bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for symptomatic hardware removal after plate fixation of olecranon fractures: a retrospective chart review
Authors: Contreras Erik S. , Lynch Daniel J. , Hatef Sarah , Speeckaert Amy L. , Goyal Kanu S.
Published: July 2021

Background:

Risk factors for removal of symptomatic hardware after plate fixation of olecranon fractures are not well defined. We examined patient, fracture, and surgical characteristics in relation to hardware removal for symptomatic instrumentation after plate and screw fixation of isolated olecranon fractures in adults.

Methods:

Eighty-four patients who underwent open reduction and internal fixation (ORIF) of isolated olecranon fractures with a plate and screw construct were analyzed retrospectively. Those with subsequent hardware removal for symptomatic hardware were identified. Charts and radiographs were reviewed to gather patient, fracture, and surgical characteristics in relation to management of their olecranon fracture. Univariate analysis was performed to test for statistical significance between groups.

Results:

Seventeen of 84 patients (20.2%) underwent hardware removal for symptomatic instrumentation at an average of 326 days after ORIF. Compared to patients who retained hardware, those who underwent removal trended younger (40.0 vs. 49.4 yr, P=0.076), had a higher percentage of one particular plate design (35% vs. 8%, P=0.026), and had their plate fixated an average of 1.3 mm farther from the olecranon tip (3.4 vs. 2.1 mm; P=0.011). There was an 8.2 times increased likelihood of hardware removal for plates that were placed more than 2 mm from the olecranon tip [1.7 to 38.7, 95% confidence interval (CI); P=0.003].

Conclusions:

This study resulted in approximately 20% rate of symptomatic hardware necessitating removal. Patients who request removal tend to be younger. Fixating the plate closer to the olecranon tip may decrease the incidence of symptomatic hardware and need for subsequent removal.

Level of Evidence:

Level III.
Discordances Between Factors Associated With Withholding Extubation and Extubation Failure After a Successful Spontaneous Breathing Trial*
Authors: Taran Shaurya , Angriman Federico , Pinto Ruxandra , Ferreyro Bruno L. , Amaral Andre Carlos Kajdacsy-Balla
Published: July 2021

OBJECTIVES:

To identify whether factors associated with withholding extubation in the ICU also predict the risk of extubation failure.

DESIGN:

Retrospective cohort study.

SETTING:

Eight medical-surgical ICUs in Toronto.

Patients:

Adult patients receiving invasive mechanical ventilation, with a first successful spontaneous breathing trial within 28 days of initial ICU admission.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The primary end point had three mutually exclusive levels, including: 1) withholding extubation after a successful spontaneous breathing trial, 2) extubation failure within 48 hours, and 3) successful extubation. Among 9,910 patients, 38% of patients were not extubated within 24 hours of their first successful spontaneous breathing trial. A total of 12.9% of patients who were promptly extubated failed within the next 48 hours. Several discrepancies were evident in the association of factors with risk of withholding extubation and extubation failure. Specifically, both age and female sex were associated with withholding extubation (odds ratio, 1.07; 95% CI, 1.03–1.11; and odds ratio, 1.13; 95% CI, 1.02–1.26, respectively) but not a higher risk of failed extubation (odds ratio, 0.99; 95% CI, 0.93–1.05; and odds ratio, 0.93; 95% CI, 0.77–1.11, respectively). Conversely, both acute cardiovascular conditions and intubation for hypoxemic respiratory failure were associated with a higher risk of failed extubation (odds ratio, 1.32; 95% CI, 1.06–1.66; and odds ratio, 1.46; 95% CI, 1.16–1.82, respectively) but not a higher odds of a withheld extubation attempt (odds ratio, 0.79; 95% CI, 0.68–0.91; and odds ratio, 1.07; 95% CI, 0.93–1.23, respectively).

CONCLUSIONS:

Several factors showed discordance between the decision to withhold extubation and the risk of extubation failure. This discordance may lead to longer duration of mechanical ventilation or higher reintubation rates. Improving the decision-making behind extubation may help to reduce both exposure to invasive mechanical ventilation and extubation failure.
Critically Ill Patients Treated for Chimeric Antigen Receptor-Related Toxicity: A Multicenter Study*
Authors: Gutierrez Cristina , Brown Anne Rain T. , May Heather P. , Beitinjaneh Amer , Stephens R. Scott , Rajendram Prabalini , Nates Joseph L. , Pastores Stephen M. , Dharshan Ananda , de Moraes Alice Gallo , Hensley Matthew K. , Feng Lei , Brudno Jennifer N. , Athale Janhavi , Ghosh Monalisa , Kochenderfer James N. , Arias Alejandro S. , Lin Yi , McEvoy Colleen , Mead Elena , Westin Jason , Kostelecky Natalie , Mian Agrima , Herr Megan M.
Published: July 2021

OBJECTIVES:

To report the epidemiology, treatments, and outcomes of adult patients admitted to the ICU after cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome.

DESIGN:

Retrospective cohort study

SETTING:

Nine centers across the U.S. part of the chimeric antigen receptor-ICU initiative.

PATIENTS:

Adult patients treated with chimeric antigen receptor T-cell therapy who required ICU admission between November 2017 and May 2019.

INTERVENTIONS:

Demographics, toxicities, specific interventions, and outcomes were collected.

