Mark , Norton Andrea M. , Matza Alexis R. , Shipherd Jillian C.
Published: April 2021

Background:

The Veterans Health Administration (VHA) does not routinely collect and document sexual orientation and gender identity (SOGI) data despite research on health disparities among sexual and gender minority (SGM) veterans. Due to the legacy of previous Department of Defense policies that prohibited disclosure of sexual or gender minority identities among active-duty personnel, minority veterans may be reluctant to respond to SOGI questions on confidential VHA surveys and in discussions with their VHA providers. Veterans may generally find SOGI questions uncomfortable and may not appreciate their relevance to health care.

Objective:

The purpose of this research was to examine veterans’ comfort in reporting identity characteristics on confidential VHA surveys and in discussion with their VHA providers and whether comfort differed by sociodemographic characteristics.

Research Design:

The project involves the secondary analysis of quantitative data from a quality improvement survey project.

Subjects:

A total of 806 veterans were surveyed.

Results:

Overall, 7.15% endorsed sexual or gender minority identity which is a higher rate than the 4.5% noted in the general US population. Cisgender and heterosexual veterans were more comfortable reporting identity characteristics both on VHA confidential surveys and in discussion with VHA providers compared with SGM veterans.

Conclusions:

These data suggest that the majority of veterans feel comfortable reporting their identities both on surveys and in the context of health care. Understanding these perceptions can assist VHA programs in implementing SOGI data collection and disclosure in clinical care, creating a welcoming environment of care for SGM veterans that does not make veterans from other backgrounds feel uncomfortable.
Physical Activity and Fatigue in Children With Intestinal Failure on Parenteral Nutrition
Authors: So Stephanie , Patterson Catherine , Betts Zachary , Belza Christina , Avitzur Yaron , Wales Paul W.
Published: April 2021

Objectives:

With improved survival of children with intestinal failure (IF), it is important to examine the impact on long‐term physical function, physical activity (PA), and fatigue and identify clinical factors that may be predictive of impairment.

Methods:

Cross‐sectional study in children with IF on parenteral nutrition (PN) compared with healthy age‐ and sex‐matched controls (HCs). Assessments included: Paediatric Quality of Life (PedsQL) Physical Function subscale, PedsQL Multi‐Dimensional Fatigue Scale, and PA Perceived Benefits and Barriers scale. PA was measured using an accelerometer. Medical data was collected by chart abstraction.

Results:

Participants included 21 children with IF (14 girls), median age 8.33 (interquartile range [IQR] 6.96–11.04) years and 33 HCs (20 boys), 8.25 (6.67–10.79) years. In those with IF, 13 (62%) were born prematurely with a median of 15 (7.5–24.5) in‐patient hospitalizations. There was a significant difference (P = 0.033) in mean steps/day in children with IF (9709 +/− 3975) compared with HCs (13104 +/− 5416), and a correlation between moderate‐to‐vigorous PA and gestational age (r = 0.642, P = 0.010). Child and parent proxy scores indicate poorer physical function and greater fatigue in the IF group, along with a correlation between greater fatigue (r = −0.538, P = 0.012), poorer physical function (r = −0.0650, P = 0.0001) in children with more hospitalizations. Barriers to PA include “I am tired” and “I am worried about my line.”

Conclusions:

Children with IF present with lower levels of PA and physical function and greater fatigue compared with their peers. Ongoing development of medical and rehabilitation intervention strategies is vital to optimize outcomes.
Electrogastrography Abnormalities in Pediatric Gastroduodenal Disorders
Authors: Bhat Sameer , Varghese Chris , Carson Daniel A. , Hayes Tommy C.L. , Andrews Christopher N. , Mousa Hayat , O'Grady Gregory , Gharibans Armen A.
Published: April 2021

Electrogastrography (EGG) is a non‐invasive method of measuring gastric electrophysiology. Abnormal gastric electrophysiology is thought to contribute to disease pathophysiology in patients with gastroduodenal symptoms but this has not been comprehensively quantified in pediatric populations. This study aimed to quantify the abnormalities in gastric electrophysiology on EGG in neonatal and pediatric patients.

