bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel Technique with Double Free Flap Design for Advanced Mandibular Osteoradionecrosis: A Case Series
Authors: Kenney Peter S. , Kiil Birgitte J.
Published: February 2021

Advanced mandibular osteoradionecrosis is arguably among the most challenging cases for reconstructive head and neck surgeons. Several reconstructive methods for complex mandibular defects have been reported; however, for advanced mandibular osteoradionecrosis, a safe option that minimizes the risk of renewed fistulation and infections is needed. For this purpose, we present a new technique using a fascia-sparing vertical rectus abdominis musculocutaneous flap as protection for a vascularized free fibula graft (FFG). This technique also optimizes recipient site healing and functionality while minimizing donor site morbidity. Our initial experiences from a 4 patient case series are included. Mean operative time was 551 minutes (SD: 81 minutes). All donor sites were closed primarily. Mean time to discharge was 13 days (SD: 7 days), and mean time to full mobilization was 2 days (SD: 1 days). This double free flap technique completely envelops the FFG and plate with nonirradiated muscle. It allows for the transfer of an FFG without a skin island, thus avoiding the need for split skin graft closure. This results in faster healing and minimizes the risk of fibula donor site morbidity. The skin island of the vertical rectus abdominis musculocutaneous flap has the added benefit of providing intraoral lining, which minimizes contractures and trismus. Although prospective long-term studies comparing this approach to other double flap procedures are needed, we argue that this technique is an optimal approach to safeguard the mandibular FFG reconstruction against the inherent risks of renewed complications in irradiated unhealthy tissue.
Plastic Surgery and COVID-19 in the GCC: Fears, Lessons Learned, and the Plan for the Future
Authors: Al Saud Nouf A. , Alanazi Shahad N. , Alshomer Feras M. , Kattan Abdullah E. , Mrad Mohamed A. , Al Fardan Zuhair , Alhumsi Taghreed R.
Published: February 2021

Background:

With the labeling of Coronavirus Disease 2019 (COVID-19) as a pandemic by the World Health Organization, national directives were issued instructing to close all cosmetic clinics, suspend all cosmetic procedures, and only operate on an emergency basis. As a result, many plastic surgeons faced challenges sustaining their practice. We aimed to investigate the effect of these national directive instructions on the surgeons and to review their strategies for adapting their practices during this new pandemic.

Methods:

A cross-sectional descriptive study was conducted using an online questionnaire. It was constructed to assess the attitudes and practices of plastic surgeons in the Gulf Cooperation Council countries during the COVID-19 lockdown. It also explored their strategies on reopening their practice, as well as their plans on modifications of practice during and after the lockdown.

Results:

In total, 197 surgeons responded to the survey. The majority were from Saudi Arabia (42.1%), followed by the United Arab Emirates (37.6%), with relatively smaller participation from the remaining countries. Over two-thirds (69.5%) indicated that the pandemic had affected their practice. Surgeons in private practices were significantly affected (P < 0.001) compared with those in the public sector. Only 39% of respondents mentioned COVID-19 testing as part of their post-pandemic surgical protocol.

Conclusions:

Surgeons’ responses to the pandemic varied. Fear and future uncertainty significantly led to a surge in the utilization of different technical means to maintain the patient pool. Surgeons’ education about post-pandemic precautions is essential to maintain high standards of care in the region.
Can Lymph Transportation Capacity Predict Treatment Efficacy of Lower Extremity Lymphedema by LVA?
Authors: Sowa Yoshihiro , Kodama Takuya , Numajiri Toshiaki
Published: February 2021

Treatment outcomes for lower extremity lymphedema (LEL) using multiple lymphaticovenular anastomoses (LVA) are still uncertain. Classification of progression of lymphedema by disease staging is a potential preoperative predictor of the efficacy of treatment, but it is difficult to judge progression of lymphedema objectively. Recent studies have indicated that lymph pump dysfunction, which reflects lymph transportation capacity, is associated with lymphedema progression. Indocyanine green (ICG) lymphography, a minimally invasive modality for pathophysiological assessment of lymphedema, can be used for rapid and objective measurement of ICG velocity (ICGv) and transit time to the knee (TTk), which are parameters of lymph transportation capacity, over a certain period. In the current study, we analyzed the relationship between these parameters and outcomes for LEL treated by multiple LVA. Thirty-four consecutive patients who underwent multiple LVA and ICG lymphography were enrolled in the study. The relationship of ICGv and TTk with the efficacy of treatment by LVA (LEL index reduction) was investigated using Pearson correlation coefficient analysis. LEL index reduction was more strongly correlated with ICGv than with TTk, whereas it was weakly correlated with both quantification methods of lymph pump function (r > 0.6). Both ICGv and TTk are objective and simple parameters that can measure lymph pump functions quickly. Lymph pump function, especially calculated with ICGv, might help predict the treatment efficacy and objective evaluation after therapeutic intervention using multiple LVA.
Epithelioid Sarcoma in a Young Child: A Case Report and Literature Review
Authors: Talbet Joseph Hany , McGrath Jennifer L. , Manrique Monica , Mantilla-Rivas Esperanza , Meany Holly J. , Oh Albert K. , Rogers Gary F.
Published: February 2021

Epithelioid sarcoma is a rare, high-grade malignant soft tissue tumor that is often misdiagnosed. Classified as a mesenchymal malignancy, it exhibits both mesenchymal and epithelial markers. Occurrence in children under age 10 is extremely rare. This report describes the clinical course and management of a 5-year-old girl who presented with epithelioid sarcoma in the distal extremity. The lesion was initially misdiagnosed and treated for over a year as a common wart.
Impact of cortisol on blood pressure and hypertension-mediated organ damage in hypertensive patients
Authors: Haddad Christelle , Courand Pierre-Yves , Berge Constance , Harbaoui Brahim , Lantelme Pierre
Published: February 2021

Objectives:

Patients with overt and subclinical Cushing's syndrome frequently develop hypertension, metabolism disorders, and atherosclerotic lesions. The aim of the present study was to test the association between cortisol and blood pressure (BP), organ damage, and metabolic parameters in hypertensive patients without hypercortisolism.

