bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness and Safety of XEN45 in Eyes With High Myopia and Open Angle Glaucoma
Authors: Fea Antonio , Sacchi Matteo , Franco Fabrizio , Laffi Gian Luca , Oddone Francesco , Costa Giacomo , Serino Federica , Giansanti Fabrizio
Published: February 2023

Précis:

XEN45 implant was an effective and safe procedure in primary open angle glaucoma (OAG) eyes with high myopia. Although the hypotony incidence rate was relatively high, it resolved with medical therapy and was of short duration.

Purpose:

The purpose of this study is to evaluate the effectiveness and safety of the XEN45 stent in eyes with OAG and high myopia.

Design:

Retrospective and multicenter study.

Methods:

Consecutive OAG patients who underwent a XEN45, either alone or in combination with cataract surgery, and had a refractive error higher than −6 D and an axial length ≥26 mm. The primary endpoint was the mean intraocular pressure (IOP) lowering at the last follow-up visit.

Results:

Thirty-one eyes were included (96.8% with a primary OAG diagnosis). The mean refraction was −13.2±5.6 (range: −6.75 to−23.0) D. In the overall study sample, preoperative mean IOP (95% CI) was significantly lowered from 23.5 (20.5–26.4) mm Hg to 13.0 (12.2–13.8) mm Hg at the last follow-up visit, P<0.0001. At the last follow-up visit, 16 (57.1%) eyes achieved an IOP ≤14 mm Hg, 11 (68.9%) of them without treatment. The number of ocular hypotensive medications was significantly reduced from 3.0±1.1 drugs at preoperatively to 0.6±1.0 drugs at the last follow-up visit, P<0.0001. Median (95% CI) follow-up was 24.0 (12.0–24.0) months. Linear regression analysis showed a significant correlation between the preoperative refraction and the IOP lowering (r=0.43, P=0.0155). Needling procedure was performed in 11 eyes (39.3%) and hypotony (defined as an IOP <6 mm Hg) was observed in 8 eyes (28.6%) during the first postoperative day and remained for a week.

Conclusion:

Although the Xen implant effectively lowered IOP in highly myopic eyes with glaucoma, the incidence of hypotony was high, and in most cases, resolved within the first month with medical management and monitoring.
Teleglaucoma Using a New Smartphone-Based Tool for Visual Field Assessment
Authors: Grau Elisabeth , Andrae Stefan , Horn Folkert , Hohberger Bettina , Ring Matthias , Michelson Georg
Published: February 2023

Précis:

COVID-19 underlines the importance of telemedical diagnostics. The smartphone-based campimetry (Sb-C) is a newly developed digital application allowing visual field testing using a head-mounted device and a smartphone. It enables visual field screening remotely from a clinic.

Background:

Sb-C is a newly developed tool for functional ophthalmic diagnosis. This study aimed to examine the comparability of the Sb-C and Octopus 900 to ensure ophthalmological care in times of social distancing.

Methods:

Total 93 eyes were included in the study. After an ophthalmological examination, the visual field was tested by the Octopus program G1 and by the smartphone-based campimeter. The Sb-C was performed using VR glasses and an iPhone 6. The software Sb-C was downloaded and installed as SmartCampiTracker app and is examining the 30-degree visual field with 59 test positions corresponding to the G pattern of Octopus G1. Sensitivities were recorded and saved on the app. In addition, test-retest reliability was tested on 6 ophthalmologically healthy participants.

Results:

The group comprised 48 women and 45 men (mean age: 62.52±12.2 y) including 19 controls, 17 patients with ocular hypertension, 11 preperimetric glaucomas, and 46 perimetric glaucomas. The mean sensitivity (MS) of all points of G1 perimetry was 23.13 dB (95% CI, 22.08–24.18). The MS of the Sb-C was 21.23 dB (95% CI, 20.37–22.08). The correlation between the mean MS measured by G1 perimetry and the Sb-C was strong (r=0.815, P<0.05). The test-retest reliability showed a correlation of r=0.591 (P<0.05).

Conclusions:

With some technical adjustments, the Sb-C shows promise for screening glaucoma and monitoring disease progression remotely from an ophthalmologic clinic.
Early Detection of Primary Open Angle, Angle Closure, and Normal Tension Glaucoma in an Asian Population Using Optical Coherence Tomography
Authors: Wu Chao-Wei , Chang Yue-Cune , Chen Hsin-Yi
Published: February 2023

Précis:

Spectral-domain optical coherence tomography (SD-OCT) facilitates early glaucoma detection in the Chinese population in Taiwan. The best parameters for primary open angle glaucoma (POAG), primary angle closure glaucoma (PACG), normal tension glaucoma (NTG), and suspected glaucoma (GS) detection are temporal inferior Bruch’s membrane opening-minimum rim width (BMO-MRW), inner temporal macular ganglion cell layer (mGCL), temporal superior Circumpapillary retinal nerve fiber layer (cpRNFL), and mean global BMO-MRW, respectively.

Purpose:

We investigated the diagnostic capability of SD-OCT for different types of early glaucoma among the Chinese population in Taiwan.

Participants and Methods:

One eye each was assessed from 113 individuals with healthy eyes, 125 individuals with suspected glaucoma (GS), and 156 patients with early glaucoma (POAG, 87; PACG, 50; and NTG, 19). Circumpapillary (cp) RNFL thickness (global and sectoral), BMO-MRW, and macular parameters, including the macular RNFL (mRNFL), mGCL, and macular inner plexiform layer (mIPL), were assessed using SD-OCT. The areas under receiver operator characteristic curves (AUCs) were calculated to evaluate the diagnostic capacity of the parameters to differentiate between healthy and early glaucomatous eyes.