Databases were systematically searched for articles utilizing EGG in neonatal and pediatric patients (⩽18 years). Primary outcomes were prevalence of abnormality, percentage of time in normal rhythm, and power ratio. Secondary outcomes were correlations between patient symptoms and abnormal gastric electrophysiology on EGG.

A total of 33 articles (1444 participants) were included. EGG methodologies were variable. Pooled prevalence of abnormalities on EGG ranged from 61% to 86% in patients with functional dyspepsia (FD), gastro‐esophageal reflux disease (GERD), and type 1 diabetes mellitus (T1DM). FD patients averaged 20.8% (P = 0.011) less preprandial and 21.6% (P = 0.031) less postprandial time in normogastria compared with controls. Electrophysiological abnormalities were inconsistent in GERD. T1DM patients averaged 46.2% (P = 0.0003) less preprandial and similar (P = 0.32) postprandial time in normogastria compared with controls, and had a lower power ratio (SMD −2.20, 95% confidence interval [CI]: −4.25 to −0.15; P = 0.036). Symptom correlations with gastric electrophysiology were inconsistently reported.

Abnormalities in gastric electrophysiology were identifiable across a range of pediatric patients with gastroduodenal symptoms on meta‐analysis. However, techniques have been inconsistent, and standardized and more reliable EGG methods are desirable to further define these findings and their potential utility in clinical practice.
Inpatient Pediatric Foreign Body Ingestion
Authors: Wood Mary L. , Potnuru Paul P. , Nair Supriya
Published: April 2021

Objective:

We generated national estimates of patient and hospitalization characteristics for pediatric inpatient admissions for foreign body ingestion (FBI) and compared these to admissions for other reasons. We further identified characteristics that were independently associated with length of stay (LOS). Finally, we hypothesized that endoscopy within 24 hours of admission was independently associated with a shorter LOS in patients admitted for FBI.

Methods:

In this retrospective study, we used data from the Kids’ Inpatient Database for 2016. Admissions for FBI were identified and national estimates of patient and hospitalization characteristics were generated. Patients admitted for FBI were compared to patients admitted for other causes. Data were analyzed for independent associations with LOS. Subgroup analysis was performed to determine whether early endoscopy was associated with a shorter LOS.

Results:

A total of 2464 admissions for FBI were identified in the database. The median (interquartile range) patient age was 4 (1–11) years with a slight male predominance. Most patients (82.6%) had an endoscopy performed during admission. Independent factors associated with increased LOS included: airway procedures, intra‐abdominal surgery, psychiatric diagnosis, esophageal disorder, and developmental delay. Among patients who required endoscopy, 56.7% were performed early (within 24 hours). Early endoscopy was independently associated with a 35% shorter LOS (incidence rate ratio = 0.65, 95% confidence interval 0.54–0.80; P=0.009).

Conclusions:

Inpatient admissions for FBI frequently require endoscopy and have a short LOS. In patients who require endoscopy during the admission, early endoscopy (within 24 hours of admission) may be associated with a shorter LOS.
Socioeconomic Mobility and Psychological and Cognitive Functioning in a Diverse Sample of Adults With and Without HIV
Authors: Weissberger Gali H. , Núñez Rodolfo A. , Tureson Kayla , Gold Alaina , Thames April D.
Published: April 2021

Objective

This cross-sectional study examined the effects of socioeconomic status (SES) mobility from childhood to adulthood on psychological and cognitive well-being in African American and non-Hispanic White HIV-positive (HIV+) and HIV-seronegative (HIV−) adults who are part of an ongoing study investigating psychosocial and neurobehavioral effects of HIV.

Methods

Participants (N = 174, 24.1% female, 59.2% African American, 67.8% HIV+) were categorized into four groups (upward mobility, downward mobility, stable-not-poor, chronic-poverty) based on self-reported childhood and current community SES (which were correlated with objective measures of SES and proxies of childhood SES). SES groups were compared on self-report measures of psychological well-being, subjective executive functioning ratings, and performance across six cognitive domains. Primary analyses were stratified by HIV status.

