bluuebunny/crossref_metadata_2025 huggingface dataset:
Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Augmented Reality Surgical Navigation for Percutaneous Pedicle Screw Placement
Authors: Charles Yann P. , Cazzato Roberto L. , Nachabe Rami , Chatterjea Anindita , Steib Jean-Paul , Gangi Afshin
Published: February 2021

Study Design:

This was a retrospective observational study.

Objective:

The aim of this study was to evaluate the accuracy of percutaneous pedicle screw placement using augmented reality surgical navigation during minimally invasive transforaminal lumbar interbody fusion (TLIF).

Summary of Background Data:

Augmented reality-based navigation is a new type of computer-assisted navigation where video cameras are used instead of infrared cameras to track the operated patients and surgical instruments. This technology has not so far been clinically evaluated for percutaneous pedicle screw placement.

Materials and Methods:

The study assessed percutaneous pedicle screw placement in 20 consecutive patients who underwent single-level minimally invasive TLIF using augmented reality surgical navigation. Facet joint violation and depression by the inserted pedicle screws were evaluated. Secondary outcome such as radiation dose exposure, fluoroscopy time, and operative time were collected for 3 phases of surgery: preparation phase, pedicle screw placement, and decompression with cage placement.

Results:

A clinical accuracy for screw placement within the pedicle (Gertzbein 0 or 1) of 94% was achieved. One screw violated the facet joint with a transarticular pathway. The screw head did not depress the facet in 54%. The use of fluoroscopy during navigation correlated with patient body-mass index (r=0.68, P<0.0001). The pedicle screw placement time corresponded to 36±5% of the total operative time of 117±11 minutes. A statistically significant decrease of 10 minutes in operative time was observed between the first and last 10 procedures which corresponded to the pedicle screw placement time decrease (48±9 vs. 38±7 min, P=0.0142). The learning curve model suggests an ultimate operative time decrease to 97 minutes.

Conclusion:

Augmented reality surgical navigation can be clinically used to place percutaneous screws during minimally invasive TLIF. However, the lack of tracking of the location of the device requires intraoperative fluoroscopy to monitor screw insertion depth especially in obese patients.

Level of Evidence:

Level III.
The Influence of Comorbidity on Postoperative Outcomes Following Lumbar Decompression
Authors: Nolte Michael T. , Parrish James M. , Jenkins Nathaniel W. , Cha Elliot D.K. , Lynch Conor P. , Mohan Shruthi , Geoghegan Cara E. , Jadczak Caroline N. , Hrynewycz Nadia M. , Singh Kern
Published: February 2021

Study Design:

Retrospective.

Objective:

Evaluate the association between comorbidity burden and reaching minimum clinically important difference (MCID) following lumbar decompression (LD).

Summary of Background Data:

There is limited research on the influence of preoperative comorbidity burden on patient-reported outcome improvement following LD.

Methods:

A prospectively maintained surgical registry was retrospectively reviewed for eligible spine surgeries between 2015 and 2019. Inclusion criteria were primary, single, or multilevel LD. Patients were excluded for missing preoperative patient-reported outcome surveys. Stratification was based on Charlson Comorbidity Index (CCI) score: 0 points (no comorbidities), 1–2 points (low CCI), ≥3 points (high CCI). Demographics and perioperative characteristics were evaluated for differences. Linear regression assessed postoperative improvement for visual analogue scale (VAS) back, VAS leg, Oswestry disability index (ODI), Short Form-12 Physical Composite Score (SF-12 PCS), and Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF) scores through 1 year. Achievement rate of MCID was compared between groups and evaluated for significant predictors.

Results:

Three hundred fourteen patients were included (123 no comorbidities, 100 low CCI, 91 high CCI). Higher CCI patients were older, more likely to smoke, and have comorbid diseases (all P<0.001). Perioperative differences included increased operative time, levels decompressed, length of stay, and discharge day in the CCI≥3 group. No differences in the rate of achieving MCID for VAS back, VAS leg, and ODI. CCI≥3 subgroup had a lower rate of reaching MCID at 6 months for SF-12 PCS, at 6 weeks for PROMIS-PF, and the overall rate for both SF-12 PCS and PROMIS-PF (all P<0.05). Multilevel procedures was a predictor for MCID achievement for ODI.

Conclusions:

Patients with increased comorbidities undergoing LD had an equivalent MCID achievement rate for pain and disability metrics through 1 year. High CCI patients did, however, have a lower rate of achieving MCID for their physical function surveys which suggests that comorbidity burden influences improvement in physical function following LD.
The Relationship Between Cervical Sagittal Balance and Adjacent Segment Disease After Three-level Anterior Cervical Discectomy and Fusion
Authors: Teo Shao Jin , Goh Graham S. , Yeo William , Chen John Li-Tat , Soh Reuben C.C.
Published: February 2021

Study Design:

Retrospective review of prospectively collected data.

Objective:

To determine the relationship between cervical sagittal balance and adjacent segment degeneration (ASD) development after 3-level anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:

ASD is a common complication after ACDF. Previous studies have shown that sagittal imbalance may be associated with ASD development after 1-level or 2-level ACDF. However, these findings may not be generalizable to 3-level procedures.

Materials and Methods:

We reviewed prospectively collected data of 46 patients who underwent 3-level ACDF at a tertiary institution. Lateral cervical radiographs taken preoperatively, postoperatively, and at last follow-up were reviewed for ASD. The mean follow-up duration was 5 years. Radiographic parameters measured were cervical sagittal alignment (CSA), segmental sagittal alignment, T1 slope (T1S), sagittal vertical axis, and T1S−cervical lordosis.