RESULTS:

One-hundred five patients treated with axicabtagene ciloleucel required ICU admission for cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome during the study period. At the time of ICU admission, the majority of patients had grade 3–4 toxicities (66.7%); 15.2% had grade 3–4 cytokine release syndrome and 64% grade 3–4 immune effector cell-associated neurotoxicity syndrome. During ICU stay, cytokine release syndrome was observed in 77.1% patients and immune effector cell-associated neurotoxicity syndrome in 84.8% of patients; 61.9% patients experienced both toxicities. Seventy-nine percent of patients developed greater than or equal to grade 3 toxicities during ICU stay, however, need for vasopressors (18.1%), mechanical ventilation (10.5%), and dialysis (2.9%) was uncommon. Immune Effector Cell-Associated Encephalopathy score less than 3 (69.7%), seizures (20.2%), status epilepticus (5.7%), motor deficits (12.4%), and cerebral edema (7.9%) were more prevalent. ICU mortality was 8.6%, with only three deaths related to cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. Median overall survival time was 10.4 months (95% CI, 6.64–not available mo). Toxicity grade or organ support had no impact on overall survival; higher cumulative corticosteroid doses were associated to decreased overall and progression-free survival.

CONCLUSIONS:

This is the first study to describe a multicenter cohort of patients requiring ICU admission with cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome after chimeric antigen receptor T-cell therapy. Despite severe toxicities, organ support and in-hospital mortality were low in this patient population.
Left Ventricular Function Changes Induced by Moderate Hypothermia Are Rapidly Reversed After Rewarming—A Clinical Study
Authors: Wisløff-Aase Kristin , Skulstad Helge , Beitnes Jan Otto , Lundblad Runar , Halvorsen Per Steinar , Fiane Arnt , Espinoza Andreas
Published: July 2021

OBJECTIVES:

Targeted temperature management (32–36°C) is used for neuroprotection in cardiac arrest survivors. The isolated effects of hypothermia on myocardial function, as used in clinical practice, remain unclear. Based on experimental results, we hypothesized that hypothermia would reversibly impair diastolic function with less tolerance to increased heart rate in patients with uninsulted hearts.

DESIGN:

Prospective clinical study, from June 2015 to May 2018.

SETTING:

Cardiothoracic surgery operation room, Oslo University Hospital.

PATIENTS:

Twenty patients with left ventricular ejection fraction greater than 55%, undergoing ascending aorta graft-replacement connected to cardiopulmonary bypass were included.

INTERVENTIONS:

Left ventricular function was assessed during reduced cardiopulmonary bypass support at 36°C, 32°C prior to graft-replacement, and at 36°C postsurgery. Electrocardiogram, hemodynamic, and echocardiographic recordings were made at spontaneous heart rate and 90 beats per minute at comparable loading conditions.

MEASUREMENTS AND MAIN RESULTS:

Hypothermia decreased spontaneous heart rate, and R-R interval was prolonged (862 ± 170 to 1,156 ± 254 ms, p < 0.001). Although systolic and diastolic fractions of R-R interval were preserved (0.43 ± 0.07 and 0.57 ± 0.07), isovolumic relaxation time increased and diastolic filling time was shortened. Filling pattern changed from early to late filling. Systolic function was preserved with unchanged myocardial strain and stroke volume index, but cardiac index was reduced with maintained mixed venous oxygen saturation. At increased heart rate, systolic fraction exceeded diastolic fraction (0.53 ± 0.05 and 0.47 ± 0.05) with diastolic impairment. Strain and stroke volume index were reduced, the latter to 65% of stroke volume index at spontaneous heart rate. Cardiac index decreased, but mixed venous oxygen saturation was maintained. After rewarming, myocardial function was restored.

CONCLUSIONS:

In patients with normal left ventricular function, hypothermia impaired diastolic function. At increased heart rate, systolic function was subsequently reduced due to impeded filling. Changes in left ventricular function were rapidly reversed after rewarming.
Union Burying Ground
Authors: Eisenberg-Guyot Jerzy , Mooney Stephen J. , Barrington Wendy E. , Hajat Anjum
Published: July 2021

Background:

Over the last several decades in the United States, socioeconomic life-expectancy inequities have increased 1–2 years. Declining labor-union density has fueled growing income inequities across classes and exacerbated racial income inequities. Using Panel Study of Income Dynamics (PSID) data, we examined the longitudinal union–mortality relationship and estimated whether declining union density has also exacerbated mortality inequities.

Methods:

Our sample included respondents ages 25–66 to the 1979–2015 PSID with mortality follow-up through age 68 and year 2017. To address healthy-worker bias, we used the parametric g-formula. First, we estimated how a scenario setting all (versus none) of respondents’ employed-person–years to union-member employed-person–years would have affected mortality incidence. Next, we examined gender, racial, and educational effect modification. Finally, we estimated how racial and educational mortality inequities would have changed if union-membership prevalence had remained at 1979 (vs. 2015) levels throughout follow-up.

Results:

In the full sample (respondents = 23,022, observations = 146,681), the union scenario was associated with lower mortality incidence than the nonunion scenario (RR = 0.90, 95% CI = 0.80, 0.99; RD per 1,000 = −19, 95% CI = −37, −1). This protective association generally held across subgroups, although it was stronger among the more-educated. However, we found little evidence mortality inequities would have lessened if union membership had remained at 1979 levels.