Results

For the HIV+ group, SES mobility was associated with psychological well-being (chronic burden of stress: F(7,101) = 3.17, mean squared error [MSE] = 49.42, p = .030, η2 = 0.14; depressive symptoms: F(7,101) = 4.46, MSE = 70.49, p = .006,η2 = 0.14), subjective ratings of executive dysfunction (F(7,101) = 6.11, MSE = 114.29, p = .001,η2 = 0.18), and objective performance in executive functioning (F(9,99) = 3.22, MSE = 249.52, p = .030, η2 = 0.15) and learning (F(9,99) = 3.01, MSE = 220.52, p = .034, η2 = 0.13). In the control group, SES mobility was associated with chronic stress burden (F(5,49) = 4.677, p = .025, η2 = 0.15); however, no other relationships between SES mobility and outcomes of interest were observed (all p values > .20). In general, downward mobility and chronic poverty were associated with worse ratings across psychological well-being measures and cognitive performance.

Conclusions

Findings within the HIV+ group are consistent with previous studies that report downward mobility to be associated with poor psychological outcomes. People living with HIV may be particularly vulnerable to the adverse effects of socioeconomic instability.
Current Situation of Medication Errors in Saudi Arabia: A Nationwide Observational Study
Authors: Alshammari Thamir M. , Alenzi Khalidah A. , Alatawi Yasser , Almordi Afnan S. , Altebainawi Ali F.
Published: April 2021

Objectives

Medication errors are common and highly preventable events that significantly affect patients’ health. This nationwide study primarily aims to quantify the rate and level of harm from the reported medication errors and to determine the medication process stages in which the reported errors occurred.

Methods

This retrospective observational study concerns medication errors reported to the General Department of Pharmaceutical Care database from March 2018 to June 2019. The database stores all aspects of medication error information, including patient, medication, and error information, along with the job position of the staff involved and contributing factors. The medication use process was categorized into these stages: ordering/prescribing, transcribing, dispensing, administering, and monitoring. We recorded each medication error based on categories from the U.S. National Coordinating Council for Medication Error Reporting and Prevention.

Results

A total of 71,332 medication error events were reported to the database. Physicians made 63,120 (88.5%) reported errors, and pharmacists most frequently detected the errors (75.9%). The majority of reported errors appeared at the prescribing phase (84.8%), followed by the transcribing (5.8%) and dispensing (5.7%) phases. A total of 4182 (5.8%) errors reached the patient. Health care professionals’ work overload and lack of experience were associated with 31.6% and 22.7% of the reported errors, respectively.

Conclusions

Our study highlights the concern regarding medication errors and their low reporting by indicating that pharmacists reported and detected the majority of errors. Promoting a no-blame culture and education for health professionals is vital for improving the error-reporting rate.
Redeployment of Health Care Workers in the COVID-19 Pandemic: A Qualitative Study of Health System Leaders’ Strategies
Authors: Panda Nikhil , Sinyard Robert D. , Henrich Natalie , Cauley Christy E. , Hannenberg Alexander A. , Sonnay Yves , Bitton Asaf , Brindle Mary , Molina George
Published: April 2021

Objectives

This study aimed to determine the strategies used and critical considerations among an international sample of hospital leaders when mobilizing human resources in response to the clinical demands associated with the COVID-19 pandemic surge.

Methods

This was a cross-sectional, qualitative research study designed to investigate strategies used by health system leaders from around the world when mobilizing human resources in response to the global COVD-19 pandemic. Prospective interviewees were identified through nonprobability and purposive sampling methods from May to July 2020. The primary outcomes were the critical considerations, as perceived by health system leaders, when redeploying health care workers during the COVID-19 pandemic determined through thematic analysis of transcribed notes. Redeployment was defined as reassigning personnel to a different location or retraining personnel for a different task.