Results:

ASD was present in 27 (58.7%) patients, but only 1 patient (2.2%) underwent reoperation at 4.8 years. The CSA, sagittal vertical axis, and T1S were similar preoperatively, but the T1S−cervical lordosis was higher in the ASD group (18.28 vs. 9.82, P=0.016). All 4 parameters were similar postoperatively and at last follow-up. The ASD group had a greater change in CSA over the follow-up period (−6.26 vs. −1.47, P=0.05), but they achieved similar sagittal alignment at last follow-up. There was no difference in clinical outcomes between the 2 groups.

Conclusions:

Unlike studies on 1-level and 2-level ACDF, this study found that cervical spinal alignment was not associated with ASD development after 3-level ACDF. ASD development also had no impact on clinical outcomes at 2 years.

Level of Evidence:

Level III—nonrandomized cohort study.
The prognostic value of Piezo1 in breast cancer patients with various clinicopathological features
Authors: Xu Hui , Chen Zhuo , Li Chouyang
Published: February 2021

The effects of piezo-type mechanosensitive ion channel component 1 (Piezo1) in sensing extracellular mechanical stress have been well investigated. Recently, Piezo1’s vital role in cancerogenesis has been demonstrated by many studies. Nonetheless, the prognostic value of Piezo1 in cancer still remains unexplored and unclear. This article aims to investigate the prognostic value of Piezo1 in breast cancer. Human Protein Atlas and the Cancer Genome Atlas (TCGA) databases were used to examine Piezo1 expression in different human tissues and human cell lines. The discrepancies of Piezo1 mRNA expression in breast cancer patients with different clinicopathological features were assessed using bc-GenExMiner. The prognostic value of Piezo1 in breast cancer patients was evaluated using Kaplan–Meier plotter. Piezo1 mRNA was extensively expressed in human tissues and cell lines, particularly in breast and cancerous breast cancer cell line MCF7. High Piezo1 expression was found correlated with poor prognosis of breast cancer. Survival analysis further confirmed unfavorable prognosis of high Piezo1 expression in breast cancer patients with lymph node positive, estrogen receptor positive, Grade 2 (Scarff-Bloom-Richardson grading system), luminal A, and human epidermal growth factor receptor 2 overexpression, respectively. This study suggested that Piezo1 can serve as a prognostic indicator of breast cancer.
Secondary Analysis of Existing Data Sets for Developmental Behavioral Pediatrics
Authors: Langkamp Diane L. , Barnes Andrew J. , Zuckerman Katharine E.
Published: February 2021

Secondary analysis of existing large, national data sets is a powerful method to address many of the complex, key research questions in developmental behavioral pediatrics (DBP). Major advantages include decreasing the time needed to complete a study and reducing expenses associated with research by eliminating the need to collect primary data. It can also increase the generalizability of research and, with some data sets, provide national estimates that may form the basis for developing policy. However, few resources are available to direct researchers who seek to develop expertise in this area. This study aims to guide investigators with limited experience in this area who wish to improve their skills in performing secondary analysis of existing large data sets. This study provides direction on the steps to perform secondary analysis of existing data sets. It describes where and how data sets can be identified to answer questions of interest to DBP. Finally, it offers an overview of a number of data sets relevant to DBP.
Postoperative Pain After Mohs Surgery: Physician Perceptions and How Those Perceptions Influence Opioid Prescribing Practices
Authors: Eikenberg Joshua D. , Taylor Savannah , Lockhart Ellen Rachel , Prickett Kyle , Phillips Mariana A.
Published: February 2021

BACKGROUND

Little is known about dermatologists' perceptions of postoperative pain and how those perceptions correlate with patient-reported pain and opioid prescribing.

OBJECTIVE

To determine dermatologists' accuracy in predicting postoperative pain compared with patient-reported pain and how physicians' perceptions affect opioid prescribing practices.

METHODS AND MATERIALS

A prospective observational study in which patients undergoing Mohs surgery rated pain on the Numerical Rating Scale (0–10). Using the same scale, the physician predicted how much pain the patient would experience postoperatively on the evening of surgery. All analgesic medications taken in postoperative period were recorded.

RESULTS

A total of 316 patients completed the study (70% completion rate). Physician predictions were correlated with patient-reported pain (p < .001; r = 0.29) and were within 2 points of patient-reported pain in 70% of cases. When physicians overestimated patient-reported by ≥3 points, they were not more likely to prescribe opioids (p = .8094). Physicians predicted higher pain for patients who were prescribed opioids (p = .0002).

CONCLUSION

Dermatologists were fairly accurate at predicting postoperative pain. Dermatologists were not more likely to prescribe opioids when pain was overpredicted.
Reconstruction of Perioral Defects After Mohs Micrographic Surgery or Excision: A Systematic Review of the Literature
Authors: Shahwan Kathryn T. , Mori Westley S. , Bakker Caitlin , Mattox Adam R. , Alam Murad , Maher Ian A.
Published: February 2021

BACKGROUND

Although many repair methods for postsurgical lip defects have been described, the literature lacks a comprehensive review of these methods.

OBJECTIVE

To perform a systematic review of lip defect repair methods after Mohs surgery or excisions.