Conclusions:

To our knowledge, this was the first individual-level US-based study with repeated union-membership measurements to analyze the union–mortality relationship. We estimated a protective union–mortality association, but found little evidence declining union density has exacerbated mortality inequities; importantly, we did not incorporate contextual-level effects. See video abstract at, http://links.lww.com/EDE/B839.
Infectious Scleritis: Pathophysiology, Diagnosis, and Management
Authors: Yu Julia , Syed Zeba A. , Rapuano Christopher J.
Published: July 2021

Infectious scleritis (IS) is a rare and severe ocular disorder responsible for approximately 5%–15% of all scleritis cases. It is often associated with a poor prognosis due to its similar clinical presentation to autoimmune scleritis, resulting in a delayed diagnosis and treatment. Therefore, differentiating between infectious and noninfectious entities is critical. Several details extracted from the patient's history and clinical examination can raise suspicion for infection. The most common predisposing factor is previous ocular surgery, especially pterygium, cataract, and vitreoretinal surgeries. Ocular trauma, poor contact lens hygiene, “eye-whitening” procedures, and subtenon triamcinolone injections have also been implicated. Clinical features of infection include the presence of scleral necrosis, hypopyon, unifocal or multifocal scleral abscesses, and mucopurulent discharge. Thorough diagnostic testing is essential before excluding infection as a possibility. Empiric broad-spectrum topical and systemic antibiotic therapy should be initiated while awaiting laboratory results and adjusted accordingly. Most IS cases require both aggressive medical and surgical treatment, and various studies have reported favorable outcomes with this combination. At this time, there is no consensus on the management of this severe ocular condition, and future studies are needed to establish clear treatment guidelines.
Online Vs In-person Education: Evaluating the Potential Influence of Teaching Modality on Dry Eye Symptoms and Risk Factors During the COVID-19 Pandemic
Authors: Talens-Estarelles Cristian , García-Marqués José Vicente , Cervino Alejandro , García-Lázaro Santiago
Published: July 2021

Objectives:

To assess the potential effects of switching to online lecture format on dry eye symptoms and dry eye disease (DED) risk factors.

Methods:

An anonymous cross-sectional online survey was conducted in 812 university students (mean age, 21.5±4.0 years). Participants were classified according to the number of hours the participants took online lectures into online students or in-person students. Respondents completed a total of three DED questionnaires (Ocular Surface Disease Index [OSDI]; 5-item Dry Eye Questionnaire; 8-item Contact Lens Dry Eye Questionnaire) and were surveyed on dry eye risk factors contemplated by the Tear Film and Ocular Surface Society Dry Eye Workshop II in addition to other factors potentially linked to dry eye.

Results:

Five hundred twenty-three subjects (64.4%) were classified into the online group and 289 (35.6%) into the in-person group. No statistically significant age (P=0.266) or sex (P=0.423) differences were found between groups. Students taking online lectures used the computer more, spent less time outdoors, practised more exercise, wore a face mask for less time, experienced fewer allergies and fewer psoriasis episodes, and obtained a higher OSDI score (P<0.029 for all). Multivariate logistic regression analysis revealed that the hours of online lectures taken per week was independently associated with having a positive OSDI score (P=0.022).

Conclusions:

Taking online lectures is independently associated with having dry eye symptoms. Despite a lower prevalence of DED risk factors, a higher computer use is probably behind the greater ocular dryness reported by online students.
Effect of longitudinal and torsional ultrasound on corneal endothelial cells: experimental study in rabbit eyes
Authors: Ungricht Emilie L. , Culp Catherine , Qu Phillip , Jensen Nathan , Harris Jacob T. , Brintz Ben J. , Mamalis Nick , Olson Randall J. , Werner Liliana
Published: July 2021

Purpose:

To compare corneal endothelial damage from longitudinal and torsional ultrasound during phacoemulsification.

Setting:

John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

Design:

Experimental study.

Methods:

9 New Zealand white rabbits underwent bilateral surgery. After incision, the Intrepid Balanced Tip of the Centurion Ozil handpiece was inserted into the anterior chamber, and the following settings were used: 50 mL/min flow, 70 mm Hg intraocular pressure, 600 mm Hg vacuum, and 60% longitudinal (1 eye) or torsional (contralateral eye) ultrasound for 30 seconds. Cumulative dissipated energy (CDE) was noted. After euthanasia and enucleation, the corneas were removed, stained with trypan blue/alizarin red, and photographed (400× photographs from 5 specific areas and 1 overview photograph from each corneal button). The ImageJ program was used to evaluate cell damage and loss in the photographs obtained from each cornea.

Results:

Cavitation bubbles around the phacoemulsification tip were generally observed in the longitudinal group. CDE was 17.4 ± 0.58 and 6.93 ± 0.15 in the longitudinal and torsional groups, respectively (P = .003). The percentage of intact cells was statistically higher in the torsional group (94.22% ± 5.99% vs 56.85% ± 22.29%), and the percentage of lost cells was statistically higher in the longitudinal group (42.10% ± 22.02% vs 4.97% ± 6.23%) (P = .003). This was observed in the analysis of the 400× photographs and the overview photographs.

