bluuebunny/crossref_metadata_2025 huggingface dataset:
Otologic Manifestations of Eosinophilic Granulomatosis With Polyangiitis: A Systematic Review
Authors: Ashman Peter E. , Chen Tiffany , Barinsky Gregory L. , Benson Brian , Babu Seilesh , Bojrab Dennis I. , Svider Peter F.
Published: February 2021

Objective:

To perform a systematic review of the diagnosis, treatment, and management of patients with otologic manifestations of eosinophilic granulomatosis with polyangiitis.

Databases Reviewed:

PubMed, Embase, Cochrane.

Methods:

A systematic search for relevant published literature in PubMed, Cochrane Library, and EMBASE databases was done. Data was collected on demographics, otologic manifestations, specific diagnostic criteria fulfilled, common clinical, and imaging findings as well as medical and surgical treatments received.

Results:

Fifteen articles encompassing 219 patients met inclusion criteria including 8 case reports and 7 case series. The mean age was 52.8 (range of 24–70). The most common otologic presenting symptoms were hearing loss (76%), otitis media with effusion (44%), vertigo (22%), tinnitus (21%), and chronic otitis media (20%). The most common diagnostic criteria observed in these patients were paranasal sinus abnormalities (75%), asthma (66%), and eosinophilia >10% (44%). The most common treatment was systemic steroids (66%), followed by surgery (52%), with myringotomy with tube insertion (M&T) (32%) and endoscopic sinus surgery (21%) being the most prevalent. Thirty-four percent of patients received an immunosuppressive agent. Successful treatments included systemic steroids (23%), surgical modalities (13%) with M&T being the most common (7%), topical nasal steroids (12%), and cyclophosphamide (10%).

Conclusion:

Hearing loss and a middle ear effusion are the most common presenting otologic manifestations of eosinophilic granulomatosis with polyangiitis. Sinonasal disease was more prevalent in patients with otologic manifestations. Primary treatment consists of systemic steroids and immunomodulation. M&T, endoscopic sinus surgery, and local steroid administration can be adjunctive measures to alleviate local disease.

Level of Evidence: Level 1
Tethered Liquid Perfluorocarbon Coating for 72 Hour Heparin-Free Extracorporeal Life Support
Authors: Roberts Teryn R. , Choi Jae Hyek , Wendorff Daniel S. , Harea George T. , Beely Brendan M. , Sieck Kyle N. , Douglass Megan E. , Singha Priyadarshini , Dean Jay B. , Handa Hitesh , Batchinsky Andriy I.
Published: February 2021

Coagulopathic complications during extracorporeal life support (ECLS) result from two parallel processes: 1) foreign surface contact and shear stress during blood circulation and 2) administration of anticoagulant drugs to prevent circuit thrombosis. To address these problems, biocompatible surfaces are developed to prevent foreign surface-induced coagulopathy, reducing or eliminating the need for anticoagulants. Tethered liquid perfluorocarbon (TLP) is a nonadhesive coating that prevents adsorption of plasma proteins and thrombus deposition. We examined application of TLP to complete ECLS circuits (membranes, tubing, pumps, and catheters) during 72 hours of ECLS in healthy swine (n = 5/group). We compared TLP-coated circuits used without systemic anticoagulation to standard of care: heparin-coated circuits with continuous heparin infusion. Coagulopathic complications, device performance, and systemic effects were assessed. We hypothesized that TLP reduces circuit thrombosis and iatrogenic bleeding, without impeding gas exchange performance or causing untoward effects. No difference in bleeding or thrombotic complication rate was observed; however, circuit occlusion occurred in both groups (TLP = 2/5; CTRL = 1/5). TLP required elevated sweep gas rate to maintain normocapnia during ECLS versus CTRL (10–20 vs. 5 L/min; p = 0.047), suggesting impaired gas exchange. Thrombus deposition and protein adhesion on explanted membranes were comparable, and TLP did not preserve platelet or blood cell counts relative to controls. We conclude that neither TLP nor standard of care is an efficacious solution to prevent coagulation disturbances during ECLS. Further testing of promising biomaterials for ECLS utilizing the model outlined here is warranted.
Impact of diabetes mellitus on the relationship between a Poiseuille-based index and fractional flow reserve in intermediate coronary lesions
Authors: Zuo Wenjie , Zhang Xiaoguo , Carvalho Abdlay , Qu Yangyang , Ji Zhenjun , Tao Zaixiao , Ma Genshan
Published: February 2021

Background

The ratio of lesion length (LL) to the fourth power of minimal lumen diameter (MLD) (LL/MLD4) is a Poiseuille-based index with good diagnostic accuracy for the detection of coronary lesions with abnormal fractional flow reserve (FFR). We aimed to evaluate the impact of diabetes mellitus (DM) on its performance in intermediate coronary stenoses.

Methods

We performed quantitative coronary angiography and simultaneous FFR measurement in 324 patients (234 non-DM and 90 DM) with 335 coronary lesions. The area under the receiver-operating characteristic curve (AUC) for angiographic parameters was determined, using an FFR value ≤0.80 to indicate the physiological significance of coronary stenoses.