MATERIALS AND METHODS

Terms related to perioral anatomy, Mohs surgery and excision, and reconstruction were used to search 8 databases. Articles were included if they reported postsurgical lip repair data for 4 or more patients, were in English, and were published from 2004 onward. Two reviewers screened all titles and abstracts, followed by the full texts of the remaining articles. Data were then extracted including author specialties, study design, demographic, tumor, and defect information, surgical procedures, outcomes, and complications.

RESULTS

Forty-two studies were eligible, including a randomized trial, 25 case series, and 16 cohort studies. Most were written by dermatologic or plastic surgeons, and most studies were small, with an average subject number of 61. Very few studies used structured outcome measures. Many repair methods were described, the most common of which were linear closures and various flaps.

CONCLUSION

Many repair methods for lip defects have been published, but overall, the quality of the available evidence is low.
Low-blood pressure phenotype underpins the tendency to reflex syncope
Authors: Brignole Michele , Rivasi Giulia , Sutton Richard , Kenny Rose Anne , Morillo Carlos A. , Sheldon Robert , Raj Satish R. , Ungar Andrea , Furlan Raffaello , van Dijk Gert , Hamdan Mohamed , Hamrefors Viktor , Engström Gunnar , Park Chloe , Soranna Davide , Zambon Antonella , Parati Gianfranco , Fedorowski Artur
Published: February 2021

Background:

We hypothesized that cardiovascular physiology differs in reflex syncope patients compared with the general population, predisposing such individuals to vasovagal reflex.

Methods:

In this multicohort cross-sectional study, we compared aggregate data of resting SBP, DBP, pulse pressure (PP) and heart rate (HR), collected from six community-based cohort studies (64 968 observations) with those from six databases of reflex syncope patients (6516 observations), subdivided by age decades and sex.

Results:

Overall, in male individuals with reflex syncope, SBP (−3.4 mmHg) and PP (−9.2 mmHg) were lower and DBP (+2.8 mmHg) and HR (+5.1 bpm) were higher than in the general population; the difference in SBP was higher at ages above 60 years. In female individuals, PP (−6.0 mmHg) was lower and DBP (+4.7 mmHg) and HR (+4.5 bpm) were higher than in the general population; differences in SBP were less pronounced, becoming evident only above 60 years. Compared with male individuals, SBP in female individuals exhibited slower increase until age 40 years, and then demonstrated steeper increase that continued throughout remaining life.

Conclusion:

The patients prone to reflex syncope demonstrate a different resting cardiovascular haemodynamic profile as compared with a general population, characterized by lower SBP and PP, reflecting reduced venous return and lower stroke volume, and a higher HR and DBP, suggesting the activation of compensatory mechanisms. Our data contribute to a better understanding why some individuals with similar demographic characteristics develop reflex syncope and others do not.

Video abstract:

http://links.lww.com/HJH/B580.
Rare Infant Case of Pulmonary Aspergilloma Highlighting Common Challenges With Voriconazole Dosing
Authors: Abo Yara-Natalie , Gwee Amanda , Osowicki Joshua
Published: February 2021

We describe a 6-week-old male-term infant with a pulmonary aspergilloma diagnosed following lobectomy for suspected pleuropulmonary blastoma, with characteristic histopathologic findings and Aspergillus detected by polymerase chain reaction. Intensive testing did not reveal primary or secondary immunodeficiency. During 5 weeks treatment with voriconazole including regular therapeutic drug monitoring and dose adjustment, a level in the target range was never achieved. When the patient developed photosensitivity, treatment was stopped without relapse over 12 months follow-up. Voriconazole dosing is notoriously challenging in children. We review the cumulative published experience with voriconazole use in infants to highlight even greater difficulty in infants. Pulmonary aspergillosis is typically a disease affecting immunocompromised or critically ill patients. In children, it is well described in those with chronic granulomatous disease (CGD) as a complication of immunosuppressive antineoplastic chemotherapy and rarely in extremely- or very-low birthweight premature neonatal intensive care patients. The diagnosis is extremely rare in children without underlying risk factors. To our knowledge, this is the first report of a pulmonary aspergilloma in an immunocompetent infant.
Job Demands and Job Control and Future Labor Market Situation
Authors: Farrants Kristin , Norberg Jan , Framke Elisabeth , Rugulies Reiner , Alexanderson Kristina
Published: February 2021

Objectives:

Investigate prospective associations between combinations of job demands/job control and future labor market situation.

Methods:

A population-based prospective cohort study of 2,194,694 individuals in paid work. Using multinomial logistic regression, we calculated the association between combinations of job demands/control in 2001, according to a job exposure matrix, and their long-term unemployment, sickness absence/disability pension, early old-age pension, emigration, and death in 2012.

Results:

Low demands/low control at baseline was associated with long-term sickness absence/disability pension at follow-up among both women and men (odds ratios [ORs] 1.49; 95% confidence intervals [CIs] 1.46–1.53). High demands/low control at baseline was associated with a higher likelihood of old-age pension among women (OR 1.91; CI 1.82–2.00), and with a lower likelihood among men (OR 0.59; CI 0.53–0.66).

