bluuebunny/crossref_metadata_2025 huggingface dataset:
A-34 Comparison of BRIEF, SRS Relationships among Children with Autism and Comorbid ADHD
Authors: Bednarz Haley M , Kana Rajesh K , Trapani Julie A
Published: August 2021

Objective

Recent investigations have found specific relationships between subscales of the Social Responsiveness Scale (SRS) and the Behavior Rating Inventory of Executive Functioning (BRIEF) among individuals with autism spectrum disorder (ASD). Aim: Examine whether Social-Executive relationships differ among individuals with ASD versus comorbid autism and attention-deficit/hyperactivity disorder (ASD + ADHD).

Method

Parent ratings on the SRS and BRIEF were obtained from the ABIDE-II database. Final sample: 25 ASD, 37 ASD + ADHD (5–12 years). T-tests examined group differences in BRIEF and SRS T-scores. Hierarchical multiple regressions examined the effect of BRIEF Index T-scores (Metacognition, MI; Behavioral Regulation, BRI) on SRS total and subscale T-scores, as well as the potential moderating effect of comorbid ADHD diagnosis.

Results

T-tests revealed that the ASD + ADHD group had higher severity T-scores on the BRIEF MI (T = 3.70, p < 0.01) and SRS Awareness (T = 4.00, p < 0.001) scales. ADHD diagnosis was associated with less severe deficits in social cognition (B = −6.33, p = 0.02). However, ADHD diagnosis did not significantly moderate the relationship between BRIEF and SRS scores. The relationship between BRIEF BRI and SRS Motivation was marginally significant and stronger among children with ADHD (B = 0.81, p = 0.0513).

Conclusions

Overall, similar profile of social-executive relationships were observed among participants with ASD and ASD + ADHD. ADHD diagnosis was associated with better understanding of social situations and ability to interpret social cues appropriately. There is some indication that ADHD diagnosis may be associated with a stronger relationship between behavior regulation and social motivation. Future work should replicate these findings with a larger sample size.
A-36 Case Study of Cerebellar Cognitive Affective Syndrome in 17-Year-Old Male with Cerebellar Arachnoid Cyst
Authors: Nicholson Laura , Marston Elizabeth , Haak Christopher , Cruz Nicole
Published: August 2021

Objective

Arachnoid cysts are often congenital and asymptomatic, however, they may contribute to neurocognitive symptoms when there is a mass effect on the brain. This case study describes how a 17-year-old with cerebellar arachnoid cyst, and minimal mass effect exhibited symptoms of cerebellar cognitive affective syndrome (CCAS), which has been mostly associated with brain tumor or injury in prior research.

Method

In this case study, a posterior cerebellar arachnoid cyst (midline) was identified incidentally (via CT scan and later MRI) following a panic attack associated with face twitching, motor tremors, and clumsiness. Background history was collected via medical records, neurologist consultation, and parent and patient interview. Patient history was significant for speech, language, motor, and academic delays.

Results

Results of a comprehensive evaluation revealed deficits in perceptual reasoning, visual memory, fine motor functioning, attention, processing speed, executive functioning, social cognition and receptive/expressive language. Multi-informant ratings indicated anxiety. Reading, writing, and mathematics fell several years below grade- level in the context of low average intellectual ability (WAIS-IV: GAI = 88).

Conclusions

Many deficits in this neuropsychological profile are typically subsumed by the cerebellum or its associated networks, and overlap with CCAS. The findings of this case study warrant consideration by clinicians of functional impairment related to cerebellar cysts and expansion of our knowledge-base of cerebellar function.
A-52 Evolving Cognitive and Neuropsychiatric Sequelae of Ruptured Arteriovenous Malformation Following Neurosurgical Intervention
Authors: Ming Shelby , O'Hara John B , Posada Carolina
Published: August 2021

Objective

Arteriovenous malformations (AVMs) are tangled masses of arteries and veins of congenital origin. AVMs are rare (~4.3% in the general population) and symptomatic cases are rarer still (0.1–1%). AVMs account for strokes in 1–2% of cases. We present the case of a 59-year-old, right-handed, Caucasian male, with nine years of formal education, who was evaluated as an inpatient following a ruptured AVM.

Method

Patient with known history of AVM (Figure 1) presented with headache and new onset seizure. Computerized tomography (CT) revealed rupture of an AVM at the right temporal-occipital junction, with resulting intraparenchymal hemorrhage within the right parieto-occipital lobe and the right ventricular system and 0.8 cm left midline shift (Figure 2). The patient underwent emergency craniotomy for evacuation of intracerebral hematoma, resection of AVM, and placement of right external ventricular drain (EVD). Electroencephalograom (EEG) revealed focal cortical dysfunction over the right hemisphere and moderate encephalopathy.

Results

(Table 1). Neuropsychological evaluation six days following emergency craniotomy revealed primary impairment in visuoperceptual and visuoconstructional skills (including left neglect; Figures 3 & 4), impairments in working memory, learning/memory of verbal information (with intact recognition), as well as impairment in aspects of language (semantic fluency). These were accompanied by dense anosagnosia pertaining to cognitive deficits, but intact insight related to his hospitalization.