Methods:

After exclusion of patients treated with corticosteroids or with Cushing's syndrome, the cohort included 623 hypertensive patients (mean ± SD age 50.3 ± 15.4 years, 50.9% men, median 24-h BP 146/88 mmHg) with an extended work-up (lipid profile, hypertension-mediated organ damage). Cortisol secretion was assessed by plasma cortisol at 0800 and 1600 h, and by 24-h urinary free cortisol (24 h UFC) normalized if required to urine creatinine (UFC/U creat).

Results:

Plasma cortisol at 1600 h, 24 h-UFC, and UFC/U creat were significantly and positively correlated with daytime, night-time, and 24-h SBP; plasma cortisol at 0800 h was not associated with BP. The strongest correlations were observed in the subgroup of aged more than 50 years (correlation coefficients between 0.23 and 0.28). These correlations remained after adjustment on plasma aldosterone. Metabolic parameters were weakly associated with cortisol. Arterial stiffness (central pulse pressure and pulse wave velocity), plasma NT-proBNP, and microalbuminuria were significantly correlated with 24 h UFC, UFC/U creat, and plasma cortisol at 1600 h.

Conclusion:

Cortisol influences weakly the level of BP independently from plasma aldosterone in hypertensive patients, particularly in older patients, and that there was weak association with HMOD. It may, therefore, be of interest to test specific treatments targeting cortisol excess in selected hypertensive patients.
Association between the proportions of carbohydrate and fat intake and hypertension risk: findings from the China Health and Nutrition Survey
Authors: He Dingliu , Sun Na , Xiong Suting , Qiao Yanan , Ke Chaofu , Shen Yueping
Published: February 2021

Objective:

The aim of this study was to expound the dietary effects of different proportions of carbohydrate and fat on hypertension in the Chinese population.

Methods:

We used data derived from the China Health and Nutrition Survey (CHNS) from 1991 to 2011. In total, 10 459 Chinese participants aged over 12 years were included in the final analysis. A multivariable Cox regression was used to calculate the hazard ratio and 95% confidence interval (95% CI) of hypertension in each group, and the medium proportion of carbohydrate and fat (MPCF) diet intake group was used as the reference.

Results:

Compared with the participants who consumed an MPCF diet, the individuals who consumed a high-carbohydrate and low-fat (HCLF) diet had a higher risk of developing hypertension (hazard ratio: 1.295, 95% CI: 1.167–1.436), especially the individuals who were young (hazard ratio: 1.422, 95% CI: 1.106–1.828), were living in rural areas (hazard ratio: 1.373, 95% CI: 1.206–1.565) and consumed alcohol (hazard ratio: 1.363, 95% CI: 1.153–1.611). In addition, a low-carbohydrate and high-fat (LCHF) diet was not associated with hypertension (hazard ratio: 0.861, 95% CI: 0.694–1.068). Moreover, these associations were observed at the majority energy intake level.

Conclusion:

An HCLF diet was significantly associated with an increased risk of hypertension.
Collecting duct-specific knockout of sphingosine-1-phosphate receptor 1 aggravates DOCA-salt hypertension in mice
Authors: Hu Gaizun , Zhu Qing , Wang Weili , Xie Dengpiao , Chen Chaoling , Li Pin-Lan , Ritter Joseph K. , Li Ningjun
Published: February 2021

Objective:

We have previously reported that renal medullary sphingosine-1-phosphate (S1P) regulates sodium excretion via the S1P type-1 receptor (S1PR1). As S1PR1 is predominantly expressed in collecting ducts (CD), the present study tested the hypothesis that the CD-S1PR1 pathway plays a critical role in sodium excretion and contributes to salt-sensitive hypertension.

Methods:

CD-specific S1PR1 knockout mice were generated by crossing aquaporin-2-Cre mice with S1PR1-floxed mice. Renal sodium excretion and arterial pressure were compared between wild type and KO mice in response to high-salt challenges and treatment of deoxycorticosterone acetate (DOCA) salt.

Results:

Protein levels of renal medullary S1PR1 were increased by 100% after high-salt intake, whereas DOCA treatment with high-salt intake blocked the increase of S1PR1 levels. Urinary sodium excretions in knockout mice were decreased by 60% compared with wild type mice after acute intravenous sodium loading (0.84 ± 0.16 vs. 2.22 ± 0.62 μmole/min per g kwt). The pressure natriuresis was impaired in knockout mice compared with wild type mice (4.32 ± 1.04 vs. 8.73 ± 0.19 μmole/min per g kwt). The chronic high-salt intake-induced positive sodium balance was enhanced in knockout mice compared with wild type mice (5.27 ± 0.39 vs. 2.38 ± 1.04 mmol/100 g BW per 24 h). After 10-day DOCA-salt treatment, knockout mice developed more severe hypertension than wild type mice (SBP 142 ± 8 vs. 115 ± 4 mmHg).