Conclusions:

This study suggests that torsional ultrasound was associated with significantly less corneal endothelial cell damage than classical longitudinal tip motion, providing further insight on mechanisms of corneal endothelial damage during phacoemulsification.
Pain is common after sexual assault and posttraumatic arousal/reactivity symptoms mediate the development of new or worsening persistent pain
Authors: Short Nicole A. , Tungate Andrew S. , Bollen Kenneth A. , Sullivan Jenyth , D'Anza Teresa , Lechner Megan , Bell Kathy , Black Jenny , Buchanan Jennie , Reese Rhiannon , Ho Jeffrey D. , Reed Gordon D. , Platt Melissa A. , Riviello Ralph J. , Rossi Catherine H. , Martin Sandra L. , Liberzon Israel , Rauch Sheila A.M. , Kessler Ronald C. , Nugent Nicole , McLean Samuel A.
Published: July 2021

Clinically significant new or worsening pain (CSNWP) is a common, yet often overlooked, sequelae of sexual assault. Little is known regarding factors influencing the development of CSNWP in sexual assault survivors. The current study used data from a recently completed prospective study to evaluate whether posttraumatic alterations in arousal and reactivity in the early aftermath of sexual assault influence the transition from acute to clinically significant new or worsening persistent pain. Women ≥ 18 years of age (n = 706) presenting for emergency care after sexual assault to 13 emergency care sites were enrolled in the study. Women completed assessments at the time of presentation as well as at 1 week (n = 706, 100%) and 6 weeks (n = 630, 91%). Nearly 70% of women reported CSNWP at the time of emergency care (n = 475, 69%), which persisted to 6 weeks in approximately 2 in 5 survivors (n = 248, 41%). A structural equation model adjusted for age, race, past trauma exposure, and preassault pain levels suggested that posttraumatic alterations in arousal/reactivity symptoms 1 week after assault partially mediated the transition from acute to persistent CSNWP. A significant portion (41%) of women sexual assault survivors develop CSNWP 6 weeks postassault. Posttraumatic arousal/reactivity symptoms in the early aftermath of assault contribute to CSNWP development; such symptoms are potential targets for secondary preventive interventions to reduce chronic postassault pain.
Effects of combined chemotherapy and anti-programmed cell death protein 1 treatment on peripheral neuropathy and neuroinflammation in mice
Authors: Livni Lital , Keating Brooke A. , Fiore Nathan T. , Lees Justin G. , Goldstein David , Moalem-Taylor Gila
Published: July 2021

A modern approach for cancer treatment is the use of immunotherapy, and particularly immune checkpoint inhibitors, such as anti-programmed cell death protein 1 (PD-1), alone and in combination with chemotherapy. The PD-1 pathway plays a crucial role in inhibiting immune responses and recently has been shown to modulate neuronal activity. However, the impact of PD-1 blockade on the development of chemotherapy-induced peripheral neuropathy is currently unknown. In this study, we show that C57BL/6 mice treated with the chemotherapeutic drug paclitaxel or cotherapy (paclitaxel and anti–PD-1), but not with anti–PD-1 alone, exhibited increased mechanical sensitivity of the hind paw. Both chemotherapy and immunotherapy caused a reduction in neurite outgrowth of dorsal root ganglion (DRG) explants derived from treated mice, whereas only paclitaxel reduced the neurite outgrowth after direct in vitro treatment. Mice treated with anti–PD-1 or cotherapy exhibited distinct T-cell changes in the lymph nodes and increased T-cell infiltration into the DRG. Mice treated with paclitaxel or cotherapy had increased macrophage presence in the DRG, and all treated groups presented an altered expression of microglia markers in the dorsal horn of the spinal cord. We conclude that combining anti–PD-1 immunotherapy with paclitaxel does not increase the severity of paclitaxel-induced peripheral neuropathy. However, because anti–PD-1 treatment caused significant changes in DRG and spinal cord immunity, caution is warranted when considering immune checkpoint inhibitors therapy in patients with a high risk of developing neuropathy.
Predictive value of quantitative sensory testing for acute and chronic postsurgical pain after total joint arthroplasty: a systematic review
Authors: Paredes Ana Cristina , Pinto Joana Milhazes , Almeida Armando , Pinto Patrícia R.
Published: July 2021

Quantitative sensory testing (QST) can be useful to identify high-risk patients for the development of chronic postsurgical pain. This systematic review aims to assess if presurgical sensory sensitivity measured using QST is associated with acute and chronic postsurgical pain after total joint arthroplasty. A systematic search was performed in September 2020 in PubMed, EMBASE, Web of Science, and Scopus, using terms related to total joint arthroplasty and QST. Prospective studies were included if they reported an association between presurgical QST and postsurgical pain in adults with osteoarthritis undergoing primary unilateral total joint arthroplasty. From 2994 identified studies, 18 met the inclusion criteria (1869 patients). Total knee arthroplasty was the most common surgery (16 studies), and pressure pain threshold was the most common test (11 studies), followed by dynamic measures (9 studies). Postsurgical pain was assessed at acute (5 studies), subacute (2 studies), and chronic (13 studies) time points. Risk of bias was assessed using the Quality in Prognosis Studies tool and evaluated as low to moderate in most domains. Fourteen studies reported at least one statistically significant association between QST and pain (acute: 4 studies, subacute: 1 study, and chronic: 9 studies). Pressure pain threshold was associated with postsurgical pain in 6 studies (of 11, 55%), heat pain threshold in 2 studies (of 6, 33%), conditioned pain modulation in 1 study (of 6, 17%), and temporal summation of pain in 5 studies (of 8, 63%). The predictive role of presurgical QST for postarthroplasty pain remains unclear, mainly because of heterogeneous methodologies and inconsistent results.
Systemic inflammatory markers in neuropathic pain, nerve injury, and recovery
Authors: Sandy-Hindmarch Oliver , Bennett David L. , Wiberg Akira , Furniss Dominic , Baskozos Georgios , Schmid Annina B.
Published: July 2021