Conclusions

This is a rare case of symptomatic AVM with neuropsychological evaluation data highlighting the associated evolving cognitive (e.g., left neglect and visuoperceptual disturbance) and neuropsychiatric deficits (e.g., dense anosagnosia) in the context of recent neurosurgical interventions (e.g., evacuation of hemorrhage, placement of EVD, etc.).
A-62 Case of Gerstmann’s Syndrome Due to Brain Tumor of Unknown Etiology
Authors: Feller Chelsea , Kelly Natalie
Published: August 2021

Objective

Gerstmann’s syndrome is a rare neurological condition that is characterized by agraphia, acalculia, finger agnosia, and right–left confusion. Gerstmann’s syndrome most commonly occurs due to stroke in parietal region of the brain. This case demonstrates the clinical presentation of Gerstmann’s syndrome in a patient due to a brain tumor in the parietal lobe.

Method

The patient is a 50-year-old, right-handed, Hispanic male with 16 years of education who reported memory changes over the last 10 months. His medical history is notable for two brain tumors of unknown etiology which have been present for 10 months. He has completed multiple biopsies and magnetic resonance imaging prior to his neuropsychological evaluation. Initial scans showed two tumors, one in the right medial occipital parietal lobe and one in the left parietal extending into the corpus callosum. The right medial occipital parietal lobe tumor has not been visualized for the past six months.

Results

His neurocognitive profile was characterized by impairments in verbal memory (both stories and word list), arithmetic, semantic fluency, and executive functioning. Across memory measures, he performed in the borderline to impaired range, and did not benefit from recognition items. Arithmetic performance was also in the borderline range and did not show improvement with additional time.

Conclusions

This case demonstrates the classical findings of Gerstmann’s syndrome with additional neurocognitive impairments in the areas of memory and executive functioning. This case is also unique in that the lesions of the parietal lobe are due to brain tumor with unknown etiology.
A-65 Quality Analysis of Deep Brain Stimulation for Obsessive–Compulsive Disorder Using a Neuropsychological Assessment Battery
Authors: Kallus Rachel , Bangert Lauren , Farace Elana
Published: August 2021

Objective

We completed a case study to investigate whether there are cognitive changes after Deep Brain Stimulation (DBS) surgery in the treatment of refractory Obsessive–Compulsive Disorder (OCD) as an initiation of a quality analysis due to increased referrals for this procedure at our institution.

Method

We evaluated a 21-year-old male before and after bilateral nucleus accumbens DBS placement for OCD. His pre-operative neurosurgery evaluation and brain imaging were unremarkable. Post-operative imaging revealed stable changes of bilateral DBS lead placement. Pre and post-operative neuropsychological testing included measures of mental status, language, memory, attention, and executive functioning.

Results

A reliable change estimate was obtained for each test. There was no significant change in performance on the Mini-Mental State Exam, Boston Naming Test, Logical Memory I/II, Faces I, Rey Complex Figure Test (RCFT) immediate and delayed recall, Wisconsin Card Sorting Test-64, Trail Making Tests A & B, Letter Fluency, Animal Fluency, and Stroop Color and Word Test (Stroop) color and color-word condition. There was significant decline for all California Verbal Learning Test-Second Edition trials (trials 1–5, short delay recall, and long delay recall) and RCFT recognition. There was significant improvement for the Stroop word condition. Conclusions. Given mixed findings, it is unclear the extent to which DBS impacted this patient’s overall cognitive functioning. Meanwhile, he showed improvement in OCD symptoms, to the degree that he could live alone, maintain employment, and independently manage daily activities. There is need for future studies to examine the cognitive effects of DBS for OCD, with larger samples and a control group.
A-74 COVID-19 and Post-Acute Sequelae of SARS-CoV-2 Infection (PASC): Acute and Longitudinal Analysis of Anosmia and Ageusia with Delayed Sudden-Onset Neuropsychiatric Symptoms
Authors: Pimental Patricia A , Ciampanelli Anna , Vora Eisha H
Published: August 2021

Objective

Patients with COVID-19 and PASC may exhibit chemosensory dysfunction associated with acute neuroinflammation from immune system overactivation (Uzunova, Pallanti, & Hollander, 2021). Neuropsychiatric disturbances in patients with no history of anxiety or depression have also been reported. These central nervous system manifestations of COVID-19 may be sequelae of trans-olfactory and infralimbic tract penetration (Speth et al., 2020).

Methods

Our case involved a 52-year-old, right-handed, American Indian female, who at three months post neuropsychological evaluation, was diagnosed with laboratory confirmed COVID-19 with onset of complete anosmia and ageusia. Two months later, a sudden-onset of panic and depression occurred with no precipitating event. All symptoms were documented daily until return of function.

Results

Pre-COVID-19 neuropsychological testing revealed findings consistent with ophthalmologic/vestibular migraine and ruled out dementia, and formal anxiety and depressive disorders. Post-COVID-19 neuropsychological analysis and follow-up revealed that anosmia and ageusia had largely resolved after 8-months, and that the delayed sudden-onset panic and depression also resolved within that same time period.

Conclusions

A paucity of data exists concerning COVID-19 and PASC anosmia and ageusia, and sudden-onset neuropsychiatric symptoms. Our case is unique since neuropsychological testing preceded the COVID-19 infection, which provided a baseline of functioning (e.g., Pocket Smell Test: 3/3 baseline and 0/3 acute COVID-19) and pre-morbid diagnostic specificity. The present case findings align with Cappali and Gatti (2021) whereby 91% of patients reported olfactory recovery, with 53% total recovery after 8-months. No other known reports simultaneously documented detailed recovery of anosmia, ageusia and delayed sudden-onset panic and depression, and COVID-19 antibody laboratory testing.
The Role of the Dorsal–Lateral Prefrontal Cortex in Reward Sensitivity During Approach–Avoidance Conflict
Authors: Rolle Camarin E , Pedersen Mads L , Johnson Noriah , Amemori Ken-ichi , Ironside Maria , Graybiel Ann M , Pizzagalli Diego A , Etkin Amit
Published: August 2021