Conclusion:

The deletion of CD-S1PR1 reduced sodium excretion, promoted sodium retention, and accelerated DOCA-salt-induced salt-sensitive hypertension, suggesting that the CD-S1PR1 signaling is an important antihypertensive pathway by promoting sodium excretion and that impairment of renal medullary S1PR1 may represent a novel mechanism for salt-sensitive hypertension.
REMOVAL OF DROPPED HEAVY SILICONE OIL BUBBLE USING AIR
Authors: El-Khayat Abdul , Sharma Ash , Mitra Arijit
Published: February 2021

Purpose:

To report a new ‟rescue” technique for the removal of a dropped heavy silicone oil (HSO) bubble, after failed aspiration with a short, 23-gauge cannula and suction pump.

Methods:

If the HSO bubble is dropped during standard, 23-gauge, transconjunctival extraction with a suction pump, filtered air can be injected into the HSO bubble to make it rise. Extraction can then be resumed with the suction pump, resulting in complete removal of HSO.

Results:

This technique has been used approximately ten times over the last 18 months with a 100% success rate and no complications.

Conclusion:

We present a safe, simple, and cost-effective ‟rescue” method for the removal of a dropped HSO bubble using air. With the rise in popularity of HSO and the development of new heavy tamponades, safe and effective techniques for their removal are becoming increasingly important.
Combining In Vivo Corneal Confocal Microscopy With Deep Learning–Based Analysis Reveals Sensory Nerve Fiber Loss in Acute Simian Immunodeficiency Virus Infection
Authors: McCarron Megan E. , Weinberg Rachel L. , Izzi Jessica M. , Queen Suzanne E. , Tarwater Patrick M. , Misra Stuti L. , Russakoff Daniel B. , Oakley Jonathan D. , Mankowski Joseph L.
Published: February 2021

Purpose:

To characterize corneal subbasal nerve plexus features of normal and simian immunodeficiency virus (SIV)-infected macaques by combining in vivo corneal confocal microscopy (IVCM) with automated assessments using deep learning–based methods customized for macaques.

Methods:

IVCM images were collected from both male and female age-matched rhesus and pigtailed macaques housed at the Johns Hopkins University breeding colony using the Heidelberg HRTIII with Rostock Corneal Module. We also obtained repeat IVCM images of 12 SIV-infected animals including preinfection and 10-day post-SIV infection time points. All IVCM images were analyzed using a deep convolutional neural network architecture developed specifically for macaque studies.

Results:

Deep learning–based segmentation of subbasal nerves in IVCM images from macaques demonstrated that corneal nerve fiber length and fractal dimension measurements did not differ between species, but pigtailed macaques had significantly higher baseline corneal nerve fiber tortuosity than rhesus macaques (P = 0.005). Neither sex nor age of macaques was associated with differences in any of the assessed corneal subbasal nerve parameters. In the SIV/macaque model of human immunodeficiency virus, acute SIV infection induced significant decreases in both corneal nerve fiber length and fractal dimension (P = 0.01 and P = 0.008, respectively).

Conclusions:

The combination of IVCM and robust objective deep learning analysis is a powerful tool to track sensory nerve damage, enabling early detection of neuropathy. Adapting deep learning analyses to clinical corneal nerve assessments will improve monitoring of small sensory nerve fiber damage in numerous clinical settings including human immunodeficiency virus.
Selective targeting of peripheral cannabinoid receptors prevents behavioral symptoms and sensitization of trigeminal neurons in mouse models of migraine and medication overuse headache
Authors: Yamamoto Toru , Mulpuri Yatendra , Izraylev Mikhail , Li Qianyi , Simonian Menooa , Kramme Christian , Schmidt Brian L. , Seltzman Herbert H. , Spigelman Igor
Published: February 2021

Migraine affects ∼15% of the world's population greatly diminishing their quality of life. Current preventative treatments are effective in only a subset of migraine patients, and although cannabinoids seem beneficial in alleviating migraine symptoms, central nervous system side effects limit their widespread use. We developed peripherally restricted cannabinoids (PRCBs) that relieve chronic pain symptoms of cancer and neuropathies, without appreciable central nervous system side effects or tolerance development. Here, we determined PRCB effectiveness in alleviating hypersensitivity symptoms in mouse models of migraine and medication overuse headache. Long-term glyceryl trinitrate (GTN, 10 mg/kg) administration led to increased sensitivity to mechanical stimuli and increased expression of phosphorylated protein kinase A, neuronal nitric oxide synthase, and transient receptor potential ankyrin 1 proteins in trigeminal ganglia. Peripherally restricted cannabinoid pretreatment, but not posttreatment, prevented behavioral and biochemical correlates of GTN-induced sensitization. Low pH-activated and allyl isothiocyanate-activated currents in acutely isolated trigeminal neurons were reversibly attenuated by PRCB application. Long-term GTN treatment significantly enhanced these currents. Long-term sumatriptan treatment also led to the development of allodynia to mechanical and cold stimuli that was slowly reversible after sumatriptan discontinuation. Subsequent challenge with a previously ineffective low-dose GTN (0.1-0.3 mg/kg) revealed latent behavioral sensitization and increased expression of phosphorylated protein kinase A, neuronal nitric oxide synthase, and transient receptor potential ankyrin 1 proteins in trigeminal ganglia. Peripherally restricted cannabinoid pretreatment prevented all behavioral and biochemical correlates of allodynia and latent sensitization. Importantly, long-term PRCB treatment alone did not produce any behavioral or biochemical signs of sensitization. These data validate peripheral cannabinoid receptors as potential therapeutic targets in migraine and medication overuse headache.
The LACE Index: A Predictor of Mortality and Readmission in Patients With Acute Myocardial Infarction
Authors: Labrosciano Clementine , Tavella Rosanna , Air Tracy , Zeitz Christopher J. , Worthley Matthew , Beltrame John F.
Published: February 2021