Results:

The parameters most suitable for detecting early POAG, PACG, NTG, and GS were temporal inferior BMO-MRW (AUC, 0.847), inner temporal mGCL (AUC, 0.770), temporal superior cpRNFL (AUC, 0.861), and mean global BMO-MRW (AUC, 0.768), respectively. Among the macular parameters, the mGCL exhibited the highest diagnostic capacity. The diagnostic capacity of the mGCL was lower than that of cpRNFL and BMO-MRW for POAG and NTG but not PACG. After adjusting for confounding variables in multivariable analysis, the AUC was determined to be 0.935 for POAG and 0.787 for GS.

Conclusion:

SD-OCT facilitates the detection of early POAG, PACG, and NTG. Using a combination of cpRNFL, BMO-MRW, and macular parameters may enhance their diagnostic capacities. Further studies are necessary to validate these findings.
Asymptomatic SARS-CoV-2 Infection by Age: A Global Systematic Review and Meta-analysis
Authors: Wang Bing , Andraweera Prabha , Elliott Salenna , Mohammed Hassen , Lassi Zohra , Twigger Ashley , Borgas Chloe , Gunasekera Shehani , Ladhani Shamez , Marshall Helen Siobhan
Published: February 2023

Background:

Asymptomatic SARS-CoV-2 infections have raised concerns for public health policies to manage epidemics. This systematic review and meta-analysis aimed to estimate the age-specific proportion of asymptomatic SARS-CoV-2 infected persons globally by year of age.

Methods:

We searched PubMed, Embase, medRxiv and Google Scholar on September 10, 2020, and March 1, 2021. We included studies conducted during January to December 2020, before routine vaccination against COVID-19. Because we expected the relationship between the asymptomatic proportion and age to be nonlinear, multilevel mixed-effects logistic regression (QR decomposition) with a restricted cubic spline was used to model asymptomatic proportions as a function of age.

Results:

A total of 38 studies were included in the meta-analysis. In total, 6556 of 14,850 cases were reported as asymptomatic. The overall estimate of the proportion of people who became infected with SARS-CoV-2 and remained asymptomatic throughout infection was 44.1% (6556/14,850, 95% CI: 43.3%–45.0%). The predicted asymptomatic proportion peaked in children (36.2%, 95% CI: 26.0%–46.5%) at 13.5 years, gradually decreased by age and was lowest at 90.5 years of age (8.1%, 95% CI: 3.4%–12.7%).

Conclusions:

Given the high rates of asymptomatic carriage in adolescents and young adults and their active role in virus transmission in the community, heightened vigilance and public health strategies are needed among these individuals to prevent disease transmission.
COVID-19 Vaccine Reactogenicity and Vaccine Attitudes Among Children and Parents/Guardians After Multisystem Inflammatory Syndrome in Children or COVID-19 Hospitalization: September 2021—May 2022
Authors: Yousaf Anna R. , Kunkel Amber , Abrams Joseph Y. , Shah Ami B. , Hammett Teresa A. , Arnold Kathryn E. , Beltran Yajira L. , Laham Federico R. , Kao Carol M. , Hunstad David A. , Hussaini Laila , Baida Nadine , Salazar Luis , Perez Maria A. , Rostad Christina A. , Godfred-Cato Shana , Campbell Angela P. , Belay Ermias D.
Published: February 2023

Background:

Multisystem inflammatory syndrome in children (MIS-C) is a multiorgan hyperinflammatory condition following SARS-CoV-2 infection. Data on COVID-19 vaccine adverse events and vaccine attitudes in children with prior MIS-C are limited. We described characteristics associated with COVID-19 vaccination, vaccine adverse events and vaccine attitudes in children with a history of MIS-C or COVID-19 and their parents/guardians.

Methods:

We enrolled children previously hospitalized for MIS-C or COVID-19 from 3 academic institutions. We abstracted charts and interviewed children and parents/guardians regarding vaccine adverse events and acceptability.

Results:

Of 163 vaccine-eligible children enrolled with a history of MIS-C and 70 with history of COVID-19, 51 (31%) and 34 (49%), respectively, received mRNA COVID-19 vaccine a median of 10 (Interquartile Range 6–13) months after hospital discharge. Among 20 children with MIS-C and parents/guardians who provided interviews, local injection site reaction of brief duration (mean 1.8 days) was most commonly reported; no children required medical care within 2 weeks postvaccination. Vaccine survey results of interviewed, vaccinated children and their parents/guardians: of 20 children with MIS-C and 15 children with COVID-19, 17 (85%) and 13 (87%), respectively, listed doctors in the top 3 most trusted sources for vaccine information; 13 (65%) and 9 (60%) discussed vaccination with their doctor.

Conclusions:

COVID-19 vaccination was well tolerated in children with prior MIS-C or COVID-19 participating in our investigation. Parents/guardians regarded their children’s doctors as a trusted source of information for COVID-19 vaccines, and most vaccinated children’s parents/guardians had discussed COVID-19 vaccination for their child with their doctor.
Long COVID in Children and Adolescents: A Retrospective Study in a Pediatric Cohort
Authors: Baptista de Lima Joana , Salazar Luís , Fernandes Alexandre , Teixeira Carla , Marques Laura , Afonso Caldas
Published: February 2023

Studies on long coronavirus disease (COVID) in children are scarce. We aimed to describe persistent symptoms and identify risk factors for its development. In our study population, 17.6% presented with long COVID, with respiratory symptoms more frequent in the first weeks and neuropsychiatric symptoms over time. Chronic conditions and obesity were risk factors, and adolescents were at a greater risk for long COVID.
Phase I/II randomized, double-masked, placebo-controlled study of processed amniotic fluid drops after PRK
Authors: Ip Colin S. , Jones D. Kyle , Weinlander Eric , Gudgel Brett , Lin Amy , Yazdani Hina , Pierce Jan , Holubkov Richard , Jensen Hailey , Church Myrna , Mifflin Mark D.
Published: February 2023

Purpose:

To evaluate the safety and efficacy of processed amniotic fluid (pAF) used postoperatively after photorefractive keratectomy (PRK).