Approach–Avoidance conflict (AAC) arises from decisions with embedded positive and negative outcomes, such that approaching leads to reward and punishment and avoiding to neither. Despite its importance, the field lacks a mechanistic understanding of which regions are driving avoidance behavior during conflict. In the current task, we utilized transcranial magnetic stimulation (TMS) and drift-diffusion modeling to investigate the role of one of the most prominent regions relevant to AAC—the dorsolateral prefrontal cortex (dlPFC). The first experiment uses in-task disruption to examine the right dlPFC’s (r-dlPFC) causal role in avoidance behavior. The second uses single TMS pulses to probe the excitability of the r-dlPFC, and downstream cortical activations, during avoidance behavior. Disrupting r-dlPFC during conflict decision-making reduced reward sensitivity. Further, r-dlPFC was engaged with a network of regions within the lateral and medial prefrontal, cingulate, and temporal cortices that associate with behavior during conflict. Together, these studies use TMS to demonstrate a role for the dlPFC in reward sensitivity during conflict and elucidate the r-dlPFC’s network of cortical regions associated with avoidance behavior. By identifying r-dlPFC’s mechanistic role in AAC behavior, contextualized within its conflict-specific downstream neural connectivity, we advance dlPFC as a potential neural target for psychiatric therapeutics.
Human Filariasis in Travelers and Migrants: A Retrospective 25-year Analysis at the Institute of Tropical Medicine, Antwerp, Belgium
Authors: Bottieau Emmanuel , Huits Ralph , Van Den Broucke Steven , Maniewski Ula , Declercq Steven , Brosius Isabel , Theunissen Caroline , Feyens Anne-Marie , Van Esbroeck Marjan , van Griensven Johan , Clerinx Jan , Soentjens Patrick
Published: August 2021

Background

Information on human filariasis in international travelers is scarce. We describe the epidemiology, clinical presentation, and outcome of these infections in a reference travel clinic over the past decades.

Methods

We reviewed all cases of filariasis diagnosed at the Institute of Tropical Medicine, Antwerp, Belgium, from 1994 to 2018. Diagnosis was obtained by either parasitological methods (confirmed) or strict clinical case definitions (probable). We assessed the characteristics of cases at diagnosis and response to therapy within 3–12 months.

Results

A total of 320 patients (median age: 41 years; 71% males) were diagnosed with 327 filarial infections (Wuchereria bancrofti = 6, Onchocerca volvulus = 33, Loa loa = 150, Mansonella perstans = 130, unspecified species = 8). Diagnosis was confirmed in 213/320 (67%) patients. European long-term travelers accounted for 166 patients (52%) and visitors/migrants from tropical countries for another 110 (34%). Central Africa was the likely region of acquisition for 294 (92%) patients. The number of filariasis cases decreased from 21.5/year on average in the 1990s to 6.3/year in the past decade, when loiasis became predominant. Cases reported symptoms in >80% of all filarial infections but mansonellosis (45/123 single infections; 37%). Lymphatic filariasis and onchocerciasis cases responded well to conventional therapy. However, 30% of patients with loiasis and mansonellosis experienced treatment failure (with diethylcarbamazine and levamisole-mebendazole, respectively).

Conclusions

The burden and species distribution of filariasis in travelers evolved in the past decades. Most presentations were symptomatic. Case management would benefit from more effective therapies for loiasis and mansonellosis.
Chronic refractory angina pectoris treated by bilateral stereotactic radiosurgical stellate ganglion ablation: first-in-man case report
Authors: Hudec Miroslav , Jiravsky Otakar , Spacek Radim , Neuwirth Radek , Knybel Lukas , Sknouril Libor , Cvek Jakub , Miklik Roman
Published: August 2021

Background

Refractory angina pectoris (AP) significantly impairs quality of life in patients with chronic coronary syndrome. Several minimally invasive methods (coronary sinus reducer, cell therapy, laser or shockwave revascularization, and spinal cord stimulation) or non-invasive methods (external counterpulzation) have been studied. However, their routine clinical use has not been widely implemented. Surgical or endoscopic sympathectomy is feasible for permanently relieving angina, but is often contraindicated due to the extent of complications associated with it. Neuromodulation by anaesthetic blockade of the left-sided stellate ganglion (SG) has been shown to relieve angina for days or weeks. To provide a long-term anti-anginal effect, novel pharmacological (phenol-based) or radiofrequency ablation techniques have been individually used to permanently destroy sympathetic pathways.

Case summary

We describe a first-in-man use of stereotactic radiosurgical SG ablation using a linear accelerator (CyberKnife) in a heart failure patient after myocardial infarction with chronic refractory AP. Repeated anaesthetic SG blockade in this patient resulted in a significant, but only short-term, clinical improvement. The left, and subsequently the right, SG was ablated by targeted irradiation. During the 1-year follow-up, the patient remained without angina. We did not observe any clinically relevant early or late complications. Atrial fibrillation that developed 2 months after the second procedure was deemed to be associated with a natural progression of co-existing heart failure.