Results

In the non-DM group, FFR was significantly related to percent diameter stenosis (%DS) (R = −0.238) and LL/MLD4 ratio (R = −0.301; P < 0.001 for both). In the DM group, there was no correlation between %DS and FFR, whereas a close-to-threshold correlation was observed for the LL/MLD4 ratio (R = −0.205; P = 0.048). The AUC of LL/MLD4 ratio was significantly different between non-diabetic and diabetic subjects (0.738 vs. 0.540; P = 0.024). Moreover, the LL/MLD4 ratio showed higher AUCs than %DS (0.738 vs. 0.635; P = 0.017) and LL (0.738 vs. 0.634; P = 0.024) in non-diabetic population but this superiority did not exist in diabetic population.

Conclusion

We showed good diagnostic accuracy of LL/MLD4 ratio for identifying ischemic lesions in patients without DM. However, there was an impaired performance in diabetic patients and thus FFR measurement is essential to determine their hemodynamic status.
Oral nutritional supplements, physical activity, and sarcopenia in cancer
Authors: Wang Junjie , Tan Shanjun , Wu Guohao
Published: February 2021

Purpose of review

Sarcopenia is prevalent in cancer patients and can occur as a result of cancer as well as cancer-related therapies. It is related to high postoperative complications, long hospitalization, slow recovery as well as low tolerance to chemotherapy. Patients with sarcopenia also have poor oncological outcomes. Oral nutritional supplements (ONS) and physical activity have shown great potentials in managing this debilitating condition. We summarized the recent developments in the assessment of sarcopenia and its management with ONS and physical activity.

Recent findings

Many methods were developed to evaluate sarcopenia including muscle quality/quantity measurement and functional tests. Recent studies have shown that ONS and physical training can be used in managing sarcopenia, especially when used together as part of a multimodal intervention. However, barriers such as low awareness and lack of training and support for both patients and healthcare workers still exist and need attention.

Recent findings highlighted the benefits of identifying sarcopenia and managing those at risk. The details of a multimodal protocol, such as components of nutritional substrates, the intensity of physical exercise, and the use of medication need to be further looked into for an optimum approach. Education and training programs need to be developed to overcome the barriers in managing sarcopenia.
Health Equity Beyond Data
Authors: Cruz Taylor M. , Smith Sheridan A.
Published: February 2021

Background:

Recent research and policy initiatives propose addressing the social determinants of health within clinical settings. One such strategy is the expansion of routine data collection on patient Race, Ethnicity, and Language (REAL) within electronic health records (EHRs). Although previous research has examined the general views of providers and patients on REAL data, few studies consider health care workers’ perceptions of this data collection directly at the point of care, including how workers understand REAL data in relation to health equity.

Objective:

This qualitative study examines a large integrated delivery system’s implementation of REAL data collection, focusing on health care workers’ understanding of REAL and its impact on data’s integration within EHRs.

Results:

Providers, staff, and administrators expressed apprehension over REAL data collection due to the following: (1) disagreement over data’s significance, including the expected purpose of collecting REAL items; (2) perceived barriers to data retrieval, such as the lack of standardization across providers and national tensions over race and immigration; and (3) uncertainty regarding data’s use (clinical decision making vs. system research) and dissemination (with whom the data may be shared; eg, public agencies, other providers, and insurers).

Conclusion:

Emerging racial disparities associated with COVID-19 highlight the high stakes of REAL data collection. However, numerous barriers to health equity remain. Health care workers need greater institutional support for REAL data and related EHR initiatives. Despite data collection’s central importance to policy objectives of disparity reduction, data mandates alone may be insufficient for achieving health equity.
The Effect of Medicare Shared Savings Program on Readmissions and Variations by Race/Ethnicity and Payer Status (December 9, 2020)
Authors: Kim Yeunkyung , Thirukumaran Caroline , Temkin-Greener Helena , Hill Elaine , Holloway Robert , Li Yue
Published: February 2021

Objective:

Accountable care organizations in the Medicare Shared Savings Program (MSSP) in the United States attempt to reduce cost and improve quality for their patients by improving care coordination across care settings. We examined the impact of hospital participation in the MSSP on 30-day readmissions for several groups of Medicare inpatients, and by race/ethnicity and payer status.

Main Data Source:

A 2010–2016 Medicare Provider Analysis and Review files.

Research Design:

With propensity score matched sample of MSSP and non-MSSP-participating hospitals, patient-level linear probability models with difference-in-differences approach were used to compare the changes in readmission rates for Medicare fee-for-service patients initially admitted for ischemic stroke, hip fracture, or total joint arthroplasty in MSSP-participating hospitals with non-MSSP-participating hospitals as well as to compare the changes in disparities in readmission rates over time.

Principal Findings:

Hospital participation in MSSP was associated with further reduced readmission rate by 1.1 percentage points (95% confidence interval: −0.02 to 0.00, P<0.05) and 1.5 percentage points (95% confidence interval: −0.03 to 0.00, P=0.08) for ischemic stroke and hip fracture cohorts, respectively, compared with non-MSSP-participating hospitals, after the third year of hospital participation in the MSSP. There was no evidence that MSSP had an impact on racial/ethnic disparities, but increased disparity by payer status (dual vs. Medicare-only) was observed. These findings together suggest that MSSP accountable care organizations may take at least 3 years to achieve reduced readmissions and may increase disparities by payer status.
Indications and limits of postoperative radiotherapy for skin malignancies
Authors: Daniels Christopher P. , Liu Howard Y.-h. , Porceddu Sandro V.
Published: February 2021

Purpose of review

To provide a summary of the current evidence, with a focus on recent publications, pertaining to indications for postoperative radiation therapy for cutaneous squamous-cell carcinoma (cSCC), basal-cell carcinoma, Merkel-cell carcinoma and melanoma of the head and neck.