Setting:

University of Utah, Moran Eye Center, Salt Lake City, Utah.

Design:

Randomized, double-masked, placebo-controlled prospective study.

Methods:

61 participants were randomized to receive either placebo or pAF drops, which were instilled 4 times per day for 1 week after PRK along with routine postoperative medications. The primary outcome measure was time to full re-epithelialization in days. Secondary measures included visual acuity at 30 days and postoperative pain scores during the first week.

Results:

There was no significant difference in time to re-epithelialization, with a median of 5 days for both groups. There were no difference in pain indicator scores during the first week and no difference in corneal staining scores at day 30 between the 2 groups. There were no adverse events.

Conclusions:

This pilot study evaluating the safety and efficacy of pAF as an additional postoperative topical medication for PRK demonstrated that pAF did not improve the rate of epithelial healing after PRK. pAF may be safely studied in other ocular conditions to determine its effect on epithelial healing.
Neuroendocrine mechanisms in oxaliplatin-induced hyperalgesic priming
Authors: Staurengo-Ferrari Larissa , Araldi Dionéia , Green Paul G. , Levine Jon D.
Published: February 2023

Stress plays a major role in the symptom burden of oncology patients and can exacerbate cancer chemotherapy-induced peripheral neuropathy (CIPN), a major adverse effect of many classes of chemotherapy. We explored the role of stress in the persistent phase of the pain induced by oxaliplatin. Oxaliplatin induced hyperalgesic priming, a model of the transition to chronic pain, as indicated by prolongation of hyperalgesia produced by prostaglandin E2, in male rats, which was markedly attenuated in adrenalectomized rats. A neonatal handling protocol that induces stress resilience in adult rats prevented oxaliplatin-induced hyperalgesic priming. To elucidate the role of the hypothalamic–pituitary–adrenal and sympathoadrenal neuroendocrine stress axes in oxaliplatin CIPN, we used intrathecally administered antisense oligodeoxynucleotides (ODNs) directed against mRNA for receptors mediating the effects of catecholamines and glucocorticoids, and their second messengers, to reduce their expression in nociceptors. Although oxaliplatin-induced hyperalgesic priming was attenuated by intrathecal administration of β2-adrenergic and glucocorticoid receptor antisense ODNs, oxaliplatin-induced hyperalgesia was only attenuated by β2-adrenergic receptor antisense. Administration of pertussis toxin, a nonselective inhibitor of Gαi/o proteins, attenuated hyperalgesic priming. Antisense ODNs for Gαi1 and Gαo also attenuated hyperalgesic priming. Furthermore, antisense for protein kinase C epsilon, a second messenger involved in type I hyperalgesic priming, also attenuated oxaliplatin-induced hyperalgesic priming. Inhibitors of second messengers involved in the maintenance of type I (cordycepin) and type II (SSU6656 and U0126) hyperalgesic priming both attenuated hyperalgesic priming. These experiments support a role for neuroendocrine stress axes in hyperalgesic priming, in male rats with oxaliplatin CIPN.
Targeting the vascular endothelial growth factor A/neuropilin 1 axis for relief of neuropathic pain
Authors: Stratton Harrison J. , Boinon Lisa , Gomez Kimberly , Martin Laurent , Duran Paz , Ran Dongzhi , Zhou Yuan , Luo Shizhen , Perez-Miller Samantha , Patek Marcel , Ibrahim Mohab M. , Patwardhan Amol , Moutal Aubin , Khanna Rajesh
Published: February 2023

Vascular endothelial growth factor A (VEGF-A) is a pronociceptive factor that causes neuronal sensitization and pain. We reported that blocking the interaction between the membrane receptor neuropilin 1 (NRP1) and VEGF-A–blocked VEGF-A–mediated sensory neuron hyperexcitability and reduced mechanical hypersensitivity in a rodent chronic neuropathic pain model. These findings identified the NRP1-VEGF-A signaling axis for therapeutic targeting of chronic pain. In an in-silico screening of approximately 480 K small molecules binding to the extracellular b1b2 pocket of NRP1, we identified 9 chemical series, with 6 compounds disrupting VEGF-A binding to NRP1. The small molecule with greatest efficacy, 4′-methyl-2′-morpholino-2-(phenylamino)-[4,5′-bipyrimidin]-6(1H)-one, designated NRP1-4, was selected for further evaluation. In cultured primary sensory neurons, VEGF-A enhanced excitability and decreased firing threshold, which was blocked by NRP1-4. In addition, NaV1.7 and CaV2.2 currents and membrane expression were potentiated by treatment with VEGF-A, and this potentiation was blocked by NRP1-4 cotreatment. Neuropilin 1-4 reduced VEGF-A–mediated increases in the frequency and amplitude of spontaneous excitatory postsynaptic currents in dorsal horn of the spinal cord. Neuropilin 1-4 did not bind to more than 300 G-protein-coupled receptors and receptors including human opioids receptors, indicating a favorable safety profile. In rats with spared nerve injury–induced neuropathic pain, intrathecal administration of NRP1-4 significantly attenuated mechanical allodynia. Intravenous treatment with NRP1-4 reversed both mechanical allodynia and thermal hyperalgesia in rats with L5/L6 spinal nerve ligation–induced neuropathic pain. Collectively, our findings show that NRP1-4 is a first-in-class compound targeting the NRP1-VEGF-A signaling axis to control voltage-gated ion channel function, neuronal excitability, and synaptic activity that curb chronic pain.
Lipoid Proteinosis Due to Homozygous Nonsense Mutation in Extracellular Matrix Protein 1 (ECM1) Gene in Three Pakistani Siblings
Authors: Tariq Hira , Jawad Shahbano , Aman Shahbaz , Saeed Anjum , Cheema Huma Arshad
Published: February 2023

Introduction

Urbach–Wiethe disease (or lipoid proteinosis) is an autosomal recessive genetic disease. It is caused by a mutation in the extracellular matrix protein 1 gene (ECM1), resulting in deposition of hyaline material at the dermoepidermal junction of the skin, around blood vessels, and at multiple other sites.