Discussion

We conclude that stereotactic radiosurgical SG ablation has the potential to become a minimally invasive and low-risk procedure to treat refractory angina patients. However, this procedure needs to be evaluated in larger patient populations.
Low-dose Methotrexate Therapy Does Not Affect Semen Parameters and Sperm DNA
Authors: Grosen Anne , Bellaguarda Emanuelle , Nersting Jacob , Hvas Christian Lodberg , Liljeqvist-Soltic Ingela , Stein Adam , Christensen Lisbet Ambrosius , Ruderman Eric M , Brown Calvin R , Schmiegelow Kjeld , Zhang John X , Kelsen Jens , Hanauer Stephen B
Published: August 2021

Background

Methotrexate is widely used in inflammatory diseases during the patients’ reproductive years. The effect on male fertility and sperm DNA integrity is largely unknown. We evaluated sperm DNA integrity and basic semen parameters according to the World Health Organization (WHO) in male patients with inflammatory diseases treated with methotrexate.

Methods

Semen samples from 14 patients on low-dose maintenance methotrexate were compared with samples from 40 healthy volunteers. Further, 5 patients delivered samples on and off methotrexate therapy for paired comparison. Sperm DNA fragmentation index (DFI), concentration, motility, and morphology were evaluated. Blood sex hormones and methotrexate levels were measured in blood and semen.

Results

DNA fragmentation index in methotrexate-treated patients was comparable with that in healthy volunteers (DFI, 11.5 vs 15.0; P = .06), and DFI did not change significantly on and off methotrexate in the paired samples (DFI, 12.0 vs 14.0; P = 0.35). Sperm concentration, motility, and morphology did not differ between men treated with methotrexate and healthy volunteers. Sperm progressive motility increased off therapy compared with on therapy (65.0% vs 45.0%, P = .04), but all fluctuations in progressive motility were within the WHO reference interval. All methotrexate polyglutamates1-5 were detected in blood, but only methotrexate polyglutamate1 in semen. Serum testosterone was unaffected by methotrexate therapy.

Conclusions

Patients treated with low-dose methotrexate have a sperm quality comparable with that of healthy volunteers, and methotrexate treatment does not increase sperm DNA fragmentation. This study does not support cryopreservation of semen before treatment initiation nor a 3-month methotrexate-free interval prior to conception.
The infinite possibilities of RNA therapeutics
Authors: Mollocana-Lara Evelyn C , Ni Ming , Agathos Spiros N , Gonzales-Zubiate Fernando A
Published: August 2021

Although the study of ribonucleic acid (RNA) therapeutics started decades ago, for many years, this field of research was overshadowed by the growing interest in DNA-based therapies. Nowadays, the role of several types of RNA in cell regulation processes and the development of various diseases have been elucidated, and research in RNA therapeutics is back with force. This short literature review aims to present general aspects of many of the molecules currently used in RNA therapeutics, including in vitro transcribed mRNA (IVT mRNA), antisense oligonucleotides (ASOs), aptamers, small interfering RNAs (siRNAs), and microRNAs (miRNAs). In addition, we describe the state of the art of technologies applied for synthetic RNA manufacture and delivery. Likewise, we detail the RNA-based therapies approved by the FDA so far, as well as the ongoing clinical investigations. As a final point, we highlight the current and potential advantages of working on RNA-based therapeutics and how these could lead to a new era of accessible and personalized healthcare.
Smoking Behavior and Prognosis After Colorectal Cancer Diagnosis: A Pooled Analysis of 11 Studies
Authors: Alwers Elizabeth , Carr Prudence R , Banbury Barbara , Walter Viola , Chang-Claude Jenny , Jansen Lina , Drew David A , Giovannucci Edward , Nan Hongmei , Berndt Sonja I , Huang Wen-Yi , Prizment Anna , Hayes Richard B , Sakoda Lori C , White Emily , Labadie Julia , Slattery Martha , Schoen Robert E , Diergaarde Brenda , van Guelpen Bethany , Campbell Peter T , Peters Ulrike , Chan Andrew T , Newcomb Polly A , Hoffmeister Michael , Brenner Hermann
Published: August 2021

Background

Smoking has been associated with colorectal cancer (CRC) incidence and mortality in previous studies, but current evidence on smoking in association with survival after CRC diagnosis is limited.

Methods

We pooled data from 12 345 patients with stage I-IV CRC from 11 epidemiologic studies in the International Survival Analysis in Colorectal Cancer Consortium. Cox proportional hazards regression models were used to evaluate the associations of prediagnostic smoking behavior with overall, CRC-specific, and non-CRC-specific survival.

Results

Among 12 345 patients with CRC, 4379 (35.5%) died (2515 from CRC) over a median follow-up time of 7.5 years. Smoking was strongly associated with worse survival in stage I-III patients, whereas no association was observed among stage IV patients. Among stage I-III patients, clear dose-response relationships with all survival outcomes were seen for current smokers. For example, current smokers with 40 or more pack-years had statistically significantly worse overall, CRC-specific, and non-CRC-specific survival compared with never smokers (hazard ratio [HR] =1.94, 95% confidence interval [CI] =1.68 to 2.25; HR = 1.41, 95% CI = 1.12 to 1.78; and HR = 2.67, 95% CI = 2.19 to 3.26, respectively). Similar associations with all survival outcomes were observed for former smokers who had quit for less than 10 years, but only a weak association with non-CRC-specific survival was seen among former smokers who had quit for more than 10 years.