Conclusions:

Combinations of job demands/job control in 2001 were associated with labor market situation in 2012.
Challenges and concerns of patients with congenital bleeding disorders affected by coronavirus disease 2019
Authors: Dorgalaleh Akbar , Tabibian Shadi , Baghaipour Mohammad Reza , Dabbagh Ali , Bahoush Gholamreza , Jazebi Mohammad , Bahraini Mehran , Fazeli Alieh , Yousefi Forough
Published: February 2021

Coronavirus disease 2019 (COVID-19) is a new medical challenge for all individuals, especially for those with underlying disorders, such as congenital bleeding disorders (CBDs). Therefore, the pandemic might significantly change the behaviour of patients with CBDs and results in some challenges. In the present study, we assessed the main challenges of COVID-19 infection to patients with CBDs. Data were collected from medical files and interviews of patients with CBDs who had COVID-19 infection. Follow-ups were performed on patients who had active severe acute respiratory syndrome coronavirus 2 infection between April and October 2020. All patients were interviewed by an expert in order to collect the pertinent data. Some questions were about patients’ preventive behaviors and feelings prior to infection, and some were about the consequences of infection on patients’ replacement therapy and bleeding management. Among 25 patients, infection and death of loved ones (n: 7, 28%), and their own (n: 5, 20%) or family members’ (n: 1, 4%) infection, and the resulting economic burden (n: 2, 8%) were main concerns. Six patients experienced depression during the pandemic. The pandemic caused all severely affected patients but one (n: 11, 92%) to abandon replacement therapy. However, two received on-demand therapy after exacerbation of their bleeding. Only one (25%) of four patients on prophylaxis received in-home therapy, whereas the others (75%) abandoned prophylaxis. It seems that COVID-19 infection has great consequences on the lives of patients with CBDs, causing some to take dangerous actions, such as abandonment of their treatment. Healthcare systems, and healthcare providers, should have an appropriate strategy for management of patients with CBDs that prevents infection and provides timely replacement therapy.
Clinical therapeutic effects of topical agents in adult patients with human immunodeficiency virus-related oral mucosa ulcers
Authors: Ding Xiuming , Xu Feihu , Zhang Xiang
Published: February 2021

Background

The number of adult patients affected by the human immunodeficiency virus (HIV) still remains high, mainly in the developing countries. However, only a few affected patients fail to experience oral lesions in the course of their experience with the virus. In particular, oral mucosa ulcers detected among HIV patients may be severe, which depictions may inhibit oral functioning and change patients’ quality of life. Thus, it can result in considerable morbidity among this group of patients. To this end, the present study aims to examine the topical agent's clinical therapeutic efficacy among adult patients suffering from HIV-related oral mucosa ulcers.

Methods

For the investigation, only randomized controlled trials on any topical agent used to treat adult patients with HIV oral mucosa ulcers are to be explored from different databases: PubMed, the Cochrane Library, PsycINFO, EMBASE, SCOPUS, Web of Science, China Biomedical Literature Database, China National Knowledge Infrastructure, VIP, and WanFang databases. All databases will be searched from their inceptions to October 2020. Additionally, 2 independent authors will evaluate the possibly eligible studies to be included in the study. They will also perform data's trial extraction and risk of bias assessment. Accordingly, all data will be analysed by means of the RevMan 5.3 software.

Results

The present study seeks to evaluate the topical agents’ clinical therapeutic efficacy to treat adult patients with HIV-related oral mucosa ulcers.

Conclusion

The study can be applicable in providing evidence of any topical agents for treating adult patients with HIV-related oral mucosa ulcers for clinical practice.

Protocol registration number

DOI 10.17605/OSF.IO/5CYR2 (https://osf.io/5cyr2/).
Integrated cognitive behavioral therapy for chronic pain
Authors: Taguchi Kayoko , Numata Noriko , Takanashi Rieko , Takemura Ryo , Yoshida Tokiko , Kutsuzawa Kana , Yoshimura Kensuke , Shimizu Eiji
Published: February 2021

Background:

We aimed to examine the feasibility of our newly-developed, integrated, and high-intensity individual cognitive behavioral therapy (CBT) protocol for treatment-resistant chronic pain.

Methods:

We conducted an open-labeled prospective single-arm trial for patients aged 18 years and above, suffering from chronic pain, and diagnosed with somatic symptom disorder with predominant pain. We provided 16 weekly sessions of CBT, each lasting for 50 minutes, which included 4 new strategies: attention shift, memory work, mental practice, and video feedback. For comparison, the study had a pre-test post-test design. The primary outcome was the change from baseline (week 1) to 16, as indicated by the Numerical Rating Scale and Pain Catastrophizing Scale. In addition, we evaluated depression, anxiety, disability, and quality of life as secondary outcomes.

Results:

Sixteen patients with chronic pain underwent our CBT program. Though there was no reduction in pain intensity, catastrophic cognition showed statistically significant improvement with a large effect size. Depression, anxiety, and disability demonstrated statistically significant improvements, with small to moderate effect sizes. No adverse events were reported.

Conclusion:

Our newly integrated CBT program for chronic pain may improve catastrophic cognition, depression, anxiety, and disability. Large-scale randomized controlled studies are necessary to investigate the program's effectiveness in the future.
The diagnostic performance of gadoxetic acid disodium-enhanced magnetic resonance imaging and contrast-enhanced ultrasound in detecting hepatocellular carcinoma
Authors: Wang Jiming , Ye Xiaofei , Li Jiangfa , He Songqing
Published: February 2021

The purpose of this study was to identify and compare the diagnostic performance of gadolinium-ethoxybenzyl-diethyltriethylenetriacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in hepatocellular carcinoma (HCC).