Case presentation

The present report describes three siblings born to nonconsanguineous parents who presented with hoarseness, macroglossia, yellow waxy skin, beaded papules on the eyelids, atrophic scars, and recurrent skin infections. Histopathologic examination showed hyaline deposition at the interface between the dermis and epidermis and at the basal lamina of blood vessels. Exome sequencing revealed a homozygous nonsense variant in ECM1. This variant created a premature stop codon, leading to loss of function. Both parents were heterozygous for the same mutation.

Conclusion

This report is a useful addition to the current knowledge base regarding this phenotypically and genetically variable genodermatosis, which is rarely reported in Pakistan.
Local and systemic reactions associated with COVID-19 vaccines: logistic regression analysis
Authors: Lu Yu , He Chen-Lu , Jiang Guan
Published: February 2023

Objective:

Universal vaccination is one of the most effective measures to control the COVID-19 epidemic. However, adverse reactions sometimes occur after vaccination. Therefore, we investigated the local and systemic adverse reactions associated with COVID-19 vaccines.

Methods:

We conducted a multicenter cross-sectional survey from 1 December 2021 to 28 February 2022 in Jiangsu, China to analyze skin and systemic reactions. We collected questionnaires from vaccination sites, communities, and hospitals. Participants could either complete an online survey using the WeChat-based survey program Questionnaire Star or complete a paper questionnaire. Individual participants remained anonymous both during and after data collection.

Results:

A total of 2136 participants successfully completed the survey. The most common symptoms were pain, swelling, and subcutaneous induration. Common systemic reactions were fatigue, muscle soreness, and dizziness and headache. The risk of reactions was associated with sex; age; history of allergy to vaccinations; history of eczema, dermatitis, or urticaria; and receiving the same type of vaccine from different manufacturers.

Conclusions:

Overall, our results indicated that many factors can influence the occurrence of local and systemic reactions associated with COVID-19 vaccines.
Verrucous venous malformation with minimal or no verrucous proliferation: a report of 16 cases
Authors: Liu Yang-He , Zhu Guan-Nan , Wang Gang , Wang Lei
Published: February 2023

Background:

Verrucous venous malformation (VVM) usually presents as verrucous hyperplasia of the epidermis and proliferation of vessels in the dermis and subcutaneous tissue. Atypical VVM without verrucous manifestation was recently reported.

Methods:

We retrospectively analyzed the clinical and histological features of VVM with minimal or no verrucous hyperplasia in 16 patients at a single dermatology department from 2002 to 2021.

Results:

All patients presented with palpable soft nodules or masses. Slightly red or light pink patches were present on the surface in 8 patients, while no obvious superficial abnormalities were present in 8 patients. In nine patients, the proliferated tissue was excised without the overlying epidermis, and in the other seven patients, the proliferated tissue with the intact epidermis was available for histological examination. All specimens showed proliferation of small to medium-sized vessels mainly in the subcutaneous tissue. Of the seven specimens with intact epidermis, five exhibited slight vascular endothelial hyperplasia in the papillary dermis and two showed no change in the papillary dermis. The endothelial cells were positive for CD31 (16/16) and focally positive for prox1 (8/16), D2-40 (14/16), Wilms tumor-1 (8/16), and Glut-1 (1/16). The pericytes around the endothelial cells were positive for smooth muscle actin (16/16).

Conclusions:

VVM with minimal or no verrucous appearance is easily misdiagnosed. Clinicopathological correlation is very important for the correct diagnosis.
Concentric Centrifugal Figurate Erythema as an Unusual COVID-19 Evanescent Skin Manifestation in a Patient With CD3+/CD45+ Lymphocyte Infiltration: A Case Report
Authors: Achell-Nava Lucía Achell , Zaldivar-Fujigaki José Luis , Pérez-Cabeza de Vaca Rebeca , Espinosa García Ana Maria , Montiel López Luis
Published: February 2023

Introduction:

Coronavirus disease 2019 (COVID-19) may be associated with various skin manifestations. Among them, figurate erythema (FE) is rare; only a few clinical reports have been published.

Herein, we reported an unusual concentric FE lesions and their immunohistochemical profile in a patient with COVID-19.

Case presentation:

A 52-year-old woman was diagnosed with COVID-19. One month later, she developed asymptomatic annular erythematous concentric ring lesions on her inner right thigh. The margin of every ring increased in coloration, and the lesions then completely resolved in 2 weeks. A biopsy revealed vasculitis of small vessels, an increase in the fluorescence intensity of CD3 and CD45, and negativity for COVID-19 RNA.

Discussion:

The results showed an unusual FE that has a clinical mixed type between erythema annulare centrifugum and erythema gyratum repens; the physiopathological mechanism in the FE due to COVID-19 is unknown; one theory involves rapid viral passage into the cutaneous vascular system that triggers an immune and inflammatory response. Although the results exhibited a negative COVID-19 RNA in the tissue, the CD3+/CD45+ lymphocyte infiltration could explain the clinical pattern as a direct inflammatory response in the small vessel or as a delayed immune response.