The role that inflammation plays in human nerve injury and neuropathic pain is incompletely understood. Previous studies highlight the role of inflammation in the generation and maintenance of neuropathic pain, but the emerging evidence from the preclinical literature for its role in the resolution of neuropathic pain remains to be explored in humans. Here, we use carpal tunnel syndrome (CTS) as a human model system of nerve injury and neuropathic pain to determine changes in serum cytokine protein levels and gene expression levels before (active stage of disease) and after carpal tunnel decompression surgery (recovery). Fifty-five patients with CTS were studied, and 21 healthy age-matched and gender-matched participants served as controls. In the active stage of the disease (CTS before surgery vs healthy controls), PTGES2 mRNA was decreased in patients (adjusted P = 0.013), while transforming growth factor-β and C-C motif chemokine ligand 5 protein levels were increased (adjusted P = 0.016 and P = 0.047, respectively). In the resolution phase (CTS before surgery vs after surgery), IL-9 mRNA was increased after surgery (adjusted P = 0.014) and expression of IL-6 mRNA and IL-4 protein levels were increased before surgery (adjusted P = 0.034 and P = 0.002, respectively). IL-9 mRNA expression negatively correlated with several (neuropathic) pain scores. By contrast, protein levels of IL-4 positively correlated with pain scores. In conclusion, we demonstrate specific dysregulation of systemic cytokine expression in both the active and resolution phases of nerve injury and neuropathic pain. IL-9 represents an interesting candidate associated with resolution of nerve injury and neuropathic pain.
Vestibular Function in Pendred Syndrome: Intact High Frequency VOR and Saccular Hypersensitivity
Authors: West Niels Cramer , Ryberg Alexander Christian , Cayé-Thomasen Per
Published: July 2021

Objective:

Although Pendred syndrome involves anatomical abnormalities in the vestibular system and patient-perceived dizziness, the literature on vestibular function is scarce. The objective was to evaluate objective vestibular function in patients with PS using the video head impulse test (VHIT) and the cervical vestibular evoked myogenic potential (cVEMP) test, assessing the high frequency vestibulo-ocular reflex (VOR) and the saccular function, respectively.

Methods:

Twenty-six subjects (52 ears) with Pendred Syndrome and severe-to-profound hearing loss (cochlear implant candidacy) were studied retrospectively. Main outcome measures were VHIT VOR gain, refixation saccades, cVEMP stimulus thresholds and amplitudes.

Results:

In total, 4 of 52 ears (8%) had pathological VHIT outcomes (2 ears with low VHIT gain and 2 ears with saccades). The mean VHIT gain value was 0.96 (range 0.63–2.02). No patients had complete VOR loss. CVEMP responses were present in 76% of tested ears and absent in 24%. The mean cVEMP amplitude value was 192 μV. Absence of cVEMP response was associated with the presence of VHIT saccades (p = 0.038) and advanced age (r
s = −0.34; p < 0.05). cVEMP amplitude was correlated with VHIT gain (r
s = 0.46; p < 0.001).

Conclusion:

Despite dysmorphic vestibular anatomy and severe loss of hearing, the VHIT VOR function is normal in patients with Pendred Syndrome. However, saccular function appears to be abnormally sensitive, as documented by low cVEMP thresholds and high amplitudes, which agrees with a “third window” effect secondary to the large vestibular aqueduct.
Thoracic computed tomography in the progressive fibrotic phenotype
Authors: Devaraj Anand , Milanese Gianluca , Sverzellati Nicola
Published: July 2021

Purpose of review

To discuss rationale and methods for determining progressive lung fibrosis on thoracic computed tomography (CT) and describe limitations and challenges

Recent findings

Identifying patients with progressive lung fibrosis is important to determine optimal treatment. Serial high-resolution computed tomography is a method of determining disease progression. A number of studies are reviewed in this article, that have explored various parameters (both visual and automated) that signify progressive fibrosis on CT.

To reliably use serial CT as a marker of disease progression in fibrotic lung disease, clinicians and radiologists need to be aware of the optimal methods for identifying changes in disease extent, and understand their limitations.
Advancing organ transplantation through HIV-to-HIV transplantation
Authors: Fuller Risa , Rana Meenakshi M.
Published: July 2021

Purpose of review

Persons living with HIV (PLWH) have a life expectancy that is nearly equivalent to the general population, and thus are facing health conditions associated with normal aging as well as long-term HIV infection. End-organ disease is associated with significant morbidity and mortality and solid organ transplantation (SOT) may be a viable option for many PLWH. We review the history and recent updates in SOT in PLWH, specifically focusing on HIV-to-HIV transplantation.

Recent findings

Following promising data out of South Africa and to expand the donor pool, the United States passed the HIV Organ Procurement Equity (HOPE) Act, allowing for HIV-to-HIV SOT. Preliminary data to date, especially in HIV-to-HIV kidney transplantation, suggest overall excellent patient and graft survival outcomes with no HIV breakthrough infection.

Preliminary HIV D+R+ SOT data to date suggest promising patient outcomes and no significant adverse events to recipients or living donors. This is an important step in expanding the donor pool and increasing opportunity for SOT in PLWH.
Urinary Cannabis Metabolite Concentrations in Cannabis Hyperemesis Syndrome
Authors: Cordova Jonathan , Biank Vincent , Black Elizabeth , Leikin Jerrold
Published: July 2021

Objective:

Cannabis Hyperemesis Syndrome (CHS) is characterized by recurrent episodes of intractable emesis associated with heavy use of cannabis. Recognition of CHS can be problematic due to the lack of specific biomarkers, which can point the clinician to the diagnosis. We present, retrospectively, a series of adolescent/young adult patients who presented to a pediatric gastroenterology (GI) service with acute on chronic nausea and vomiting, subsequently found to have CHS with associated elevated urinary cannabis metabolite concentrations.