Conclusions

This large consortium of CRC patient studies provides compelling evidence that smoking is strongly associated with worse survival of stage I-III CRC patients in a clear dose-response manner. The detrimental effect of smoking was primarily related to noncolorectal cancer events, but current heavy smoking also showed an association with CRC-specific survival.
Not Your Average Mediastinal Mass: A Case of a Large Mediastinal Teratoma in a Patient With a History of Polio Disease
Authors: Wilson Sara M , Lojek Andrei S B , Zamora-Berridi Grettel J , Hodgson John A
Published: August 2021

Mediastinal masses can be challenging to the surgical team and anesthetic considerations vary according to the location, pathology, surgical approach, and patient comorbidities. We report the case of a 21 cm symptomatic intrathoracic teratoma in a postpartum patient with a history of poliomyelitis. Significant challenges were presented for anesthetic induction, potential extracorporeal membrane oxygenation, and the use of neuraxial pain techniques and neuromuscular blockade. This case report demonstrates techniques to safely manage a patient with a large symptomatic mediastinal mass and potential neuromuscular disease.
Rapid specialization of counter defenses enables two-spotted spider mite to adapt to novel plant hosts
Authors: Salehipourshirazi Golnaz , Bruinsma Kristie , Ratlamwala Huzefa , Dixit Sameer , Arbona Vicent , Widemann Emilie , Milojevic Maja , Jin Pengyu , Bensoussan Nicolas , Gómez-Cadenas Aurelio , Zhurov Vladimir , Grbic Miodrag , Grbic Vojislava
Published: August 2021

Genetic adaptation, occurring over a long evolutionary time, enables host-specialized herbivores to develop novel resistance traits and to efficiently counteract the defenses of a narrow range of host plants. In contrast, physiological acclimation, leading to the suppression and/or detoxification of host defenses, is hypothesized to enable broad generalists to shift between plant hosts. However, the host adaptation mechanisms used by generalists composed of host-adapted populations are not known. Two-spotted spider mite (TSSM; Tetranychus urticae) is an extreme generalist herbivore whose individual populations perform well only on a subset of potential hosts. We combined experimental evolution, Arabidopsis thaliana genetics, mite reverse genetics, and pharmacological approaches to examine mite host adaptation upon the shift of a bean (Phaseolus vulgaris)-adapted population to Arabidopsis. We showed that cytochrome P450 monooxygenases are required for mite adaptation to Arabidopsis. We identified activities of two tiers of P450s: general xenobiotic-responsive P450s that have a limited contribution to mite adaptation to Arabidopsis and adaptation-associated P450s that efficiently counteract Arabidopsis defenses. In approximately 25 generations of mite selection on Arabidopsis plants, mites evolved highly efficient detoxification-based adaptation, characteristic of specialist herbivores. This demonstrates that specialization to plant resistance traits can occur within the ecological timescale, enabling the TSSM to shift to novel plant hosts.
Quick or Broad Patents? Evidence from U.S. Startups
Authors: Hegde Deepak , Ljungqvist Alexander , Raj Manav
Published: August 2021

We study the effects of patent scope and review times on startups and externalities on their rivals. We leverage the quasi-random assignment of U.S. patent applications to examiners and find that grant delays reduce a startup’s employment and sales growth, chances of survival, access to external capital, and future innovation. Delays also harm the growth, access to external capital, and follow-on innovation of the patentee’s rivals, suggesting that quick patents enhance both inventor rewards and generate positive externalities. Broader scope increases a startup’s future growth (conditional on survival) and innovation but imposes negative externalities on its rivals’ growth and innovation.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online
Development and Validation of a Nonremission Risk Prediction Model in  First-Episode Psychosis: An Analysis of 2 Longitudinal Studies
Authors: Leighton Samuel P , Krishnadas Rajeev , Upthegrove Rachel , Marwaha Steven , Steyerberg Ewout W , Gkoutos Georgios V , Broome Matthew R , Liddle Peter F , Everard Linda , Singh Swaran P , Freemantle Nicholas , Fowler David , Jones Peter B , Sharma Vimal , Murray Robin , Wykes Til , Drake Richard J , Buchan Iain , Rogers Simon , Cavanagh Jonathan , Lewis Shon W , Birchwood Max , Mallikarjun Pavan K
Published: August 2021

Psychosis is a major mental illness with first onset in young adults. The prognosis is poor in around half of the people affected, and difficult to predict. The few tools available to predict prognosis have major weaknesses which limit their use in clinical practice. We aimed to develop and validate a risk prediction model of symptom nonremission in first-episode psychosis. Our development cohort consisted of 1027 patients with first-episode psychosis recruited between 2005 and 2010 from 14 early intervention services across the National Health Service in England. Our validation cohort consisted of 399 patients with first-episode psychosis recruited between 2006 and 2009 from a further 11 English early intervention services. The one-year nonremission rate was 52% and 54% in the development and validation cohorts, respectively. Multivariable logistic regression was used to develop a risk prediction model for nonremission, which was externally validated. The prediction model showed good discrimination C-statistic of 0.73 (0.64, 0.81) and adequate calibration with intercept alpha of –0.014 (–0.34, 0.31) and slope beta of 0.85 (0.42, 1.27). Our model improved the net-benefit by 16% at a risk threshold of 50% compared to the strategy of treating all, equivalent to 16 more detected nonremitted first-episode psychosis individuals per 100 without incorrectly classifying remitted cases. Once prospectively validated, our first episode psychosis prediction model could help identify patients at increased risk of nonremission at initial clinical contact.
The Effect of Intrapartum Oxygen Supplementation on Category II Fetal Monitoring
Authors: Raghuraman N. , López L.D. , Carter E.B. , Stout M.J. , Macones G.A. , Tuuli M.G. , Cahill A.G.
Published: August 2021

(Am J Obstet Gynecol. 2020;223:905.e1–905.e7)