Conclusion:

Our findings suggest an immunohistochemical small vessel vasculitis pattern with an unusual clinical FE that differs from other types of COVID-19–associated FE or erythema reported previously.
A Gift You Give Yourself: A Preemptive Intervention for Student Mental Health
Authors: Roman Christopher
Published: February 2023

Introduction

Burnout, stress, and compromised mental health are known issues for clinical trainees. Various interventions have shown efficacy, but they are generally training-based and therefore not practical for “just in time” use when a student is struggling. Stigma surrounding mental health is another challenge to this aspect of wellness.

Methods

At the beginning of their training, physician assistant (PA) students from 3 cohorts at Butler University wrote short reflections on resiliency and their motivation for training. This, along with an encouraging note from a faculty member, was placed in a box and wrapped. Students then kept the box to open during a time of stress or self-doubt. An anonymous survey about this intervention was sent to these students in April 2021.

Results

Almost all survey respondents remembered the activity and had a positive impression of it. Nearly half opened the gift box during their training, with a majority opening it during the didactic phase rather than the clinical phase. Most of those who opened the gift box viewed it favorably. Participants reported high levels of self-stigma regarding mental health and help-seeking.

Discussion

The gift box intervention was well-received and used by many students. This is a “just in time” intervention to support struggling learners when they need it most, as opposed to most interventions that are more structured in their delivery and use. The high level of self-stigma for mental health help-seeking is a concern and warrants continued investigation.
A Retrospective Comparison of Orthotic Interventions on Charcot Feet
Authors: Benson Clayton S. , VanPelt Michael D. , Wang Jijia , Johnson Matthew , Liu George T. , Raspovic Katherine , Dane Wukich , Tiffany Graham
Published: February 2023

Introduction

This retrospective chart review aims to find evidence supporting a difference in complications rates and progression of Charcot deformity between two orthotic interventions: the CROW and the custom calf lacer ankle foot orthosis. The existing evidence base to support the use of orthoses in the prevention and treatment of diabetic foot ulcers secondary to Charcot arthropathy is extremely limited.

Methods

Subjects were diagnosed with diabetes mellitus and Charcot arthropathy and referred for orthotic treatment. A billing audit of subjects treated between September 1, 2018, and May 1, 2020, was generated using L codes L2330 and L4631.

Subjects were excluded if they received a midfoot or higher amputation before application of the offloading device. In total, 87 charts were retrospectively reviewed, and 47 subjects were included.

Results

No significant difference was found in complication rate between the two groups. The first year of orthotic intervention had the highest number of complications for both devices. In addition, most calf lacer subjects wore the orthosis for 2 to 3 years, whereas most CROW subjects wore the orthosis for 2 years.

Conclusions

These findings suggest that both orthotic interventions available to treat diabetic foot ulcers secondary to Charcot arthropathy have similar complication rates. More research is needed to determine the clinical benefits of prescribing one intervention over the other.

Clinical Relevance

Although clinical empirical evidence suggests lower complication rates with the use of calf lacer AFOs, this study found no statistical difference in the overall number of complications observed with the two orthotic interventions.
Effectiveness of Dynamic Metacarpophalangeal Splint in Treatment of Ulnar Deviation of Rheumatoid Arthritis on Pinch Strength and Functional Ability in Women
Authors: Kumari Rohina , Saharawat Sakshi
Published: February 2023

Introduction

Rheumatoid arthritis (RA) causes structural damage that causes joint deformity including metacarpophalangeal (MCP) joint ulnar drift (UD), thus hindering the pinch strength and the functional ability of the hand. Orthosis or splints are designed to maintain the hand’s function, improve joint alignment, restore biomechanical balance, and reduce tissue stress. Limited studies have been done on the effects of dynamic splint on pinch strength and functional ability. Therefore, the purpose of this study was to evaluate and quantify the effects of dynamic MCP splint in treatment of ulnar deviation of RA on pinch strength and functional ability in women.

Methods

Twenty women with RA were recruited and completed a 4-week intervention period with dynamic MCP splint. Pinch strength and functional ability score were measured at baseline and after 4 weeks.

Results

The results showed a significant improvement in pinch strength (mean ± SD, 11.68 ± 2.14 to 13.53 ± 2.14; P = 0.000) and functional ability score (mean ± SD, 22.70 ± 9.12 to 19.70 ± 8.14; P = 0.000).

Conclusion

The results of this study show that the dynamic MCP splint had a positive impact on rheumatoid hands that align the joints in their functional position. The dynamic MCP splint improved the mechanical stability of the hand, thus reducing pain and stress on joints, which in turn improves the pinch strength and functional ability of rheumatoid hand.

Clinical Relevance

To increase patient acceptance and use of the splint, the splint designed and used in this study was compact and only covered the affected areas and joints of the hand. Because there was no involvement of the wrist joint and the fingertips were free, the splint was lightweight and allowed the patient to perform activity while wearing it.
Immediate Impacts of Two Foot Orthotic Designs on Foot Posture Index, Gait, and Comfort in Adults With Asymptomatic, Flexible Pes Planus
Authors: Mullen Ashley , Kenworthy Sally , Ewing Kathryn , Forbus Michelle , Hoelscher Thompson Regan
Published: February 2023

Introduction

Flexible flatfeet are commonly treated with functional foot orthoses (FFOs) and University of California Berkeley Laboratory (UCBL) designs. This study sought to evaluate the immediate effects of low-profile FFOs and high-profile UCBL orthoses on Foot Posture Index (FPI), spatiotemportal measures of gait, and perceived comfort and compliance in adults with flexible flatfeet.