Results

Nine hospital leaders from 9 hospitals in 8 health systems located in 5 countries (United States, United Kingdom, New Zealand, Singapore, and South Korea) were interviewed. Six hospitals in 5 health systems experienced a surge of critically ill patients with COVID-19, and the remaining 3 hospitals anticipated, but did not experience, a similar surge. Seven of 8 hospitals redeployed their health care workforce, and 1 had a redeployment plan in place but did not need to use it. Thematic analysis of the interview notes identified 3 themes representing effective practices and lessons learned when preparing and executing workforce redeployment: process, leadership, and communication. Critical considerations within each theme were identified. Because of the various expertise of redeployed personnel, retraining had to be customized and a decentralized flexible strategy was implemented. There were 3 concerns regarding redeployed personnel. These included the fear of becoming infected, the concern over their skills and patient safety, and concerns regarding professional loss (such as loss of education opportunities in their chosen profession). Transparency via multiple different types of communications is important to prevent the development of doubt and rumors.

Conclusions

Redeployment strategies should critically consider the process of redeploying and supporting the health care workforce, decentralized leadership that encourages and supports local implementation of system-wide plans, and communication that is transparent, regular, consistent, and informed by data.
Hypermetabolic Unicentric Castleman Disease of Kidney on FDG PET/CT
Authors: Wang Peipei , Hou Guozhu , Li Fang , Cheng Xin
Published: April 2021

A 62-year-old man presented with a huge lesion of left kidney on ultrasound in a health examination 1 month ago. The mass showed hypervascularity on enhanced CT and intense FDG uptake on FDG PET/CT in the lower pole of kidney, which suggested renal malignancy. The histopathological result after surgical resection of the mass confirmed the diagnosis of Castleman disease, the hyaline vascular variant.
Incidental Finding of a Parotid Basal Cell Adenoma With High Tracer Uptake on 68Ga-DOTATOC PET/CT
Authors: Pinot Fanny , Uguen Arnaud , Leclere Jean-Christophe , Thuillier Philippe , Abgral Ronan
Published: April 2021

A 67-year-old man was referred to our department to undergo a 68Ga-DOTATOC PET/CT during the systematic follow-up of a small intestine neuroendocrine tumor. PET revealed an incidental focal increased uptake of 68Ga-DOTATOC matching with a left intraparotid lesion on the combined contrast-enhanced CT, suggestive of a benign salivary tumor. An MRI was performed to characterize this lesion, and finally, the patient underwent surgery. Histological analysis confirmed the presence of a basal cell adenoma.
Recurrent Subcutaneous Ewing Sarcoma on 18F-FDG PET/CT
Authors: Wu Junhao , Liu Ya , Gong Weidong , Liao Taiping , Zhang Chunyin
Published: April 2021

Subcutaneous Ewing sarcoma is very rare. This report presents the case of a 23-year-old woman with a history of primary subcutaneous Ewing sarcoma who recently found a gradually increasing mass. Recurrent subcutaneous Ewing sarcoma was thus suspected. 18F-FDG PET/CT was performed and showed an FDG-avid mass in her buttocks. Subsequent histopathological and immunohistochemical tests were consistent with subcutaneous Ewing sarcoma.
Distinguishing Meningioma From Metastasis of Prostate Cancer on 68Ga-PSMA PET/CT
Authors: Filizoglu Nuh , Oksuzoglu Kevser , Ozguven Salih
Published: April 2021

Meningiomas are typically benign and the most common primary brain tumors. They are usually diagnosed based on their characteristic appearance on both MRI and CT. Meningiomas can easily be misdiagnosed as metastasis of prostate cancer due to their high 68Ga-PSMA uptake on 68Ga-PSMA PET/CT. We present a case of a metastatic prostate adenocarcinoma with PSMA-avid lesion in the right frontal lobe on 68Ga-PSMA PET/CT. Later, MRI confirmed the brain lesion as meningioma.
Management of traumatic laryngotracheal separation: Case series and review
Authors: Reeve Nathaniel H. , Kim Yuna , Kahane Jacob B. , Spinner Alycia G. , Ng Matthew , Wang Robert C.
Published: April 2021