Recent findings

Meta-analyses in cSCC and Merkel-cell carcinoma have shown an association between postoperative radiation therapy and overall survival. Prospective phase III data in head and neck cSCC has shown excellent locoregional control following surgery and postoperative radiation therapy. The addition of concurrent cytotoxic chemotherapy to postoperative radiation therapy has not improved outcomes in either of these two entities. Postoperative immune checkpoint inhibition or combined BRAF and MEK blockade in stage-III melanoma improves progression-free survival whereas postoperative radiation therapy does not.

Further improvement in outcomes with high-risk cSCC and Merkel-cell carcinoma might be achieved with concurrent or sequential immune checkpoint inhibition and postoperative radiation therapy. Postoperative radiation therapy for cutaneous melanoma should be reserved for patients in whom novel systemic therapies are not a treatment option.
Bioengineering for head and neck reconstruction: the role of customized flaps
Authors: Gualtieri Tommaso , Taboni Stefano , Ferrari Marco , Gilbert Ralph
Published: February 2021

Purpose of review

The purpose of this review is to provide the reader with an overview of the present and future applications of bioengineering for head and neck reconstruction, ranging from the application of Computed Assisted Surgery (CAS) to the most recent advances in 3D printing and tissue engineering.

Recent findings

The use of CAS in head and neck reconstruction has been demonstrated to provide shorter surgical times, improved reconstructive accuracy of bone reconstruction, and achieves better alignment of bone segments in osteotomized reconstructions. Beyond its classical application in bone reconstructions, CAS has demonstrated reliability in the planning and harvesting of soft tissue flaps. To date, literature regarding bioengineering for head and neck reconstruction is mainly focused on in-vitro and animal model experiments; however, some pioneering reports on human patients suggest the potential feasibility of this technology.

Bioengineering is anticipated to play a key role in the future development of customized flaps for head and neck reconstruction. These technologies are particularly appealing as a new technology to address certain unsolved challenges in head and neck reconstruction.
Glucocorticoids Improve Enteral Feeding Tolerance in Pediatric Short Bowel Syndrome With Chronic Intestinal Inflammation
Authors: Wang Fangfang , Gerhardt Brandi K. , Iwansky Sarah N. , Hobson Brandy , Logan Samantha , Mercer David F. , Quiros‐Tejeira Ruben E.
Published: February 2021

Objectives:

A group of short bowel syndrome (SBS) patients developed chronic intestinal inflammation while struggling weaning off parenteral nutrition (PN). They did not respond to standard management of SBS and food allergy. We treated them with glucocorticoids and described the outcome.

Methods:

Our study is a retrospective descriptive study. We reviewed records from the intestinal rehabilitation program from 2006 to 2017. We identified 15 patients whose lab values, pathology results, and clinic notes were reviewed.

Results:

We had more patients (n = 10) with diagnosis of gastroschisis, and more female patients (n = 9). Seven patients weaned off PN with median treatment duration of 5 months, 5 of which remained on budesonide for significant period of time (median: 7.5 months). One of these 7 patients relapsed, as the patient resumed glucocorticoids because of recurrence of chronic intestinal inflammation. Six of 15 children had significant eosinophils in their initial biopsy, 5 of these children weaned off PN whereas 1 child's gastrointestinal (GI) bleeding stopped. Four patients were not able to decrease PN calorie. Two of these patients’ GI bleeding stopped, the other 2 had normalized histology.

Conclusions:

For SBS children with histologically confirmed chronic intestinal inflammation, glucocorticoids may help promote enteral feeding tolerance. Glucocorticoids regimen should be chosen individually. Patients are more likely to respond if initial histology has significant eosinophilic infiltration. Patients may need to remain on glucocorticoids for over 6 months.
Alternative Diagnoses in Pediatric Fecal Microbiota Transplant Referral Patients
Authors: Ruan Wenly , Kellermayer Richard
Published: February 2021

The incidence of Clostridioides difficile infection (CDI) has been increasing in the United States. About 10–20% recur after initial treatment, with increasing recurrence following subsequent treatment courses. This sequence can lead to recurrent CDI (rCDI), refractory to conventional therapeutics resulting in the most common indication for fecal microbiota transplantation (FMT). FMT is the most effective microbial therapeutic to date and can cure rCDI in 80–90% of cases. There is growing concern, however, for pathogen transmission through FMT, underscoring the importance of careful recipient selection. In adults referred for FMT with a tentative diagnosis of rCDI, alternative diagnoses were recognized in 25% of patients, but such observation in children is lacking. In this single-center retrospective study, alternative diagnoses (eg, constipation/overflow diarrhea, inflammatory bowel disease) were found in 13 (22.4%) of 58 children who were referred for FMT evaluation for rCDI. Of the patients who were diagnosed with rCDI, 16 (27.6%) did not require FMT.
Dubin-Johnson Syndrome as Differential Diagnosis for Neonatal Cholestasis
Authors: Junge Norman , Goldschmidt Imeke , Wiegandt Jessica , Leiskau Christoph , Mutschler Frauke , Laue Tobias , Ohlendorf Johanna , Stalke Amelie , Hartleben Björn , Stindt Jan , Keitel Verena , Baumann Ulrich , Pfister Eva-Doreen
Published: February 2021