Two researchers searched PubMed, EMBASE, and Cochrane Library databases from the inception of each database to 10 February 2020, to find comparative studies of Gd-EOB-DTPA-MRI and CEUS in detection of HCC.

The study included eight studies (374 patients). MRI is superior to CEUS in diagnostic sensitivity of HCC, P = .03. The diagnostic sensitivity of MRI in lesions with a diameter of less than 30 mm was significantly higher than that of CEUS, P = .04. MRI and CEUS had no significant difference in diagnostic specificity of HCC, P = .95. Summary Receiver Operating Characteristics (SROC) of MRI showed a larger than that of CEUS, but with P > .05.

Gd-EOB-DTPA-MRI showed higher sensitivity than CEUS for hepatocellular carcinoma lesions, especially for lesions of less than 30 mm across.
Insights from the comparisons of SARS-CoV and COVID-19 outbreaks
Authors: Liu Wen-Yi , Chuang Yen-Ching , Liu Ting-Jun , Chien Ching-Wen , Tung Tao-Hsin
Published: February 2021

Coronavirus disease 2019 (COVID-19) is one of infectious diseases caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At the beginning of 2020, a sudden outbreak of novel pneumonia, originated from Wuhan, China, swiftly evolves to a worldwide pandemic, alike the severe acute respiratory syndrome (SARS) in 2003. However, Chinese-style innovation in response to the outbreak of COVID-19 helped China to reach a faster and more effective success in the containment of this epidemic. This review summarizes insights from the comparisons of severe acute respiratory syndrome coronavirus (SARS-CoV) and COVID-19 outbreaks on the basis of preventive strategies in China for this coronavirus pandemic.
Primary synchronous colloid adenocarcinoma and squamous cell carcinoma in the same lung
Authors: Liu Yang , Kang Lin , Hao Han , Zhang Xiuzhi , Zheng Guona , Guo Xiaowan , Zhao Huanfen
Published: February 2021

Rationale:

Double primary lung cancer (DPLC) is a relatively rare type of lung cancers. According to whether the diagnosis interval between lesions is more than 6 months, it can be divided into synchronous DPLC (sDPLC) and metachronous DPLC (mDPLC). Here, we describe a case of sDPLC in which one of the components is a rare colloid adenocarcinoma (CA).

Patient concerns:

A 69-year-old male was admitted to the hospital due to chest distress and shortness of breath for 1 year, getting worse in the last 15 days.

Diagnosis:

Both HE staining and IHC supported the diagnosis of CA in the right lower lobe and moderately differentiated squamous cell carcinoma in the right upper lobe.

Interventions:

The patient was treated with 3 cycles of adjuvant chemotherapy with pemetrexed and lobaplatin after the right upper lobectomy, wedge resection of the right lower lobe and lymph node dissection under video-assisted thoracoscope.

Outcomes:

Our plan was to follow him up with general physical examination, chest-abdomen CT and serum tumor markers every 6 months for 2 years. The patient was still alive until the last follow-up in November 2020.

Lessons:

CA of the lung is a rare primary lung adenocarcinoma. The diagnosis should be based on the patient's clinical characteristics, imaging examination and pathological characteristics, and also need to be differentiated from other mucinous adenocarcinomas. Interestingly, our patient developed not only a CA in the right lower lobe, but also a moderately differentiated squamous cell carcinoma in the right upper lobe.
Double remission of chronic lymphocytic leukemia and secondary acute myeloid leukemia after venetoclax monotherapy
Authors: Wang Lei , Lin Na
Published: February 2021

Rationale:

The abnormal expression of B-cell lymphoma-2 (Bcl-2) family members is often associated with the progression of the disease. Bcl-2 inhibitors (eg, venetoclax) were first reported to inhibit the proliferation of malignant lymphocytes and have a significant effect on patients with chronic lymphoblastic leukemia, but research on myeloid tumors is relatively delayed. Venetoclax was approved in 2018 for the treatment of acute myeloid leukemia (AML) patients who were not suitable for high-dose chemotherapy. The approval of venetoclax is an advance in the treatment of hematological tumors.

Patient concerns:

Here we report a 64-year-old male with an increased white blood cell (WBC) count (39.0 × 109/L) and lymphocyte count (30.6 × 109/L) on physical examination in July 2014. The patients were diagnosed with chronic lymphocytic leukemia (CLL) through bone marrow (BM) smears and immunophenotyping without any cytogenetic or molecular abnormalities. Chlorambucil was prescribed, WBC was stable between 15 × 109/L and 25 × 109/L in the past 6 years. He came to the hospital again in May 2020 and complained of fatigue for 2 weeks. WBC (16.7 × 109/L) and lymphocyte (14.76 × 109/L) counts were increased, hemoglobin (HGB) and platelet (PLT) were decreased in peripheral blood, which indicated the progression of the disease.

Diagnoses:

The patient was diagnosed as secondary AML after CLL based on the clinical and laboratory findings.

Interventions:

He achieved a morphological complete remission in both AML and CLL without any adverse reactions after one course of venetoclax monotherapy.

Outcomes:

He received standard daunorubicin and cytarabine combined with venetoclax as consolidation therapy and is now ready for allogeneic-hematopoietic stem cell transplantation.