Introduction:

Improving patient outcomes after acute myocardial infarction (AMI) may be facilitated by identifying patients at a high risk of adverse events before hospital discharge. We aimed to determine the accuracy of the LACE (Length of stay, Acuity, Comorbidities, Emergency presentations within prior 6 months) index score (a prediction tool) for predicting 30-day all-cause mortality and readmission rates (independently and combined) in South Australian AMI patients who had an angiogram.

Methods:

All consecutive AMI patients enrolled in the Coronary Angiogram Database of South Australia Registry at two major tertiary hospitals and discharged alive between July 2016 to June 2017. A LACE score was calculated for each patient, and receiver operating characteristic curve analysis was performed.

Results:

Analysis of registry patients found a 30-day unplanned readmission rate of 11.8% and mortality rate of 0.7%. Moreover, the LACE index was a moderate predictor (C-statistic = 0.62) of readmissions in this cohort, and a score ≥10 indicated moderate discriminatory capacity to predict 30-day readmissions.

Conclusion:

The LACE index shows moderate discriminatory capacity to predict 30-day readmissions and mortality. A cut-off score of nine to optimize sensitivity may assist clinicians in identifying patients at a high risk of adverse outcomes.
Building Capacity for Integrated Occupational Safety, Health, and Well-Being Initiatives Using Guidelines for Total Worker Health® Approaches
Authors: Pronk Nicolaas P. , McLellan Deborah L. , Dennerlein Jack T. , Anderson Paul , Karapanos Melissa , Nagler Eve , Schmidt Devyne , Spoonheim Joel , Wallace Lorraine M. , Sorensen Glorian
Published: February 2021

Objectives:

To describe the process used to build capacity for wider dissemination of a Total Worker Health® (TWH) model using the infrastructure of a health and well-being vendor organization.

Methods:

A multiple-case study mixed-methods design was used to learn from a year-long investigation of the experiences by participating organizations.

Results:

Increased capacity for TWH solutions was observed as evidenced by the participation, plans of action, and experience ratings of the participating organizations. The planning process was feasible and acceptable, although the challenges of dealing with the COVID-19 pandemic only afforded two of the three worksites to deliver a comprehensive written action plan.

Conclusions:

A suite of services including guidelines, trainings, and technical assistance is feasible to support planning, acceptable to the companies that participated, and supports employers in applying the TWH knowledge base into practice.
The value of faculty during student on-site evaluations
Authors: Roberts Mary Ellen E. , Ruppert Susan D. , Tyler Diane O. , Meadows Richard F.
Published: February 2021

The American Academy of Nurse Practitioners Certification Board recognizes the value of nurse practitioner faculty in evaluating students at the clinical site. The Board of Commissioners recently approved the awarding of clinical hours to nurse practitioner faculty for clinical site visits. This article outlines the rationale and procedure for conducting and documenting student visits that can be applied to recertification.
Utilization of SEMAC-VAT MRI for Improved Visualization of Posterior Fossa Structures in Patients With Cochlear Implants
Authors: Amin Nikul , Pai Irumee , Touska Philip , Connor Steve E. J.
Published: February 2021

Objective:

The number of cochlear implant (CI) users is ever increasing worldwide, as is the utilization of magnetic resonance imaging (MRI) as a key diagnostic modality for pathology of the brain and surrounding structures. Despite advances in MRI compatibility with CI, metal artefact remains a significant issue that needs to be addressed. We test our hypothesis that the slice encoding for metal artefact correction and view angle tilting (SEMAC-VAT) metal artefact reduction technique improves demonstration of posterior fossa structures on MRI in CI recipients.

Study Design:

A retrospective case review.

Setting:

A tertiary referral hearing implant and skull base center.

Intervention(s):

Dedicated MRI of the posterior fossa using T1 spin echo post-gadolinium sequences with and without the application of SEMAC-VAT in CI recipients.

Main Outcome Measure(s):

Extent and severity of the artefact and visualization of surrounding anatomic structures with and without the application of SEMAC-VAT, allowing for direct comparison.

Results:

Eight CI recipients with nine CI devices were analyzed. We noted a significant reduction in signal void and improved visibility of the ipsilateral hemisphere in every case. Penumbra size increased although there was improved visibility through the penumbra. There was improved visualization of key intracranial structures, such as the ipsilateral internal auditory canal, cerebellopontine angle, cerebellar hemisphere, and brainstem.