Objectives:

Dubin-Johnson syndrome (DJS) is an autosomal recessive disorder in which multidrug-resistance-associated protein 2 (MRP2) deficiency causes an excretion disorder of conjugated bilirubin from hepatocytes into bile canaliculi. Its clinical presentation as neonatal cholestasis (NC) is rare but represents an important differential diagnosis. We aimed to define DJS-specific characteristics in NC, in particular in contrast to biliary atresia (BA) patients, and to highlight diagnostic tools that can help to avoid invasive diagnostic tests.

Methods:

We performed a review of case records from 2006 to 2020 and compared 4 DJS patients to 26 patients with proven BA consecutively diagnosed from 2014 to 2017. DJS was diagnosed by urine coproporphyrin analysis (UCA) and by genetic analysis (GA) for disease-associated ABCC2 variants.

Results:

Four male patients with NC were diagnosed with DJS by UCA and GA. DJS patients presenting as NC showed significantly lower values for aspartate aminotransferase (AST) (P < 0.001), for alanine aminotransferase (ALT) (P = 0.002) and for gamma-glutamyl transferase (GGT) (P < 0.001) compared with BA patients. Other examinations, however, could not clearly discriminate them (e.g.: stool colour, serum bile acids, total serum bilirubin).

Conclusions:

DJS is not only a rare differential diagnosis in NC with a suspicious phenotype (almost normal AST, ALT) but also shows overlapping features with BA. It should, therefore, be considered in every infant with NC and an atypical liver enzyme pattern to protect patients from unnecessary, invasive examinations. For this, UCA is a fast and reliable diagnostic tool. Confirmation based on GA is recommended. DJS patients have a good long-term prognosis.
Post-Heart Transplant Care Pathway's Impact on Reducing Length of Stay
Authors: Guertin Lisa , Earle Melinda , Dardas Todd , Brown Christopher
Published: February 2021

Background:

Prolonged length of stay (LOS) has undesirable consequences including increased cost, resource consumption, morbidity, and disruptions in hospital flow.

Local Problem:

A high-volume heart transplant center in the Pacific Northwest had a mean index hospital LOS of 23 days, with a goal of 10 days according to the institutional heart transplant care pathway.

Methods:

A retrospective, regression analysis was used to identify the factors contributing to LOS of 41 post-heart transplant patients.

Interventions:

The post-heart transplant care pathway and order set were modified accordingly and reintroduced to the health care team.

Results:

Factors contributing to LOS included number of days (1) until the first therapeutic calcineurin inhibitor level, (2) until intravenous diuretics were no longer required, and (3) outside of a therapeutic calcineurin inhibitor range. The interventions reduced the mean LOS by 8 days.

Conclusions:

Increased awareness of LOS, education, and consistent use of care pathways can significantly reduce length of stay.
Adopting the Fall Tailoring Interventions for Patient Safety (TIPS) Program to Engage Older Adults in Fall Prevention in a Nursing Home
Authors: Tzeng Huey-Ming , Jansen Lynn S. , Okpalauwaekwe Udoka , Khasnabish Srijesa , Andreas Brenda , Dykes Patricia C.
Published: February 2021

Background:

Falls are the leading cause of injury-related hospitalizations and deaths among older adults globally.

Local problem:

About 24% of Canadian nursing home residents fall annually. This quality improvement project evaluated the impact of the Fall Tailoring Interventions for Patient Safety (TIPS) program on preventing falls and fall-related injuries among older adult nursing home residents in a subacute care unit in Canada.

Methods:

We used the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines for reporting. The intervention site is a 15-bed subacute care unit within a government-funded nursing home.

Intervention:

The Fall TIPS program was adapted to a nursing home setting to prevent falls. It provides fall prevention clinical decision support at the bedside.

Results:

The rates of falls and injuries decreased after implementing the Fall TIPS intervention.

Conclusion:

Engaging nursing home older adult residents in fall prevention is crucial in translating evidence-based fall prevention care into clinical practice.
Implementing the Clinical Occurrence Reporting and Learning System
Authors: Goh Hongli Sam , Tan Vivian , Chang Jessy , Lee Chen Na , Zhang Hui
Published: February 2021

Background:

Most incident reporting systems have been questioned for their effectiveness in improving patient safety as they serve as an administrative reporting system.

Local Problem:

The long-term-care sector faced unique challenges, such an aging population and resource constraints, and its current incident reporting systems lack contextualization to address its needs.

Methods:

This quality improvement project was conducted at a 624-bed nursing home in Singapore from January to September 2019, using the Plan-Do-Study-Act methodology.

Intervention:

The existing incident reporting system (known as Clinical Occurrence Reporting and Learning System—CORALS) was redesigned to facilitate double-loop learning and workplace improvement initiatives.

Results:

The results demonstrated significant improvement in nurses' postintervention knowledge and confidence in handling future adverse events and greater staff awareness and information dissemination on patient safety issues.