Methods:

We describe 15 patients referred to our pediatric GI division for intractable emesis with spot urinary cannabis metabolite carboxy-THC (THC-COOH) concentrations from January 1, 2018 through April 20, 2019. Urinary testing was performed using gas chromatography mass−spectrometry (GC−MS) in a manner consistent with Clinical Laboratory Improvement Amendments (CLIA) requirements at Mayo Clinic laboratory (Rochester, MN). The laboratory cutoffs were 3.0 ng/mL. Data was extracted via chart review and analyzed via online statistical application.

Results:

Fifteen patients (seven females, eight males) were studied with an average age of 17.7 years. All patients reported frequent cannabis use for at least 1 month and exhibited intractable, non-bilious emesis for at least 2 weeks. Twelve patients also reported weight loss. Two patients had underlying gastrointestinal disease (one with Crohn disease and one with irritable bowel syndrome). All patients had essentially normal GI workup including laboratory tests, imaging studies and endoscopies.

Fourteen of 15 patients had urinary THC-COOH concentrations >100 ng/mL, with seven individuals exhibiting levels >500 ng/mL. One patient had a urinary TCH-COOH concentration level under 100 ng/mL had not used cannabis for 2 weeks. Most other patients had used cannabis within 2 days of providing a urine sample. The Binomial test for CHS patients with urinary THC-COOH levels over 100 ng/mL was significant with a P-value of <0.0005 (one tail test).

Conclusion:

CHS is associated with an elevated urinary THC-COOH level usually exceeding 100 ng/mL, which is indicative of significant chronic cannabis exposure. In patients with a history consistent with CHS, urine THC-COOH testing may help guide the diagnostic evaluation of these patients and decrease the need for further workup.
Platelet Dysfunction Because of Amlodipine in Bone Marrow Transplant Recipient
Authors: Gözmen Salih , Gözmen Şükran Keskin
Published: July 2021

Background:

Hypertension (HTN) is a complication of pediatric hematopoietic stem cell transplantation. We report a pediatric stem cell transplant patient who had HTN and adverse event because of amlodipine.

Observation:

Seven-year-old boy had haploidentical stem cell transplantation with post-transplant cyclophosphamide. He had complete donor chimerism at the end of one month. Amlodipine was started on day +36 for HTN. On day +41, he had petechiae. Platelet function analyzer (PFA)-100 was abnormal. After amlodipine was stopped, petechiae disappeared and PFA-100 returned to normal.

Conclusions:

Abnormal PFA-100 and the patient complaints indicated the possibility of amlodipine-induced platelet dysfunction through inhibition of calcium-mediated platelet reactions.
Application of Multiplex Polymerase Chain Reaction for Pathogen Identification and Antibiotic Use in Children With Respiratory Infections in a PICU
Authors: Yoshida Kota , Hatachi Takeshi , Okamoto Yuya , Aoki Yoshihiro , Kyogoku Miyako , Moon Miyashita Kazue , Inata Yu , Shimizu Yoshiyuki , Fujiwara Futoshi , Takeuchi Muneyuki
Published: July 2021

OBJECTIVES:

To compare the pathogen identification rate and use of antibiotics before and after the implementation of multiplex polymerase chain reaction testing in children with respiratory infections in a PICU.

DESIGN:

Single-center, pre-post study.

SETTING:

PICU of Osaka Women’s and Children’s Hospital, Osaka, Japan.

PATIENTS:

Consecutive children with respiratory infections who were admitted to the PICU between December 2017 and November 2018 (premultiplex polymerase chain reaction period) and between March 2019 and February 2020 (postmultiplex polymerase chain reaction period).

INTERVENTIONS:

Conventional rapid antigen tests and bacterial culture tests were performed throughout the study period. Multiplex polymerase chain reaction testing using the FilmArray respiratory panel (BioFire Diagnostics, Salt Lake City, UT) was conducted to detect 17 viruses and three bacterial pathogens. During the postmultiplex polymerase chain reaction period, we did not recommend prescribing antibiotics for stable children, depending on the virus species and laboratory test results.

MEASUREMENTS AND MAIN RESULTS:

Ninety-six and 85 children were enrolled during the pre- and postmultiplex polymerase chain reaction periods, respectively. Rapid antigen tests identified pathogens in 22% of the children (n = 21) during the premultiplex polymerase chain reaction period, whereas rapid antigen tests and/or multiplex polymerase chain reaction testing identified pathogens in 67% of the children (n = 57) during the postmultiplex polymerase chain reaction period (p < 0.001). The most commonly identified pathogen using multiplex polymerase chain reaction testing was human rhino/enterovirus. Bacterial pathogens were identified in 50% of the children (n = 48) and 60% of the children (n = 51) during the pre- and postmultiplex polymerase chain reaction periods (p = 0.18). There were no differences in antibiotic use (84% vs 75%; p = 0.14), broad-spectrum antibiotic use (33% vs 34%; p = 0.91), or the duration of antibiotic use within 14 days of admission (6.0 vs 7.0 d; p = 0.45) between the pre- and postmultiplex polymerase chain reaction periods.