Laryngotracheal separation injuries are a rare but serious condition, as survival from such injuries relies on proper airway management. As a result, recommendations for management have been based on small case reports and expert opinion. We reviewed our last 10 years of experience with managing laryngotracheal separation injuries and identified 6 cases for chart review. Awake tracheostomy or videolaryngobronchoscopy was used in each case to initially obtain the airway. Surgical repair was then performed immediately using nonabsorbable monofilament suture or a miniplate, and a low fenestrated tracheostomy was placed. All of our patients who followed up were decannulated, eating regular diets, and had satisfactory voice quality at 3 months postoperatively. Review of the literature revealed that, while management strategies have changed over time, treatment still varies widely depending on surgeon preference and the details of each injury. Outcomes from our series suggest that our described techniques and management strategies can be used with good outcomes. We believe that this is due to securing a safe airway, early surgical intervention with no unnecessary tissue dissection, effective reconstruction of the airway, and the fenestrated tracheostomy technique.
P-selectin antibody treatment after blunt thoracic trauma prevents early pulmonary arterial thrombosis without changes in viscoelastic measurements of coagulation
Authors: Schutzman Linda M. , Rigor Rob R. , Lin Yung-Ling J. , Dang An N. , Le Peter H. , Singh Harjeet B. , Yu Bohan , Wisner Peter H. , Musson Cristien C. , Clark Isaiah J. , Galante Joseph M. , Brown Ian E.
Published: April 2021

INTRODUCTION

Previously, in a murine model of blunt thoracic trauma, we provided evidence of primary pulmonary thrombosis associated with increased expression of the cell adhesion molecule, P-selectin. In this study, mice are treated with P-selectin blocking antibody after injury to investigate the clinical viability of this antibody for the prevention of pulmonary thrombosis. In addition, viscoelastic testing is performed to investigate if P-selectin inhibition has a detrimental impact on normal hemostasis.

METHODS

A murine model of thoracic trauma was used. Mice were divided into sham control and experimental injury groups. Thirty minutes after trauma, mice were treated with the following: P-selectin blocking antibody, isotype control antibody, low-dose heparin, high-dose heparin, or normal saline. At 90 minutes, whole blood was collected for characterization of coagulation by viscoelastic coagulation monitor (VCM Vet; Entegrion, Durham, NC). Mean clotting time, clot formation time, clot kinetics (α angle), and maximum clot firmness were compared between each treatment group.

RESULTS

Mice that received P-selectin antibody 30 minutes after blunt thoracic trauma had four- to fivefold less (p < 0.001) arterial fibrin accumulation than those that received the isotype control. In both sham and trauma groups, compared with vehicle (normal saline) alone, no statistical difference was noted in any coagulation parameters after injection with P-selectin antibody, isotype control, or low-dose heparin. In addition, blinded histopathological evaluation yielded no difference in hemorrhage scores between injured mice treated with P-selectin blocking antibody and those treated with isotype antibody control.

CONCLUSION

This study supports the clinical use of P-selectin blocking antibody for the prevention of pulmonary thrombosis by confirming its efficacy when given after a blunt thoracic trauma. In addition, we demonstrated that the administration of P-selectin antibody does not adversely affect systemic coagulation as measured by viscoelastic testing, suggesting that P-selectin antibody can be safely given during the acute posttraumatic period.
Resolution of organ dysfunction as a predictor of long-term survival in necrotizing soft tissue infections: Analysis of the AB103 Clinical Composite Endpoint Study in Necrotizing Soft Tissue Infections trial and a retrospective claims database-linked chart study
Authors: Brakenridge Scott C. , Wilfret David A. , Maislin Greg , Andrade Katherine E. , Walker Valery , May Addison K. , Dankner Wayne M. , Bulger Eileen M.
Published: April 2021

BACKGROUND

Necrotizing soft tissue infections (NSTIs) are an acute surgical condition with high morbidity and mortality. Timely identification, resuscitation, and aggressive surgical management have significantly decreased inpatient mortality. However, reduced inpatient mortality has shifted the burden of disease to long-term mortality associated with persistent organ dysfunction.