Conclusion:

A double-looped system could improve nurses' patient safety awareness and their workplace practices, which would ultimately lead to better patient outcomes.
Anxiety in Hospice Inpatients With Advanced Cancer, From the Perspective of Their Informal Caregivers
Authors: Duijn Jette M. , Zweers Danielle , Kars Marijke C. , de Graeff Alexander , Teunissen Saskia C. C. M.
Published: February 2021

Anxiety is a common symptom in patients with advanced cancer. Early recognition of anxiety is difficult, especially when the physical condition of patients declines and patients are not able to verbally express about their concerns. Under these circumstances, informal caregivers may be a valuable source of information. The aim of this study was to explore anxiety in hospice inpatients with advanced cancer from the perspective of their informal caregivers. Fourteen informal caregivers were interviewed; 64% were women and the median age was 55 years. Informal caregivers assessed patients' anxiety as moderate to severe and identified a negative impact of anxiety on physical, psychological, social, and spiritual dimensions of the patients' lives. They indicated a variety of expressions of anxiety and mentioned physical and mental deterioration as an important source of anxiety. Informal caregivers recognized patients' needs as having a safe environment, presence of people around, and a sense of control over the situation. Although the patients' perspective is the gold standard, informal caregivers can be a valuable source of information in identifying anxiety and providing personalized support. Therefore, informal caregivers should be more involved in the care for anxious patients to improve early recognition of anxiety and to ameliorate anxiety management for this vulnerable patient population.
Measures of Lactation Outcomes in Women Delivering Preterm Infants
Authors: Parker Leslie A. , Cacho Nicole , Bendixen Marion M. , Sullivan Sandra , Magãlhaes Marina , Krueger Charlene , Mueller Martina
Published: February 2021

Background

Mother’s own milk (MOM) is well known to decrease prematurity-related morbidities, yet mothers delivering preterm infants often produce insufficient quantities of milk to provide these benefits. Although a critical need exists for research to support lactation success in this vulnerable population, development and investigation of interventions to increase available MOM for infant consumption requires consistent, valid, and reliable measures of lactation outcomes.

Objectives

The aim of this study was to compare and contrast methods of measuring lactation outcomes in mothers of preterm infants and evaluate their advantages and disadvantages.

Methods

Measures of lactation outcomes were reviewed and synthesized. Insights on best practices and future research directions are provided.

Results

Volume of MOM produced, lactation duration, and time to onset of secretory activation are important measures of lactation success. The most valid and reliable measure of milk production is likely weighing each vial of expressed milk combined with test weighing when infants breastfeed. Measures of lactation duration should include actual days mothers lactated rather than limiting to infant consumption of MOM as a proxy for duration and include not only whether mothers are lactating at infant discharge but whether they are also lactating at other health-relevant time points during hospitalization. Although time to onset of secretory activation is an important lactation outcome, information regarding valid and reliable indicators of onset in women delivering preterm infants is limited, and investigation of such indicators is a research priority. Variables that may affect lactation outcomes, including time to initiation of expression following delivery, duration of expression sessions, expression method, time spent in skin-to-skin care, maternal demographics and comorbidities, as well as maternal intent to lactate, must be considered when researchers investigate lactation outcomes in mothers of very low birth weight infants.

Discussion

Consistent and valid measures of lactation outcomes are required to produce reliable results from which evidence-based practice recommendations can be developed in order to improve lactation success in this vulnerable population.
Limited Utility of Reverse Algorithm Syphilis Testing in HIV Clinic Among Men Who Have Sex With Men
Authors: Dionne-Odom Jodie , Van Der Pol Barbara , Boutwell Alex , Biligowda Niranjan , Schmid Daphne G. , Hook Edward W.
Published: February 2021

Background

The reverse algorithm for syphilis diagnosis consists of a treponemal antibody screening immunoassay followed by confirmatory nontreponemal antibody testing. It is increasingly used in the United States despite studies suggesting limited cost-effectiveness in high-prevalence groups.

Methods

In this retrospective cross-sectional study, we included men who have sex with men tested with the reverse algorithm in an Alabama HIV clinic between March 2015 and February 2017. Trep-Sure enzyme immunoassay (EIA) was used for the initial screen, followed by reflex nontreponemal reactive rapid plasma reagin (RPR) testing of specimens with positive results. Sociodemographic and clinical data were extracted from the electronic medical record and stratified according to EIA screen positivity. Quantitative EIA antibody index values were collected to assess test performance at various thresholds.

Results

Among 1693 men tested for syphilis with the reverse algorithm in HIV clinic, 808 (48%) had a positive initial EIA screen. A majority (53%) of men with subsequent RPR testing had a nonreactive RPR (EIA+/RPR−), and 19% (19/98) of these EIA+/RPR− samples tested had a negative confirmatory Treponema pallidum particle agglutination testing result. Analysis of quantitative EIA index values using a receiver operating characteristics curve suggested that a threshold >8 (rather the current threshold of antibody index 1.2) improved the performance of the test.

Conclusions

Among men who have sex with men tested in HIV clinic, the syphilis reverse algorithm was inefficient because of high rates of prior syphilis and false-positive EIA screening. Frequent syphilis screening in high-prevalence populations is an important part of the US epidemic response, and the traditional algorithm is preferred.
Meibomian Gland Contrast Sensitivity and Specificity in the Diagnosis of Lipid-deficient Dry Eye: A Pilot Study
Authors: Yeh Thao N. , Lin Meng C.
Published: February 2021

SIGNIFICANCE

Lipid deficiency due to meibomian gland (MG) dysfunction is believed to account for the vast majority of patients with dry eye compared with aqueous deficiency. Clinicians commonly evaluate MG length to determine a disease, but our research with isotretinoin users suggests that MG contrast is also an important characteristic to consider.