While oxygen is routinely administered in response to category II electronic fetal monitoring (EFM) patterns, there is not currently any evidence that this practice is beneficial for the neonate. Maternal oxygen supplementation in this context is meant to reduce fetal hypoxia, but a recent study suggests umbilical artery lactate was not improved with oxygen supplementation compared with therapy using room air (RA). This was a secondary analysis of that study, aimed at investigating how oxygen supplementation affects other markers of category II EFM.
Maternal Mortality in the United States: Recent Trends, Current Status, and Future Considerations
Authors: Joseph K.S. , Boutin A. , Lisonkova S. , Muraca G.M. , Razaz N. , John S. , Mehrabadi A. , Sabr Y. , Ananth C.V. , Schisterman E.
Published: August 2021

(Obstet Gynecol. 2021;137:763–771)

Despite what reputable publications have lead health physicians and experts to believe, reports from the National Center for Health Statistics show United States maternal mortality rates have not increased, rather the surveillance of maternal deaths has improved.
Association Between the Reproductive Health of Young Women and Cardiovascular Disease in Later Life: Umbrella Review
Authors: Okoth K. , Chandan J.S. , Marshall T. , Thangaratinam S. , Thomas G.N. , Nirantharakumar K. , Adderley N.J.
Published: August 2021

(BMJ. 2020;371:1–21)

One third of annual global deaths (17.9 million) can be attributed to cardiovascular disease (CVD). Risk factors for women include some outcomes related to pregnancy and fertility, however, these are often underrecognized. Hypertensive disorders of pregnancy, gestational diabetes mellitus, placental abruption, and low birth weight, and preterm births occur in up to one third of parous women in developed countries. Risk of CVD is also associated with early age at menarche/early menopause and use of hormonal contraceptive agents. This study aimed to conduct an umbrella review of systematic reviews to evaluate associations between female-specific risk factors (eg, adverse pregnancy outcomes and issues related to fertility) and CVD outcomes.
Prelabour Uterine Rupture: Characteristics and Outcomes
Authors: Al-Zirqi  , Vangena S.
Published: August 2021

(BJOG. 2020;127:1637–1644)

Prelabor uterine rupture is very rare. Complete uterine rupture is more likely in scarred uteri compared with unscarred uteri and can lead to catastrophic outcomes. While trial of labor after cesarean delivery is endorsed by the American College of Obstetricians and Gynecologists for appropriate patients, the repeat cesarean rate is around 91%. It is not clear which outcomes are associated with preterm uterine rupture. This retrospective study looked at data from Norway between 1967 and 2008 to identify the characteristics, risk factors, outcomes, and incidence of complete and partial rupture before onset of labor.
Obstetric Admissions to Intensive Care Units in Australia and New Zealand: A Registry-based Cohort Study
Authors: Maiden M.J. , Finnis M.E. , Duke G.J. , Huning E.Y.S. , Crozier T.M.E. , Nguyen N. , Biradar V. , McArthur C. , Pilcherd D.
Published: August 2021

(BJOG. 2020;127:1558–1567)

Critically ill, obstetric patients have unique characteristics and despite risk for complications, this patient population is often excluded from research. While there have been single-center and regional studies as well as national reports from Canada, France, The Netherlands and the UK, the epidemiology of obstetric patients admitted to the intensive care unit (ICU) in the southern hemisphere is lacking. The aim of this study was to examine the epidemiology of critically ill, obstetric patients in Australia and New Zealand.
The Use of Magnetic Resonance Imaging to Predict Placenta Previa With Placenta Accreta Spectrum
Authors: Ishibashi H. , Miyamoto M. , Shinmoto H. , Soga S. , Matsuura H. , Kakimoto S. , Iwahashi H. , Sakamoto T. , Hada T. , Suzuki R. , Takano M.
Published: August 2021

(Acta Obstet Gynecol Scand. 2020;99:1657–1665)

Placenta previa with placenta accrete spectrum (PAS) affects an increasing number of pregnancies and is associated with risk for massive hemorrhage and maternal morbidity. Recently, studies have examined the use of magnetic resonance imaging (MRI) to predict placenta previa with PAS. Some studies have found high specificity and sensitivity using certain MRI findings to make this prediction, while others have found this tool less useful. The aim of this study was to examine the diagnostic accuracy of MRI findings to predict posterior and anterior placenta previa with PAS.
Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for Screening to Detect Major Depression Among Pregnant and Postpartum Women: Systematic Review and Meta-analysis of Individual Participant Data
Authors: Levis B. , Negeri Z. , Sun Y. , Benedetti A. , Thombs B.D.
Published: August 2021

(BMJ. 2020;371:m4022)