Materials and Methods

Fourteen individuals with self-reported asymptomatic flexible flatfeet participated in this randomized cross-sectional study. Custom FFOs and UCBL orthoses were fabricated for each participant, who then walked at a self-selected speed in each condition on a Zeno Mat. Foot Posture Index, perceived comfort and compliance, and spatiotemporal parameters were collected across conditions.

Results

There were no significant differences in velocity, cadence, step length, stride width, toe-in/toe-out, or stance center of pressure distance percentage. Stance phase duration significantly increased from baseline to UCBL condition. There was a statistically significant decrease bilaterally in FPI from baseline to FFO and from baseline to UCBL orthosis, but not between FFO and UCBL orthosis. There were no significant differences in comfort and compliance ratings between FFOs and UCBL orthoses.

Conclusions

With regard to immediate effects, both the UCBL and FFO designs improve foot posture without significant impact on spatiotemporal gait patterns or perceived comfort and compliance. Additional research is needed to determine the longevity of these effects.

Clinical Relevance

The results of this study support the use of both FFOs and UCBL orthoses when trying to provide foot posture correction for adults with asymptomatic flexible flatfeet.
A Survey of Clinical Practice Patterns of Physical Therapists for the Use of Ankle-Foot Orthoses or Functional Electrical Stimulation Poststroke
Authors: Brown Lisa , Johnston Therese E. , Keller Sarah , Denzer-Weiler Caitlin
Published: February 2023

Objective

The aims of this study were (1) to understand the practice patterns and decision-making factors of physical therapists (PTs) when choosing ankle-foot orthoses (AFOs) or functional electrical stimulation (FES) for patients with mobility deficits secondary to poststroke hemiplegia and (2) to explore perceived gaps in knowledge to inform development of a clinical practice guideline (CPG).

Methods

A mixed-methods web-based survey collected quantitative and qualitative data from practicing PTs. Descriptive analysis of quantitative data and thematic content analysis of the qualitative data were completed.

Results

The 103 PTs were practicing clinicians with a doctoral degree and specialized board certification. A higher level of confidence with AFOs compared with FES was reported, along with increased inclusion of AFOs compared with FES for assessments and treatments. The PTs considered outcomes across the International Classification of Functioning, Disability and Health (ICF) when choosing devices, noting barriers in access and reimbursement as influential factors in clinical decision making. Fewer than 50% participated in continuing education on AFO or FES. Perceived knowledge gaps and educational needs included assessment and intervention strategies to support clinical decision making. The PTs considered themselves influential in the decision-making process and more than 95% of the respondents replied that a CPG on AFO and FES poststroke would impact clinical practice.

Conclusion

Themes related to education, clinical decision-making, access, and reimbursement were identified. A CPG may provide valuable information to address gaps in knowledge to improve clinical practice and decision-making.

Clinical Relevance

This research aims to inform the development of a CPG to address needs and gaps in knowledge identified by practicing clinicians. The information gained will inform knowledge translation strategies to promote best practices when implementing AFO and FES to improve activity and participation levels of individuals poststroke.
Adjusting to Changing Environments: Virtual Preseason SCAT5 Assessment in Canadian Male Youth Football Players
Authors: Syrydiuk Reid A. , Penner Linden C. , Sick Stacy , Eliason Paul , Galarneau Jean-Michel , Leggett Benjamin , Galea Olivia , Schneider Kathryn J. , Emery Carolyn A.
Published: February 2023

Objective:

To provide preseason reference scores for Canadian youth tackle football players on the Sport Concussion Assessment Tool 5 (SCAT5) and to examine whether age, concussion history, and self-reported medical diagnoses are associated with SCAT5 subcomponent performance.

Design:

Cross-sectional study.

Setting:

Calgary, Alberta.

Participants:

Five hundred one male youth football players (ages 13-18 years) participating in the 2021 season.

Assessment of Risk Factors:

SCAT5 subcomponents were assessed by age group (13-14, 15-16, 17-18), concussion history (0, 1, 2+, and yes/no), and self-reported diagnoses (headache disorder, attention-deficit/hyperactive disorder, learning disability/dyslexia, and depression, anxiety, or other psychiatric disorder).

Main Outcome Measures:

Virtual video administration (vs traditional in-person testing) of the SCAT5 was completed, and subcomponent scores included total number of symptoms (/22), symptom-severity score (/132), Standardized Assessment of Concussion [orientation (/5), immediate memory (/30), concentration (/5), delayed recall (/10)], and modified Balance Error Scoring System (/30). Kruskal–Wallis, one-way analysis of variance , Mann–Whitney U, or independent t tests were used to assess possible associations depending on number of groups and data normality.

Results:

Virtual SCAT5 assessment scores across all outcomes did not differ by age group or concussion history. The median number of symptoms and median symptom-severity score at baseline was 2, and 173 players (34.5%) reported no symptoms. Median total number of errors on the modified Balance Error Scoring System was 3. Participants with certain self-reported diagnoses (attention-deficit/hyperactive disorder, dyslexia) demonstrated poorer performance on some SCAT5 subcomponents (symptom reporting, Standardized Assessment of Concussion).

Conclusions:

Baseline SCAT5 performance did not differ by age group or concussion history in male youth football players. Diagnoses of the self-reported disorders examined may be important considerations for interpretation of the SCAT5 assessment.
Injuries in Youth Volleyball Players at a National Championship: Incidence, Risk Factors, and Mechanisms of Injury
Authors: Vaandering Kenzie , Meeuwisse Derek , MacDonald Kerry , Eliason Paul H. , Graham Robert F. , Chadder Michaela K. , Lebrun Constance M. , Emery Carolyn A. , Schneider Kathryn J.
Published: February 2023

Objective:

To evaluate injury incidence rates, types, mechanisms, and potential risk factors in youth volleyball.