PURPOSE

This study aimed to determine the sensitivity and specificity of MG contrast for the diagnosis of lipid-deficient dry eye (LDDE).

METHODS

This case-control study used demographic data, Standard Patient Evaluation of Eye Dryness (SPEED) scores, average tear lipid layer thickness (TLLT), fluorescein tear breakup time (FTBUT), upper eyelid meibography images, and meibum quality and quantity scores for individuals with LDDE (SPEED score ≥10 and TLLT ≤35 interferometric color units) and normal individuals (SPEED ≤2 and TLLT ≥80 interferometric color units).

RESULTS

Thirty-one eyes of 22 controls (mean ± SD age, 22.7 ± 5.5 years) and 13 eyes of 12 cases (mean ± SD age, 43.9 ± 17.2 years) were included. Normalized MG contrast was significantly correlated with FTBUT (r = 0.35, P = .02), percent MG atrophy (r = −0.50, P < .001), and SPEED scores (r = −0.49, P < .001). The receiver operating characteristic curve for LDDE diagnosis classifiers MG contrast, MG atrophy, and meibum quantity score had areas under the curve of 0.83, 0.64, and 0.73, respectively. Meibomian gland contrast cutoff at 28.3 intensity units yielded optimal correct classification of subjects (84.1%; sensitivity, 0.69; specificity, 0.90). Cases had shorter FTBUT (P < .001), worse meibum quality (P = .02) and quantity (P = .02) scores, and lower MG contrast (P < .001) compared with controls. Subjects with low MG contrast (≤28.3) had 14.9 higher odds of having LDDE (95% confidence interval, 2.84 to 78.4) compared with subjects with high MG contrast (>28.3).

CONCLUSIONS

Meibomian gland contrast correlates well with clinical parameters and symptoms, shows good sensitivity and excellent specificity for diagnosing LDDE, and can be a useful diagnostic parameter for monitoring MG changes due to age, disease, or intervention.
Comparison of Subjective and Objective Methods of Corneoscleral Limbus Identification from Anterior Segment Optical Coherence Tomography Images
Authors: Skrok Marta K. , Alonso-Caneiro David , Przeździecka-Dołyk Joanna , Siedlecki Damian
Published: February 2021

SIGNIFICANCE

This study evaluates the reliability and validity of an automatic method of the external and internal limbal points identification from anterior segment optical coherence tomography (OCT) images in comparison with manual delineation.

PURPOSE

The purpose of this work was to evaluate the repeatability and precision of a previously proposed automatic method of external and internal limbal points identification and to compare them with the manual delineation by experienced clinicians in terms of limbus diameter.

METHODS

Optical coherence tomography tomograms obtained for 12 healthy volunteers without a history of eye diseases were analyzed. Fifteen OCT tomograms were captured for each patient. For all the images, the external and internal limbal points were determined using both the automatic and manual methods. The external and internal limbus diameters were used as the comparative parameter between the methods under consideration. The statistical analysis included mean, standard deviation, the Passing-Bablok regression, and the Pearson correlation coefficient.

RESULTS

A strong linear dependence between the automatic and manual methods was identified. While compared with the subjective estimates from clinicians, the automatic technique overestimated the external limbus diameter (bias equals 0.21 mm for optometrist and 0.23 mm for ophthalmologist) and slightly underestimated the internal limbus diameter (bias equals 0.13 mm for optometrist and 0.04 mm for ophthalmologist). The automatic method showed significantly better repeatability than the manual method in the case of external limbal points identification and comparably high repeatability for internal limbal points recognition.

CONCLUSIONS

Because of high precision and excellent repeatability, the automatic method of limbal points identification may be successfully used for estimation of the dynamic changes in the geometry of the anterior segment of the eye, where the large number of captured OCT images needs to be processed automatically with high precision.
Tear Fluid and Serum Vitamin D Concentrations in Unilateral Pterygium
Authors: Örnek Nurgül , Oğurel Tevfik , Kısa Üçler
Published: February 2021

SIGNIFICANCE

Vitamin D has antiangiogenic, anti-inflammatory, and antifibrotic properties, which may play an inhibitory role on pterygium formation. Vitamin D concentration was measured in few studies, and contradictory results have been reported. There is no study investigating tear fluid concentration of vitamin D in pterygium patients.

PURPOSE

This study evaluated tear fluid and serum vitamin D concentrations of pterygium patients in comparison with healthy controls.

METHODS

Thirty-five (21 male, 14 female) patients with unilateral pterygium and 25 (18 male, 7 female) healthy controls were included in this case-control study. After full ophthalmic examination, blood samples were taken, and basal tear fluid was collected using glass microcapillary tubes. Tear fluid and serum vitamin D concentrations were analyzed using enzyme-linked immunosorbent assay and analyzed statistically.