CONCLUSIONS:

Although the pathogen identification rate, especially for viral pathogens, increased using multiplex polymerase chain reaction testing, antibiotic use did not reduce in children with respiratory infections in the PICU. Definitive identification of bacterial pathogens and implementation of evidence-based antimicrobial stewardship programs employing multiplex polymerase chain reaction testing are warranted.
Anatomic Subunit Approach to Composite Reconstruction of Facial Gunshot Wounds
Authors: Heffern Eric , Nevil Collin , Przylecki Wojciech , Andrews Brian T.
Published: July 2021

With a rise in gun violence in the United States, surgeons are tasked with effectively managing penetrating facial trauma. The purpose of this study is to assess methods used for successful composite reconstruction of each anatomical facial subunit following penetrating trauma. A retrospective chart review was performed in subjects undergoing craniofacial reconstruction following penetrating trauma. Reconstructive methods were analyzed through operative reports. Subjects were categorized by anatomical subunit reconstructed (mandible, maxilla (malar complex and roof/palate), orbit, and cranium) and method of reconstruction (open reduction internal fixation only, bone graft, free flap, implant, and tissue expansion). Thirty-six subjects underwent reconstruction for penetrating facial trauma. Involved subunits include 24 mandible, 11 malar complex, 13 palate, 18 orbit, and 11 cranium. Predominate reconstruction method was open reduction internal fixation only for mandible (45.8%), bone grafting for malar complex (81.8%), implant for orbit (66.7%) and cranium (63.6%), and local tissue rearrangement for palate (84.6%). The predominate bone graft donor site was iliac for mandible (42.9%), rib for malar complex (36.3%) and orbit (40.0%), and frontal bone for cranium (42.8%). The predominate free flap was osteocutaneous for all mandible, orbit, and cranium and 7 of 10 (70.0%) palate reconstructions. Tissue expansion was used in all subunits except cranium. In conclusion, bone grafting, implants, free tissue transfer, and tissue expansion are all viable reconstruction options for penetrating trauma. There is no single approach to use, and decisions regarding definitive reconstruction method should be based upon anatomical subunit involved and the size/area of defects.
The Confusion of Determining the Landmark in the Craniofacial Soft Tissue Analyzes: Nasion or Sellion?
Authors: Bahşi Ilhan , Orhan Mustafa , Kervancioğlu Piraye
Published: July 2021

In the literature, most of the craniofacial anthropometric landmarks found on both bones and soft tissue have been clearly defined and widely used. However, it seems that few landmarks such as nasion are generally often set incorrectly. Therefore, in this study, it was aimed to examine the nasion and sellion in the dry bones and to review the definitions of each landmarks. A total of 41 adult skulls, whose nasofrontal region was not deformed and whose age, gender and ethnic origin were not known, were examined. It was found that nasion and sellion are at the same point in 24 of the 41 (58.54%) bones examined, and that in 17 of them (41.46%), sellion is below the nasion. In the bones where the sellion is below the nasion, the average distance between each two landmarks was determined as 4.53 ± 0.95 mm. Consequently, we think that it is not possible to determine nasion in the indirect craniofacial soft tissue analyzes, and it would be better to use sellion as a reference landmark instead of nasion.
A Comparison of Methods for Predicting Future Cognitive Status
Authors: Appiah Frank , Charnigo Richard J.
Published: July 2021

Purpose:

The present work compares various methods for using baseline cognitive performance data to predict eventual cognitive status of longitudinal study participants at the University of Kentucky’s Alzheimer’s Disease Center.

Methods:

Cox proportional hazards models examined time to cognitive transition as predicted by risk strata derived from normal mixture modeling, latent class analysis, and a 1-SD thresholding approach. An additional comparator involved prediction directly from a numeric value for baseline cognitive performance.

Results:

A normal mixture model suggested 3 risk strata based on Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) T scores: high, intermediate, and low risk. Cox modeling of time to cognitive decline based on posterior probabilities for risk stratum membership yielded an estimated hazard ratio of 4.00 with 95% confidence interval 1.53-10.44 in comparing high risk membership to low risk; for intermediate risk membership versus low risk, the modeling yielded hazard ratio=2.29 and 95% confidence interval=0.98-5.33. Latent class analysis produced 3 groups, which did not have a clear ordering in terms of risk; however, one group exhibited appreciably greater hazard of cognitive decline. All methods for generating predictors of cognitive transition yielded statistically significant likelihood ratio statistics but modest concordance statistics.

Conclusion:

Posterior probabilities from mixture modeling allow for risk stratification that is data-driven and, in the case of CERAD T scores, modestly predictive of later cognitive decline. Incorporating other covariates may enhance predictions.
Core Imaging Library - Part I: a versatile Python framework for tomographic imaging
Authors: Jørgensen J. S. , Ametova E. , Burca G. , Fardell G. , Papoutsellis E. , Pasca E. , Thielemans K. , Turner M. , Warr R. , Lionheart W. R. B. , Withers P. J.
Published: July 2021

We present the Core Imaging Library (CIL), an open-source Python framework for tomographic imaging with particular emphasis on reconstruction of challenging datasets. Conventional filtered back-projection reconstruction tends to be insufficient for highly noisy, incomplete, non-standard or multi-channel data arising for example in dynamic, spectral andin situtomography. CIL provides an extensive modular optimization framework for prototyping reconstruction methods including sparsity and total variation regularization, as well as tools for loading, preprocessing and visualizing tomographic data. The capabilities of CIL are demonstrated on a synchrotron example dataset and three challenging cases spanning golden-ratio neutron tomography, cone-beam X-ray laminography and positron emission tomography.