METHODS

We performed a combined analysis of NSTI patients from the AB103 Clinical Composite Endpoint Study in Necrotizing Soft Tissue Infections randomized-controlled interventional trial (ATB-202) and comprehensive administrative database (ATB-204) to determine the association of persistent organ dysfunction on inpatient and long-term outcomes. Persistent organ dysfunction was defined as a modified Sequential Organ Failure Assessment (mSOFA) score of 2 or greater at Day 14 (D14) after NSTI diagnosis, and resolution of organ dysfunction defined as mSOFA score of 1 or less.

RESULTS

The analysis included 506 hospitalized NSTI patients requiring surgical debridement, including 247 from ATB-202, and 259 from ATB-204. In both study cohorts, age and comorbidity burden were higher in the D14 mSOFA ≥2 group. Patients with D14 mSOFA score of 1 or less had significantly lower 90-day mortality than those with mSOFA score of 2 or higher in both ATB-202 (2.4% vs. 21.5%; p < 0.001) and ATB-204 (6% vs. 16%: p = 0.008) studies. In addition, in an adjusted covariate analysis of the combined study data sets D14 mSOFA score of 1 or lesss was an independent predictor of lower 90-day mortality (odds ratio, 0.26; 95% confidence interval, 0.13–0.53; p = 0.001). In both studies, D14 mSOFA score of 1 or less was associated with more favorable discharge status and decreased resource utilization.

CONCLUSION

For patients with NSTI undergoing surgical management, persistent organ dysfunction at 14 days, strongly predicts higher resource utilization, poor discharge disposition, and higher long-term mortality. Promoting the resolution of acute organ dysfunction after NSTI should be considered as a target for investigational therapies to improve long-term outcomes after NSTI.

LEVEL OF EVIDENCE

Prognostic/epidemiology study, level III
Development of a computed tomography perfusion protocol to support large animal resuscitation research
Authors: Abdou Hossam , Elansary Noha , Poliner David , Patel Neerav , Edwards Joseph , Richmond Michael , Rasmussen Todd , Ptak Thomas , Scalea Thomas M. , Morrison Jonathan J.
Published: April 2021

BACKGROUND

Adequate cerebral perfusion is crucial for a positive neurological outcome in trauma; however, it is difficult to characterize in the acute setting with noninvasive methods. Intra-arterial computed tomography perfusion may offer a solution. The aim of this study was to develop an intra-arterial computed tomography perfusion protocol for resuscitation research.

METHODS

The study examined intra-arterial contrast administration for computed tomography perfusion (CTP) acquisition. It consisted of three phases: intra-arterial contrast dose finding, evaluation of reproducibility, and evaluation during hypotension. Blood pressure and laser Doppler flow data were collected. In phase 1, animals underwent CTPs using several intra-arterial contrast injection protocols. In phase 2, animals underwent two CTPs 7 hours apart using the 2.5 mL/s for 3-second protocol. In phase 3, animals underwent CTPs at several pressures following a computer-controlled bleed including euvolemia and at systolic pressures of 60, 40, and 20 mm Hg. Phase 1 CTPs were evaluated for contrast-to-noise ratio. In phase 2, CTPs were compared within each animal and with laser Doppler flow using linear regression. Phase 3 CTPs were graphed against systolic pressure and fitted with a nonlinear fit.

RESULTS

The protocol using 2.5mL/s for 3 seconds was optimal, demonstrating a contrast-to-noise ratio of 40.1 and a superior arterial input function curve compared with the 1 mL/s bolus. Cerebral blood flow demonstrated high concordance between baseline and end of study CTPs (R2 = 0.82, p < 0.001). Cerebral blood flow also compared moderately well against laser Doppler flow during 8 (R2 = 0.53, p = 0.03); however, laser Doppler flow did not perform well during hypovolemia, and the favorable concordance was not maintained (R2 = 0.45, p = 0.06). Cerebral blood flow was graphed against systolic blood pressure and fitted with a nonlinear fit (R2 = 0.95, p = 0.003).