Lessons:

Our case presents a challenge to traditional treatment. New drugs such as venetoclax have shown outstanding effects in this respect. High expression of Bcl-2 can identify the responders of venetoclax. These findings should be validated in future clinical trials. We fully believe that in the near future, the comprehensive use of targeted drugs with different mechanisms will not only improve the quality of life of patients, but also completely change the prognosis of patients with recurrent and refractory hematological malignancies.
Differences in supraspinatus occupation ratio between the symptomatic, the contralateral asymptomatic shoulder and control subjects
Authors: Navarro-Ledesma Santiago , Fernandez-Sanchez Manuel , Luque-Suarez Alejandro
Published: February 2021

The relationship between supraspinatus tendon thickness and the acromiohumeral distance (AHD) at both rest position and shoulder elevation is still to be explored in those with chronic shoulder pain. The aim is to compare supraspinatus occupation ratio (OR) at 0° and 60° of shoulder elevation measured by ultrasound imaging in the symptomatic shoulder, the contralateral asymptomatic shoulder and in healthy subjects. This was across-sectional, observational study. A sample of 56 participants with subacromial pain syndrome in their dominant arm was recruited in 3 different primary care centres. Forty participants without shoulder pain were also recruited. The AHD at 0° and 60° of active shoulder abduction as well as the supraspinatus tendon thickness were measured by ultrasound in these groups. Supraspinatus OR at 60° was significantly greater in symptomatic compared to asymptomatic shoulders (P = .04) and healthy shoulders (P = .008). The percentage of change in supraspinatus OR from rest position to 60° was also greater in symptomatic shoulders when comparing with asymptomatic (P = .01) and healthy shoulders (P = .03). No other statistically significant differences for the rest of comparisons were found. Supraspinatus OR may explain shoulder pain in chronic conditions. Further studies at acute and chronic conditions after a physiotherapy treatment are needed to explore its usefulness in clinical practice.
Analysis of 17,428 pregnant women undergoing non-invasive prenatal testing for fetal chromosome in Northeast China
Authors: Dai Rulin , Yu Yang , Zhang Han , Li Leilei , Jiang Yuting , Liu Ruizhi , Zhang Hongguo
Published: February 2021

Non-invasive prenatal testing (NIPT) is an incomparable prenatal screening technology, but we should undergo amniocentesis to confirm fetal chromosome when pregnancies receive a positive result via NIPT. We aimed to investigate the detection rate and positive predictive value of NIPT results in pregnancies from Northeast China, and to determine the reasons for false positive and false negative NIPT results.

This study evaluates 17,428 singleton pregnancies had undergone NIPT detection. 202 samples were NIPT positive with the detection rate was 1.16% (202/17,428). Among all the positive samples, 160 samples (79.21%) were referred for an amniocentesis procedure to investigate the fetal chromosome. The positive predictive value of T21, T18, and T13 was found to be 75% with a 0.07% false positive rate. Positive predictive value from high to low was as follows: trisomy 21 (84.38%), followed by trisomy 18 (61.54%), autosomal abnormalities (52.94%), sex chromosomal abnormalities (38.46%), and trisomy 13 (33.33%). The positive predictive values for sex chromosome abnormalities turned out to be mosaic sex chromosome aneuploidies (83.33%), followed by XYY (57.14%), XXY (37.50%), XXX (36.36%), and Monosomy X (28.95%). Out of the 160 samples had amniocentesis, the true positive cases in trisomy 21 had a higher percentage of Z-scores compared with the false positive cases in trisomy 21 (P < .05). And the true positive cases in trisomy 18 had a significantly higher percentage of Z-scores compared with the false positive cases in trisomy 18 (P < .01).

These findings indicate that the positive predictive value of T21, T18, and T13 was found to be 75% with a 0.07% false positive rate. It is worth noting that the positive predictive value of NIPT for autosomes and sex chromosomes. Moreover, if women receive a positive result via NIPT, they should pay attention to the results with undergoing further prenatal diagnosis.
Gender-specific association between non-alcoholic fatty liver disease and type 2 diabetes mellitus among a middle-aged and elderly Chinese population
Authors: Ni Liping , Yu Dan , Wu Tianfeng , Jin Fubi
Published: February 2021

Limited data are available regarding the association of non-alcoholic fatty liver disease (NAFLD) with the risk of type 2 diabetes mellitus (T2DM) in China. Therefore, the purpose of this study is to evaluate the gender-specific association between NAFLD and T2DM risk in a middle-aged and elderly Chinese population.

This cross-sectional study was carried out in a group of 1492 Chinese adults (60.30% males) aged between 45 and 69 years old, in Hangzhou city, Zhejiang province who were attending their annual health check-up from June 2015 to December 2016 in the Medical Center for Physical Examination, Zhejiang Hospital. Face-to-face interviews were conducted using a written questionnaire. NAFLD was divided into none, mild, moderate/severe based on ultrasound examination. Logistic regression analyses were employed to determine the relationship between NAFLD and the risk of T2DM, with adjustment of potential confounding variables.

Of the 1492 participants, 163 (10.92%) were diagnosed with T2DM. Educational level, smoking, body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose (FG), triglycerides (TG), alanine aminotransferase (ALT), asparagine aminotransferase (AST)and the prevalence of T2DM were significantly higher in males than in females (P < .05). Besides, females had significantly higher levels of high density lipoprotein-cholesterol (HDL-C) (1.51 ± 0.37 vs 1.29 ± 0.42, P < .001) than males. Pearson bivariate correlation analysis indicated that FG was positively associated with weight, BMI, WC, WHR, SBP, DBP, TG, TC, ALT and AST in both males and females (P < .05). Besides, FG was inversely associated with HDL-C in females (P < .001). After adjusting for confounding variables, NAFLD was positively associated with the risk of T2DM, and the effect of NAFLD on T2DM was stronger in males (OR = 2.442, 95%CI: 1.003–3.757) than in females (OR = 1.814, 95%CI: 1.011–3.257).