This article is part of the theme issue ‘Synergistic tomographic image reconstruction: part 2’.
Enhanced diffuse optical tomographic reconstruction using concurrent ultrasound information
Authors: Di Sciacca G. , Di Sieno L. , Farina A. , Lanka P. , Venturini E. , Panizza P. , Dalla Mora A. , Pifferi A. , Taroni P. , Arridge S. R.
Published: July 2021

Multimodal imaging is an active branch of research as it has the potential to improve common medical imaging techniques. Diffuse optical tomography (DOT) is an example of a low resolution, functional imaging modality that typically has very low resolution due to the ill-posedness of its underlying inverse problem. Combining the functional information of DOT with a high resolution structural imaging modality has been studied widely. In particular, the combination of DOT with ultrasound (US) could serve as a useful tool for clinicians for the formulation of accurate diagnosis of breast lesions. In this paper, we propose a novel method for US-guided DOT reconstruction using a portable time-domain measurement system. B-mode US imaging is used to retrieve morphological information on the probed tissues by means of a semi-automatical segmentation procedure based on active contour fitting. A two-dimensional to three-dimensional extrapolation procedure, based on the concept of distance transform, is then applied to generate a three-dimensional edge-weighting prior for the regularization of DOT. The reconstruction procedure has been tested on experimental data obtained on specifically designed dual-modality silicon phantoms. Results show a substantial quantification improvement upon the application of the implemented technique.

This article is part of the theme issue ‘Synergistic tomographic image reconstruction: part 2’.
Conserved and specialized functions of Type VII secretion systems in non-tuberculous mycobacteria
Authors: Lagune Marion , Petit Cecile , Sotomayor Flor Vásquez , Johansen Matt D. , Beckham Kathrine S. H. , Ritter Christina , Girard-Misguich Fabienne , Wilmanns Matthias , Kremer Laurent , Maurer Florian P. , Herrmann Jean-Louis
Published: July 2021

Non-tuberculous mycobacteria (NTM) are a large group of micro-organisms comprising more than 200 individual species. Most NTM are saprophytic organisms and are found mainly in terrestrial and aquatic environments. In recent years, NTM have been increasingly associated with infections in both immunocompetent and immunocompromised individuals, prompting significant efforts to understand the diverse pathogenic and signalling traits of these emerging pathogens. Since the discovery of Type VII secretion systems (T7SS), there have been significant developments regarding the role of these complex systems in mycobacteria. These specialised systems, also known as Early Antigenic Secretion (ESX) systems, are employed to secrete proteins across the inner membrane. They also play an essential role in virulence, nutrient uptake and conjugation. Our understanding of T7SS in mycobacteria has significantly benefited over the last few years, from the resolution of ESX-3 structure in

Mycobacterium smegmatis

, to ESX-5 structures in

Mycobacterium xenopi

and

Mycobacterium tuberculosis

. In addition, ESX-4, considered until recently as a non-functional system in both pathogenic and non-pathogenic mycobacteria, has been proposed to play an important role in the virulence of

Mycobacterium abscessus

; an increasingly recognized opportunistic NTM causing severe lung diseases. These major findings have led to important new insights into the functional mechanisms of these biological systems, their implication in virulence, nutrient acquisitions and cell wall shaping, and will be discussed in this review.
COVID-19 vaccine hesitancy and refusal and associated factors in an adult population in Saskatchewan, Canada: Evidence from predictive modelling
Authors: Muhajarine Nazeem , Adeyinka Daniel A. , McCutcheon Jessica , Green Kathryn , Fahlman Miles , Kallio Natalie
Published: July 2021

Background

A high population level of vaccination is required to control the COVID-19 pandemic, but not all Canadians are convinced of the value and safety of vaccination. Understanding more about these individuals can aid in developing strategies to increase their acceptance of a COVID-19 vaccine. The objectives of this study were to describe COVID-19 vaccine acceptance, hesitancy and refusal rates and associated factors in Saskatchewan, Canada.

Methods

This study consisted of a weighted sample of 9,252 survey responses from 7,265 Saskatchewan adults (≥18 years) between May 4, 2020 and April 3, 2021. The outcome variable was vaccine intention: vaccine acceptance, hesitancy, and refusal. The independent variables were layered into socio-demographic factors, risk of exposure to coronavirus, mitigating behaviours, and perceptions of COVID-19. Data were analyzed using multinomial logistic regression and a classification and regression tree.

Results

Seventy-six percent of the respondents indicated that they had been or were willing to be vaccinated, 13% had not yet decided, and the remaining 11% said they would not be vaccinated. Factors that increased the likelihood of vaccine refusal and hesitancy were lower education level, financial instability, Indigenous status, and not being concerned about spreading the coronavirus. Perceiving COVID-19 to be more of a threat to one’s community and believing that one had a higher risk of illness or death from COVID-19 decreased the likelihood of both vaccine refusal and hesitancy. Women and newcomers to Canada were more likely to be unsure about getting vaccinated. Respondents who did not plan to be vaccinated were less likely to wear face masks and practice physical distancing.

Conclusion

While many Canadians have voluntarily and eagerly become vaccinated already, reaching sufficient coverage of the population is likely to require targeted efforts to convince those who are resistant or unsure. Identifying and overcoming any barriers to vaccination that exist within the socio-demographic groups we found were least likely to be vaccinated is a crucial component.