Depression in pregnant and postpartum women is common and rates of detection and management could potentially improve with screening. Self-report depression symptom questionnaires such as the Edinburgh Postnatal Depression Scale (EPDS) could be used as part of a full assessment when depression is suspected. This study used individual participant data meta-analysis to assess the accuracy of EPDS screening and whether EPDS screening accuracy differs by timing of screen, patient age, and residence.
Antenatal Dexamethasone for Early Preterm Birth in Low-resource Countries
Authors: Oladapo O.T. , Vogel J.P. , Piaggio G. , Nguyen M.H. , Althabe F. , Gülmezoglu A.M. , Bahl R. , Rao S.P.N. , De Costa A. , Gupta S. , Baqui A.H. , Khanam R. , Shahidullah M. , Chowdhury S.B. , Ahmed S. , Begum N. , D Roy A. , Shahed M.A. , Jaben I.A. , Yasmin F. , Rahman M.M. , Ara A. , Khatoon S. , Ara G. , Akter S. , Akhter N. , Dey P.R. , Sabur M.A. , Azad M.T. , Choudhury S.F. , Matin M.A. , Goudar S.S. , Dhaded S.M. , Metgud M.C. , Pujar Y.V. , Somannavar M.S. , Vernekar S.S. , Herekar V.R. , Bidri S.R. , Mathapati S.S. , Patil P.G. , Patil M.M. , Gudadinni M.R. , Bijapure H.R. , Mallapur A.A. , Katageri G.M. , Chikkamath S.B. , Yelamali B.C. , Pol R.R. , Misra S.S. , Das L. , Nanda S. , Nayak R.B. , Singh B. , Qureshi Z. , Were F. , Osoti A. , Gwako G. , Laving A. , Kinuthia J. , Mohamed H. , Aliyan N. , Barassa A. , Kibaru E. , Mbuga M. , Thuranira L. , Githua N.J. , Lusweti B. , Ayede A.I. , Falade A.G. , Adesina O.A. , Agunloye A.M. , Iyiola O.O. , Sanni W. , Ejinkeonye I.K. , Idris H.A. , Okoli C.V. , Irinyenikan T.A. , Olubosede O.A. , Bello O. , Omololu O.M. , Olutekunbi O.A. , Akintan A.L. , Owa O.O. , Oluwafemi R.O. , Eniowo I.P. , Fabamwo A.O. , Disu E.A. , Agbara J.O. , Adejuyigbe E.A. , Kuti O. , Anyabolu H.C. , Awowole I.O. , Fehintola A.O. , Kuti B.P. , Isah A.D. , Olateju E.K. , Abiodun O. , Dedeke O.F. , Akinkunmi F.B. , Oyeneyin L. , Adesiyun O. , Raji H.O. , Ande A.B.A. , Okonkwo . , Ariff S. , Soofi S.B. , Sheikh L. , Zulfiqar S. , Omer S. , Sikandar R. , Sheikh S. , Giordano D. , Gamerro H. , Carroli G. , Carvalho J. , Neilson J. , Molyneux E. , Yunis K. , Mugerwa K. , Chellani H.K.
Published: August 2021

(N Engl J Med. 2020;383:2514–2525)

Antenatal glucocorticoids are a common intervention in preventing adverse outcomes associated with preterm birth. The evidence supporting this intervention is based on trials in high-resource settings, however, and a 2015 trial in low-resource countries found scaling up this intervention caused an increase in neonatal death, stillbirth and suspected maternal infection. The World Health Organization (WHO) has issued guidelines restricting the use of antenatal glucocorticoids to certain situations. This study, the WHO ACTION-1 (Antenatal Corticosteroids for Improving Outcomes in Preterm Newborns) trial, aimed to determine the levels of safety and efficacy of dexamethasone in women at risk for early preterm birth in low-resource countries compared with placebo.
What Is New About Transfusions for Preterm Infants? An Update
Authors: Kirpalani H. , Whyte R.K.
Published: August 2021

(Neonatology. 2019;115:406–410)

Practices for the transfusion for preterm infants vary widely between centers and there is a lack of consensus on the best approach. There is only a small amount of randomized controlled trial (RCT) evidence available, but 2 larger trials comparing high and low hemoglobin transfusion levels will report their findings soon. These trials use an outcome of neurodevelopmental impairment at 2 years and together report on 1744 infants. This review aims to describe the conclusions of the existing RCT literature, call attention to new observational data, and discuss the possibility of individualizing blood transfusions in infants.
Anesthetic Management of Women With Heart Failure During Pregnancy: A Retrospective Cohort Study
Authors: Jayasooriya G. , Silversides C. , Raghavan G. , Balki M.
Published: August 2021

(Int J Obstet Anesth. 2020;44:40–50)

The increases in plasma volume, cardiac output, and heart rate caused by pregnancy may also lead to heart failure in women with underlying cardiac disease. Pregnancy may even reveal first-time symptoms of cardiac disease in tandem with hemodynamic stress, presenting with de novo cardiovascular conditions such as preeclampsia or peripartum cardiomyopathy. Since hypertensive disorders complicate up to 10% of pregnancies, and because known associations exist between heart failure in pregnancy and preeclampsia, this study aimed to examine management (anesthetic, medical, and obstetric) and etiologies of pregnant women with clinical heart failure presenting to a tertiary care center in Canada.
The Crossed-leg Position Increases the Dimensions Within the Acoustic Target Window for Neuraxial Needle Placement in Term Pregnancy: A Prospective Observational Study
Authors: Sharma M. , Qasem F. , Sebbag I. , Jones P.M. , Singh S.I.
Published: August 2021

(Int J Obstet Anesth. 2020;44:106–111)

Anatomic changes associated with pregnancy may render conduct of neuraxial procedures in parturients more difficult. The standard position for a neuraxial block requires a patient to sit on a bed with the spine flexed and legs supported on a stool, but spinal flexion may be improved by instead sitting cross-legged on the bed. Given the lack of prospective studies on this topic, the aim of this study was ultrasonographic assessment of the paramedian target area’s size when a pregnant woman sits in the cross-legged position (CLP) for neuraxial needle placement compared with standard sitting position (SP). The authors hypothesized that a CLP would increase the measured lengths of the posterior longitudinal ligament (PLL) indicating an improved acoustic window between vertebrae.
Determining Competence in Performing Obstetric Combined Spinal-epidural Procedures in Junior Anesthesiology Residents: Results From a Cumulative Sum Analysis
Authors: Lew E. , Allen J.C. , Goy R.W.L. , Ithnin F. , Sng B.L.
Published: August 2021

(Int J Obstet Anesth. 2020;44:33–39)