Conclusions:

Application of SEMAC-VAT produces a significant reduction in signal void and improved visualization of key structures within the temporal bone and posterior cranial fossa in patients with CIs without the need for removal of the internal magnet.
Clinical Implementation of Second-generation Minimally Invasive Image-guided Cochlear Implantation Surgery
Authors: Labadie Robert F. , Riojas Katherine , Von Wahlde Kathleen , Mitchell Jason , Bruns Trevor , Webster Robert , Dawant Benoit , Fitzpatrick J. Michael , Noble Jack
Published: February 2021

Objective:

Minimally invasive, image-guided cochlear implantation (CI) surgery consists of drilling a precise tunnel from the surface of the mastoid cortex through the facial recess to target the scala tympani. In the first set of clinical trials of this technique, heat-induced facial nerve paresis (House-Brackmann II/VI) occurred on a patient on the last day of the initial trial which was scheduled to be halted secondary to a change in the regulatory requirements dictated by the 2012 the Food and Drug Administration Safety and Innovation Act requiring Investigational Device Exemption approval for previously exempted customized medical device testing. To address this adverse event, extensive changes were made to the drilling protocol; additionally, a custom insertion tool was developed. To address the Food and Drug Administration Safety and Innovation Act, an Investigational Device Exemption was submitted and, subsequently approved. Herein is described our first clinical implementation of the modified technique.

Patient:

Seventy-year-old with profound, postlingual sensorineural hearing loss who had previously undergone right CI via traditional approach in 2015.

Intervention:

Minimally invasive image-guided left CI.

Main Outcome Measure:

Time of intervention, final location of CI electrode array within cochlea.

Results:

Surgery took 155 minutes of which the largest components (in descending order) were soft tissue work, closure, and drilling. Full scala tympani insertion with angular insertion depth of 557 degrees of the electrode array was achieved. There were no complications, and the patient had an uneventful recovery and activation.

Conclusions:

Minimally invasive, image-guided CI surgery is achievable and reduces the mastoid depression associated with traditional CI surgery.

ClinicalTrials.gov information:

Study NCT03101917, Microtable Microstereotactic Frame and Drill Press and Associated Method for Cochlear Implantation

Level of Evidence:

Case Report.
Cost-Utility Analysis of Bilateral Cochlear Implantation in Adults With Severe to Profound Sensorineural Hearing Loss in Poland
Authors: Skarzynski Piotr Henryk , Ciesla Katarzyna , Lorens Artur , Wojcik Joanna , Skarzynski Henryk
Published: February 2021

Objective:

The aim of the study was to develop a Markov model and apply it for the evaluation of three different treatment scenarios for adult patients with severe to profound bilateral sensorineural hearing loss.

Study Design:

Prospective Observational Study.

Settings:

Hospital.

Patients:

A clinical group of 22 adult patients (59.1% men, 40.9% women) aged from 59.13 ± 8.9 years were included in the study. The study comprised two arms: patients in group 1 received the second cochlear implant one to three months after the first implant; while patients in group 2 got the second cochlear implant approximately one year after the first implant.

Main Outcome Measures:

All participants were first asked to complete an AQoL-8D questionnaire. For the cost-effectiveness analyses, a Markov model analyzed as microsimulation was developed to compare the different treatment options.

Results:

The analyses show that bilateral cochlear implantation strategies are cost-effective compared to the ‘no treatment’ alternative when having a 10-year model time horizon. When all three model scenarios are compared, the bilateral simultaneous cochlear implantation strategy (Scenario 3) compared to the ‘no treatment’ option is even more cost-effective than the Scenarios 1 and 2, compared with the ’no treatment’ alternative.

Conclusions:

The model results summarize that bilateral (sequential and simultaneous) cochlear implantation that are represented in the model scenarios, are cost-effective strategies for Polish adult patients with bilateral severe to profound sensorineural hearing loss.
Underreporting of Vestibular Schwannoma Incidence Within National Brain Tumor and Cancer Registries in the United States
Authors: Marinelli John P. , Nassiri Ashley M. , Habermann Elizabeth B. , Lohse Christine M. , Holton Sara J. , Carlson Matthew L.
Published: February 2021

Objective:

Reports using large brain tumor and cancer registries suggest that the incidence of vestibular schwannoma is considerably lower in the United States compared with other countries. The current study compares the incidence and disease characteristics of vestibular schwannoma within a large tertiary referral center's brain tumor and cancer registry using nationally mandated reporting protocols to disease incidence in the same population using an externally validated population-based consortium.

Study Design:

Population-based study spanning 1,945,007 person-years.

Setting:

Large tertiary referral center.

Patients:

Adults with sporadic vestibular schwannoma.

Main Outcome Measure:

Disease incidence rates from 2004 to 2016.

Results:

From 2004 to 2016, the incidence of vestibular schwannoma in the tumor registry was 1.3 per 100,000 person-years whereas the population-based cohort had an incidence of 4.4 per 100,000 person-years. From 2012 to 2016, the incidence in the tumor registry was 1.4 per 100,000 person-years compared with 5.2 in the population-based cohort. Patients within the population-based cohort were significantly more likely to have smaller tumors at diagnosis (78% intracanalicular versus 45%; p = 0.004) and consequently more likely to undergo management consisting of observation with serial imaging as opposed to treatment with either microsurgery or radiosurgery (71% versus 28%; p = 0.001).