Design:

Prospective cohort.

Setting:

2018 Canadian Youth National Volleyball Tournament.

Participants:

Thousand eight hundred seventy-six players [466 males, 1391 females, mean age 16.2 years (±1.26)] consented to participate (19.5%).

Assessment of Risk Factors:

Sex (male/female), age group, position, and underage players.

Main Outcome Measures:

Players completed a questionnaire (demographic information, injury, and concussion history). Medical attention injuries were recorded by tournament medical personnel through an injury report form (eg, mechanism and type). Injury was defined as any physical complaint seeking onsite medical attention. Concussion was defined using the fifth International Consensus. Injury rates adjusted for cluster by team were calculated by sex. Exploratory multivariable Poisson regression was used to analyze potential risk factors (eg, sex, age group, position, and underage players) for injury, adjusted for cluster by team and offset by athlete exposures (AEs).

Results:

There were 101 injuries in the 7-day tournament {IRFemale = 6.78 injuries/1000 AEs [95% confidence interval (CI), 5.27-8.72]; IRMale = 4.30 injuries/1000 AEs (95% CI, 2.55-7.24)}. Joint sprain (n = 29, 28.71%) and concussion (n = 26, 25.74%) were the most common. Most concussions were associated with ball-to-head contact (61.5%). There was no statistically significant difference in injury rate by sex (IRRF/M: 1.47; 95% CI, 0.80-2.69). The rates of injury in U14 were higher than U18 (IRRU14: 2.57; 95% CI, 1.11-5.98).

Conclusions:

Injury rates are high in youth volleyball tournament play, with the highest rates in U14. More research is needed to inform the development of volleyball-specific injury prevention strategies.
Injury Burden in Professional European Football (Soccer): Systematic Review, Meta-Analysis, and Economic Considerations
Authors: Pulici Luca , Certa Denis , Zago Matteo , Volpi Piero , Esposito Fabio
Published: February 2023

Objective:

We performed a systematic review and meta-analysis to evaluate the injury burden and the related economic cost in European professional male football players.

Data Sources:

Multiple database research was performed up to August 5, 2022 (PubMed, EMbase, Scopus, Cochrane Library), including only studies that reported severity in the number of days of absence for each injury, incidence reported in the number of injuries/1000 hours, or reported number of injuries and exposure time and adult male football players, professionals from European clubs. Two reviewers extracted data and assessed paper quality with the Strengthening the Reporting of Observational Studies in Epidemiology statement and the Newcastle–Ottawa Scale.

Main Results:

Twenty-two studies have reported incidence, severity, and burden of injuries in professional football. The highest injury burden was found for ligament–joint injuries (37.9 days/1000 hours; 222 397 €/1000 hours) and for muscle injuries (34.7 days/1000 hours; 203 620 €/1000 hours). Injury locations with high burden were knee injuries (34.8 days/1000 hours; 20 4206 €/1000 hours)—mainly anterior cruciate ligament injuries (14.4 days/1000 hours; 84 499 €/1000 h)–followed by thigh injuries (25.0 days/1000 hours; 146 700 €/1000 hours), hamstrings injuries (15.4 days/1000 hours; 90 367 €/1000 hours), hip-and-groin injuries (16.1 days/1000 hours; 94 475 €/1000 hours), primarily adductor muscles injuries (9.4 days/1000 hours; 55 159€/1000 hours), and ankle injuries (13.1 days/1000 h; 76 871 €/1000 hours) with ankle sprains (7.4 days/1000 hours; 43 423 €/1000 hours).

Conclusions:

Being exposed to injury risk has serious consequences for individual and club performance and economy. This review identified the most relevant targets in injury management, compared their injury data with reference values, and provided economic evidence when trying to gain buy-in from the key decision makers.
Injuries and Illnesses During the 53rd FIS Nordic World Ski Championships 2021 in Oberstdorf: A Prospective Cohort Study
Authors: Kastner Tom , Junge Astrid , Weith Moritz , Porzig Florian , Disch Alexander C. , Edouard Pascal , Wolfarth Bernd , Hollander Karsten
Published: February 2023

Objective:

For the 3 Nordic ski disciplines of cross-country skiing, Nordic combined, and ski jumping, data on injuries and illnesses during major sporting events only exist from the Winter Olympics of 2010 to 2018. So far, an investigation has not been conducted during the Nordic World Ski Championships.

Design:

Prospective cohort study.

Setting:

Fédération Internationale de Ski (FIS) Nordic World Ski Championships 2021 in Oberstdorf, Germany.

Participants:

Overall, 663 athletes from 65 nations participated in the FIS Nordic World Ski Championships 2021. The study population included 344 athletes from 32 nations.

Interventions:

National medical teams were invited to report daily all newly incurred or exacerbated injuries and illnesses.

Main Outcome Measures:

All reported injuries and illnesses that occurred during the championships from February 23 until March 7, 2021, were analyzed. Injury and illness rates were calculated with 95% confidence intervals (95% CIs).

Results:

The 32 reporting nations returned 88.4% of the daily report forms. The incidence of injuries was 4.7 (95% CI, 2.4-6.9) per 100 athletes in the 3 Nordic ski disciplines. The incidence of illness was also 4.7 (95% CI, 2.4-6.9) per 100 athletes with a relative proportion of infection-related illnesses of 31.3%.