RESULTS

The mean ± standard deviation age of patients was 51.7 ± 16.7 years in the study group and 50.6 ± 18.7 years in the control group, respectively (P = .82). The mean tear fluid vitamin D concentration was statistically significantly higher than the mean serum concentration in the study groups (P < .0001). The mean tear fluid (P = .76) and serum vitamin D concentrations (P = .53) did not reveal statistically significant difference between patients and controls. There was no statistically significant difference for tear fluid vitamin D concentration between pterygium eyes and fellow eyes (P = .93). The difference in concentrations was compared within the pterygium subgroups, and it was found that the mean serum vitamin D concentration trended toward lower values as the stage of pterygium increased, and the mean tear fluid vitamin D concentration trended toward higher values as the stage of pterygium increased, although these differences were not statistically significant (all, P > .05).

CONCLUSIONS

Tear fluid and serum vitamin D concentrations do not seem to have a role in pterygium pathogenesis.
High- and Low-contrast Letter Acuity during Image Motion in Normal Observers and Observers with Infantile Nystagmus Syndrome
Authors: Bedell Harold E. , Song Sop
Published: February 2021

SIGNIFICANCE

High-contrast acuity in individuals with infantile nystagmus syndrome (INS) is poorer than expected from their ongoing retinal image motion, indicating a sensory loss. Conversely, acuity for larger low-contrast letters in these observers may be limited by image motion alone.

PURPOSE

The aim of this study was to assess visual acuity for letters of different contrast in normal observers and individuals with idiopathic INS under conditions of comparable retinal image motion.

METHODS

Visual acuity was measured using projected Landolt C charts in 3 normal observers and 11 observers with presumed idiopathic INS. Normal observers viewed each chart after reflection from a front-surface mirror that underwent continuous 4-Hz ramp motion with amplitudes ranging from 4 to 9.6° and simulated foveation durations of 20 to 80 milliseconds. Observers with INS viewed the charts directly. By reciprocally varying the luminance of the projected charts and a superimposed veiling source, Landolt C's were presented on a background luminance of 43 cd/m2 with Weber contrasts between −12 and −89%.

RESULTS

Whereas normal observers' high-contrast acuity during imposed image motion depends only on the duration of the simulated foveation periods, acuity for low-contrast optotypes also worsens systematically as motion intensity (frequency × amplitude) increases. For comparable parameters of retinal image motion, high-contrast acuity in all but one of the observers with INS was poorer than in normal observers. On the other hand, low-contrast acuity in the two groups of observers was similar when the retinal image motion was comparable.

CONCLUSIONS

Reduced high-contrast acuity in observers with INS appears to be attributable primarily to a sensory deficit. On the other hand, the reduction of low-contrast acuity in observers with INS may be accounted for on the basis of retinal image motion.
Comparative Analysis of Tear Proteins in Keratoconic Scleral Lens Wearers with Variation in Limbal Clearance
Authors: Yeung Debby , Murphy Paul J. , Sorbara Luigina
Published: February 2021

SIGNIFICANCE

Cytokine and protease analysis revealed relative changes in the post-lens tear film of scleral lenses with low and high limbal clearances. Results from this study indicate that midperipheral lens fit is an important fitting feature that can impact the inflammatory response of a keratoconic eye.

PURPOSE

The purpose of this study was to investigate changes in levels of inflammatory mediators in the post-lens tear film of keratoconic scleral lens wearers with varying limbal clearance designs.

METHODS

Twenty-two keratoconic eyes were fitted with two sets of scleral lenses that were consistent in lens diameter and central sagittal depth but varied in limbal clearance by approximately 50 μm. Lenses were worn in a randomly assigned order for a 2-week period each. At each follow-up visit, immediately after lens removal, tear samples were collected with a microcapillary tube (10 μL, 0.5 mm in diameter) from the bowl of the inverted scleral lens. Tear cytokine and protease analysis was performed using a multiplex electrochemiluminescent array (Meso Scale Discovery, Rockville, MD) instrument. Levels of interleukins 1, 6, and 8; tumor necrosis factor α; and matrix metalloproteinases 1 and 9 were compared and analyzed.

RESULTS

Levels of interleukin 1β, tumor necrosis factor α, and matrix metalloproteinase 1 increased with high limbal clearance (P = .01, .006, and .02, respectively). No change in interleukins 6 and 8 levels was found (P > .05). A decrease in matrix metalloproteinase 9 was noted in post-lens tear film of scleral lenses with high limbal clearance (P = .10).

DISCUSSION

Relative changes in the cytokine and protease levels were found when comparing low and high limbal clearance, indicating that the midperipheral lens fit is an important feature that can impact the inflammatory response of the keratoconic eye.
L1CAM Expression in Recurrent Estrogen Positive/HER2 Negative Breast Cancer: A Novel Biomarker Worth Considering
Authors: Moisini Ioana , Zhang Huina , D’Aguiar Marcus , Hicks David G. , Turner Bradley M.
Published: February 2021