Conclusions:

The reliance on pathology specimens and cancer-related treatment data for the national registration of new cancer and brain tumor diagnoses may introduce selection bias and underreporting of benign brain tumors that frequently involve observation as a primary treatment modality. This selection bias likely accounts for the discrepant incidence rates of vestibular schwannoma reported between the United States and other countries.
The features of the typical traumatic brain injury patient in the ICU are changing: what will this mean for the intensivist?
Authors: Newcombe Virginia F.J. , Chow Andrew
Published: February 2021

Purpose of review

To describe the key features and epidemiology of traumatic brain injury (TBI) and how they may be changing, with an emphasis on how this may affect care in the intensive care unit.

Recent findings

TBI has been traditionally perceived as occurring mainly in a younger, predominantly male population injured in high velocity motor vehicle crashes or assaults. However, there are an increasing number of patients over 65 years who have sustained a TBI secondary to low velocity falls. Considering the effects of frailty, comorbidities and extracranial injuries is important when making management decisions. Mild TBI comprises a third of those admitted and as a significant proportion may have poor outcomes secondary to their TBI they should be assessed to ensure appropriate follow-up. Multimodal monitoring may offer a way in the future to offer more personalised management to this very complex and heterogeneous patient group.

This review highlights the urgent need to develop more age-inclusive TBI consensus management guidelines aimed at improving short- and long-term outcomes for the large and growing TBI population. Being elderly does not necessarily portend a poor outcome, and more research is needed to better triage, guide management and prognosticate on these patients.
Donor-specific antibody and sensitized patients in intestinal transplantation
Authors: Matsumoto Cal S. , Rosen-Bronson Sandra
Published: February 2021

Purpose of review

It has been well established that antibody to donor HLA pretransplant and the development of anti-human leukocyte antigen (HLA) antibodies posttransplant contribute to inferior graft survival outcomes. This article serves to review the current status of the management of pretransplant sensitized intestinal transplant candidate as well as to review posttransplant care of patients that harbor antidonor HLA antibodies.

Recent findings

The intestinal transplant candidate oftentimes presents for transplant listing with high levels of anti-HLA antibodies that necessitate a careful preoperative strategy to avoid a donor–recipient pair that would result in a positive crossmatch. In the end, donor intestine offer acceptance is based on a balance between recipient clinical needs and allowable immunologic risk tolerance. The use of virtual crossmatching (VXM) enables the transplant center to effectively gauge the immunologic risk of each potential donor–recipient pair far in advance of allocating resources toward pursuing a donor organ. In those candidates with high levels of preformed donor anti-HLA antibodies, desensitization with a novel technique of donor splenic perfusion has been described as well as a single-center experience with a conventional desensitizing protocol. Posttransplant, with the use of a denovo donor-specific antibody (dnDSA) monitoring and treatment protocol, the well known deleterious effects of dnDSA can potentially be ameliorated, thus improving outcome. Efforts to establish a formal histologic criteria for antibody-mediated rejection (ABMR) in the intestinal graft continues to evolve with recent findings describing the relationship between DSA and histopathologic findings.

Techniques such as the use of VXM, novel desensitization methods and protocols, monitoring and eradicating dnDSA, along with establishing new criteria for ABMR have all contributed to improving the outcomes in transplanting the immunologically challenging intestine.
Influence of Family History on Children With Irritable Bowel Syndrome
Authors: Fu Yinan , Thomas Ron , Cares Kristen
Published: February 2021

The influence of family history on children with irritable bowel syndrome (IBS) is unknown. We conducted a retrospective study to compare the clinical profile and management differences between children with a family history of IBS (FH‐IBS) versus without. A total of 251 children were included in the study, 75 (30%) had FH‐IBS and 176 (70%) did not. No significant differences were observed between the 2 groups in sex composition, age at initial visit, age of IBS diagnosis, dietary modifications, supplements, laxatives, antispasmodics, antidiarrheals, and cyproheptadine use. Children with FH‐IBS were, however, more like to have psychological comorbidities (41% vs 23%, P = 0.003), and were more likely to receive psychological counseling (49% vs 23%, P < 0.001) and antidepressant treatment (36% vs 15%, P < 0.001) versus children without. We concluded that children with FH‐IBS are more likely to have underlying psychological disorders and receive psychological interventions.
Can powered exoskeletons improve gait and balance in multiple sclerosis? A retrospective study
Authors: Russo Margherita , Maggio Maria Grazia , Naro Antonino , Portaro Simona , Porcari Bruno , Balletta Tina , De Luca Rosaria , Raciti Loredana , Calabrò Rocco Salvatore
Published: February 2021

Multiple sclerosis (MS) is a progressive neurologic disorder that can profoundly influence mobility, independence and quality of life. Gait dysfunction in MS is common, resulting in an increased risk of losing walking ability. Robotic exoskeletons have been developed to offer a new form of locomotor training. The aim of our study was to investigate the effectiveness of the powered exoskeleton (Ekso) in improving gait and balance in patients affected by MS. Twenty patients with MS (mean ± SD: age = 43.7 ± 10.3 years; 66.7% male) were enrolled in this retrospective study. They were divided into two groups, matched for demographic data (age and sex) and medical characteristics (disease duration and Expanded Disability Status Scale), but differing for the type of rehabilitation training performed. Group 1 [experimental group (EG)] received gait training with the Ekso device, whereas group 2 (control group) performed traditional gait training. Although both trainings led to a significant improvement in the ability to walk and balance, only in the EG a significant improvement in walking speed (10 Meter Walk test; P = 0.002), in person’s mobility (Timed Up and Go test; P = 0.002), and in the perception of mental well-being (MSQoL-M; P = 0.004), with a good usability and acceptance of the device, was found. Powered exoskeletons could be considered a valuable tool to improve functional outcomes and get the therapeutic goal in patients with MS.
Preference and Influencing Factors of Advance Care Planning for Chinese Elderly Patients With Chronic Diseases
Authors: Yang Zhen , Hou Bailing , Chen Ping , Zhang Huijun
Published: February 2021