Conclusions:

Although the incidence of injuries of the Nordic disciplines was comparable with those of the 2010 to 2018 Winter Olympics, the incidence of illnesses was lower than during the previous 3 Winter Olympic Games with a lower rate of infection-related illnesses. This might be caused by the high hygiene measures due to the coronavirus disease 2019 pandemic.
Improving chlamydia risk screening by using the CDC's 5 Ps approach to sexual health history
Authors: Gautam Ramesh , Orrino Jacob
Published: February 2023

Background:

Chlamydia trachomatis is infecting service members (SMs) at a rate of two to three times that of the U.S. population. Currently, the military only screens female SMs under the age of 25 years, leaving many at-risk males to go undetected leading to further transmission.

Local Problem:

Service members are not routinely assessed for high-risk sexual activities, leading to increased chlamydia rate in Fort Bragg. At the primary care project site, screening was only done per HEDIS measure leading to only 5% STI positivity rate. The purpose of this project was to identify and screen SMs who are at high risk for chlamydia using the CDC's 5 Ps approach.

Methods:

This project took place at a large primary care clinic that only cared for active-duty soldiers over a 3-month period.

Interventions:

The CDC's 5 Ps questionnaire was administered to SMs 30 years and younger during routine appointments. The SMs deemed high risk from the questionnaire were screened using urine G/C NAAT testing.

Results:

Four hundred forty-nine SMs were assessed using the CDC's 5 Ps approach. The questionnaire identified 91 SMs (20%) at higher risk for STIs. Of the 45 urine samples submitted, six were positive for STIs. Of the six positive cases, five were male. Targeted screening resulted in 13.3% positive rate compared with the 5% in the current practice.

Conclusion:

The result suggests that targeted screening of young males and females can identify high-risk sexual behaviors leading to increased findings of asymptomatic chlamydia carriers, ultimately leading to decreased chlamydia incidence.
Patient reflections, challenges, and supports related to early liver transplant for severe alcohol-associated liver disease
Authors: Chen Po-Hung , Sung Hannah C. , Punchhi Gopika , Krach Michelle , Greenberg Ross , Gianaris Kevin , Teles Mayan , Kaplow Katya , Wheatley Jason , Cameron Andrew M. , Chander Geetanjali
Published: February 2023

Transplant centers conventionally require at least 6 months of alcohol abstinence before offering liver transplants for alcohol-associated liver disease. However, early liver transplant (ELT)—proceeding with a transplant when clinically necessary without first meeting the conventional requirement—is increasingly gaining attention. In our study, we qualitatively assessed ELT recipients’ perceived challenges and supports regarding alcohol-associated liver disease, transplant, and posttransplant survivorship. To diversify perspectives based on gender, race/ethnicity, age, time since ELT, and pretransplant abstinence duration, we purposively recruited ELT recipients and conducted semistructured interviews. Recruitment continued until data saturation. We analyzed transcripts using inductive thematic analysis. We interviewed 20 ELT recipients between June and December 2020 and identified themes within 3 participant-characterized time periods. Three themes emerged in life before severe illness: (1) alcohol as a “constant” part of life, (2) alcohol use negatively affecting relationships and work life, and (3) feeling “stuck” in the cycle of drinking. Two themes emerged during the severe illness period: (4) rapidity of health decline and (5) navigating medical care and the 6-month abstinence requirement. Finally, in life after transplant, 4 themes emerged: (6) feelings of shame or stigma and new self-worth, (7) reconnecting with others and redefining boundaries, (8) transplant as a defining point for sobriety, and (9) work-related challenges. Overall, participants expressed gratitude for receiving a gift of life and acknowledged their responsibilities to the new liver. ELT recipient experiences reveal complex psychosocial challenges related to addiction, inadequate support system, and stigma, particularly in the posttransplant period. The care of ELT recipients would be incomplete if focused solely on optimizing patient or graft survival.
The trends in cost associated with liver transplantation in the US: Analysis of weighted hospital data
Authors: Lee David U. , Hastie David J. , Lee Ki Jung , Addonizio Elyse , Fan Greg H. , Chou Harrison , Jung Daniel , Lee Keeseok , Lominadze Zurabi
Published: February 2023

This study aims to evaluate recent annualized trends in the cost-burden of inpatient hospitalizations associated with liver transplantation (LT) in the US as stratified by patient demographics and medical characteristics. From 2016 to 2019 National Inpatient Sample was used to select patients who underwent LT, from which the weighted charge estimates were derived and converted to admission costs using inflation-adjusted charge-to-cost ratios. The adjusted values were stratified using select patient variables and graphed across the respective years to derive goodness-of-fit for each trend (expressed with R
2 and p-values). From 2016 to 2019, the estimated total number of LT-related hospitalizations in the US were 6685, 7075, 7260, and 7815 cases respectively. There was a general increase in the total cost of LT-related hospitalizations over the years: $945.75, $1010.23, $1052.46, and $1143.84 in millions of dollars (0.98, 0.01). Furthermore, positive trends in total cost were observed in the following strata: patients aged 35–49 (0.92, 0.04) and above 65 (0.91, 0.05), Whites (0.99, 0.01), those with congestive heart failure (0.98, 0.01), ≥2 comorbidities (0.97, 0.02), hepatic encephalopathy (0.93, 0.04), and those with private insurance (0.93, 0.04), as well as LT performed in the Northeast (0.94, 0.03), Midwest (0.92, 0.04), and South (0.91, 0.04). Total cost associated with hepatitis C declined significantly (0.94, 0.03). With respect to mean costs, positive trends were observed in the following strata: those with other or cryptogenic liver disease (0.93, 0.03), ≥2 comorbidities (0.96, 0.02), and LT performed in the Northeast region (0.93, 0.04). The number of liver transplants performed in the US, as well as the associated costs, are rising. Given the apparent rising costs in specific patient populations, economic and public health policies must focus on cost containment within these groups to ensure appropriate usage of resources.