We investigate L1 cell adhesion molecule (L1CAM) expression in estrogen receptor (ER)-positive/human epidermal growth factor receptor (HER2)-negative breast carcinomas. The finding of a potential correlation between high L1CAM expression and recurrent/metastatic disease in luminal A and B breast carcinomas may be helpful for risk stratification and open opportunities for targeted therapies. 304 cases comprising 152 cases of ER-positive, progesterone receptor (PR)-positive/negative, and HER2-negative recurrent/metastatic breast carcinomas and 152 nonrecurrent controls were included. ER, PR, HER-2, Ki-67 status, Nottingham grade, tumor size, tumor stage, number of foci, lymph node status, lymphovascular invasion, phenotype, laterality, age at diagnosis and first distant or local recurrence were recorded. L1CAM positive cases showed increased specificity for recurrence and these patients were significantly younger than L1CAM negative ones. Compared with L1CAM negative recurrent cases, L1CAM positive ones had a noticeably higher Ki-67, tended to be larger and recurred sooner. All L1CAM positive recurrent/metastatic cases were of the luminal B subtype compared with 67.3% of the L1CAM negative cases. L1CAM is highly specific for recurrence in a subset of breast cancer patients and may be associated with more aggressive behavior, particularly in luminal B breast cancers with higher Ki-67 expression. Further investigation about the prognostic value of L1CAM is warranted.
Objective Visual Analog Scale for Biopsy Diagnosis of Helicobacter pylori Infection in Clinical Practice
Authors: Boylan Katherine E. , Patrey Shruti , McMullen Phillip D. , Tesic Vera , Weber Christopher R. , Hart John , Setia Namrata
Published: February 2021

Historic and current pathology society guidelines recommend using visual gestalt to identify substantial inflammatory cell infiltrate in Helicobacter pylori gastritis, but these scales were subjectively designed. This study aims to objectively investigate the density of inflammation that justifies additional workup for H. pylori infection. We retrospectively identified 2 patient cohorts who had undergone endoscopy with gastric biopsies; 1 with H. pylori infection (n=66), confirmed with a positive stool antigen test and/or Campylobacter-like organism test, and 1 without infection (n=81). Antral and body biopsies were selected from each case, if available, and stained with MUM-1 to highlight mucosal plasma cells. Digital analysis was performed to calculate the number of plasma cells/mm2, termed the “inflammatory score” (IS). Patients with H. pylori infection had an average of 1289 plasma cells/mm2 in the antrum and 835 plasma cells/mm2 in the body, compared with 346 plasma cells/mm2 in the antrum and 178 plasma cells/mm2 in the body in patients without infection. IS cut-off values for a positive infection were 714 plasma cells/mm2 in the antrum and 316 plasma cells/mm2 in the body, with high sensitivities and specificities in both the antrum (92%, 92%) and body (85%, 84%), respectively. A visual analog scale was created to provide a histologic correlate of the observed IS ranges and cut-offs. This practical and objective scale is associated with a high sensitivity and specificity for diagnosing H. pylori infection and justifies moving away from upfront universal H. pylori testing in routine clinical practice.
Twenty-Four–Hour Esophageal pH Measurement in Mechanically Ventilated Children: A Prospective Cohort Study*
Authors: Gupta Priyanka , Sankar Jhuma , Kumar B. Kiran , Jat Kana Ram , Mukherjee Aparna , Kapil Arti , Kabra Sushil K. , Lodha Rakesh
Published: February 2021

Objectives:

To assess the prevalence of gastroesophageal reflux in mechanically ventilated children using 24-hour esophageal pH-metry and its role as a risk factor for ventilator-associated pneumonia.

Design:

Prospective cohort study.

Setting:

PICU of a tertiary care hospital from North India.

Patients:

Mechanically ventilated children 1–15 years old in PICU from July 2015 to June 2017, excluding those receiving acid suppressants, known cases of gastroesophageal reflux disease, having upper gastrointestinal bleed.

Intervention:

Demographic details, baseline investigations, diagnosis, treatment details, and Pediatric Risk of Mortality III score were recorded at enrollment. Gastroesophageal reflux was evaluated using 24-hour esophageal pH-metry. Children were followed up for 7 days or 48 hours after extubation for development of ventilator-associated pneumonia using Centers for Disease Control and Prevention criteria. Pathologic acidic gastroesophageal reflux was defined as fall in esophageal pH less than 4 for more than 4% of total time, whereas pathologic alkaline gastroesophageal reflux as rise in esophageal pH greater than 7 for more than 17% of total time.

Measurements and Main Results:

Sixty-one children (median [interquartile range], age 73 mo [30–132 mo]; 44 boys [72%]) were enrolled. Median Pediatric Risk of Mortality III score was 10.0 (3–16). Median duration of ventilation was 6 days (3–9 d). Pathologic gastroesophageal reflux (acidic or alkaline) was present in 47 children (77%). Twelve children (19.7%) met criteria for pathologic acidic gastroesophageal reflux, whereas 44 children (72.1%) had pathologic alkaline gastroesophageal reflux; nine children (14.7%) had both pathologic acidic and alkaline gastroesophageal reflux. Of the enrolled children, 17 (27.9 %) developed ventilator-associated pneumonia. No patient had both pathologic acidic gastroesophageal reflux and ventilator-associated pneumonia. Of 17 children who developed ventilator-associated pneumonia, 12 (70.5%) had pathologic alkaline gastroesophageal reflux as compared to 32 children (72.7%) among the 44 children who did not develop ventilator-associated pneumonia (p = 0.87).

Conclusions:

The current study shows high incidence of gastroesophageal reflux on 24-hour esophageal pH-metry in mechanically ventilated children with medical diagnoses. The significance of this finding and its impact on ventilator-associated pneumonia and other ventilator-associated events need to be examined in larger studies.