CONCLUSION

Computed tomography perfusion using intra-arterial contrast injection may offer a novel alternative to traditional CTP protocols that could prove a useful additional tool in the setting of resuscitation research.
Does shock index, pediatric age-adjusted predict mortality by trauma center type?
Authors: Austin John R. , Ye Chaonan , Lee Moon O. , Chao Stephanie D.
Published: April 2021

BACKGROUND

Pediatric trauma patients are treated at adult trauma centers (ATCs), mixed pediatric and ATCs (MTC), or pediatric trauma centers (PTCs). Shock index, pediatric age-adjusted (SIPA) can prospectively identify severely injured children. This study characterized the differences in mortality and hospital length of stay (LOS) among pediatric trauma patients with elevated SIPA (eSIPA) at different trauma centers types.

METHODS

Pediatric patients (1–14 years) were queried from the 2013 to 2016 National Trauma Data Bank. Patients with eSIPA were included for analysis. The primary outcome was mortality. Secondary outcomes included rates of splenectomy, computed tomography chest scans, laparotomy, and hospital LOS. Unadjusted frequencies and multivariable regression analyses were performed. An alpha level of 0.01 was used to determine significance.

RESULTS

Out of 189,003 pediatric trauma patients, 15,832 were included for analysis. After controlling for age, race, sex, payment method, Injury Severity Score, Glasgow Coma Scale score, hospital teaching status, and number of hospital beds, there was no significant difference in mortality among eSIPA patients at ATCs (odds ratio [OR], 0.753; p = 0.078) and MTCs (OR, 1.051; p = 0.776) when compared with PTCs. This remained true even among the most severely injured eSIPA patients (Injury Severity Score > 25). Splenectomy rates were higher at ATCs (OR, 3.234; p = 0.005), as were computed tomography chest scan rates (ATC OR, 4.423; p < 0.001; MTC OR, 6.070; p < 0.001) than at PTCs. There was a trend toward higher splenectomy rates at MTCs (OR, 2.910; p = 0.030) compared with PTCs, but this did not reach statistical significance. Laparotomy rates and hospital LOS were not significantly different.

CONCLUSION

Among eSIPA pediatric trauma patients, there was no difference in mortality between trauma center types. However, other secondary findings indicate that specialty care at PTCs may help optimize the care of pediatric trauma patients.

LEVEL OF EVIDENCE

Retrospective cohort study, level IV.
The Effects of Ibuprofen Consumption on the Incidence of Postpartum Depression
Authors: Kapulsky Leonid , Christos Paul , Ilagan John , Kocsis James
Published: April 2021

Objectives

Postpartum depression (PPD) is a common and debilitating psychiatric condition whose etiology is yet to be fully elucidated. Anti-inflammatory medications have been shown to be effective in the treatment of major depressive disorder but there have only been a few trials examining whether anti-inflammatory medications can serve as effective prophylactic agents against the development of major depressive disorder. Prophylaxis against PPD with anti-inflammatory agents has never been studied.

Materials and Methods

We performed a prospective observational trial examining whether consumption of higher doses of the nonsteroidal anti-inflammatory drug ibuprofen is associated with a lower incidence of PPD. We recruited high-risk women and collected data on Edinburgh Postnatal Depression Scale, Patient-Reported Outcome Measurement Information System pain scale and clinical assessment of PPD at postpartum weeks 0, 3, and 6. Subjects were instructed to keep a log of medication consumed.

Results

When looking at the total sample, we found that higher consumption of ibuprofen was associated with lower incidence of PPD, although this result was nonsignificant (P= 0.26). When we stratified by concurrent psychotropic medication, we found that among women not taking psychotropic medications, higher consumption of ibuprofen at week 3 was significantly associated with a lower likelihood of having PPD at week 3 (P= 0.03).

Discussion

We found that ibuprofen consumption was significantly associated with a reduced risk of development of PPD at week 3 among high-risk women not taking psychotropic medications.
Low-Dose Aripiprazole-Induced Nocturnal Enuresis in a 9-Year-Old Boy: A Case Report and the Possible Underlying Mechanism
Authors: Özdemir Yahya Esad , Tanir Yaşar
Published: April 2021