Our data showed that NAFLD was significantly associated with the risk of T2DM in middle-aged and elderly males than in females. Further prospective cohort studies are needed to determine the causal effect of NAFLD on T2DM.
The relationship between alcohol consumption and knee osteoarthritis in Korean population over 50 years-old
Authors: Kim Seong-Kyu , Bae Jisuk , Choe Jung-Yoon
Published: February 2021

There is still debate regarding the pathogenic relationship between alcohol intake and osteoarthritis (OA). This study investigated the association between alcohol consumption and knee OA in a Korean population.

Among 8058 subjects who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) 2012, a total of 2917 subjects over the age of 50 and taken plain radiography was included in this analysis. Knee OA was classified based on the Kellgren–Lawrence (K–L) grading scale. Multivariate logistic regression analyses were used to evaluate the odds ratios (ORs) and 95% confidence intervals (CIs) of variables for knee OA (K–L grade ≥ 2).

There were 1022 subjects with knee OA (29.2%). Subjects with knee OA tended to have lower daily alcohol intake (g/day) than did those without knee OA (10.4 [6.2–14.6] vs. 15.8 [12.8–18.8], P = .04). Similarly, those with knee OA demonstrated less makgeolli intake than did those without knee OA (P = .002). Subjects who consumed >0.6 g/day of beer also demonstrated less knee OA than did those who consumed <0.6 g/day of beer (OR 0.68, 95% CI 0.46–0.99). However, knee OA was not associated with the categories of alcohol consumption amount (g/day), including total daily alcohol intake (g/day), soju daily intake (g/day), and makgeolli daily intake (g/day) (P > .05 of all).

Alcohol consumption was negatively associated with prevalence of knee OA in a Korean population. This preliminary observation will need to be confirmed in future studies.
Clinical Impact of Organ-Preserving Surgery for Pancreatic Neuroendocrine Neoplasms
Authors: Tsuchikawa Takahiro , Tanaka Kimitaka , Nakanishi Yoshitsugu , Asano Toshimichi , Noji Takehiro , Nakamura Toru , Okamura Keisuke , Shichinohe Toshiaki , Hirano Satoshi
Published: February 2021

Objectives

Organ-preserving surgery (OPS) has been accepted for pancreatic neuroendocrine neoplasms, particularly for the management of small tumors. This study aimed to analyze the surgical outcome following this treatment at our institute, focusing on the perioperative factors and postoperative locoregional recurrence.

Methods

We analyzed 71 consecutive patients with no synchronous liver metastasis. These patients were classified into 1 of 2 groups: the standard operation group (SOG, 41 patients) with prophylactic regional lymph node dissection and the organ-preserving surgery group (OPG, 30 patients). We performed OPS based on size criteria (tumor size <1.5 cm in nonfunctional pancreatic neuroendocrine neoplasms and <2 cm in insulinoma with no evident bulky lymph node swelling on preoperative imaging).

Results

The median follow-up periods were 37 months. The OPG included enucleation, partial resection, proximal parenchymal pancreatectomy, central pancreatectomy, spleen-preserving distal pancreatectomy, and Warshaw operation. The SOG included pancreatoduodenectomy and distal pancreatectomy, showing no statistically significant differences between the 2 groups in terms of operation time, hospitalization duration, and postoperative complications. Ten patients showed lymph node metastasis (25%) only in the SOG. There were no locoregional recurrent cases in the OPG.

Conclusions

In selected patients, OPS may be effective based on the appropriate tumor size criteria.
Psychometric Impact of Priapism on Lives of Adolescents and Adults With Sickle Cell Anemia: A Sequential Independent Mixed-Methods Design
Authors: Idris Ibrahim M. , Bonnet Kemberlee , Schlundt David , Abba Akib , Galadanci Jamil , Burnett Arthur L. , DeBaun Michael R.
Published: February 2021

Despite priapism being one of the most frequent complications of sickle cell anemia (SCA) in male individuals, little has been reported about the impact of priapism in this population. The authors used a sequential independent mixed-methods design, which used both international multicenter focus group discussions (n=35) and a quantitative patient-reported outcome measure (n=131) to determine the impact of priapism on men with SCA in Nigeria and the United States. The authors analyzed data from focus groups using an iterative inductive-deductive approach. Comparison of the Priapism Impact Profile data was done using the Kruskal-Wallis H test. Our result showed that priapism, across cultures, is associated with shame and embarrassment. These emotions interfere with timely clinical and family communication about priapism symptoms and complications. Participants were dissatisfied with the quality of care at emergency facilities. The quality of life and physical wellness of men with SCA-related priapism were significantly different for the 3 groups: (1) priapism condition getting better, (2) priapism condition getting worse, and (3) priapism condition remain the same (P=0.002 and P=0.019, respectively). Psychological, sexual, and physical wellbeing are all adversely affected by priapism. Evidence-based methods are necessary for adequate medical, educational, and psychological treatment for recurrent priapism.
Risk of Disseminated Gonococcal Infections With Terminal Complement Blockade
Authors: Graciaa Sara H. , Graciaa Daniel S. , Yildirim Inci , Chonat Satheesh
Published: February 2021