The incidence of chronic diseases among elderly patients increases annually with the accelerating aging process in China. Complications arising from the progression of these diseases may affect the ability of the aged to communicate and make decisions about future medical and personal care. This study aimed to investigate acceptance and influencing factors of advance care planning for community-dwelling elderly patients with chronic diseases in the Republic of China. Using a convergent parallel mixed-methods design, 471 elderly Chinese nationals older than 60 years with chronic diseases were recruited using convenience sampling. Quantitative data collection used Chinese versions of the Elderly Death Attitude Scale, Modified Barthel Index Rating Scale, and the Advance Care Planning Acceptance Questionnaire, followed by 14 patients drawn from the quantitative phase. Interviews were thematically analyzed. The results showed that attitude to death and quality of life were key predictors of advance care planning implementation preference, whereas family support and past medical experience were significant factors. The study highlighted the importance of conducting regular education about death, paying attention to quality of life, providing family support, and discussing past medical experience in order to implement advance care planning for elderly patients with chronic diseases in China.
The Impact of the SARS-CoV-2 Pandemic on Human Immunodeficiency Virus and Bacterial Sexually Transmitted Infection Testing and Diagnosis in Oregon
Authors: Menza Timothy W. , Zlot Amy I. , Garai Jillian , Humphrey Sarah , Ferrer Josh
Published: February 2021

Human immunodeficiency virus, Neisseria gonorrhoeae/Chlamydia trachomatis, and syphilis testing decreased with the implementation of mitigation measures for SARS-CoV-2 and did not return to 2019 levels by September 2020. However, primary and secondary syphilis diagnoses increased during mitigation measures. Sexual health services are essential during the SARS-CoV-2 pandemic.
Afterword to “Working on the Frontlines From Home: Residents’ Experiences With Telepsychiatry During the COVID-19 Pandemic”
Authors: PLAKUN ERIC M.
Published: February 2021

The coronavirus disease 2019 (COVID-19) pandemic thrust health care professionals around the globe to the frontlines to care for those affected by this medical crisis. While many surgical and procedural medical subspecialties experienced drastic declines in patient visits during this time, the demand for psychiatric services was more stable. In response to statewide stay at home orders, third-year residents in the psychiatry outpatient clinic described in this article quickly transitioned to telepsychiatry to continue providing care to their patients. While providing care from home, these residents experienced a number of challenges that serve as important lessons for enhancing competence in telepsychiatry services.
Relationship Between Psychiatric Inpatient Beds and Jail Populations in the United States
Authors: GAO Y. NINA
Published: February 2021

Background:

The US criminal justice system has witnessed dramatic increases in its mentally ill population during the past 50 years. The decreasing number of psychiatric beds is one proposed cause and more psychiatric beds may be one solution.

Objective:

This study examined the relationships among large changes in local psychiatric bed capacity, local jail inmate populations, and the psychiatric burden at local general hospitals.

Methods:

The study used a kernel method to identify abrupt changes in psychiatric bed capacity using the American Hospital Association Survey and Medicare Provider of Services data. Data were aggregated to the hospital referral region–year level and matched to the National Inpatient Sample of hospital discharges 1988-2015 and the Annual Survey of Jails 1985-2014. Subsequent analysis by event study examined the effect of abrupt bed changes on numbers of jail inmates.

Results:

Decreases in local psychiatric bed capacity were associated with an average increase of 256.2 jail inmates (95% confidence interval: 3.3-509.1). Increases in psychiatric bed capacity were associated with an average decrease of 199.3 jail inmates (95% confidence interval: −457.4 to 58.8). There was limited evidence for spillovers to general hospitals immediately following decreases in psychiatric beds.

Conclusions:

Decreases in local psychiatric bed capacity appear to be associated with subsequent increases in local jail populations. There was no clear evidence of treatment shifting from psychiatric units to local general hospitals. These findings support concerns that a consequence of reducing psychiatric inpatient bed capacity is an increase in the jail population due to more psychiatrically ill inmates, aggravating the challenge of psychiatric treatment delivery within the US criminal justice system.
Autism Spectrum Disorder in Early Intervention in Psychosis Services: Implementation and Findings of a 3-step Screening and Diagnostic Protocol
Authors: TREISE CATE , SIMMONS CAROLINE , MARSHALL NICOLA , PAINTER MICHELLE , PEREZ JESUS
Published: February 2021