Aripiprazole is an atypical antipsychotic commonly used in the treatment of psychiatric disorders, such as schizophrenia, bipolar disorder, and irritability associated with autism spectrum disorder. Common adverse effects associated with aripiprazole usage in children and adolescents are nausea, vomiting, extrapyramidal adverse effects, akathisia, sedation, tremor, and increased appetite. Enuresis is one of the least expected adverse effects during aripiprazole use. The pathophysiology of aripiprazole-induced enuresis has not been fully clarified. To our knowledge, our report presents enuresis related to aripiprazole use at the lowest dose in the literature. In this report, we present the case of a 9-year-old boy who developed nocturnal enuresis after the beginning of low-dose aripiprazole treatment.
Lithium-Induced Treatment-Resistant Akathisia: A Case Report and Literature Overview
Authors: Demir Bahadir , Sancaktar Muhammet , Altindag Abdurrahman
Published: April 2021

Objective

A case of lithium-induced akathisia is presented, a side effect that has only rarely been reported in the literature.

Case

A 49-year-old married woman was hospitalized 4 weeks before her presentation to our outpatient clinic due to a manic episode with psychotic features. Lithium carbonate (600 mg/d) was started for mood stabilization and soon, thereafter, she developed akathisia, which did not respond to reducing the dose of risperidone and addition of propranolol and lorazepam. The akathisia resolved when lithium was discontinued and replaced with valproic acid for mood stabilization.

Discussion

Akathisia is commonly overlooked or misdiagnosed by physicians. This case report is presented to alert physicians to the possible emergence of akathisia when the lithium ion is prescribed for mood stabilization.
Quantitative Proteomics Identifies PTP1B as Modulator of B Cell Antigen Receptor Signaling
Authors: Schwarz Jennifer J. , Grundmann Lorenz , Kokot Thomas , Kläsener Kathrin , Fotteler Sandra , Medgyesi David , Köhn Maja , Reth Michael , Warscheid Bettina
Published: April 2021

B cell antigen receptor (BCR) signaling is initiated by protein kinases and limited by counteracting phosphatases that currently are less well studied in their regulation of BCR signaling. We here used the B cell line Ramos to identify and quantify human B cell signaling components. Specifically, a protein tyrosine phosphatase profiling revealed a high expression of the protein tyrosine phosphatase 1B (PTP1B) in Ramos and human naïve B cells. The loss of PTP1B leads to increased B cell activation. Through substrate trapping in combination with quantitative mass spectrometry, we identified 22 putative substrates or interactors of PTP1B. We validated Igα, CD22, PLCγ1/2, CBL, BCAP and APLP2 as specific substrates of PTP1B in Ramos B cells. The tyrosine kinase BTK and the two adaptor proteins GRB2 and VAV1 were identified as direct binding partners and potential substrates of PTP1B. We showed that PTP1B dephosphorylates the inhibitory receptor protein CD22 at phosphotyrosine 807. We conclude that PTP1B negatively modulates BCR signaling by dephosphorylating distinct phosphotyrosines in B cell specific receptor proteins and various downstream signaling components.
Microglia complement signaling promotes neuronal elimination and normal brain functional connectivity
Authors: Deivasigamani Senthilkumar , Miteva Mariya Timotey , Natale Silvia , Gutierrez-Barragan Daniel , Basilico Bernadette , Di Angelantonio Silvia , Pape Constantin , Bolasco Giulia , Galbusera Alberto , Gozzi Alessandro , Ragozzino Davide , Gross Cornelius T.
Published: April 2021

Complement signaling is thought to serve as an opsonization signal to promote the phagocytosis of synapses by microglia. However, while its role in synaptic remodeling has been demonstrated in the retino-thalamic system, it remains unclear whether complement signaling mediates synaptic pruning in the brain more generally. Here we show that mice lacking the complement 3 receptor (C3r), the major microglia complement receptor, fail to show a deficit in either synaptic pruning or axon elimination in the developing mouse cortex. Instead, mice lacking C3r show a deficit in the perinatal elimination of neurons, both in the retina as well as in the cortex, a deficit that is associated with increased cortical thickness and enhanced functional connectivity in these regions in adulthood. These data demonstrate a preferential role for complement in promoting neuronal elimination in the developing brain and argue for a reconsideration of the role of complement in synaptic pruning.