Epidural techniques can be challenging to master and require practice. The required number of cases to demonstrate competency in epidural procedures varies widely. Residents must complete 40 epidural or combined spinal-epidurals (CSEs) to show competency according to Accreditation Council for Graduate Medical Education International (ACGME-I) requirements. At the study center, CSE training consists of didactic teaching, 10 one-on-one supervised sessions using a model, and 10 supervised and coached CSEs, followed by 3 Direct Observation of Procedures assessments. This study used cumulative sum (CUSUM) analysis, a tool for defining failure rates, plotting learning curves and mapping levels of competence, to determine the minimum experience needed to demonstrate competency in obstetric CSE procedures among junior residents.
Management of Pain After Cesarean Delivery Without Intrathecal Morphine: Networking for the Best Answer
Authors: Barry G. , Uppal V.
Published: August 2021

(Can J Anesth/J Can Anesth. 2020;67:1704–1709)

Acute pain after cesarean delivery (CD) is a predictor of important short-term and long-term outcomes including postpartum depression. Intrathecal opioids are often provided as post-CD analgesia following CD using neuraxial analgesia. However, when spinal anesthesia or intrathecal morphine are not good options, truncal blocks and local anesthetic wound infiltration (WI) are possible alternatives. Common truncal blocks used in this context include the transversus abdominis plane (TAP) block or quadratus lumborum block (QLB). A recent network meta-analysis (NMA) by Sultan et al compared single-injection TAP block, single-dose WI and continuous wound catheter (WC) in terms of 24-hour opioid consumption. TAP block and WC showed lower opioid consumption and pain scores that WI or inactive control. TAP block also had a longer time-to-first analgesic request than inactive controls.
Patient and Procedural Risk Factors for Increased Postoperative Pain After Cesarean Delivery Under Neuraxial Anesthesia: A Retrospective Study
Authors: Mehdiratta J.E. , Saab R. , Chen Z. , Li Y.J. , Habib A.S.
Published: August 2021

(Int J Obstet Anesth. 2020;44:60–67)

Satisfactory postcesarean pain management is important for many reasons, including allowing early mobility to decrease thromboembolic risk, improved newborn care, and decreased risk for postpartum depression. There is still room for improvement in the management of postoperative pain in cesarean patients and a need to better understand individual variability. This study aimed to identify risk factors associated with increased postoperative pain following cesarean delivery (CD).
Effects of State Law Limiting Postoperative Opioid Prescription in Patients After Cesarean Delivery
Authors: Potnuru P.P. , Patel S.D. , Birnbach D.J. , Epstein R.H. , Dudaryk R.
Published: August 2021

(Anesth Analg. 2021;132:752–760)

Opioids are routinely prescribed following cesarean delivery in the United States, though 1 in 300 of these patients experience new-onset persistent opioid use. As the duration of opioid prescriptions is the strongest indicator of persistent opioid use, the State of Florida passed a law restricting the duration of opioid prescriptions for acute pain to 3 days. Prescriptions may be extended to 7 days if the prescriber documents medical necessity. Studies have been conducted examining the effects of these laws on the general surgery population, there is a lack of studies specifically exploring the impact on cesarean delivery patients. This study aimed to examine the impact of this law, HB 21, on discharge opioid prescription practices in patients undergoing cesarean delivery.
Experimental Studies of Latissimus Dorsi Detrusor Myoplasty for Bladder Acontractility: A Systematic Review
Authors: Forte Antonio J. , Boczar Daniel , Huayllani Maria T. , Moore Pamela A. , Moran Steven L. , Okanlami Oluwaferanmi O. , Ninković Milomir , Broer Peter N.
Published: August 2021

Current therapies that allow patients with bladder acontractility to void are limited. The standard therapy is clean intermittent catheterization. Latissimus dorsi detrusor myoplasty (LDDM) has been shown to provide functional contraction and allow patients with bladder acontractility to void voluntarily. Our goal was to summarize experimental studies of LDDM. We hypothesized that experimental studies would show that latissimus dorsi muscle (LDM) flaps for detrusor myoplasty have superior outcomes when compared with other types of flaps. On January 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, Cochrane Central Register of Controlled Trials, and EMBASE databases, without time frame limitations, to identify articles on the use of LDDM. We excluded studies that investigated other treatments. Of 54 articles identified by the search, three fulfilled the eligibility criteria. A total of 24 dogs underwent procedures and were evaluated with a maximum follow-up of 9 months. Three types of procedures were performed: LDM in situ reconfiguration, LDM myoplasty, and augmentation cystoplasty after supratrigonal cystectomy. Electrical stimulation, cystography, urodynamic and hydrodynamic measurements, and microscopic examinations were performed. Innervated LDM flaps transferred to the bladder were able to contract and promote voiding in response to electrical stimulation. Experimental studies have shown the feasibility of LDDM in canine models. Although no comparison groups were included, innervated LDM flap transferred to the bladder showed promising results regarding contraction capable of voiding.
Breast Implant-Associated Anaplastic Large Cell Lymphoma: My Personal Journey
Authors: Platt Kimberly
Published: August 2021

I am one of only a few patients who have undergone reimplantation with breast implants directly after a diagnosis of breast implant associated-anaplastic large cell lymphoma (BIA-ALCL). This decision was a very personal one and many may question why I would make such a rash decision so soon after being diagnosed. I am proof that this new type of man-made cancer, unknown until the mid-to-late 90s or early 2000s, developed as a result of textured breast implants. The objective of this article is to bring awareness to health care professionals about BIA-ALCL, provide a brief history of the United States Food and Drug Administration textured breast implant approvals and subsequent recall, and talk about the emotional rollercoaster this diagnosis brings to the patient.