Evidence indicates that autism spectrum disorder (ASD) is underidentified in populations with psychosis, but that clinical presentations of comorbid ASD and psychosis (ASD-P) and specific treatment needs that may relate to this group are not well understood. In fact, recent studies of ASD in first-episode psychosis suggest that there may be a specific clinical presentation of ASD-P. In response, the Cambridgeshire and Peterborough Early Intervention in Psychosis (EIP) service in the UK implemented and evaluated a 3-step ASD screening and diagnostic protocol, using the Autism Spectrum Disorder in Adults Screening Questionnaire (ASDASQ), case note review, and the Autism Diagnostic Observation Schedule (ADOS-2) and the Childhood Autism Spectrum Test (CAST). As a quality improvement project, the evaluation aimed to (1) establish the prevalence of patients with ASD-P, (2) describe characteristics of the clinical presentation of ASD-P and compare them to those of patients suffering from psychosis but no ASD, and (3) determine any differences in treatment between psychosis patients with and without ASD. Notably, at least 9% of the EIP service caseload met the criteria for a diagnosis of ASD-P, with half identified via the implementation of this protocol. The patients with ASD-P had specific clinical presentations and treatment needs that differed from those of patients with psychosis but no ASD. Thus, the findings from this study supported existing evidence concerning the underdetection of ASD in EIP populations. Our findings also added to emerging evidence for a clinical presentation of ASD-P with specific treatment needs. Our protocol has now been established as routine practice, and its implementation has improved the detection and treatment of patients with ASD-P within our EIP service.
Exercise ECG for coronary artery disease screening in people living with HIV
Authors: Muccini Camilla , Galli Laura , Poli Andrea , Godino Cosmo , Gianotti Nicola , Nozza Silvia , Giusti Maria C. , Lazzarin Adriano , Margonato Alberto , Castagna Antonella , Spagnuolo Vincenzo
Published: February 2021

Background:

Coronary artery disease (CAD) is one of the leading causes of death among people living with HIV (PLWH). We evaluated ECG stress testing (EST) for detecting CAD in PLWH with multiple cardiovascular risk factors.

Methods:

CORDIS was a cross-sectional study conducted in PLWH. Inclusion criteria were men at least 50 years or postmenopausal women, HIV-1 RNA less than 50 copies/ml and at least one of the following cardiovascular risk factor: familial history of CAD, smoking, hypertension, hypercholesterolemia or diabetes. Patients with a previous diagnosis of CAD or with cardiac symptoms were excluded. EST was performed concomitantly with bilateral carotid color-Doppler ultrasonography (CDU) and evaluated by a cardiologist. Results were described by median (interquartile range) or frequency (%). Logistic regression was applied to evaluate predictive factors of inducible myocardial ischemia (IMI).

Results:

EST and CDU were performed in 309 individuals; IMI prevalence was 7.4% [95% confidence interval (CI): 5.0–11.0%]. Among patients with a normal CDU, no cases of IMI were observed. In people with abnormal CDU, IMI prevalence increased accordingly with the atherosclerotic cardiovascular disease (ASCVD) risk score: 10.2%, 16.9%, 19.7%, 27.8% and 30.4% among individuals with ASCVD score 7.5% or less, more than 7.5%, more than 10%, more than 15% and more than 20%, respectively (P for trend: 0.02). At multivariate analysis, ASCVD risk score was associated with EST suggestive of IMI (adjusted odds ratio for 1% increase = 1.08; 95% CI: 1.02–1.13, P = 0.005) and with confirmed IMI (adjusted odds ratio for 1% increase = 1.11; 95% CI: 1.04–1.19, P = 0.003).

Conclusion:

Prevalence of IMI was 7.4% in the CORDIS study. We suggest EST as first-line screening for CAD in PLWH without cardiac symptoms, with an abnormal CDU and a high ASCVD risk score.
Cardiac Transplantation in HIV-Positive Patients: A Narrative Review
Authors: Wairimu Faith , Ward Natalie C. , Liu Yingwei , Dwivedi Girish
Published: February 2021

Before the introduction of highly active antiretroviral therapy, patients infected with HIV experienced poor prognosis including high rates of opportunistic infections, rapid progression to AIDS, and significant mortality. Increased life expectancy after therapeutic improvements has led to an increase in other chronic diseases for these patients, including cardiovascular disease and, in particular, end-stage heart failure. Historically, HIV infection was deemed an absolute contraindication for transplantation. Since the development of highly active antiretroviral therapy, however, life expectancy for HIV-positive patients has significantly improved. In addition, there is a low incidence of opportunistic infections and the current antiretrovirals have an improved toxicity profile. Despite this, the current status of cardiac transplants in HIV-positive patients remains unclear. With this in mind, we conducted a narrative review on cardiac transplantation in patients with HIV.
Biomarkers in sepsis: can they help improve patient outcome?
Authors: Kyriazopoulou Evdoxia , Poulakou Garyfallia , Giamarellos-Bourboulis Evangelos J.
Published: February 2021

Purpose of review

Biomarkers, mainly procalcitonin, are commonly used in sepsis diagnosis, prognosis and treatment follow-up. This review summarizes the potential benefit of their use for the critically ill.

Recent findings

Increased clinical evidence from randomized clinical trials of biomarker-guided treatment suggests a trend for appropriate but short antimicrobial treatment for the critically ill. Procalcitonin (PCT) is the most studied biomarker; in the majority of randomized clinical trials, the use of a stopping rule of antibiotics on the day when PCT is below 80% from baseline or less than 0.5 ng/ml was proven effective to reduce length of antimicrobial treatment, antibiotic-associated adverse events and infectious complications like infections by multidrug-resistant organisms and Clostridium difficile. Survival benefit was also noted.

Biomarkers, mainly PCT, may help improve sepsis outcome by restriction of injudicious antimicrobial use.