Paroxysmal nocturnal hemoglobinuria is a clonal hematopoietic stem cell disorder resulting in complement-mediated hemolysis. Eculizumab, a monoclonal antibody against complement protein C5, has been shown to reduce both intravascular hemolysis and risk for thrombosis, and thereby improve the quality of life in these patients. While the infection risk from Neisseria meningitidis due to terminal complement blockade can be mitigated with appropriate immunizations and prophylactic antibiotics, these patients remain vulnerable to infections from Neisseria gonorrhoeae. Physicians and families should be aware of disseminated and severe gonococcal infections in patients receiving complement blockade, especially in this era of emerging cephalosporin and azithromycin resistance.
Prevalence of Urogenital Mycoplasma genitalium Infection, United States, 2017 to 2018
Authors: Torrone Elizabeth A. , Kruszon-Moran Deanna , Philips Christi , Morris Monica R. , Bowden Katherine E. , Papp John , Bachmann Laura H. , Weinstock Hillard , Kersh Ellen N.
Published: February 2021

During the 2017–2018 National Health and Nutrition Examination Survey, urine samples from participants aged 14 to 59 years were tested for Mycoplasma genitalium infection. Overall prevalence was 1.7% (95% confidence interval [CI], 1.1%–2.7%). Prevalence was similar between males (1.8% [95% CI, 0.9%–3.1%]) and females (1.7% [95% CI, 0.8%–3.0%]).
Interest, Concerns, and Attitudes Among Men Who Have Sex With Men and Health Care Providers Toward Prophylactic Use of Doxycycline Against Chlamydia trachomatis Infections and Syphilis
Authors: Park Justin J. , Stafylis Chrysovalantis , Pearce Daniel D. , Taylor Jeff , Little Susan J. , Kojima Noah , Gorin Aleksandr M. , Klausner Jeffrey D.
Published: February 2021

Background

Prophylactic administration of doxycycline is regarded as a potential new public health strategy to combat the rising rates of Chlamydia trachomatis infections and syphilis among men who have sex with men. We conducted a survey-based study to evaluate how community members and health care providers in Southern California would perceive doxycycline preexposure/postexposure prophylaxis (PrEP/PEP) to predict its acceptability and identify potential areas of concern.

Methods

We conducted an online cross-sectional survey among community members who identify as men who have sex with men and health care providers with prescribing authority in Southern California to investigate the current attitudes toward doxycycline PrEP/PEP, including their willingness to accept. We analyzed the data using descriptive statistics and binary logistic regression.

Results

Among 212 enrolled community member participants, 67.5% indicated they would take doxycycline PrEP/PEP if offered by their provider. Higher acceptability was significantly associated with several characteristics, including recent history of bacterial sexually transmitted infection diagnosis and current use of HIV PrEP. For health care providers, 89.5% of 76 enrolled participants expressed willingness to prescribe doxycycline PrEP/PEP to their patients if recommended by the Centers for Disease Control and Prevention, but only 43.4% were willing if not. Both community members and health care providers demonstrated high levels of concern toward possible drug resistance.

Conclusions

Doxycycline PrEP/PEP as a preventive strategy against chlamydial infections and syphilis would likely be accepted among community members and health care providers. Clear guidelines from public health officials and further clarification on the strategy's potential impact on developing drug resistance may be necessary to ensure successful implementation.
Feasibility and Accuracy of HIV Testing of Children by Caregivers Using Oral Mucosal Transudate HIV Tests
Authors: Dziva Chikwari Chido , Simms Victoria , Kranzer Katharina , Dringus Stefanie , Chikodzore Rudo , Sibanda Edwin , Webb Karen , Redzo Nicol , Mujuru Hilda , Apollo Tsitsi , Ncube Getrude , Hatzold Karin , Bernays Sarah , Weiss Helen A. , Ferrand Rashida A.
Published: February 2021

Background:

Children encounter multiple barriers in accessing facilities. HIV self-testing using oral mucosal transudate (OMT) tests has been shown to be effective in reaching hard-to-reach populations. We evaluated the feasibility and accuracy of caregivers conducting HIV testing using OMTs in children in Zimbabwe.

Methods:

We offered OMTs to caregivers (>18 years) living with HIV to test children (2–18 years) living in their households. All caregivers were provided with manufacturer instructions. In Phase 1 (January–December 2018, 9 clinics), caregivers additionally received a demonstration by a provider using a test kit and video. In Phase 2 (January–May 2019, 3 clinics), caregivers did not receive a demonstration. We collected demographic data and assessed caregiver's ability to perform the test and interpret results. Caregiver performance was assessed by direct observation and scored using a predefined checklist. Factors associated with obtaining a full score were analyzed using logistic regression.

Results:

Overall 400 caregivers (83.0% female, median age 38 years) who were observed tested 786 children (54.6% female, median age 8 years). For most tests, caregivers correctly collected oral fluid [87.1% without provider demonstrations (n = 629) and 96.8% with demonstrations (n = 157), P = 0.002]. The majority correctly used a timer (90.3% without demonstrations and 96.8% with demonstrations, P = 0.02). In multivariate logistic regression caregivers who obtained a full score for performance were more likely to have received a demonstration (odds ratio 4.14, 95% confidence interval: 2.01 to 8.50).

Conclusions:

Caregiver-provided testing using OMTs is a feasible and accurate HIV testing strategy for children. We recommend operational research to support implementation at scale.